RESUMEN
Total knee arthroplasty (TKA) remains a lifesaving procedure for advanced gonarthrosis. However, patella resurfacing (PR) in TKA remains a controversial procedure, leading to extensive discussions amongst orthopedic surgeons, regarding its indications and results. Based on these premises, we present a clinical case of a 70-year-old Caucasian woman admitted for pain, swelling and limitation of left knee joint mobility. Her medical history records an Ahlback stage IV gonarthrosis with simultaneous bilateral TKA surgery performed in different hospital, when two NexGen cemented total prostheses were implanted with patellar resurfacing being performed only on the right side. Our clinical (American Knee Society Score, Lonner and Feller scales) and radiological evaluations (CT scan and Xray) revealed left patellar arthrosis and a slight lateral subluxation of the patella. The chosen treatment plan was revision surgery for PR and patellar prosthesis with a cemented patellar component, cross-linked polyethylene, no 32 NexGen model with 8.5 mm thickness. The immediate and distant postoperative evolution was favorable. Extensive literature review shows that, at present, PR remains at surgeon's discretion mainly based on his previous results. Therefore, we believe there is an imperative need to develop high quality studies based on accurate scientific evidence to universally establish valid guidelines for PR in TKA.
RESUMEN
(1) Background: Resorbable Mg-based implants represent a new direction in orthopedic surgery but have some drawbacks, such as their rapid biodegradation and increased rate of corrosion. Some in vitro studies hypothesized that tissue necrosis, incision dehiscence, risk of gas embolization in vital organs, interference with coagulation processes, and trophocyte viability impairment can occur. (2) Methods: We conducted an in vivo study on ten rabbit cases, in two groups; group one, consisting of six cases, received cylindrical implants of Mg-1Ca alloy in tibial intramedullary bone tissue. Group two, consisting of four cases, received Mg-1Ca parallelepiped implants, in the thigh muscular tissue. We recorded and compared weight (preoperatively and at 2, 4, and 6 weeks postoperatively), complete blood count, serum electrolytes, liver and kidney functional markers, and coagulation parameters, prior to and at 6 weeks after surgery. Local evolution was assessed radiologically and with tissue biopsies with complete pathology analysis. (3) Results: All biological markers and clinical evolution were favorable, showing good integration of the implants with none of the local or systemic signs of degradation. (4) Conclusions: Our study shows that the clinical use of Mg-1Ca bioresorbable alloys can be safe as none of the cited local or systemic complications have been identified.