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.

Improvement of survival after 10 years with the Durom-type hip resurfacing prosthesis in selected patients: Experience of a public university hospital. / Mejoría de la supervivencia a los 10 años con la prótesis de recubrimiento de cadera tipo Durom en pacientes seleccionados. Experiencia de un hospital público universitario.

INTRODUCTION: Hip resurfacing arthroplastys are a valid alternative for the treatment of degenerative hip disorders in young adults. Poor results and adverse soft tissue effects have been reported with high levels of chromium and cobalt, limiting its indications. Objective is to analyze clinical and functional survival results of the Durom system 10 years after its implementation in a public hospital. The hypothesis is that better results and survival are obtained in patients selected according to FDA criteria. MATERIAL AND METHODS: Retrospective cohort study of 83 patients, 91 hips in 76 men and 7 women operated between 2005 and 2013 with Durom-type prostheses. Demographic study, diagnosis, BMI, radiological study, serum chromium cobalt levels, functional assessment according to MPD and HSS, complications and survival at 10 years of follow-up. A cohort of active men under 65 years of age and heads over 48mm is selected. RESULTS: Follow-up time of 121 months with a range from 84 to 176 months. With a mean age of 52.78 years, with 4 deaths and loss of follow-up of 3 cases. There are 12 complications that require reoperation (14.45%) with 2 chronic infections, 4 femoral neck fractures, 4 acetabular loosening and 2 cases of pseudotumors. With an overall survival of 85.4% (71-91.9) and 87.85% (85.5-91.1) in the absence of infection. No statistical relationship between complications and neck narrowing and the angles of inclination of the components. In selected patients, 69 men and 73 hips, we obtained an overall survival of 91.82% and excluding infection of 93.18% at 10 years. CONCLUSIONS: The indication of the Durom system in the treatment of degenerative processes in selected active young patients presents better results and survival at 10 years, although somewhat lower than other highly indicated veneering models.

Fractura periprotésica acetabular intraoperatoria / Intraoperative acetabular periprotesic fracture

Resumen: Las fracturas intraoperatorias acetabulares (FIA) son una complicación rara con incidencia de 2 a 5%. Presentamos la revisión de una serie de 13 casos, que aborda diagnóstico, tratamiento y resultados. Material y métodos: entre 2006 y 2018 realizamos 4,800 artroplastías primarias de cadera (ATC). En nuestro hospital identificamos 13 casos con FIA con un seguimiento de 38.3 meses. Resultados: Dos casos fueron estables con manejo conservador; 11 casos inestables: en siete casos colocamos trabecular metal, en un caso aumentamos diámetro acetabular, en un caso recambio de cotilo, en un caso revisión con anillo tipo Ganz y un caso no aceptó tratamiento. El uso de trabecular metal es un implante que ayuda eficazmente y con buenos resultados en FIA. Conclusión: Estas fracturas son raras, conocer el implante a utilizar es imperativo, ya que si los implantes están sobredimensionados, con mayor rigidez o hemisféricos, los pacientes tienen mayor riesgo de sufrir esta complicación.

Abstract: Intraoperative acetabular fractures (IAF) is a rare complication with an incidence 2% - 5%. We present the review of a series of 13 cases, discussing diagnosis, treatment and results. Material and methods: Between 2006 and 2018, we performed 4800 primary hip arthroplasties (THA) In our hospital, we identified 13 cases with FIA with a follow-up of 38.3 months. Results: Two cases were stable with conservative management; 11 unstable cases: seven cases we placed trabecular metal, one case we increased acetabular diameter, one case acetabular replacement, one case revision with Ganz type ring and one case do not accept treatment. The use of trabecular metal is an implant that helps effectively and with good results in FIA. Conclusion: These fractures are rare, knowing the implant to use is mandatory because if the implants are oversized, with greater rigidity or hemispheric, patients have increased risk of suffering from this complication.

Modular diaphyseal anchor stems with locking screws in the hip revision with massive femoral defects. / Vástagos modulares de anclaje diafisario con tornillos de bloqueo en la revisión de cadera con defectos femorales masivos.

INTRODUCTION: Complex femoral defects with insufficient isthmus (Paprosky III and IV) and Vancouver B3 periprosthetic fractures determines the fixation of the revision stems. The objective is to evaluate the results of the modular revision stems with diaphyseal anchor and distal block (Revitan Zimmer Biomet GmbH, Winterthur, Switzerland). Our hypothesis is that this procedure offers a stable primary fixation in cases of alteration of the femoral isthmus. MATERIAL AND METHODS: Retrospective cohort study of 38 patients, minimum follow-up of 12 months (12-94) with severe femoral defects treated with Revitan stems distally blocked. An endofemoral or transfemoral approach was used. The subsidence was assessed according to Callahan's method and bone neoformation according to Nordin. Merle d'Aubigné-Postel was used and complications and reoperations were collected. A statistical analysis was performed with SPSS and a significance level p < 0.05 was considered. RESULTS: Between 2009 and 2017, 147 revisions were carried out with Revitan stem, 38 locked, 23 men and 15 women, with an average age of 74 years and an average follow-up of 64 months. The cause of the review was: 15 septic loosenings, 14 aseptic, two fractures and seven stable fibrous unions. Right fixation was obtained in 27 cases, there were four loosenings, three screw breakages, three infections, one of dislocation and one of femoral nerve injury. The MDP increased significantly from 11.26 to 14.98. CONCLUSIONS: Distally locked conical modular stems are a good alternative in femoral defects with isthmus involvement if proper canal filling and bicortical screw fixation are achieved.

Reconstruction for pelvic discontinuity and massive acetabular defects. / Reconstrucción acetabular con el sistema Cup-Cage para discontinuidades pélvicas y defectos acetabulares masivos.

OBJECTIVE: The acetabular reconstruction with massive acetabular defects and pelvic discontinuity is a complex surgery with important difficulties for the orthopaedic surgeon. The objective of this study is to show the short and midterm results of the acetabular revision with the Cup-Cage construct in a consecutive serie of cases. MATERIAL AND METHODS: Retrospectively we reviewed 22 consecutive patients with massive acetabular defects (8 Paprosky IIIa and 9 IIIB); 5 pelvic discontinuities; 2 pelvic fractures during the implantation of primary artroplasty, and one pelvic pseudoarthrosis. All were reoperated with a trabecular metal acetabular component and a Cup-Cage. We did clinical and radiological follow-up to detect machanical failures and loosening of the implant. RESULTS: With a middle follow-up of 45.06 months (12-73 months) we did not see any radiographic failure of the implant (component migration, osteolysis neither rupture of the implant or screws). The complications (13,63%) included one recurrent luxation, one infection and one recurrent subluxation. The Merle d'Aubigné-Postel score improved from 6.91 to 14.36 and the punctuation in the range of motion from 2.91 to 4.36 on average of the values preoperatively and postoperatively respectively and improvement in Harris Hip Score 30 (16-55) to 72 (40-90) in the latest follow up. CONCLUSION: The acetabular reconstruction with the Cup-Cage system is a valid alternative for the reconstruction of massive acetabular defects (Paprosky type IIIA and IIIB) and pelvic discontinuities offering good results at short and midterm follow-up.

[Case report: total hip replacement in osteogenesis imperfecta]. / Artroplastía total de cadera en osteogénesis imperfecta. A propósito de un caso.

We study, apropos of a case, a total hip arthroplasty in a patient with osteogenesis imperfecta. The characteristics of this disease, such as high risk of fracture and the presence of deformities, make this surgery a challenge for the orthopedic surgeon. In this manuscript, we review for the first time in this indication the preoperative planning and the selection of implants, with special emphasis on measures for the prevention of complications.

En este trabajo se ha estudiado, a propósito de un caso, la cirugía de artroplastía total de cadera en un paciente con osteogénesis imperfecta. Las características propias de esta enfermedad, como son el elevado riesgo de fractura y la presencia de deformidades, convierten esta cirugía en un reto para el cirujano ortopédico. En este manuscrito se revisa, de forma inédita para esta indicación, la planificación preoperatoria y la elección del tipo de implantes, con especial interés en las medidas para la prevención de complicaciones.

Artroplastía total de cadera en osteogénesis imperfecta. A propósito de un caso / Case report: total hip replacement in osteogenesis imperfecta

Resumen: En este trabajo se ha estudiado, a propósito de un caso, la cirugía de artroplastía total de cadera en un paciente con osteogénesis imperfecta. Las características propias de esta enfermedad, como son el elevado riesgo de fractura y la presencia de deformidades, convierten esta cirugía en un reto para el cirujano ortopédico. En este manuscrito se revisa, de forma inédita para esta indicación, la planificación preoperatoria y la elección del tipo de implantes, con especial interés en las medidas para la prevención de complicaciones.

Abstract: We study, apropos of a case, a total hip arthroplasty in a patient with osteogenesis imperfecta. The characteristics of this disease, such as high risk of fracture and the presence of deformities, make this surgery a challenge for the orthopedic surgeon. In this manuscript, we review for the first time in this indication the preoperative planning and the selection of implants, with special emphasis on measures for the prevention of complications.

The impact of subsidence on straight and curved modular cementless revision stems in hip revision surgery. / Impacto del hundimiento en vástagos de revisión rectos y curvos modulares en cirugía de revisión de cadera.

Subsidence is one of the potential complications in femoral stem revision total hip arthroplasty surgery, and can affect stability and osseointegration. A retrospective study was conducted on the outcomes at one year and 5 years (specifically subsidence and clinical relevance) of 40 consecutive femoral total hip arthroplasty revisions, comparing two modular cementless revision stems, Straight vs. Curved, with 20 patients in each group. No mechanical failure was observed, and there was an improvement in functional outcomes. Mean radiological subsidence was 9.9±4.9mm (straight=10.75mm vs. curved=9.03mm), with no statistically significant difference between groups (p=0,076). Fourteen patients (35%) had ≥10mm of subsidence, up to a maximum of 22mm. The subsidence found in this study is similar to published series, with no short-term clinical manifestations, or an increased number of complications or stem loosening in either the Straight or Curved group. No differences in subsidence were observed at one year and 5 years after surgery between the 2 types of stems.

[High recurrence and good functional results after arthroscopic resection of pigmented villonodular synovitis]. / Alta recidiva y buenos resultados funcionales tras la resección artroscópica de la sinovitis villonodular pigmentaria de la rodilla.

INTRODUCTION: Pigmented villonodular synovitis (PVS) is a synovial proliferation disorder of uncertain aetiology, with some controversy as regards its proper treatment. The purpose of the study was to evaluate the functional outcome and recurrence rate in a series of patients diagnosed with both the diffuse and the localised type of PVS and treated by arthroscopic resection. MATERIAL AND METHODS: Twenty-four patients diagnosed with PVS were retrospectively assessed. There were 11 cases with the diffuse type, and 13 cases with the localised type of PVS. They were followed-up for a median of 60 months (range, 34-204). They underwent arthroscopic synovectomy, and were functionally evaluated with IKDC, WOMET, and Kujala scores. RESULTS: There was recurrence in 8 out of 13 (61.5%) cases with the diffuse type of PVS. Two of these patients were treated with radiation. One patient underwent surgical resection with an open procedure due to extra-articular involvement. The remaining 5 patients underwent a second arthroscopic resection, and no recurrence was subsequently observed. Cases with localised PVS did not recur after a single arthroscopic resection. IKDC, WOMET and Kujala scores improved by 30.6, 37.4 and 34.03 points, respectively. DISCUSSION: Pigmented villonodular synovitis treated by arthroscopic resection showed good functional results at mid-term follow-up. A single arthroscopic resection was sufficient to treat the localised PVS, whereas the diffuse type of PVS required a second arthroscopic resection in most cases, due to its high rate of recurrence.