Impact of cadaveric practices on arthroscopic knee training for Orthopaedic Surgery and Traumatology residents. / Impacto de las prácticas cadavéricas en la formación artroscópica de rodilla de los residentes de Cirugía Ortopédica y Traumatología.

BACKGROUND AND OBJECTIVES: There currently is a considerable variability in the content of training programs and courses for orthopaedic surgeons in training. Besides this, there is still no consensus regarding which is the most effective methodology for improving learning of the technique or for its qualitative evaluation. A study was carried out to assess the influence of carrying out a cadaveric practical course on the acquisition of arthroscopic technical skills in fifth-year residents. MATERIAL AND METHODS: A knee arthroscopy cadaveric course was performed in which 48 students participated. Different technical aspects during a knee arthroscopy, as well as the residents skill and the execution time were evaluated before and after the course using a specific questionnaire. RESULTS: There was a significant statistic improvement between the initial and final evaluation, increasing from 11,7 till 17,1 (maximum 20) points. Also, a significant improvement in all the parameters analysed was observed; the identification of anatomic structures (p = 0.001), the palpation of specific structures (p = 0.032), and the time necessary for the arthroscopic knee check (p = 0.015). CONCLUSIONS: A knee arthroscopy cadaveric course improves significantly the technical skills of surgeons in training.

[Functional and quality of life results after a total knee replacement per year and five years of follow-up]. / Resultados funcionales y de calidad de vida tras una artroplastía total de rodilla al año y cinco años de seguimiento.

INTRODUCTION: Classically the results of any joint replacement surgery are evaluated at a minimum of 5 years. This period could be considered excessive to evaluate the functional results of this procedure. The objective of this study is to compare functional and quality of life results to 1 and five years of follow-up following a total knee replacement (TKR). MATERIAL AND METHODS: Prospective observational study. All patients visited one year after the implantation of TKR were included. All of these filled out the SF-36 questionnaire and the KSS valuation scale. Both were administered again at age five after surgery. RESULTS: 689 patients were initially included in the study (163 men [23.7%] and 526 women [76.3%]) with an average age of 72.2 years. At age 5,585 (84.9%) of these patients were re-analyzed. While the knee section of the KSS scale remained similar in these two periods, the function section of the KSS titration scale showed a slight worsening over time (p = 0.008). With respect to SF-36, the physical summation worsened at five years (p = 0.00) and the mental summation remained stable (n.s.) between the year and five years after surgery. DISCUSSION: Five years after a TKR, the physical exam does not vary from the year of surgery. However, the subjective evaluation measured by the function-KSS section and the physical SF-36, worsen slightly during this period. This could be due to aging patients.

INTRODUCCIÓN: Clásicamente los resultados de cualquier cirugía de reemplazo articular se evalúan en un mínimo de cinco años. Este período podría considerarse excesivo para evaluar los resultados funcionales de este procedimiento. El objetivo de este estudio es comparar los resultados funcionales y de calidad de vida a uno y cinco años de seguimiento tras una artroplastía total de rodilla (ATR). MATERIAL Y MÉTODOS: Estudio prospectivo observacional. Se incluyeron todos aquellos pacientes visitados un año después de la implantación de una ATR. Todos ellos rellenaron el cuestionario SF-36 y la escala de valoración KSS. Ambos fueron administrados nuevamente al cabo de cinco años de la cirugía. RESULTADOS: 689 pacientes fueron incluidos inicialmente en el estudio (163 hombres [23.7%] y 526 mujeres [76.3%]) con una edad media de 72.2 años. A los cinco años, 585 (84.9%) de estos pacientes fueron analizados de nuevo. Mientras que la sección rodilla de la escala KSS se mantenía similar en estos dos períodos, la sección función de la escala de valoración KSS mostraba un leve empeoramiento con el tiempo (p = 0.008). Con respecto al SF-36, el sumatorio físico empeoraba a los cinco años (p = 0.00) y el sumatorio mental se mantenía estable (n.s.) entre un año y cinco años tras la cirugía. DISCUSIÓN: Después de cinco años de una ATR, el examen físico no varía con respecto al año de la cirugía. Sin embargo, la evaluación subjetiva medida mediante la sección función-KSS y el SF-36 físico empeoran ligeramente durante este período. Esto podría ser debido al envejecimiento de los pacientes.

Pressure algometry is an excellent tool to measure knee pain relief after a closing-wedge high tibial osteotomy.

PURPOSE: The aim of this study was to assess the utility of pressure algometry (PA) to measure pain relief in the medial part of the knee after a closing-wedge high tibial osteotomy (CWHTO). METHODS: Prospective study including 44 CWHTO. Pain relief was evaluated with the visual analogue scale (VAS) and PA, a radiological study was done and a functional assessment was carried out with the KSS preoperatively, at 6-months and at 1-year after the surgery. PA was applied to the medial and lateral part of the knee and to the infra-clavicular fossa as a control point. RESULTS: The mechanical femorotibial angle was changed from 172.2° (SD2.2) to 180.6° (SD2.6) (p=0.00). KSS Knee improved from 53.4 (SD11.2) to 92.8 (SD7.3) (p=0.00), KSS Function from 69.4 (SD9.3) to 93.1 (SD8) (p=0.00). The VAS went from 6.84 (SD1.5) to 2.5 (SD2.1) (p=0.00) at the 1-year follow-up. The pressure pain threshold (PPT), measured with PA in the medial part of the knee also improved from 348.8kPa (SD159.3) to 447.1kPa (SD218.8) (p=0.01). However, the PPT in the lateral part of the knee and in the sub-clavicular fossa remained the same from the preoperative period to 6-months and 1-year, postoperatively. Neither were there any differences between the 6-month and 1-year postoperative values in terms of the different functional, radiological and pain relief obtained. CONCLUSION: The pain relief obtained after a CWHTO in the medial part of the knee can be measured by using PA. Furthermore, the functional and pain improvement obtained at 1-year follow-up is no better than those obtained at 6-months postoperatively.

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

El hundimiento protésico es una de las potenciales complicaciones de los vástagos femorales de anclaje diafisario no cementado en las cirugías de revisión protésica, lo cual puede afectar a la estabilidad y a la osteointegración del componente. En este estudio retrospectivo evaluamos los resultados al año y a los 5 años (especialmente el hundimiento y la relevancia clínica) de 40 revisiones de vástago femoral consecutivas, comparando 2 vástagos de revisión modulares no cementados rectos vs. curvos, con 20 pacientes en cada grupo. No se observó ningún fracaso mecánico y se obtuvo una mejoría en cuanto a resultados funcionales en la totalidad de los casos. El hundimiento radiológico medio fue de 9,9±4,9mm (p=0,076); 14 pacientes (35%) tuvieron ≥10mm de hundimiento, con un máximo de 22mm en un caso. Nuestros resultados son similares a las series publicadas en la literatura, sin manifestaciones clínicas a corto-medio plazo ni incremento del número de complicaciones o aflojamiento del vástago en ninguno de los 2 grupos. No se observaron diferencias en cuanto al hundimiento protésico al año y a los 5 años posteriores a la cirugía entre los 2 tipos de vástagos (AU)

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 (AU)

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.

[Cemented stems in revision total knee arthroplasty on patients older than 75 y/o. Clinical and radiological analysis]. / Vástagos cementados en recambios de prótesis total de rodilla en pacientes mayores de 75 años. Análisis clínico y radiológico.

BACKGROUND: The purpose of this study was to analyze the clinical and radiological evolution of the total knee revision arthroplasty with cemented stems in patients over 75 years. MATERIAL AND METHODS: A retrospective analysis was performed in all the subjects who underwent revision of total knee arthroplasty with cemented stems between 2008 and 2014 in our center. Twenty-seven individuals over 75 years met the inclusion criteria. We assessed the Knee Society Score and range of motion for clinical outcome. We evaluated the implant stability with radiographs through radiolucent lines according to the modified radiological scale of the Knee Society; we registered the complications and prosthetic survival. RESULTS: With an average age of our participants of 82.6 ± 4.4 years and a follow-up of 43 ± 14.4 months, we did not find any mechanical failure of the components. The functional average score was 115 ± 32 in the total KSS, of which 77 ± 17.5 points were in the KSS knee and 42 ± 24 in the KSS function. The average range of motion was 98º ± 17. Radiologically, 18 patients presented radiolucent lines, but only three needed follow-up using the modified Knee Society radiographic scoring system. CONCLUSIONS: The results revealed that cemented stems are a good method for fixation in the revision of total knee arthroplasty in people over 75 years. We observed acceptable medium-term clinical results with a low risk of radiological failure, despite the high number of radiolucencies.

Analizar la evolución funcional y radiológica de los pacientes mayores de 75 años intervenidos de cirugía de revisión de rodilla con vástagos cementados.

Vástagos cementados en recambios de prótesis total de rodilla en pacientes mayores de 75 años. Análisis clínico y radiológico / Cemented stems in revision total knee arthroplasty on patients older than 75 y/o. Clinical and radiological analysis

Resumen: Antecedentes: Analizar la evolución funcional y radiológica de los pacientes mayores de 75 años intervenidos de cirugía de revisión de rodilla con vástagos cementados. Material y métodos: Mediante análisis retrospectivo, hemos revisado a 27 individuos mayores de 75 años a quienes se les ha implantado una prótesis total de rodilla de revisión con vástagos cementados en nuestro centro entre 2008-2014. Durante el seguimiento, se realizó un análisis clínico mediante la escala Knee Society Score y de movilidad de la rodilla, un análisis radiológico de la estabilidad de los implantes por medio de la escala radiológica modificada de la Knee Society, el registro de las complicaciones y la supervivencia protésica. Resultados: Con una edad media de los participantes de 82.6 ± 4.4 años y un seguimiento medio de 43 ± 14.4 meses, no hemos observado ningún caso de aflojamiento mecánico de los componentes. La valoración funcional ha sido de 115 ± 32 puntos en la escala total KSS, de los cuales 77 ± 17.5 puntos pertenecen al KSS rodilla y 42 ± 24 puntos al KSS función. El rango medio de movilidad fue de 98o ± 17. A nivel radiológico, 18 sujetos mostraron radiolucencias periprotésicas; según los criterios de la escala radiológica de la Knee Society, solo tres requirieron seguimiento clínico-radiológico estricto. Conclusiones: La cementación de los vástagos en prótesis totales de rodilla de revisión se trata de un buen sistema de fijación en personas mayores de 75 años, con elevada supervivencia del implante, buen resultado funcional y bajo porcentaje de aflojamiento radiológico a pesar de la aparición frecuente de radiolucencias.

Abstract: Background: The purpose of this study was to analyze the clinical and radiological evolution of the total knee revision arthroplasty with cemented stems in patients over 75 years. Material and methods: A retrospective analysis was performed in all the subjects who underwent revision of total knee arthroplasty with cemented stems between 2008 and 2014 in our center. Twenty-seven individuals over 75 years met the inclusion criteria. We assessed the Knee Society Score and range of motion for clinical outcome. We evaluated the implant stability with radiographs through radiolucent lines according to the modified radiological scale of the Knee Society; we registered the complications and prosthetic survival. Results: With an average age of our participants of 82.6 ± 4.4 years and a follow-up of 43 ± 14.4 months, we did not find any mechanical failure of the components. The functional average score was 115 ± 32 in the total KSS, of which 77 ± 17.5 points were in the KSS knee and 42 ± 24 in the KSS function. The average range of motion was 98o ± 17. Radiologically, 18 patients presented radiolucent lines, but only three needed follow-up using the modified Knee Society radiographic scoring system. Conclusions: The results revealed that cemented stems are a good method for fixation in the revision of total knee arthroplasty in people over 75 years. We observed acceptable medium-term clinical results with a low risk of radiological failure, despite the high number of radiolucencies.

Knee joint infection after ACL reconstruction: prevalence, management and functional outcomes.

PURPOSE: Septic arthritis after an ACL reconstruction is a rare but serious complication. Functional outcomes of these patients have not been studied in depth in large series. The aim of this study was to determine the prevalence and management of knee joint infection following ACL reconstruction and to assess the functional outcomes. METHODS: A retrospective assessment of knee joint infections occurring after arthroscopically assisted ACL reconstructions done from 2006 to 2009 in two hospitals by the same surgical team is presented. Patients with signs and symptoms of joint infection along with blood and synovial effusion laboratory parameters suggestive of infection were considered as septic arthritis. All the patients were treated with antibiotic therapy according to antibiotic sensitivity and had at least one arthroscopic lavage. Final outcomes were assessed and compared with a control group using the KT-1000 arthrometer, functional testing and radiological examination. RESULTS: Fifteen (1.8 %) out of 810 patients included in the study were considered as a joint infection. Microbiology showed that coagulase-negative Staphylococcus was present in 10 patients, Staphylococcus Aureus in three patients (2 MSSA and 1 MRSA) and Propinebacterium sp. in one patient. In one patient, the micro-organism was unknown. At a mean follow-up of 39.3 ± 13 months, the Lysholm score was 77.7 ± 15.3, the IKDC score was 70.4 ± 19.5, and the KT-1000 compared to the non-injured contralateral knee showed a mean difference of 1.3 ± 2 mm. Functional outcomes in the control group were slightly better than those obtained in the infected group (Lysholm score; 90.7 ± 9.4, p = 0.007. IKDC score; 86.6 ± 6.8, p = 0.004). All but one patient retained their reconstructed ACL. CONCLUSIONS: The prevalence of septic arthritis after an ACL reconstruction in this series was 1.8 %. Arthroscopic lavages along with antibiotic treatment led us to preserve all but one graft. Functional outcomes in the infected patients were not as good as those obtained in patients without infection.

[Delayed healing in long bone fracture: radiologic course and treatment]. / Retraso de consolidación en fractura de hueso grande: evolución radiológica y tratamiento.

Isolated long bone fractures are unusual and may be missed in the initial X-rays, especially when they are minimally displaced. The delayed treatment of these fractures may cause various complications, such as delayed bone healing or seudoarthrosis, which are difficult to manage. Our clinical case shows delayed healing in a long bone fracture and how the radiologic course may assist in the therapeutic management of this complication.