AVIP Project (Prosthetic Virtual Friend): Study of clinical-functional outcomes and satisfaction with a mobile application in the perioperative management and follow-up of hip arthroplasty. / Proyecto AVIP (Amigo VIrtual Protésico): estudio de resultados clínico-funcionales y de satisfacción con una aplicación móvil en el manejo perioperatorio y seguimiento de implantes protésicos de cadera.

OBJECTIVE: To analyze the clinical, quality of life, and healthcare quality outcomes obtained in a series of patients undergoing total hip arthroplasty (THA), who were empowered and monitored using the AVIP application. These results will be compared with a control group followed through a standard protocol. MATERIAL AND METHOD: Randomized clinical trial with parallel groups involving patients with an indication for THA. Clinical variables were measured and compared using the WOMAC and mHHS, pain assessed by the VAS, quality of life with the SF-12 test. Walking capabilities were analyzed using the Functional Gait Assessment Scale, along with satisfaction levels assessed through the SUCE questionnaire, and perceived anxiety levels related to the process. RESULTS: A total of 68 patients were evaluated, with 31 patients in the AVIP group and 33 in the Control group completing the follow-up. Both groups demonstrated improvement in clinical outcomes based on the WOMAC and mHHS hip tests, a reduction in perceived pain, and an enhancement in quality of life according to the SF-12 test. Patients in the AVIP study group exhibited non-inferiority in clinical outcomes and satisfaction compared to the control group, as well as lower anxiety levels and improved walking capabilities after the first month of follow-up. Notably, 82.25% of the follow-up visits for this group were conducted remotely. CONCLUSION: The implementation of a mHealth application like AVIP can be safely offered to selected patients undergoing hip arthroplasty, enabling effective monitoring and providing continuous information and training.

[Translated article] Trabecular titanium implants in complex acetabular revision surgery.

INTRODUCTION: Acetabular revision surgery is a surgical challenge, especially when complex bone defects appear. This makes primary fixation and osseointegration of the implants difficult, which conditions the appearance of complications. Trabecular titanium implants attempt to solve these problems. OBJECTIVES: To evaluate our clinical-radiological results, the survival of the implants and the appearance of mid-term complications in acetabular revision surgery in a series of 37 acetabular replacements with Paprosky type IIIA and IIIB bone defects in which a trabecular titanium Cup-Cage revision implant was used. MATERIAL AND METHOD: We conducted an observational, descriptive and retrospective study of 37 cases with complex acetabular defects (20 type IIIA and 17 type IIIB, five of them with pelvic discontinuity) in which the acetabular component was replaced by trabecular titanium cups between 2011 and 2019. We analysed clinical results (pain and functionality) and radiological parameters (restoration of the hip rotation centre and the mobilisation of the implants), as well as the appearance of complications. RESULTS: The mean follow-up was 61 months. We obtained a median improvement of 8 points on the Merlé D'Aubigné-Postel functionality scale and 6 points on the VAS scale of pain perceived by the patient. We recorded two cases of acetabular loosening, one case of dislocation and three surgical wound infections without affecting the implant. CONCLUSIONS: The use of trabecular titanium Cup-Cage implants could be a valid option in acetabular revision surgery with complex acetabular defects, presenting good clinical and radiological results and in terms of complications and survival of the implants, mainly due to their good primary fixation and subsequent osseointegration.

Trabecular titanium implants in complex acetabular revision surgery. / Implantes de titanio trabecular en cirugía de revisión acetabular compleja.

INTRODUCTION: Acetabular revision surgery is a surgical challenge, especially when complex bone defects appear. This makes primary fixation and osseointegration of the implants difficult, which conditions the appearance of complications. Trabecular titanium implants attempt to solve these problems. OBJECTIVES: To evaluate our clinical-radiological results, the survival of the implants and the appearance of mid-term complications in acetabular revision surgery in a series of 37 acetabular replacements with Paprosky type IIIA and IIIB bone defects in which a trabecular titanium Cup-Cage revision implant was used. MATERIAL AND METHOD: We conducted an observational, descriptive and retrospective study of 37 cases with complex acetabular defects (20 type IIIA and 17 type IIIB, five of them with pelvic discontinuity) in which the acetabular component was replaced by trabecular titanium cups between 2011 and 2019. We analyzed clinical results (pain and functionality) and radiological parameters (restoration of the hip rotation centre and the mobilization of the implants), as well as the appearance of complications. RESULTS: The mean follow-up was 61 months. We obtained a median improvement of 8 points on the Merlé D'Aubigné-Postel functionality scale and 6 points on the VAS scale of pain perceived by the patient. We recorded two cases of acetabular loosening, one case of dislocation and three surgical wound infections without affecting the implant. CONCLUSIONS: The use of trabecular titanium Cup-Cage implants could be a valid option in acetabular revision surgery with complex acetabular defects, presenting good clinical and radiological results and in terms of complications and survival of the implants, mainly due to their good primary fixation and subsequent osseointegration.

Fracturas de acetábulo tratadas mediante osteosíntesis. Resultados a largo plazo / Surgical treatment of acetabular fractures. Long term outcomes

Resumen: Introducción: las fracturas de acetábulo constituyen entre el 0.3 y 0.6% total de fracturas observadas, siendo estás lesiones relativamente infrecuentes. Objetivo: evaluar los resultados clínico-radiológicos del tratamiento quirúrgico mediante osteosíntesis de fracturas acetabulares con un seguimiento mínimo de 11.5 años. El objetivo secundario fue determinar la tasa de fracaso de la cadera de estos pacientes e identificar los factores de riesgo implicados. Materia y métodos: analizamos retrospectivamente una muestra de 23 pacientes intervenidos de fractura acetabular mediante reducción abierta y fijación interna, con un seguimiento medio de 14 años (11.5-17.5). Clasificamos las fracturas según Judet y Letournel en simples y complejas. Analizamos la evolución clínica y radiológica de estos pacientes mediante la escala de Harris. Resultados: obtuvimos una puntuación media de 81.90/100, objetivamos mejores resultados en fracturas de trazo simple respecto a fracturas complejas (p = 0.027). Evidenciamos mejores resultados clínicos en los pacientes con una reducción anatómica de la fractura (86.9/100), respecto a los que no fue posible (74.38/100) (p = 0.033). Fue necesaria la reintervención con artroplastía por mala evolución clínica en tres pacientes (13%). Como predictores de mal pronóstico para el desarrollo de coxartrosis identificamos las fracturas complejas y la reducción no anatómica de la fractura (p < 0.05). Encontramos relación entre índice de masa corporal (IMC) > 30 con peores resultados funcionales (p = 0.151). Conclusiones: el tratamiento quirúrgico de pacientes tratados con fracturas acetabulares presenta buenos resultados clínicos y radiológicos a largo plazo. Como factores de riesgo para la progresión de coxartrosis con suficiente impronta clínica como para ser necesaria una artroplastía identificamos, las fracturas complejas, la reducción no anatómica y un IMC > 30.

Abstract: Introduction: acetabular fractures constitute between 0.3 and 0.6% of all observed fractures, being these injuries relatively infrequent. Objective: to evaluate clinical and radiological outcomes of surgical treatment of patients with acetabular fracture treated in our hospital with a minimal follow-up of 11.5 years. The secondary objective is to determine the rate of failure in the hip joint of these patients and establish risk factors that are involved. Material and methods: 23 patients with acetabular fractures that were treated by open reduction and internal fixation (ORIF) were retrospectively analysed. They were follow-up during an average of 14 years (range 11.5-17.5). Fractures were classified by Judet y Letournel as simple or complex. Clinical and radiological outcomes were analysed by Harris scale. Results: We obtained an average of 81.90/100 on the Harris scale, aiming at better outcomes on simple fractures compare to those that were complex (p = 0.027). Higher scores were also achieved on those patients with an anatomical reduction (p = 0.033). Three patients required revision and placement of a total arthoplasty (13%). However, patients with body mass index (BMI) > 30 tend to achieve poor clinical results (p = 0.151). Conclusions: ORIF may be suggested for acetabular fractures since good clinical and radiological outcomes were recorded on a long-term follow-up. Complex fractures, non-anatomical reduction and BMI > 30 were identified as risk factors to coxarthrosis progression.

Total reverse arthroplasty of the shoulder and structural bone graft in glenoid defects: Short-term results. / Artroplastia total inversa de hombro e injerto óseo estructural en defectos glenoideos: resultados a corto plazo.

OBJECTIVE: To evaluate the clinical and radiological results of a series of patients with a glenoid bone defect treated by reverse total shoulder arthroplasty associated with a bone graft stabilized with a trabecular titanium glenoid component (Axioma SMR Lima®). MATERIAL AND METHODS: Retrospective descriptive study of 16 consecutive patients with an average age of 68.2years. In 13 cases they were primary arthroplasties and in 3 revision ones. The data included in the study were obtained by reviewing the clinical history. The glenoid defect was classified according to Gupta et al. The pre- and postoperative clinical assessment included the score on the visual analogue pain scale (VAS), the result of the Constant score and the active joint balance. Radiographically, the integration of the bone graft and the fixation of the components were assessed. RESULTS: The average follow-up was 42.1months. The average VAS score improved from 7.5 preoperative points to 2.5 points in the last control (P=.006) and on the Constant score from 35.8 pre-surgical points to 64.4 points (P=.001). The average joint balance went from 54° of abduction, 54° of antepulsion, 24° of external rotation and internal rotation to preoperative trochanter to 120° of abduction (P=.001), 124° of antepulsion (P=.001), 63° of external rotation (P=0.001) and internal rotation at L5 in the last clinical control. In all patients, graft integration and the absence of component loosening were observed. The incidence of complications was 6.2%. DISCUSSION: The treatment of glenoid defects by reverse total shoulder arthroplasty and a bone graft stabilized by trabecular titanium metaglene presents good clinical and radiological results and a low rate of short-term complications.

[Surgical treatment of acetabular fractures. Long term outcomes]. / Fracturas de acetábulo tratadas mediante osteosíntesis. Resultados a largo plazo.

INTRODUCTION: acetabular fractures constitute between 0.3 and 0.6% of all observed fractures, being these injuries relatively infrequent. OBJECTIVE: to evaluate clinical and radiological outcomes of surgical treatment of patients with acetabular fracture treated in our hospital with a minimal follow-up of 11.5 years. The secondary objective is to determine the rate of failure in the hip joint of these patients and establish risk factors that are involved. MATERIAL AND METHODS: 23 patients with acetabular fractures that were treated by open reduction and internal fixation (ORIF) were retrospectively analysed. They were follow-up during an average of 14 years (range 11.5-17.5). Fractures were classified by Judet y Letournel as simple or complex. Clinical and radiological outcomes were analysed by Harris scale. RESULTS: We obtained an average of 81.90/100 on the Harris scale, aiming at better outcomes on simple fractures compare to those that were complex (p = 0.027). Higher scores were also achieved on those patients with an anatomical reduction (p = 0.033). Three patients required revision and placement of a total arthoplasty (13%). However, patients with body mass index (BMI) > 30 tend to achieve poor clinical results (p = 0.151). CONCLUSIONS: ORIF may be suggested for acetabular fractures since good clinical and radiological outcomes were recorded on a long-term follow-up. Complex fractures, non-anatomical reduction and BMI > 30 were identified as risk factors to coxarthrosis progression.

INTRODUCCIÓN: las fracturas de acetábulo constituyen entre el 0.3 y 0.6% total de fracturas observadas, siendo estás lesiones relativamente infrecuentes. OBJETIVO: evaluar los resultados clínico-radiológicos del tratamiento quirúrgico mediante osteosíntesis de fracturas acetabulares con un seguimiento mínimo de 11.5 años. El objetivo secundario fue determinar la tasa de fracaso de la cadera de estos pacientes e identificar los factores de riesgo implicados. MATERIA Y MÉTODOS: analizamos retrospectivamente una muestra de 23 pacientes intervenidos de fractura acetabular mediante reducción abierta y fijación interna, con un seguimiento medio de 14 años (11.5-17.5). Clasificamos las fracturas según Judet y Letournel en simples y complejas. Analizamos la evolución clínica y radiológica de estos pacientes mediante la escala de Harris. RESULTADOS: obtuvimos una puntuación media de 81.90/100, objetivamos mejores resultados en fracturas de trazo simple respecto a fracturas complejas (p = 0.027). Evidenciamos mejores resultados clínicos en los pacientes con una reducción anatómica de la fractura (86.9/100), respecto a los que no fue posible (74.38/100) (p = 0.033). Fue necesaria la reintervención con artroplastía por mala evolución clínica en tres pacientes (13%). Como predictores de mal pronóstico para el desarrollo de coxartrosis identificamos las fracturas complejas y la reducción no anatómica de la fractura (p < 0.05). Encontramos relación entre índice de masa corporal (IMC) > 30 con peores resultados funcionales (p = 0.151). CONCLUSIONES: el tratamiento quirúrgico de pacientes tratados con fracturas acetabulares presenta buenos resultados clínicos y radiológicos a largo plazo. Como factores de riesgo para la progresión de coxartrosis con suficiente impronta clínica como para ser necesaria una artroplastía identificamos, las fracturas complejas, la reducción no anatómica y un IMC > 30.

[Femoral revision surgery with fully coated stems. Long-term results of 78 cases]. / Cirugía de revisión femoral con vástagos monobloque de recubrimiento completo. Resultados a largo plazo de 78 casos.

INTRODUCTION: Loss of bone stock and anatomical alteration of the proximal femur make femoral revision surgery a complex procedure in which the choice of implant will be critical. Our goal is to assess the clinical and radiological results of complete coating Monoblock stems. MATERIAL AND METHODS: Retrospective study of 78 consecutive cases of femoral review surgery intervened by our unit. RESULTS: The average follow-up was 122 months. The average score on the Harris Hip Score was 81.2 ± 11.4 points. An age of less than 65 years, a minor femoral defect according to Paprosky classification (I, II and IIIA), the existence of a single previous surgery and the non-occurrence of intra or postoperative complications, was associated with better clinical and functional outcomes (p < 0.05).Cumulative survival was 96.7% at age 10 if we consider as failure the removal of the stem by aseptic loosening and 92% if we consider withdrawal for any cause to fail. CONCLUSION: Despite the current tendency to use modularity in femoral review surgery and given the results presented, we consider that complete coating monoblock stems provide a firm and stable fixation. However, the worst results in patients with major defects have led to other options being considered.

INTRODUCCIÓN: La pérdida de stock óseo y la alteración anatómica del fémur proximal hacen de la cirugía de revisión femoral un procedimiento complejo en la que la elección del implante será fundamental. Nuestro objetivo es valorar los resultados clínicos y radiológicos de los vástagos monobloque de recubrimiento completo. MATERIAL Y MÉTODOS: Estudio retrospectivo de 78 casos consecutivos de cirugía de revisión femoral intervenidos por nuestra unidad. RESULTADOS: El seguimiento medio fue de 122 meses. La puntuación media en la escala de Harris Hip Score fue de 81.2 ± 11.4 puntos. Una edad menor de 65 años, un defecto femoral menor según la clasificación de Paprosky (I, II y IIIA), la existencia de una única cirugía previa y la no aparición de complicaciones intraoperatorias o postoperatorias se asoció con mejores resultados clínicos y funcionales (p < 0.05). La supervivencia acumulada fue de 96.7% a los 10 años si consideramos como fracaso la retirada del vástago por aflojamiento aséptico y de 92% si consideramos como fracaso la retirada por cualquier causa. CONCLUSIÓN: Pese a la tendencia actual al uso de la modularidad en cirugía de revisión femoral y dados los resultados presentados, consideramos que los vástagos monobloque de recubrimiento completo proporcionan una fijación firme y estable. Sin embargo, los peores resultados obtenidos en pacientes con defectos óseos mayores han provocado que se valore otro tipo de opciones.

Treatment of intraarticular calcaneal fractures by reconstruction plate. Results and complications of 86 fractures. / Tratamiento de las fracturas intraarticulares de calcáneo mediante placa de reconstrucción. Resultados y complicaciones de 86 fracturas.

OBJECTIVE: To evaluate the results of surgical treatment of intraarticular calcaneal fractures, and also to analyze the variables that influence the final clinical and radiological outcomes as well as the complications. MATERIAL AND METHODS: We retrospectively analyzed 86 intraarticular calcaneal fractures in 78 patients, who underwent surgery with an extended lateral approach and reconstruction plate. The mean age was 48 years (16-74 years) and the mean follow-up was 4.6 years (9-99 months); 54 patients (69.2%) suffered falls from less than 3m in height or banal injuries and 24 patients (30.8%) falls from more than 3m in height or high energy-accidents. According to the Sanders classification we operated 12 (15%) typeII, 54 (62.8%) typeIII and 20 (23.2%) typeIV fractures. RESULTS: The postoperative mean AOFAS score was 73.9 points, with good or excellent results in 57% of the patients. Twelve cases (14%) suffered surgical wound complications and 11 (12.8%) required subtalar arthrodesis. Significantly better results were obtained in the patients younger than 30 years old, patients that fell from less than 3m in height and patients with Sanders fractures types II and III compared to typeIV, which were associated with higher rate of subtalar arthrodesis. CONCLUSIONS: We consider that open reduction and internal fixation of intraarticular fractures of the calcaneus with reconstruction plate is a valid treatment alternative. Given the complications described and the secondary subtalar arthrodesis rate, we recommend a meticulous technique carried out by experienced surgeons.

Reverse shoulder arthroplasty in 3 and 4 part proximal humeral fractures in patients aged more than 65 years: Results and complications. / Tratamiento de las fracturas de húmero proximal en pacientes mayores de 65 años con prótesis inversa: resultados y complicaciones.

INTRODUCTION: The treatment of 3and 4 part proximal humeral fractures in elderly patients is still controversial. The frequent co-existence of poor quality bone and rotator cuff abnormalities in patients with multiple clinical conditions and with difficulties for physical rehabilitation leads to disappointing clinical results, even when the radiological images are acceptable. OBJECTIVE: To evaluate the clinical, radiological, and functional results in patients over 65 years old with complex proximal humerus fractures treated with reverse shoulder arthroplasty. MATERIAL AND METHODS: A prospective review was carried out on 30 patients (26 women and 4 men) with proximal humeral fractures treated with reverse shoulder arthroplasty in our department. The mean age was 74.9 years (SD=6.3), and the mean follow-up was 34.5 months (SD=19.3). RESULTS: Clinical and functional results were acceptable, with a mean forward flexion of 124° and a mean external rotation of 13°. The mean abbreviated Constant abbreviated score was 49.1 (SD=14.1), 27 (SD=6.3) in the UCLA scale, and 32.2 (SD=19.2) in the QuickDASH questionnaire. The large majority (80%) of the patients are pain free, and they do not need medication to do daily activities. The complication rate was 13.3%. CONCLUSIONS: We consider that reverse shoulder arthroplasty is a valid option to treat 3and 4 part proximal humeral fractures in elderly patients. The surgical goals should include the anatomical reconstruction of the tuberosities, avoiding enlargement of the operated arm greater than 2cm.

Skin Abscess due to Serratia marcescens in an Immunocompetent Patient after Receiving a Tattoo.

The incidence of skin infections caused by Serratia marcescens is extremely low and such infections are typically observed in immunocompromised patients. The clinical manifestations of these infections include cellulitis, abscesses, fluctuant nodules, or granulomatous lesions. Infections caused by S. marcescens are very difficult to treat due to their resistance to many antibiotics, which often leads to specific and prolonged treatment. Infections after receiving a tattoo are very rare and are caused by unhygienic conditions or the inexperience of the tattooist. In this paper we present the case of a 32-year-old male with no comorbidity, who presented an abscess caused by S. marcescens in a area that was tattooed one month earlier. The case was resolved with surgery and antimicrobial therapy that was based on the antibiogram. To our knowledge, this is the first reported case of a S. marcescens skin infection following a tattoo, in the absence of immunosuppression.