Impact of Kinesiotherapy Rehabilitation on Quadriceps Femoris Muscle Strength and Functionality in Total Hip Arthroplasty Patients / Impacto de la Rehabilitación con Kinesioterapia en la Fuerza y Funcionalidad del Músculo Cuádriceps Femoral en Pacientes con Artroplastía Total de Cadera

SUMMARY: The objective was measure quadricep strength after Total Hip Arthroplasty (THA) and kinetic treatment and then determine its impact on the functional recovery of patients with hip osteoarthritis. A total of 79 (25 were male and 54 were female) patients with THA. Exclusion criteria were previous extra-system kinetic treatment, operated on for hip fracture, not completing the treatment. Maximum Isometric Strength (MIS), Time Up and Go (TUG), Modified Harris Hip Score. There was a significant increase in the MIS of the post-treatment operated knee extension in both men and women (p < 0.0001 SE = 0.43; p < 0.0001 SE = 1.22, respectively). In the TUG, the execution time was significantly lower post-treatment in both men and women (p < 0.0001 SE = 0.77; p < 0.0001 SE = 0.94, respectively). The final Harris score increased significantly post-treatment in male and female (p < 0.0001 SE = 2.90; p < 0.0001 SE = 1.96, respectively). the association between MIS and the Harris score, it was noted that, for a 1 kg increase in this measure compared to the initial assessment, the Harris score, after 12 weeks of treatment, increased by 0.179 points (β = 0.179; p = 0.050). The conclusions were Indicate an increase in knee extension MIS of the operated hip after treatment in both sexes. At the same time, functionality increased post-treatment in both male and female.

El objetivo del estudio fue medir la fuerza del músculo cuádriceps femoral después de la artroplastia total de cadera (THA, por sus siglas en inglés) y el tratamiento kinésico, para determinar su impacto en la recuperación funcional de pacientes con osteoartritis de cadera. En el estudio participaron 79 pacientes con THA (25 hombres y 54 mujeres). Se excluyeron quienes tuvieron tratamiento Kinésico previo fuera del hospital, operación por fractura de cadera y no completar el tratamiento. Las principales medidas tomadas fueron: Fuerza Máxima Isométrica (MIS), Time UP and GO (TUG), Puntuación Modificada de Harris de Cadera. Hubo un aumento significativo en la MIS de la extensión de rodilla del lado operado después del tratamiento tanto en hombres (p<0,0001, EE=0,43) como en mujeres (p<0,0001, EE=1,22). En el TUG, el tiempo de ejecución fue significativamente menor después del tratamiento en hombres (p<0,0001, EE=0,77) y mujeres (p<0,0001, EE=0,94). La puntuación final de Harris aumentó significativamente después del tratamiento en hombres (p<0,0001, EE=2,90) y mujeres (p<0,0001, EE=1,96). En cuanto a la asociación entre MIS y la puntuación de Harris, se observó que por cada aumento de 1 kg en esta medida en comparación con la evaluación inicial, la puntuación de Harris aumentó en 0,179 puntos después de 12 semanas de tratamiento (β=0,179; p=0,050). En conclusión se observó un aumento en la MIS de la extensión de rodilla del lado operado después del tratamiento en ambos sexos. Al mismo tiempo, la funcionalidad aumentó después del tratamiento tanto en hombres como en mujeres.

Evaluation of core decompression outcome in systemic lupus erythematosus with hip osteonecrosis: a retrospective cohort study

Abstract Background Osteonecrosis is a major cause of morbidity for patients with systemic lupus erythematosus (SLE). Although core decompression is an approved and trusted technique to prevent further joint deterioration, this surgical method seems to be less beneficial for SLE patients. We aimed to evaluate the outcomes of core decompression in SLE patients with primary stages of femoral head osteonecrosis. Methods In this study, 23 patients (39 affected hip joints) with osteonecrosis of the femoral head with stage II of the disease, based on the Ficat-Arlet classification system, underwent core decompression. Also, patients demographic characteristics, clinical data, medication history, comorbidities, immunological findings, hip plain radiographs, history of total hip arthroplasty after core decompression, and patients satisfaction with joint function according to the Oxford hip score questionnaire were obtained. Results In the study, 53.8% of affected joints showed signs of radiographic deterioration in follow-up imaging. Sixty-one and a half percent (61.5%) of patients had unsatisfactory joint performance. A third (33.3%) of affected hip joints underwent total hip arthroplasty up to 5 years from core decompression. SLE patients with a history of receiving bisphosphonate were 83.2% less dissatisfied with their joint function than patients without a history of bisphospho-nate use (P < 0.02). Of the 23 studied cases, the mean cumulative dose of prednisolone before and after core decompression surgery was 46.41 mg and 14.74 mg respectively. Besides, one case (2.6%) that had a high anti-phospholipid antibodies level during follow-up did not have any radiographic deterioration, and 9 cases (23.1%) had some degrees of radiographic deterioration. Conclusions The patients group that used bis-phosphonate, had a higher level of satisfaction with joint function after core decompression. Patients with high-level anti-phospholipid antibodies are related to a poor prognosis after core decompression.

Minimum effective concentration of ropivacaine for ultrasound-guided transmuscular quadratus lumborum block in total hip arthroplasty: a randomized clinical trial

Abstract Objective: This trial aimed to identify the Minimum Effective Concentration (MEC90, defined as the concentration which can provide successful block in 90% of patients) of 30 mL ropivacaine for single-shot ultrasound-guided transmuscular Quadratus Lumborum Block (QLB) in patients undergoing Total Hip Arthroplasty (THA). Methods: A double-blind, randomized dose-finding study using the biased coin design up-and-down sequential method, where the concentration of local anesthetic administered to each patient depended on the response from the previous one. Block success was defined as a Numeric Rating Scale (NRS) score during motion ≤ 3 at 6 hours after arrival in the ward. If the block was successful, the next subject received either a 0.025% smaller dose (probability of 0.11) or the same dose (probability of 0.89); otherwise, the next subject received a 0.025% higher ropivacaine concentration. MEC90, MEC95 and MEC99 were estimated by isotonic regression, and the corresponding 95% Confidence Intervals (95% CIs) were calculated by the bootstrapping method. Results: Based on the analysis of 52 patients, MEC90, MEC95, and MEC99 of ropivacaine for QLB were estimated to be 0.352% (95% CI 0.334-0.372%), 0.363% (95% CI 0.351-0.383%), and 0.373% (95% CI 0.363-0.386%). The concentration of ropivacaine at 0.352% in a volume of 30 ml can provide a successful block in 90% of patients. Conclusions: For ultrasound-guided transmuscular QLB in patients undergoing THA, 0.352% ropivacaine in a volume of 30 ml can provide a successful block in 90% of patients. Further dose-finding studies and large sample size are required to verify the concentration.

Artroplastia total de cadera por abordaje anterior directo (Hueter)

Introducción: La artroplastia de cadera se considera un tratamiento exitoso en ortopedia. El abordaje anterior directo, a través del intervalo de Hueter, evita la disección de inserciones musculares del hueso y disminuye la alteración de los tejidos blandos alrededor de la cadera. Objetivos: Presentar los resultados de artroplastias totales de cadera primarias, realizadas por abordaje anterior directo. Métodos: Se realizó un estudio descriptivo-prospectivo, tipo serie de casos, con pacientes intervenidos por artroplastia total de cadera primaria no cementada a través de abordaje anterior directo. Resultados: Predominaron el sexo femenino y los grupos etarios de 45 y 60 años. El índice de masa corporal resultó bajo y hubo escaso riesgo anestésico. El tiempo quirúrgico superó las dos horas, con escaso sangrado operatorio. La correcta colocación del componente acetabular y el femoral permitió que la deambulación iniciara en menos de tres días. Las complicaciones fueron escasas y se resolvieron con el tratamiento adecuado. Conclusiones: El empleo de abordaje anterior directo para artroplastias totales de cadera primarias ofrece resultados muy satisfactorios.

Introduction: Hip arthroplasty is considered a successful treatment in Orthopedics. The direct anterior approach, through Hueter interval, avoids the dissection of muscular attachments to the bone and decreases the alteration of the soft tissues around the hip. Objectives: To report the results of primary total hip arthroplasties, performed by direct anterior approach. Methods: A descriptive-prospective case series study was carried out with patients who underwent primary uncemented total hip arthroplasty through a direct anterior approach. Results: The female sex and the age groups of 45 and 60 years predominated. The body mass index was low and there was little anesthetic risk. Surgical time exceeded two hours, with little operative bleeding. The correct placement of the acetabular and femoral components allowed ambulation to begin in less than three days. Complications were rare and resolved with appropriate treatment. Conclusions: The use of the direct anterior approach for primary total hip arthroplasties offers very satisfactory results.

Artroplastia total de cadera en dos instituciones ortopédicas de Cuba

Introducción: La artroplastia total de cadera se considera un procedimiento seguro y eficaz que alivia el dolor, y mejora la salud física y la calidad de vida en los pacientes. Objetivos: Caracterizar la artroplastia total de cadera en pacientes intervenidos en el Hospital Ortopédico Docente "Fructuoso Rodríguez" y el Complejo Científico Ortopédico "Frank País". Métodos: Estudio descriptivo retrospectivo de pacientes intervenidos con artroplastia total de cadera en el Hospital Ortopédico Docente "Fructuoso Rodríguez" y el Complejo Científico Ortopédico "Frank País", entre septiembre de 2019 y marzo de 2021. Resultados: Predominaron el sexo femenino y las edades entre 60 y 62 años, con lateralidad izquierda. El principal diagnóstico preoperatorio resultó la coxartrosis. El tamaño de la copa acetabular y la cabeza del componente femoral fueron similares. La prótesis acetabular se fijó por presión. Conclusiones: Se encontraron grandes semejanzas en cuanto a la edad, el sexo, la lateralidad, el tamaño de los componentes acetabular y cabeza femoral, el tipo de fijación del componente acetabular y la cantidad de tornillos empleados. En el diagnóstico preoperatorio prevaleció la artrosis de cadera.

Introduction: Total hip arthroplasty is considered a safe and effective procedure that relieves pain and improves physical health and quality of life in patients. Objectives: To characterize the patients who underwent total hip arthroplasty at Fructuoso Rodríguez Teaching Orthopedic Hospital and Frank País Orthopedic Scientific Complex. Methods: A retrospective descriptive study was conducted with patients who underwent total hip arthroplasty at Fructuoso Rodríguez Teaching Orthopedic Hospital and Frank País Orthopedic Scientific Complex, from September 2019 to March 2021. Results: The female sex and the ages between 60 and 62 years predominated, with left laterality. The main preoperative diagnosis was coxarthrosis. The size of the acetabular cup and the head of the femoral component were similar. The acetabular prosthesis was fixed by pressure. Conclusions: Great similarities were found in terms of age, sex, laterality, the size of the acetabular components and femoral head, the type of fixation of the acetabular component and the number of screws used. Osteoarthritis of the hip prevailed In the preoperative diagnosis.

Resultados clínicos en cirugía de revisión protésica de cadera con defectos acetabulares leves: estudio comparativo retrospectivo de cotilos con doble movilidad y cotilos monopolares / Clinical results in hip replacement surgery with mild acetabular defects: a retrospective comparative study of cups with dual mobility and monopolar cups

Resumen: Introducción: la cirugía de revisión protésica de cadera constituye una indicación quirúrgica que se encuentra en crecimiento en los últimos años. La artroplastía total de cadera de revisión (ATCr) se trata de un reto quirúrgico destacado debido a la dificultad técnica de la propia cirugía. Entre las complicaciones de la cirugía de revisión des-tacan las luxaciones, el aflojamiento aséptico y la infección. Objetivo: comparar los resultados clínico-radiológicos, así como la incidencia de complicaciones, de dos muestras independientes de pacientes intervenidos de artroplastía total de cadera de revisión (ATCr) con defectos acetabulares leves-moderados utilizando implantes de doble movilidad respecto a implantes monopolares. Material y métodos: estudio retrospectivo comparativo de dos cohortes de 30 pacientes intervenidos de cirugía de revisión acetabular mediante cabezas monopolares de 36 mm o doble movilidad, respectivamente. Todos los pacientes presentaban defectos acetabulares tipo I o II de Paprosky. Se evaluaron los resultados con las escalas EVA, WOMAC y Harry hip score (HHS) pre y postoperatorios en ambas cohortes. Asimismo, se analizaron la incidencia de complicaciones postoperatorias y la tasa de supervivencia entre ambos grupos. Resultados: el seguimiento medio fue de 5.8 años (1-10.3 años). La diferencia entre los resultados pre y postoperatorios en cada cohorte fue significativa para la escala EVA, WOMAC y HHS. Las diferencias obtenidas en dichas escalas entre los distintos grupos de estudio no hallaron diferencias significativas. La incidencia de complicaciones postoperatorias entre ambas cohortes fue similar, sin encontrar diferencias significativas. Conclusiones: consideramos que la doble movilidad no aporta superioridad en cuanto a resultados clínico-funcionales e incidencia de complicaciones postoperatorias respecto a los montajes monopolares en cirugía de revisión acetabular con defectos leves-moderados.

Abstract: Introduction: hip revision arthroplasty surgery is a surgical procedure that has been growing in recent years. Revision total hip arthroplasty (THA) is a notable surgical challenge due to the technical difficulty of the surgery itself. Complications of revision surgery includes dislocation, aseptic loosening, and infection. Objective: to compare the clinical-radiological results, as well as the incidence of complications, of two independent samples of patients who underwent revision total hip arthroplasty (rTHA) with mild-moderate acetabular defects using dual mobility implants compared to monopolar implants. Material and methods: retrospective comparative study of two cohorts of 30 patients who underwent acetabular revision surgery using large 36 mm monopolar heads or dual mobility respectively. All patients had Paprosky type I or II acetabular defects. The results on the VAS scale, WOMAC, and Harry hip score (HHS) were evaluated pre and postoperatively in both cohorts. Likewise, the incidence of postoperative complications and the survival rate between both groups were analyzed. Results: mean follow-up was 5.8 years (1-10.3 years). The difference between the pre and postoperative results in each cohort was significant for the VAS, WOMAC and HHS scale. The differences obtained in these scales between the different study groups did not find significant differences. The incidence of postoperative complications between both cohorts was similar, without finding significant differences. Conclusions: we consider that dual mobility does not provide superiority in terms of clinical-functional results and incidence of postoperative complications with respect to monopolar assemblies in acetabular revision surgery with mild-moderate defects.

¿Cuándo se reanuda la conducción después del reemplazo total de cadera primario? / When to resume driving after primary total hip arthroplasty?

Resumen: Introducción: la literatura actual relaciona el regreso a la conducción vehicular con múltiples variables. Sin embargo, los datos actuales sobre el tiempo de regreso a la conducción luego de una artroplastía total de cadera (ATC) son diversos e incluso contradictorios. Por lo tanto, nos hemos planteado el objetivo de determinar el tiempo requerido para volver a conducir en un grupo de pacientes sometidos a una ATC primaria mediante un abordaje posterolateral, centrándonos específicamente en vehículos de marcha manual. Material y métodos: hemos estudiado los resultados clínico-funcionales de 112 pacientes sometidos a una ATC primaria entre Enero de 2019 y Enero de 2020 en un hospital de alta complejidad en Cádiz, Andalucía, España. Resultados: la mediana del tiempo de regreso a la conducción fue de tres semanas (RIC 2-4). Hemos identificado que 89.3% de los pacientes pudo volver a conducir antes de la sexta semana posterior a la cirugía. Además, en 92% de los casos, los pacientes se sintieron aún más seguros al conducir después de la ATC que antes de la intervención. Conclusión: consideramos que a la sexta semana de una ATC es seguro reanudar la conducción de un vehículo.

Abstract: Introduction: the current literature relates the return to driving with multiple variables. For various reasons, the current data on the time to return to driving after a total hip arthroplasty (THA) are diverse and even contradictory. We have proposed the objective of determining the time required to drive a manual gear vehicle again in a group of patients who underwent primary THA through a posterolateral approach with focus on manual gear cars. Material and methods: we have studied the functional results of 112 patients who underwent primary THA between January 2019 and January 2020 in a high level in Cadiz, Andalusia, Spain. Results: the median return to driving was three weeks (IQR 2-4). We have identified that 89.3% of the patients were able to drive again before the sixth week after surgery and in 92% of the cases they did so feeling even safer than before the THA. Conclusion: we consider that after the sixth week of an THA it is safe to resume driving a vehicle.

Recursos eletroterapêuticos em pacientes de pós-operatório submetidos a artroplastia total de quadril / Electrotherapeutic resources in post-surgical patients to total hip arthroplasty

A artroplastia total de quadril é um procedimento para substituir um quadril "doente", por meio de articulações artificiais (próteses), sendo considerada uma das maiores cirurgias e avanços no tratamento de doenças ortopédicas e, é uma das cirurgias mais realizadas no mundo. São utilizadas várias técnicas para colaborar para o sucesso da cirurgia, trazendo maior conforto ao paciente, principalmente no pós cirúrgico, como é o caso da eletroterapia, que pode ser definida basicamente como o uso de corrente elétrica como agente terapêutico. Trata-se de uma revisão narrativa que demonstra os impactos do uso da eletroterapia nos pacientes de pós operatório que foram submetidos a artroplastia total de quadril e identifica qual a melhor forma de uso dos recursos eletroterapêuticos no pós operatório da artroplastia total de quadril. A cinesioterapia precoce acelera a recuperação funcional após artroplastia total do quadril e devemos sempre estimulá-la, porém, com a estimulação elétrica neuromuscular (EENM) demonstrou melhorarias na dor e no desempenho em relação a aceleração da recuperação. A estimulação elétrica muscular de baixa frequência associada à fisioterapia tradicional é superior à fisioterapia isolada no aumento da força dos músculos, o que é acompanhado por uma restauração do melhor equilíbrio muscular entre os membros cirúrgicos e não cirúrgicos. As técnicas e protocolos de fisioterapia para o tratamento da ATQ são diversos e têm demonstrado resultados positivos clínicos significativos na literatura.

Total hip arthroplasty is a procedure to replace a "diseased" hip, through artificial joints (prostheses), being considered one of the greatest surgeries and advances in the treatment of orthopedic diseases and is one of the most performed surgeries in the world. Some techniques are used to contribute to the success of the surgery, bringing greater comfort to the patient, especially in the postoperative period, as is the case of electrotherapy, which can be basically defined as the use of electric current as a therapeutic agent. This is a narrative review that demonstrates the impacts of the use of electrotherapy in postoperative patients who underwent total hip arthroplasty and identifies the best way to use electrotherapeutic resources in the postoperative period of total hip arthroplasty. Early kinesiotherapy accelerates functional recovery after total hip arthroplasty. study with neuromuscular electrical stimulation (NMES) showed improvements in pain and performance in relation to recovery acceleration. Low-frequency electrical muscle stimulation associated with traditional physical therapy is superior to physical therapy alone in increasing muscle strength, which is accompanied by a restoration of better muscle balance between the surgical and non-surgical limbs. Physical therapy techniques and protocols for the treatment of THA are diverse and have shown significant positive clinical results in the literature.

Early mobilization after total hip or knee arthroplasty: a substudy of the POWER. 2 study

Abstract Background Early mobilization after surgery is a cornerstone of the Enhanced Recovery After Surgery (ERAS) programs in total hip arthroplasty (THA) or total knee arthroplasty (TKA). Our goal was to determine the time to mobilization after this surgery and the factors associated with early mobilization. Methods This was a predefined substudy of the POWER.2 study, a prospective cohort study conducted in patients undergoing THA and TKA at 131 Spanish hospitals. The primary outcome was the time until mobilization after surgery as well as determining those perioperative factors associated with early mobilization after surgery. Results A total of 6093 patients were included. The median time to achieve mobilization after the end of the surgery was 24 hours [16-30]. 4,222 (69.3%) patients moved in ≤ 24 hours after surgery. Local anesthesia [OR = 0.80 (95% confidence interval [CI]: 0.72-0.90); p= 0.001], surgery performed in a self-declared ERAS center [OR = 0.57 (95% CI: 0.55-0.60); p< 0.001], mean adherence to ERAS items [OR = 0.93 (95% CI: 0.92-0.93); p< 0.001], and preoperative hemoglobin [OR = 0.97 (95% CI: 0.96-0.98); p< 0.001] were associated with shorter time to mobilization. Conclusions Most THA and TKA patients mobilize in the first postoperative day, early time to mobilization was associated with the compliance with ERAS protocols, preoperative hemoglobin, and local anesthesia, and with the absence of a urinary catheter, surgical drains, epidural analgesia, and postoperative complications. The perioperative elements that are associated with early mobilization are mostly modifiable, so there is room for improvement.

Resultados post operatorios en pacientes con prótesis total de revisión de cadera mas injerto óseo cadavérico de banco de tejidos en el Hospital de Clínicas en el periodo 2017 al 2020 / Postoperative results in patients with total hip revision arthroplasty and cadaveric bone graft of tissue bank at the Hospital de Clínicas in the period 2017 to 2020

Introducción: La artroplastia total de cadera de revisión junto con la utilización de injerto óseo cadavérico de banco de tejidos es una alternativa de tratamiento eficaz ante los procedimientos de reemplazo con déficit óseo femoral o acetabular. El presente estudio, analizó los resultados post operatorios en pacientes intervenidos quirúrgicamente en el Hospital de Clínicas. Materiales y métodos: Estudio descriptivo. Muestreo no probabilístico de casos consecutivos atendidos en la Cátedra de Ortopedia y Traumatología de la Facultad de Ciencias Médicas (U.N.A). Fueron captados pacientes con indicación de artroplastia total de cadera de revisión (ATCR) más injerto óseo cadavérico de banco de tejidos, entre diciembre 2017 - octubre 2020, previo consentimiento informado. Se relevaron datos cuya caracterización fue posible mediante un instrumento establecido previamente, ingresado en base Excel. Resultados: 12 pacientes con déficit óseo femoral y acetabular han sido tratados con artroplastia total de cadera de revisión más injerto óseo cadavérico de banco de tejidos, en donde además de la funcionalidad y a través de seguimientos radiológicos se ha determinado la osteointegración total de los aloinjertos. La relación masculino-femenina fue 1/1, siendo el diagnóstico preoperatorio para la colocación de la prótesis de revisión más injerto óseo cadavérico de banco de tejidos el aflojamiento séptico en un 75%. El motivo de consulta más frecuente fue dolor y la secreción y el tiempo quirúrgico fue en promedio de 116 minutos. Conclusión: La artroplastia total de cadera de revisión más aloinjerto presenta óptimos resultados en relación a la osteointegración total y funcionalidad.

Introduction: Revision total hip arthroplasty with use of cadaveric bone graft is an effective treatment for replacement procedures in patients with bone loss femoral or acetabular. The present study analyzed the postoperative results in patients who underwent surgery at the Hospital de Clínicas. Materials and methods: Descriptive study. Non-probabilistic sampling of consecutive cases treated at the Department of Orthopedics and Traumatology of Hospital de Clínicas. Data of patients with indication for revision total hip arthroplasty plus cadaveric bone graft from a tissue bank with prior informed consent,were analyzed between December 2017 and October 2020. Results: 12 patients with femoral and acetabular bone deficits have been treated with revision total hip arthroplasty plus cadaveric bone graft from a tissue bank. A radiological and functional follow up was made. The male-female ratio was 1/1, with the preoperative diagnosis for placement of the revision prosthesis plus cadaveric bone graft,from the tissue bank,was septic loosening in 75%. The most frequent symptom was pain, all revision total hip arthroplasties were performed through a posterior approach, and the surgical time was an average of 116 minutes,using a later approach in all cases.Two intraoperative fracture was presented, and were resolved. Conclusion: Revision total hip arthroplasty plus allograft presents optimal results in relation to total osseointegration and functionality.

Artroplastia total de cadera bilateral en un tiempo: una opción quirúrgica para pacientes con coxartrosis severa bilateral / Simultaneous bilateral total hip arthroplasty: a surgical option for patients with several bilateral hip osteoarthritis

Total hip arthroplasty is a successful procedure with high rates of functional satisfaction and pain relief. A large number of patients with bilateral hip pathology will require both hip joint replacement, from there born the inquietude to knowing benefits and disadvantage of bilateral simultaneous hip arthroplasty. We present a female patient case who developed bilateral hip osteoarthritis secondary to development dysplasia of the hip which was surgically managed with bilateral arthroplasty at one time. We show a follow-up report of the case and a review of the literature to know the main advantages of this new current of hip arthroplasty in patients with bilateral hip pathology

Uso tópico de ácido tranexámico en artroplastías totales de cadera: análisis retrospectivo de sus ventajas / Topical use of tranexamic acid in total hip arthroplasties: retrospective analysis of its advantages

Resumen: Introducción: El ácido tranexámico (ATX) intravenoso (IV) ha demostrado su utilidad para evitar la anemia postquirúrgica, pero pocos estudios han analizado su administración tópica. Hace siete años implementamos una nueva administración tópica (humedeciendo tres compresas con 1.5 g de ATX) en nuestras artroplastías totales de cadera (ATC) primarias. El objetivo de este estudio ha sido comparar la pérdida de sangre, estancia hospitalaria y complicaciones sin uso de ATX, uso tópico o 10 mg/kg IV más tópico. Material y métodos: Serie retrospectiva consecutiva de 274 pacientes intervenidos de ATC (promedio 70 años [59-76], 59% mujeres) operados de 2014 a 2019. Se compararon pérdida de hemoglobina y hematocrito, transfusiones de sangre, estancia hospitalaria, complicaciones tromboembólicas y mortalidad a 30 días entre tres grupos: no tranexámico (44.2%), tópico (45.6%), tópico + IV (9.9%). Resultados: Después de 24 y 48 horas, la hemoglobina y el hematocrito disminuyeron menos (p < 0.05) en los pacientes tratados con ATX (tópico y/o IV). Se requirió transfusión de sangre en 32% de los pacientes sin ATX, 12% de los tratados sólo con ATX tópico (RR = 3.24 [IC de 95%: 1.69-6.20]) y 0% de los pacientes que recibieron ATX IV (p = 0.005) (RR = 4.07 [IC de 95%: 2.14-7.48]). La estancia hospitalaria se redujo en tres días con ATX (p < 0.001). No hemos observado efectos adversos relacionados con ATX. Conclusiones: El uso del ATX en ATC reduce significativamente la anemia, las transfusiones y la estancia hospitalaria sin aumentar las complicaciones. El ATX tópico aislado (compresas hemostáticas) es menos eficaz que el uso tópico IV + tópico, pero ambos mejoran significativamente la anemia, las transfusiones y la estancia hospitalaria en comparación con su no utilización.

Abstract: Introduction: Intravenous (IV) tranexamic acid (TXA) has shown its usefulness to prevent postsurgical anemia, but few studies have analyzed its topical administration. Seven years ago, we implemented a new topical administration (moistening three gauzes with 1.5 g of TXA) in our primary total hip arthroplasties (THA). The objective of this study was to compare blood loss, hospital stay and complications without the use of TXA, topical use or 10 mg/kg IV plus topical. Material and methods: Consecutive retrospective series of 274 patients undergoing CTA (mean 70 years [59-76], 59% women) operated from 2014 to 2019. Loss of hemoglobin and hematocrit, blood transfusions, hospital stay, thromboembolic complications were compared and 30-day mortality among three groups: non-tranexamic (44.2%), topical (45.6%), topical + IV (9.9%). Results: After 24 and 48 hours, hemoglobin and hematocrit decreased less (p < 0.05) in patients treated with TXA (topical and/or IV). Blood transfusion was required in 32% of patients without TXA, 12% of those treated with topical TXA only (RR = 3.24 [95% CI: 1.69-6.20]), and 0% of patients who received IV TXA (p = 0.005) (RR = 4.07 [95% CI: 2.14-7.48]). Hospital stay was reduced three days with TXA (p < 0.001). We have not observed any adverse effects related to TXA. Conclusions: The use of TXA in CTA significantly reduces anemia, transfusions and hospital stay without increasing complications. Isolated topical TXA (hemostatic pads) is less effective than topical IV + topical use, but both significantly improve anemia, transfusions, and hospital stay compared to no use.

Restauración de la biomecánica en artroplastia total de cadera por luxación congénita alta / Restoration of Biomechanics in Total Hip Arthroplasty Due to High Congenital Dislocation

La osteoartritis secundaria a displasia o luxación congénita de cadera conlleva grandes dificultades para el cirujano que reconstruye la cadera. Los casos con escasa deformidad no difieren prácticamente de la reconstrucción primaria convencional. En el extremo opuesto están los casos con graves hipoplasias del acetábulo, escaso desarrollo femoral, luxación completa, discrepancia importante de las extremidades y gran cabalgamiento del trocánter mayor. Por las enormes dificultades que pueden representar para la cirugía, nos trazamos el objetivo de discutir nuestro caso, con las consideraciones y resultados del tratamiento elegido. Se presenta paciente femenina de 54 años de edad, con antecedentes de salud previa, que nos llegó a consulta con una grave deformidad congénita, acortamiento del miembro inferior derecho (6 cm) y limitación dolorosa de todos los movimientos de la cadera. Se constata una luxación congénita grado C de Hartofilakidis y IV de Crowe, que muestra como parte del tratamiento, la artroplastia total con injerto autólogo y reimplantación del cótilo en el acetábulo verdadero, para recuperar el centro de rotación del acetábulo y la osteotomía femoral de acortamiento para la implantación del vástago femoral. Se exponen los requerimientos, procederes técnicos y resultados alcanzados(AU)

Osteoarthritis secondary to congenital hip dysplasia or dislocation poses great difficulties for the surgeon reconstructing the hip. Cases with little deformity do not differ practically from conventional primary reconstruction. At the opposite end there are cases with severe acetabulum hypoplasia, poor femoral development, complete dislocation, significant limb discrepancy, and great thrust of the greater trochanter. Due to the enormous difficulties that they can represent for surgery, we set the objective of discussing our case, with the considerations and results of the chosen treatment. A 54-year-old female patient is reported, she has previous health history, and she came for consultation with severe congenital deformity, shortening of her right lower limb (6 cm) and painful limitation of all hip movements. Congenital dislocation grade C of Hartofilakidis and IV of Crowe was confirmed, which showed as part of the treatment, the total arthroplasty with autologous graft and reimplantation of the cup in the true acetabulum, to recover the center of rotation of the acetabulum and the shortening femoral osteotomy for implantation of the femoral stem. Requirements, technical procedures and results achieved are informed(AU)

Componentes protésicos más usados en la artroplastia total de cadera en las provincias centrales / Most Used Prosthetic Components in Total Hip Arthroplasty in Central Provinces

Introducción: La cirugía de la artroplastia y el recambio de una prótesis de cadera es una cirugía compleja y costosa. La estrategia quirúrgica y componentes protésicos son completamente diferentes en función de las deformidades óseas existentes y características anatómicas personales de cada paciente, por tanto, la planificación de suministros de los diferentes componentes es básica para cubrir las demandas de la población necesitada y la adecuada eficiencia económica para evitar gastos innecesarios por sobreestimación o infraestimación de las demandas. Objetivos: Determinar las necesidades por medidas de los diferentes tipos de componentes protésicos utilizados en la artroplastia total de cadera en las provincias centrales y de este modo optimizar las inversiones, con las ventajas económicas que supone. Métodos: Estudio longitudinal descriptivo retrospectivo de los casos operados de artroplastia total de cadera en el Hospital Arnaldo Milián Castro de Villa Clara, desde diciembre de 1998 hasta la fecha. Se analizan las variables edad, sexo, procedencia y componentes protésicos. Se recoge la información en la base de datos creada en SPSS, donde se realizan los análisis estadísticos. Resultados: La edad media fue 62,36 años. El grupo de 61 - 80 años fue el de mayor incidencia con 215 pacientes. Predominó el sexo masculino 51,8 por ciento. La mayor incidencia, correspondió a Villa Clara con 692 pacientes. Los componentes cementados 46 - 50 fueron los más usados y en los no cementados los más usados fueron 48-56. Vástagos Tipo Müller 7.5 - 12.5. RALCA Cementadas T0-T4, no cementados T1-T3. En las SLA, 11.5 y 13. Los cuellos estándar fueron los de mayor incidencia con 390 pacientes. Conclusiones: Con las incidencias de las diferentes medidas utilizadas por cada uno de los componentes expresados, se puede determinar con bastante exactitud la demanda de cada medida por cada 100 casos pendientes de operación. Esto permite satisfacer las demandas de las medidas más usadas y hacer una distribución apropiada a la hora del suministro, lo que redundaría en un beneficio económico vital en las actuales condiciones del país(AU)

Introduction: The arthroplasty surgery and the replacement of a hip replacement is a complex and expensive surgery. The surgical strategy and prosthetic components are completely different depending on the existing bone deformities and personal anatomical characteristics of each patient, therefore, the planning of supplies of the different components is essential to meet the demands of the needy population and adequate economic efficiency to avoid unnecessary expenses due to overestimation or underestimation of claims. Objective: To determine the needs by measurements of the different types of prosthetic components used in total hip arthroplasty in the central provinces and thus optimize investments, with the economic advantages that it entails. Methods: A retrospective descriptive longitudinal study was carried out of the total hip arthroplasty operated cases at Arnaldo Milián Castro Hospital in Villa Clara, from December 1998 to date. Age, sex, origin and prosthetic components are the variables examined. The information is collected in the database created in SPSS, statistical analyzes was performed. Results: The mean age was 62.36 years. The group of 61-80 years was the one with the highest incidence (215 patients). Male sex predominated (51.8 percent). The highest incidence corresponded to Villa Clara (692 patients). The cemented components 46-50 were the most used and in the uncemented components the most used were 48-56. Müller Stems 7.5 - 12.5. RALCA Cemented T0-T4, uncemented T1-T3. In the SLA the most used were 11.5 and 13 respectively. Standard necks were those with the highest incidence (390 patients). Conclusions: The demand for each measure can be determined quite accurately for every 100 cases pending operation with the incidents of the different measures used by each of the components expressed, allowing to meet the demands of the most used measures and appropriate distribution at supplying, which would result in vital economic benefit in the current conditions of the country(AU)

Premio de Investigación SCHOT 2020: desarrollo y validación de un modelo multivariables de predicción de estadía hospitalaria en pacientes mayores de 65 años sometidos artroplastia total de cadera electiva en Chile utilizando aprendizaje de máquinas / 2020 SCHOT Research award: Development an a multivariable prediction model of hospital stay in elderly chilean patients undergoing elective total hip arthroplasty using machine learning

INTRODUCCIÓN La predicción de la estadía hospitalaria luego de una artroplastia total de cadera (ATC) electiva es crucial en la evaluación perioperatoria de los pacientes, con un rol determinante desde el punto de vista operacional y económico. Internacionalmente, se han empleado macrodatos (big data, en inglés) e inteligencia artificial para llevar a cabo evaluaciones pronósticas de este tipo. El objetivo del presente estudio es desarrollar y validar, con el empleo del aprendizaje de máquinas (machine learning, en inglés), una herramienta capaz de predecir la estadía hospitalaria de pacientes chilenos mayores de 65 años sometidos a ATC por artrosis. MATERIALES Y MÉTODOS Empleando los registros electrónicos de egresos hospitalarios anonimizados del Departamento de Estadísticas e Información de Salud (DEIS), se obtuvieron los datos de 8.970 egresos hospitalarios de pacientes sometidos a ATC por artrosis entre los años 2016 y 2018. En total, 15 variables disponibles en el DEIS, además del porcentaje de pobreza de la comuna de origen del paciente, fueron incluidos para predecir la probabilidad de que un paciente presentara una estadía acortada (< 3 días) o prolongada (> 3 días) luego de la cirugía. Utilizando técnicas de aprendizaje de máquinas, 8 algoritmos de predicción fueron entrenados con el 80% de la muestra. El 20% restante se empleó para validar las capacidades predictivas de los modelos creados a partir de los algoritmos. La métrica de optimización se evaluó y ordenó en un ranking utilizando el área bajo la curva de característica operativa del receptor (area under the receiver operating characteristic curve, AUC-ROC, en inglés), que corresponde a cuan bien un modelo puede distinguir entre dos grupos. RESULTADOS El algoritmo XGBoost obtuvo el mejor desempeño, con una AUC-ROC promedio de 0,86 (desviación estándar [DE]: 0,0087). En segundo lugar, observamos que el algoritmo lineal de máquina de vector de soporte (support vector machine, SVM, en inglés) obtuvo una AUC-ROC de 0,85 (DE: 0,0086). La importancia relativa de las variables explicativas demostró que la región de residencia, el servicio de salud, el establecimiento de salud donde se operó el paciente, y la modalidad de atención son las variables que más determinan el tiempo de estadía de un paciente. DISCUSIÓN El presente estudio desarrolló algoritmos de aprendizaje de máquinas basados en macrodatos chilenos de libre acceso, y logró desarrollar y validar una herramienta que demuestra una adecuada capacidad discriminatoria para predecir la probabilidad de estadía hospitalaria acortada versus prolongada en adultos mayores sometidos a ATC por artrosis. CONCLUSIÓN Los algoritmos creados a traves del empleo del aprendizaje de máquinas permiten predecir la estadía hospitalaria en pacientes chilenos operado de artroplastia total de cadera electiva

Introduction The prediction of the length of hospital stay after elective total hip arthroplasty (THA) is crucial in the perioperative evaluation of the patients, and it plays a decisive role from the operational and economic point of view. Internationally, big data and artificial intelligence have been used to perform prognostic evaluations of this type. The present study aims to develop and validate, through the use of artificial intelligence (machine learning), a tool capable of predicting the hospital stay of patients over 65 years of age undergoing THA for osteoarthritis. Material and Methods Using the electronic records of hospital discharges de-identified from the Department of Health Statistics and Information (Departamento de Estadísticas e Información de Salud, DEIS, in Spanish), the data of 8,970 hospital discharges of patients who had undergone THA for osteoarthritis between 2016 and 2018 were obtained. A total of 15 variables available in the DEIS registry, in addition to the poverty rate in the patient's borough of origin were included to predict the probability that a patient would have a shortened (< 3 days) or prolonged (> 3 days) stay after surgery. By using machine learning techniques, 8 prediction algorithms were trained with 80% of the sample. The remaining 20% was used to validate the predictive capabilities of the models created from the algorithms. The optimization metric was evaluated and ranked using the area under the receiver operating characteristic curve (AUC-ROC), which corresponds to how well a model can distinguish between two groups. Results The XGBoost algorithm had the best performance, with an average AUC-ROC of 0.86 (standard deviation [SD]: 0.0087). Secondly, we observed that the linear support vector machine (SVM) algorithm obtained an AUC-ROC of 0.85 (SD: 0.0086). The relative importance of the explanatory variables showed that the region of residence, the administrative health service, the hospital where the patient was operated on, and the care modality are the variables that most determine the length of stay. Discussion The present study developed machine learning algorithms based on freeaccess Chilean big data, which helped create and validate a tool that demonstrates an adequate discriminatory capacity to predict shortened versus prolonged hospital stay in elderly patients undergoing elective THA. Conclusion The algorithms created through the use of machine learning allow to predict the hospital stay in Chilean patients undergoing elective total hip arthroplasty Introduction The prediction of the length of hospital stay after elective total hip arthroplasty (THA) is crucial in the perioperative evaluation of the patients, and it plays a decisive role from the operational and economic point of view. Internationally, big data and artificial intelligence have been used to perform prognostic evaluations of this type. The present study aims to develop and validate, through the use of artificial intelligence (machine learning), a tool capable of predicting the hospital stay of patients over 65 years of age undergoing THA for osteoarthritis. Material and Methods Using the electronic records of hospital discharges de-identified from the Department of Health Statistics and Information (Departamento de Estadísticas e Información de Salud, DEIS, in Spanish), the data of 8,970 hospital discharges of patients who had undergone THA for osteoarthritis between 2016 and 2018 were obtained. A total of 15 variables available in the DEIS registry, in addition to the poverty rate in the patient's borough of origin were included to predict the probability that a patient would have a shortened (< 3 days) or prolonged (> 3 days) stay after surgery. By using machine learning techniques, 8 prediction algorithms were trained with 80% of the sample. The remaining 20% was used to validate the predictive capabilities of the models created from the algorithms. The optimization metric was evaluated and ranked using the area under the receiver operating characteristic curve (AUC-ROC), which corresponds to how well a model can distinguish between two groups. Results The XGBoost algorithm had the best performance, with an average AUC-ROC of 0.86 (standard deviation [SD]: 0.0087). Secondly, we observed that the linear

Evaluation of the range of motion of a hip arthroplasty system: a computer simulation study / Avaliação da amplitude de movimento de um sistema artroplástico do quadril: estudo por simulação computacional

ABSTRACT Objective: To date, the literature lacks consensus on the most efficient method to measure the range of motion of an in vitro prosthetic system. In this study, we propose the use of a relatively low-cost online software to measure the range of motion of hip prosthetic implants manufactured in Brazil and compare its results with the current technical standards for hip arthroplasty. Methods: Three different diameters of femoral heads were evaluated (28 mm, 32 mm, and 36 mm). The mean values of the angular displacement of the prosthesis in each motion axis were obtained by computer simulations. Results: The range of motion with each femoral head was 28mm (extension/flexion: 148°, internal/external rotation: 179°, adduction/abduction: 107°), 32 mm (152°/185°/114°), and 36 mm (158°/193°/120°). Conclusion: The computational method showed that the larger the femoral head, the greater the range of motion of the hip joint prosthetic system. Additional clinical studies are necessary to compare the physical results obtained with the values found in this study by computational modeling. Level of evidence V, Experimental study.

RESUMO Objetivo: A maneira mais eficiente de se aferir a amplitude de movimento de um sistema protético in vitro ainda não é bem estabelecido na literatura. Assim, o presente estudo propõe a utilização de um software online de custo relativamente baixo para mensuração da amplitude de movimento de um conjunto protético nacional de quadril e comparar os resultados obtidos com a norma técnica vigente para as artroplastias de quadril. Métodos: A avaliação foi realizada com três diferentes diâmetros de cabeças femorais (28 mm, 32 mm e 36 mm); os valores médios do deslocamento angular da prótese em cada eixo de movimento foram obtidos por meio de simulações computacionais no programa Autodesk Inventor. Resultados: as amplitudes de movimento obtidas foram: cabeça 28mm (extensão/flexão: 148°, rotação interna/externa: 179°, adução/abdução: 107°), cabeça 32° (152°/185°/114°), cabeça 36° (158°/193°/120°). Conclusão: O método computacional utilizado no presente estudo possibilitou concluir que quanto maior a cabeça femoral, maior será a amplitude de movimento do sistema protético para articulação de quadril. Novos estudos clínicos, tanto pré quanto pós-operatórios, devem ser realizados para comparar os resultados físicos obtidos com os valores encontrados nesta avaliação por meio de modelo computacional. Nível de Evidência V, Estudo experimental.

Protrusio acetabular en artroplastía total de cadera: diez tácticas para un buen resultado quirúrgico / Total hip arthroplasty in protrusio acetabuli: ten tips to improve surgical outcomes

Los pacientes candidatos a artroplastía total de cadera con protrusio acetabular asociada generan distintos desafíos en los equipos quirúrgicos. Múltiples estrategias han sido utilizadas a lo largo de los años para optimizar los resultados. Mediante una revisión de la evidencia actualizada disponible, proponemos diez tácticas a realizar en el manejo de estos pacientes que pueden mejorar y hacer predecible el tratamiento de un paciente con protrusio acetabular al que se le realiza una artroplastía total de cadera. Nivel de Evidencia V.

Patients with acetabular protrusio and osteoarthritis are a challenge for the surgical team. Many strategies have been developed to anticipate, plan and optimize the surgical results of these patients. Based on the current available clinical evidence, we propose ten tips to improve the surgical management of hip arthroplasty patients with protrusio acetabuli. Level of Evidence V.

Canal flare index evaluation for different dog breeds / Avaliação do canal flare index femoral de diferentes raças de cães

ABSTRACT: This study determined the canal flare index (CFI) of four dog breeds using two distinct femoral regions as a reference. Thirty-five radiographs of the hip joints of Golden Retrievers (GRG), German Shepherds (GSG), Labrador Retrievers (LRG), and Rottweilers (RG) of both sexes were used. Seventy experimental units were submitted to CFI calculation. Objective (CFIob) and subjective (CFIsub) values of the CFI of each experimental unit were determined according to the anatomical reference used for the calculation. A significant difference in the CFIob between the Golden Retriever and German Shepherd breeds (1.68 ± 0.16 and 1.49 ± 0.08), and in the CFIsub between Golden Retriever, German Shepherd, and Rottweiler breeds (2.09 ± 0.31, 1.86 ± 0.11, and 1.84 ± 0.18) was reported. The subjective form of measurement showed higher values than the objective form (GRG: 2.09 ± 0.31; GSG: 1.86 ± 0.11; LRG: 2.07 ± 0.12; RG: 1.84 ± 0.18). The CFI values of each breed were similar, suggesting a certain racial pattern. A significant difference in the interobserver assessment for both CFIsub and CFIob, in all races was observed. The CFI analysis identified morphological patterns of the proximal femur in the different races. Results indicated the need for standardization of the anatomical references used to calculate the CFI because there were statistical differences among the measurements among the observers.

RESUMO: Objetivou-se determinar o canal flare index (CFI) de quatro raças específicas de cães, utilizando-se duas regiões femorais distintas como referência. Foram analisadas 35 radiografias de articulações coxofemorais de cães das raças Golden Retriever (GGR), Pastor Alemão (GPA), Labrador Retriever (GLR) e Rottweiler (GR), de ambos os sexos, configurando 70 unidades experimentais submetidas ao cálculo do CFI. Determinaram-se os valores objetivo (CFIob) e subjetivo (CFIsub) do CFI de cada unidade experimental de acordo com a referência anatômica utilizada para o cálculo. Houve diferença significativa do CFIob entre as raças Golden Retriever e Pastor Alemão (1,68 ± 0,16 e 1,49 ± 0,08), e do CFIsub entre as raças Golden Retriever, Pastor Alemão e Rottweiler (2,09 ± 0,31, 1,86 ± 0,11 e 1,84 ± 0,18). A forma subjetiva de mensuração apresentou valores maiores que a forma objetiva (GGR: 2,09 ± 0,31; GPA: 1,86 ± 0,11; GLR: 2,07 ± 0,12; GR: 1,84 ± 0,18). Os valores de CFI de cada raça se apresentaram similares, sugerindo haver determinado padrão racial. Houve diferença significativa na avaliação interobservadores, tanto do CFIsub quanto CFIob, em todas as raças. A análise do CFI identificou padrões morfológicos do fêmur proximal nas diferentes raças. Os resultados indicaram a necessidade de padronização dos referenciais anatômicos utilizados para o cálculo do CFI, uma vez que houve relevância estatística entre as diferentes mensurações entre os observadores.

Porous Lattice Structure of Femoral Stem for Total Hip Arthroplasty / Estructura de Diseño Poroso por Latice de Vástago Femoral para Artroplastia Total de Cadera

Abstract Total Hip Arthroplasty (THA) is one of the surgical procedures carried out satisfactorily in procedures for osteoarthritis and trauma lesions. ATC surgery reduces pain and improves the quality of life of young patients. Therefore, it is of great importance to improve the properties of hip implants, since current implants do not match their lifespan with the life expectancy of a young patient. This is because the solid prostheses that currently exist have a higher Young's modulus, and therefore are too rigid compared to the bone tissue. On the other hand, the cyclic and continuous loads to which the hip joint is subjected in daily activities, can cause loosening and consequent implant loss The present work proposes an implant manufactured with a porous lattice structure, which aims to reduce stiffness, allow bone growth and a more effective mechanical load transfer. Three computational models subjected to static charges were evaluated and compared: 1) healthy femur, 2) implanted femur with a commercial prosthesis, and 3) implanted femur with a prosthesis with lattice structure. For the computational analysis it was decided to perform a static analysis of a person standing on the left foot; a load equivalent to the body weight was applied on the head of the femur, balancing the reaction forces in the system of forces (contact force, body weight, and abductor muscle).. The results were shown in terms of displacement, compression and deformation. The model implanted with a prosthesis with a lattice design presented a slight decrease in displacement, and a decrease in compression and deformation values, which indicated that the proposed design has a better distribution and transport of the loads through its structure.

Resumen La artroplastia total de cadera (ATC) es uno de los tratamientos quirúrgicos llevados a cabo de manera satisfactoria en procedimientos para la osteoartritis y lesiones de trauma. La ATC reduce el dolor y mejora la calidad de vida de los pacientes. Por lo tanto, es de gran importancia mejorar las propiedades de los implantes de cadera, ya que los implantes actuales tienen un tiempo de vida útil y deben cumplir con las expectativas de rehabilitación para los pacientes. Esto se debe a que las prótesis sólidas que existen actualmente tienen un módulo de Young más elevado, y por lo tanto son demasiado rígidas a comparación del tejido óseo. Por otro lado, las cargas cíclicas y continuas a las que se ve sometida la articulación de la cadera en actividades diarias, pueden ser causa del aflojamiento y consecuente pérdida del implante. El presente trabajo propone un implante fabricado con una estructura porosa tipo látice, el cual tiene como objetivos reducir la rigidez, permitir crecimiento óseo y una transferencia de cargas mecánicas más efectiva. Se evaluaron y compararon tres modelos computacionales sometidos a cargas estáticas: 1) fémur sano, 2) fémur implantado con una prótesis comercial, y 3) fémur implantado con una prótesis con estructura látice. Para el modelo computacional se optó por hacer un análisis estático de una persona parada sobre el pie izquierdo; donde se aplicó una carga equivalente del peso corporal sobre la cabeza del fémur, equilibrando las fuerzas de reacción en el sistema de fuerzas (fuerza de contacto, peso corporal, y músculo abductor). Los resultados fueron mostrados en términos de desplazamiento, compresión y deformación. El modelo implantado con una prótesis con un diseño tipo látice presentó una ligera disminución de desplazamiento, y disminución en los valores de compresión y deformación, lo que indicó que el diseño propuesto posee una mejor distribución y transporte de las cargas a través de su estructura.

Manejo de fractura de cuello femoral en paciente con amputación supracondílea femoral bilateral y revisión de la literatura / Femoral neck fracture management in patient with bilateral femoral supracondylar amputation and literature review

Resumen: El tratamiento de un paciente con amputación supracondílea femoral bilateral, y que ha sufrido una fractura de cuello femoral, es un evento poco común tanto para el cirujano ortopédico como para el equipo de rehabilitación. Presentamos un caso, en el cual se discuten diferentes dificultades en su tratamiento, elección de implante y regreso a sus actividades diarias. Se trata de un joven con diagnóstico de amputación traumática bilateral supracondílea, con fractura de cuello femoral, tratado mediante artroplastía total de cadera primaria no cementada. La evaluación de la funcionalidad de la prótesis total de cadera con escala de Houghton fue al cabo de 12 meses, se obtuvo una puntuación final de 9 puntos, los cuales son el resultado de una rehabilitación satisfactoria.

Abstract: The treatment of a patient with amputation above the knee who has suffered a femoral neck fracture is a challenge for both the orthopedic surgeon and the rehabilitation team. We present a case, in which different difficulties are discussed in their treatment, choice of implant and return to their daily activities. The clinical case of a young man diagnosed with supracondylar bilateral traumatic amputation, with fracture of the femoral neck, treated by total non-cemented hip arthroplasty is presented. The functionality of the total hip prosthesis with Houghton scale after 12 months, obtaining a final score of 9 points which are the result of a satisfactory rehabilitation.