Importance of the gender and preoperative knee sagittal alignment to avoid unnecessary tibial resection in TKR.

BACKGROUND: Standard resections according to the TKR manufacturers can lead to unnecessary bone resections in some patients. The objective of this study was to determine in which patients is recommended to perform a minimal tibial resection (MTR) that could restore the joint line height (JLH). METHODS: Navigation records of 108 consecutive posterior cruciate-substituting TKR performed by one surgeon were analyzed. Optimal tibial resection depth to restore the JLH (0 mm) was calculated by an algorithm. Postoperatively, the knees were distributed in two groups: those in which a MTR (depth ≤ 8 mm) would have been enough to restore the JLH and those in which a standard resection depth would have been necessary. ROC curves and Youden index were used to determine the cutoff point of the coronal and sagittal mechanical axis that predicted a MTR restoring the JLH. Multivariate analysis was used to identify independent factors associated with requiring an MTR. RESULTS: A MTR could be required in 20 (18.5%) knees. In the ROC curve analyses, the cutoff points that best discriminated between minimal and standard tibial resection was ≤ 3° of varus and < 2° of flexion preoperative deformity. Multivariate analysis showed that female gender and preoperative flexion < 2° were significant predictors of requiring a MTR to restore JLH. CONCLUSION: A MTR with the JLH restoration could be possible in female patients with a preoperative sagittal deformity less than 2° of flexion. Preoperative coronal alignment had no influence to discriminate when a MTR is required.

Complications of computer-assisted navigation in total knee replacement: retrospective cohort of eight hundred and seventy eight consecutive knees.

PURPOSE: The main objective was to analyze the computer-assisted navigation (CAN)-specific complications that forced to switch to conventional procedure in primary total knee replacement (TKR). The secondary objective was to determine the influence of those complications on TKR short-term survival. METHODS: Retrospective study of 878 primary TKR in 753 patients. Two consecutive versions of the OrthoPilot navigation system (Braun Aesculap, Germany) were used during the study time. Specific complications of CAN were defined as those due to the instrumentation (hardware or software failures), which were classified in one of two categories according to whether they occurred during the registration or tracking process. RESULTS: There were 20 (2.3%) complications related to the navigation system use that forced to switch to conventional surgery: in 11 (1.2%) knees due to loosening of the tracking pins, and in the other nine (1.0%) there were information system failures. There was a trend for a higher conversion rate to conventional surgery with the use of the first version of the software. There were no fractures, infections, or nerve injuries at the pin site. We found no differences in the distribution of baseline variables among those with or without conversion to conventional surgery. There was no significant difference (p = 0.488) in the two year survival between patients with or without conversion. CONCLUSION: CAN for primary TKR is a safe method with few specific complications that forced to switch from the navigated to the conventional procedure. Conversion to conventional surgery did not affect the short-term survival of TKR.

Internet searches by the Spanish population for unqualified information on the treatment of osteoarthritis. / Búsqueda en Internet de información no cualificada sobre el tratamiento de la artrosis por la población española.

OBJECTIVE: There is a current trend in the population to search the Internet for unqualified medical information that may affect the recommendations given in specialist consultation. The aim of this study was to analyse the tendency of the Spanish population to search the Internet for unqualified information on current treatments for osteoarthritis. MATERIAL AND METHOD: Google Trends was used analyse the information gathered from the Internet, combining potential key search terms related to the current treatment of osteoarthritis. For each term the relative search volume was calculated, and its trend between 2009 and 2019. Spearman's correlation was used to study the direction of the trend. RESULTS: All the infiltration methods had increasing trends and no statistically significant differences were found between them (P=.769). The term that showed the best correlation over time was «prp¼ with Spearman's correlation =.90, and the term with the highest relative search volume was «growth factors¼. Prosthetic treatment generated more interest than conservative treatments, where there was more interest in knee replacement than hip replacement (P<.001). CONCLUSION: In Spain, the search for unqualified information on the treatment of osteoarthritis has increased over the past 10 years. There is more interest in prosthetic treatment than the more conservative treatments. There is more interest in knee replacement than hip replacement. There are no differences with regard to the different methods of joint injections.

Using WhatsApp® in our clinical practice: a pilot study. / El uso del WhatsApp® en nuestra práctica clínica: estudio piloto.

OBJECTIVE: To evaluate the use of WhatsApp as a clinical tool and determine the perception of orthopaedic surgeons of its usefulness. MATERIAL AND METHODS: Orthopaedic surgeons attending a scientific meeting were invited to complete an anonymous and structured survey on the use of the application in the clinical setting. RESULTS: A total of 41 (38%) surveys were correctly completed. Of the respondents, 100% had been either senders or receivers of clinical information via the application. Ninety-three percent had used the application to consult in relation to a clinical case. Of the respondents, 78% belonged to a WhatsApp group in which clinical information is shared: 71% agreed that communication between clinicians through WhatsApp is a useful tool for making therapeutic decisions. CONCLUSION: The use of WhatsApp for clinical purposes by orthopaedic surgeons is widespread. Most consider it a useful tool in therapeutic decision making.

Factors predicting one-year mortality of patients over 80 years operated after femoral neck fracture. / Factores predictivos de la mortalidad al año en pacientes mayores de 80 años intervenidos de fractura del cuello femoral.

INTRODUCTION: In the Spanish population, previous studies related to mortality after hip fracture are based on patients aged 60 to 102years and did not stratify patients according to the type of fracture. The objective of this study was to identify the factors with influence on mortality at one postoperative year in patients aged 80years or older after a femoral neck fracture. MATERIAL AND METHOD: Retrospective study of cases and controls. Consecutive patients operated between 2015 and 2016 were included. Baseline characteristics, medical history and previous medication, analytical parameters, Charlson index, ASA scale, Barthel index and Pfeiffer questionnaire were studied. Surgical data and complications were recorded during follow-up. Survival was assessed by the Kaplan-Meier method and the variables that affected it by Cox regression. RESULTS: Mortality one year postoperatively was 21.1% and mean survival 10.3months (95%CI: 9.7-10.9). The Cox regression showed that age >87years, Barthel score ≤85 and the combination of anticoagulants with INR ≥1.5 were significant predictors of mortality during the first year of follow-up. CONCLUSION: The predictors of mortality during the first postoperative year after femoral neck fracture in octogenarian or older patients were: age>87years, physical dependence measured by a Barthel index score ≤85, and the use of anticoagulants with a INR ≥1.5 at admission.

One year follow-up after treatment with CCH for Dupuytren's disease: A prospective view. / Evolución al año de tratamiento con CCH para la contractura de Dupuytren: estudio prospectivo.

Aim Clostridium histolyticum collagenase (CCH) is nowadays an alternative treatment for the contracture of Dupuytren. Our objective is to assess its effectiveness at one year in a series of consecutive patients. MATERIAL AND METHOD: Prospective study with minimum follow-up of one year. Evaluation of results and adverse effects. RESULTS: A total of 75 joints treated in 51 patients were included. The average age was 65.18years (SD: 7.288) and 82.7% were males. The initial mean contraction of the MCP was 34.0 degrees (SD: 27.37), PIP 41.5 degrees (SD: 31.33) and combined impairment (MCF+IFP) of 75.5 degrees (SD: 35.2). Efficacy was achieved in 68 patients (90.7%). Adverse effects were mild and self-limiting. The mean correction for the MCP joint was 28.96 degrees (SD: 26.90) and for PIP it was 28.72 degrees (SD: 24.30). The recurrence rate was 18 (24.0%) joints in 14 patients, being more frequent in severe cases. QuickDASH score showed minimal differences measured before the intervention and once a year. DISCUSSION: Our results show a better outcome in mild cases; the outcome was more favourable and with a higher success rate in the MCP joint. QuickDASH score is not a useful tool for the assessment of Dupuytren's contracture. CONCLUSIONS: Treatment with CCH for Dupuytren's contracture is an effective treatment in the medium term. It has a poorer outcome in combined joint disorders, 5th finger, PIP and severe cases.

Efficacy and adverse effects of collagenase use in the treatment of Dupuytren's disease: a meta-analysis.

AIMS: The aim of this meta-analysis was to assess the safety and efficacy of collagenase clostridium histolyticum compared with fasciectomy and percutaneous needle fasciotomy (PNF) for Dupuytren's disease. MATERIALS AND METHODS: We systematically searched PubMed, EMBASE, LILACS, Web of Science, Cochrane, Teseo and the ClinicalTrials.gov registry for clinical trials and cohort or case-control studies which compared the clinical outcomes and adverse effects of collagenase with those of fasciectomy or PNF. Of 1345 articles retrieved, ten were selected. They described the outcomes of 425 patients treated with collagenase and 418 treated by fasciectomy or PNF. Complications were assessed using inverse-variance weighted odds ratios (ORs). Clinical efficacy was assessed by differences between the means for movement of the joint before and after treatment. Dose adjustment was applied in all cases. RESULTS: Random-effects modelling showed that patients treated with collagenase had 3.24 increased odds of adverse effects compared with those treated by fasciectomy (OR 4.39) or PNF (OR 1.72,). The effect was lost when only major complications were assessed. Joint movement analysis revealed a difference between means of less than 10%, indicating equivalent clinical efficacy in the short and medium term for collagenase and fasciectomy. We were unable to analyse this for PNF due to a shortage of data. CONCLUSION: There were no significant differences in effect size between collagenase and fasciectomy. The use of collagenase was associated with a higher overall risk of adverse effects than both fasciectomy and PNF. Cite this article: Bone Joint J 2018;100-B:73-80.

Toxic dermatitis secondary to treatment with collagenase clostridium histolyticum for Dupuytren´s disease.

OBJECTIVE: Secondary effects and drug reactions relative to collagenase Clostridium histolyticum treatment for Dupuytren's contracture are frequent. In only a few cases these secondary effects are considered serious. The mechanism that produces these effects of production is not well understood. CLINICAL REPORT: We present the case report of a woman with fifth finger interphalangeal joint treatment with generalized skin rash as a complication of collagenase Clostridium histolyticum treatment. DISCUSSION: We discuss treatment, causes and mechanisms of this rare complication from this treatment and review the bibliography about mechanisms for the different types of immunological reactions that may occur after treatment with collagenase Clostridium histolyticum and the possibility of crossed reactions with Clostridiopeptidase A used to treat skin lacerations.