Past and projected temporal trends in arthroscopic hip surgery in Spain between 1998 and 2018. / Tendencias temporales pasadas y proyectadas en la cirugía artroscópica de cadera en España entre 1998 y 2018.

OBJECTIVE: Describe the population incidence of hip arthroscopy from 1998 to 2018 and to project the trends for the year 2030, as well as to describe the variations in the population incidence between the autonomous communities. MATERIAL AND METHOD: A retrospective review of the minimum basic data set from 1998 to 2018 was carried out. Temporal evolution was analyzed and the variables associated with the indication (age, sex, regions) were identified. For each region, the crude rate per 100,000 inhabitants was calculated. The 2019-2030 projection was made using linear regression. RESULTS: In Spain between 1998 and 2018 a total of 10,663 arthroscopic hip surgeries were carried out. The population incidence in 1998 was 0.14 CAC per 100,000 inhabitants, while in 2018 it was 4.09. For the year 2030 an increase of 156.9% in the number of arthroscopic hip surgeries is expected (P<.001). On average, 57.7% of all procedures (95% CI 55.2-60.2) were done in men and the highest incidence was found in ages ≤44 years. The geographical variation was 81%, being up to 15.4 times the difference in incidence per 100,000 inhabitants between some regions. CONCLUSIONS: The number of hip arthroscopies in Spain has been increasing in the 1998-2018 period and this growing trend is expected to continue until 2030. In Spain, hip arthroscopic procedures are performed more frequently in male patients and in under 45 years old. The variability of the population incidence between the autonomous communities is high.

[Translated article] Past and projected temporal trends in arthroscopic hip surgery in Spain between 1998 and 2018.

OBJECTIVE: Describe the population incidence of hip arthroscopy from 1998 to 2018 and to project the trends for the year 2030, as well as to describe the variations in the population incidence between the autonomous communities. MATERIAL AND METHOD: A retrospective review of the minimum basic data set from 1998 to 2018 was carried out. Temporal evolution was analysed and the variables associated with the indication (age, sex, regions) were identified. For each region, the crude rate per 100,000 inhabitants was calculated. The 2019-2030 projection was made using linear regression. RESULTS: In Spain between 1998 and 2018 a total of 10,663 arthroscopic hip surgeries were carried out. The population incidence in 1998 was 0.14 CAC per 100,000 inhabitants, while in 2018 it was 4.09. For the year 2030 an increase of 156.9% in the number of arthroscopic hip surgeries is expected (p<.001). On average, 57.7% of all procedures (95% CI 55.2-60.2) were done in men and the highest incidence was found in ages≤44 years. The geographical variation was 81%, being up to 15.4 times the difference in incidence per 100,000 inhabitants between some regions. CONCLUSIONS: The number of hip arthroscopies in Spain has been increasing in the 1998-2018 period and this growing trend is expected to continue until 2030. In Spain, hip arthroscopic procedures are performed more frequently in male patients and in under 45 years old. The variability of the population incidence between the autonomous communities is high.

[Translated article] Results of cementless total knee arthroplasty in patients over 70 years of age.

OBJECTIVE: To analyse the clinical and radiologic results, the survival and complications obtained in 70 year or older patients who underwent cementless total knee arthroplasty (TKA). MATERIAL AND METHOD: An observational study of patients operated between January 2014 and December 2016 was carried out according to the Natural Knee model (Zimmer®, USA). The main variables were the Oxford Knee Score, the visual analogue scale, the presence of radiolucencies, complications, survival and reasons for revision. RESULTS: Of 104 TKA, 86 were available for revision. The median age was 76 years. The mean follow-up was 5.4 years (range 3.7-6.9). The Oxford Knee Score punctuation showed a median of 17 presurgical (range 0-40) and 37 post surgical (range 5-48), P<.001. The 87.2% of the patients obtained a clinically significant improvement. The median visual analogue scale punctuation was 8 for presurgical (range 4-10) and 2 for post surgical (range 1-9), P<.001. The 88.3% of the patients obtained a clinically significant decrease. Three months after the surgery, the 55.81% of the TKAs presented radiolucencies around the tibial plateau. At the end of the follow-up, radiolucencies were present in 30.23% of the TKAs. Survival from all causes was 91.86% at 77.2 months and 96.5% due to aseptic loosening. CONCLUSION: Cementless knee prostheses are a valid option in patients aged 70 or older, presenting good clinical, radiological and survival results.

Results of cementless total knee arthroplasty in patients over 70 years of age. / Resultados de la artroplastia total de rodilla no cementada en pacientes mayores de 70 años.

OBJECTIVE: To analyze the clinical and radiologic results, the survival and complications obtained in 70 year or older patients who underwent cementless total knee arthroplasty (TKA). MATERIAL AND METHOD: An observational study of patients operated between January 2014 and December 2016 was carried out according to the Natural Knee model (Zimmer®, USA). The main variables were the Oxford Knee Score, the visual analog scale, the presence of radiolucencies, complications, survival and reasons for revision. RESULTS: Of 104 TKA, 86 were available for revision. The median age was 76 years. The mean follow-up was 5.4 years (range 3.7-6.9). The Oxford Knee Score punctuation showed a median of 17 presurgical (range 0-40) and 37 post surgical (range 5-48), P<.001. The 87.2% of the patients obtained a clinically significant improvement. The median visual analog scale punctuation was 8 for presurgical (range 4-10) and 2 for post surgical (range 1-9), P<.001. The 88.3% of the patients obtained a clinically significant decrease. Three months after the surgery, the 55.81% of the TKAs presented radiolucencies around the tibial plateau. At the end of the follow-up, radiolucencies were present in 30.23% of the TKAs. Survival from all causes was 91.86% at 77.2 months and 96.5% due to aseptic loosening. CONCLUSION: Cementless knee prostheses are a valid option in patients aged 70 or older, presenting good clinical, radiological and survival results.

Trend in Spain in the use of total ankle arthroplasty versus arthrodesis in the period 1997-2017. / Tendencia en España en el uso de artroplastia total de tobillo frente a artrodesis en el periodo 1997-2017.

OBJECTIVE: The main objective of this study is to compare proportionally the incidence of total ankle arthroplasty (TAA) versus ankle arthrodesis and to determine the variables that may have influenced its indication. The secondary objective is to analyse the trend in the use of TAA using a population-based analysis and to compare our results with those reported by national registries in other countries. MATERIAL AND METHOD: A retrospective review of the Minimum Basic Data Set from 1997-2017 was performed. Subjects were categorised according to surgical procedure. Their temporal evolution was analysed and hospital variables associated with the indication (age, sex, hospital complexity) were identified. In order to compare the trend in Spain with respect to other countries, the information was standardised as number of procedures per 100,000 inhabitants/year and a projection was made for the five-year period 2020-2025. RESULTS: In the period 1997-2017, 11,669 ankle arthrodesis and 1,049 TAAs were performed. The trend was increasing and significant for both procedures, however, in the last 10 years analysed the proportional trend of TAA decreased significantly. Being female (OR 1.32), being 65 years or older (OR 1.50) and being operated in a complex hospital (OR 1.31) were associated with the indication for a TAA. Compared to other countries, Spain has much lower rates of TAA utilisation, with minimal growth estimated for the year 2025. CONCLUSION: Although the use of TAA has increased, its growth has been lower than that of ankle arthrodesis and its current trend is proportionally decreasing, with female sex, age≥65 years and the patient being operated in a medium/high complexity hospital being associated with the indication for TAA. Compared with other countries, Spain has much lower rates of use and its projection over the next five years, although increasing, is expected to be minimal.

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.

Primary total hip arthroplasty with fourth-generation ceramic bearings: Clinical and survival results with a minimum follow-up of 5 years. / Prótesis total de cadera primaria con par de fricción cerámica sobre cerámica de cuarta generación: resultados clínicos y de supervivencia con un seguimiento mínimo de 5 años.

OBJECTIVE: To evaluate the clinical results and survival of primary hip prosthesis with ceramic delta bearings (C-C) with a minimum follow-up of 5years. MATERIAL AND METHOD: A total of 205 primary hip arthroplasties performed between 2008 and 2012 were studied. The clinical results, pre-surgical and at 5years of follow-up were evaluated using the Harris Hip Score (HHS), the Short Form-36 (SF-36), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and the visual analogue scale (VAS). The position of the prosthetic components, periprosthetic osteolysis, loosening of the prosthetic components and ruptures of the ceramic components were studied radiologically. The adverse events related to bearings were recorded according to their diameter, paying special attention to prosthetic dislocations and the presence of noise. Survival with an endpoint of prosthetic revision for any cause was estimated using the Kaplan-Meier method. RESULTS: Significant improvements were obtained in the HHS (88.7% of good/excellent results), SF36, WOMAC and EVA, P<.001. There were 19 adverse events related to the prosthesis (4 periprosthetic fractures, 4 dislocations, 2 superficial infections, 1 mobilization of the cup, 2 noises, 4 aseptic loosenings and 2 breaks of the prosthetic neck); 47.3% needed revision. The cumulative survival of the prostheses was 97.5% (95%CI: 96.4-98.5). No differences were found in survival, prosthetic adverse events, noise incidence or dislocations and clinical results among the different diameters used. CONCLUSIONS: Primary hip prostheses with fourth-generation ceramic bearings showed good survival in the medium term, and good clinical results.

Factors associated with the development of avascular necrosis of the femoral head after non-displaced femoral neck fracture treated with internal fixation. / Factores asociados al desarrollo de necrosis avascular de cabeza femoral tras fractura del cuello femoral no desplazada tratada con fijación interna.

OBJECTIVE: To identify the factors with influence on the development of avascular necrosis of the femoral head (ANFH) in patients with non-displaced femoral neck fractures treated with internal fixation. MATERIAL AND METHOD: Retrospective study of cases and controls. We included non-displaced femoral neck fractures treated with internal fixation, and that presented ANFH with a postoperative follow-up of at least 2 years. The baseline variables, active comorbidities of the patients, the time for surgery and the number of screws used for osteosynthesis were recorded. Comparisons were made between the groups, those that presented ANFH and those that did not. By area under the curve, the cut-offs of age and time for surgery were located. RESULTS: An association between sex, active comorbidities and number of screws used and the development of ANFH was not observed. The cut-off points for age and time for surgery were≤69 years and≤43hours, respectively. No significant correlation was observed for the cut-off time for surgery. In the multivariate analysis, age≤69 years was a significant predictor of the development of ANFH (OR 4.6; 95% CI 1.1 to 17.9; P=.028). CONCLUSIONS: The patients aged 69 years or younger were at increased risk of developing ANFH after undisplaced femoral neck fracture treated with percutaneous screws.

Arthrodesis of the proximal interphalangeal joint of the 4th and 5th finger using an interlocking screw device to treat severe recurrence of Dupuytren's disease. / Artrodesis de la articulación Interfalángica proximal del 4.° y 5.° dedo utilizando un dispositivo de tornillos entrelazados a compresión en el tratamiento de la recidiva grave de la enfermedad de Dupuytren.

OBJECTIVE: To assess the radiological and functional outcome of arthrodesis of the 4th and 5th finger using the APEX™ (Extremity Medical, Parsippany,NJ)intermedullary interlocking screw system in patients with severe recurrence of Dupuytren's disease. MATERIAL AND METHOD: The DASH questionnaire and the VAS scale were used to assess the clinical outcomes. The angle of arthrodesis, fusion time and implant fixation were evaluated on x-rays. The patients were monitored for complications during surgery and the follow-up period. RESULTS: The sample comprised 6 patients. Mean follow up was 19.6 months. All of the patients presented clinical and radiological evidence of fusion at 8 weeks, with fusion angles of 30° (3) and 45° (3). There were no complications and none of the implants had to be removed. The functional outcomes in these patients were poor. CONCLUSION: The system offers a reliable method for IPJ arthrodesis at a precise angle. It promotes stable fixation that does not require prolonged immobilisation. It can be used together with other procedures on the hand with severe recurrence of DD. The functional outcomes for this group of patients using this device were poor.