[Intraosseous vancomycin in total knee arthroplasty]. / Vancomicina intraósea en artroplastía total de rodilla.

INTRODUCTION: intravenous antibiotic prophylaxis has significantly reduced the incidence of periprosthetic joint infection (PJI) in knee surgeries. However, for patients colonized with methicillin-resistant Staphylococcus aureus (MRSA) or those at risk of colonization, prophylaxis should include vancomycin. Intraosseous (IO) administration of vancomycin could enhance its effectiveness in total knee arthroplasty (TKA). MATERIAL AND METHODS: a retrospective review was conducted, including 143 patients at risk of PJI scheduled for TKA who received IO vancomycin along with intravenous (IV) cefazolin, referred to as group I (GI), between May 2021 and December 2022. The occurrence of complications in the first three postoperative months was evaluated. Results were compared with 140 patients without risk factors who received standard IV prophylaxis, designated as group II (GII). RESULTS: in GI, 500 mg of IO vancomycin was administered, injected into the proximal tibia, in addition to standard IV prophylaxis. In GII, patients received only IV cefazolin. The incidence of complications was 1.64% in GI and 1.4% in GII. The PJI rate at 90 postoperative days was 0.69% in GI and 0.71% in GII. CONCLUSIONS: IO vancomycin administration, along with standard IV prophylaxis, provides a safe and effective alternative for patients at risk of MRSA colonization. This approach minimizes complications associated with IV vancomycin use and addresses logistical challenges of timely administration.

INTRODUCCIÓN: la profilaxis antibiótica intravenosa ha reducido significativamente la incidencia de infección articular periprotésica (IAP) en cirugías de rodilla. No obstante, para pacientes colonizados con Staphylococcus aureus resistente a meticilina (SARM) o aquellos con riesgo de colonización, la profilaxis debe incluir vancomicina. La administración intraósea de vancomicina podría potenciar su efectividad en la artroplastía total de rodilla. MATERIAL Y MÉTODOS: se realizó una revisión retrospectiva que incluyó a 143 pacientes en riesgo de IAP programados para artroplastía total de rodilla que recibieron vancomicina intraósea junto a cefazolina intravenosa (IV), a quienes denominamos grupo I (GI), entre mayo de 2021 y diciembre de 2022. Se evaluó la aparición de complicaciones en los primeros tres meses postoperatorios. Los resultados se compararon con 140 pacientes sin factores de riesgo que recibieron profilaxis intravenosa estándar, denominados grupo II (GII). RESULTADOS: en el GI, se administraron 500 mg de vancomicina intraósea, inyectados en la tibia proximal, además de la profilaxis intravenosa estándar. En el GII, los pacientes recibieron sólo cefazolina intravenosa. La incidencia de complicaciones fue de 1.64% en el GI y de 1.4% en el GII. La tasa de IAP a los 90 días postoperatorios fue de 0.69% en el GI y de 0.71% en el GII. CONCLUSIONES: la administración de vancomicina intraósea, junto con la profilaxis intravenosa estándar, ofrece una alternativa segura y eficaz para pacientes con riesgo de colonización por SARM. Este enfoque minimiza las complicaciones asociadas con el uso intravenoso de vancomicina y soluciona los desafíos logísticos de la administración oportuna.

[Partial exchange of components in chronic hip infection]. / Intercambio parcial de componentes en infección crónica de cadera.

INTRODUCTION: one- or two-stage total revision is considered the gold standard for the treatment of hip arthroplasty with chronic infection. However, during the removal of a fixed prosthetic component, the host bone may be damaged, making definitive prosthetic reimplantation difficult. OBJECTIVE: we present a series of patients treated for chronic periprosthetic hip infection with preservation of one fixed component. MATERIAL AND METHODS: this study included 12 patients with hip arthroplasty and chronic periprosthetic infection scheduled for one or two-stage partial replacement with retention of a fixed component between June 2015 and January 2021. The minimum follow-up period was 2 years (mean, 4.08 years). None of the 12 patients in this series was lost to follow-up. We evaluated the evolution through clinical examination, Harris Hip Score, laboratory and radiological studies. RESULTS: at a mean follow-up of 4.08 years after prosthetic reimplantation, two of the 12 patients had recurrence of infection (16.6%), and the mean Harris hip score reached 63.6 points at the last follow-up assessment. CONCLUSIONS: fixed implant preservation may be an acceptable option for patients with chronic periprosthetic hip infection when removal of the fixed component results in significant bone loss compromising future reimplantation. However, more studies are required on this treatment method.

INTRODUCCIÓN: la revisión total en una o dos etapas se considera el estándar de oro para el tratamiento de la artroplastía de cadera con infección crónica. Sin embargo, durante la extracción de un componente protésico fijo, el hueso del huésped puede dañarse, lo que dificulta la reimplantación definitiva de la prótesis. OBJETIVO: presentamos una serie de pacientes tratados por infección crónica periprotésica de cadera con la preservación de un componente fijo. MATERIAL Y MÉTODOS: este estudio retrospectivo incluyó a 12 pacientes con artroplastía de cadera e infección periprotésica crónica programadas para revisión parcial en una o dos etapas con retención de un componente fijo entre Junio de 2015 y Enero de 2021. El período mínimo de seguimiento fue de dos años (media, 4.08 años). Ninguno de los 12 pacientes de esta serie se perdió en el seguimiento. Evaluamos la evolución a través del examen clínico, puntuación de cadera de Harris, estudios de laboratorio y radiológicos. RESULTADOS: con un seguimiento promedio de 4.08 años después de la reimplantación protésica, dos de los 12 pacientes presentaron recurrencia de la infección (16.6%) y la puntuación media de Harris en la cadera alcanzó 63.6 puntos en la última evaluación de seguimiento. CONCLUSIONES: la preservación del implante fijo puede ser una opción aceptable para pacientes estrictamente seleccionados con infección periprotésica crónica de cadera cuando la extracción del componente fijo produce una pérdida ósea significativa que compromete la reconstrucción futura. Se necesitan más estudios sobre este método de tratamiento.

Total hip arthroplasty in patients under 50 years old: Does cementless fixation have better results? / Reemplazo total de cadera en pacientes menores de 50 años: ¿tiene la fijación no cementada mejores resultados?

BACKGROUND: Cementless fixation for hip arthroplasties has increased in the last decades, particularly in younger patients. The purpose of this study was to compare the long-term results three different types of fixations in patients under 50years old. METHODS: Cemented, hybrid and cementless fixations were assessed in patients under 50years old with a minimum follow-up of 8years. Loosening, demarcation, complications, and prosthesis survival were assessed. Functional analysis was performed with the modified Harris Hip Score and Visual analogue scale was collected. RESULTS: Final series consisted in 222 patients. Significant improvement was observed regarding mHHS and VAS score in each group. We observed statistically significant difference regarding demarcation between the groups (P<.001). The higher rate of acetabular and femoral stem loosening was observed in the cemented (20.0%) and hybrid (18.9%) group. The lowest prosthesis survival rate after 16 years was observed in hybrid group (P<.001). CONCLUSION: Total hip replacement has good long-term clinical and functional outcomes. The lowest rate of prosthesis survival was observed in hybrid group with 84.2% after 16years.

Early appearance of radiolucent lines around total knee arthroplasty in rheumatoid arthritis patients. How does it impact the aseptic failure rate and functional outcomes at 13 years of follow-up? / [Artículo traducido] Aparición temprana de líneas radiolúcidas alrededor de la artroplastia total de rodilla en pacientes con artritis reumatoide. ¿Cuál es su impacto en la tasa de fracaso aséptico y los resultados funcionales a los 13 años de seguimiento?

INTRODUCTION: Aseptic total knee arthroplasty (TKA) failure has been associated with radiolucent lines. This study aimed to determine the impact of the early appearance of radiolucent lines (linear images of 1, 2, or > 2mm at the cement-bone interface) around the TKA on prosthetic survival and functional outcomes in rheumatoid arthritis (RA) patients during a 2-20 years follow-up. METHODS: We retrospectively analyzed a consecutive series of RA patients treated with TKA between 2000 and 2011. We comparatively analyzed patients with and without radiolucent lines around implants. Clinical outcomes were assessed with the knee society score (KSS) collected before surgery, at years 2, 5, and 10, and at the last postoperative follow-up. The knee society roentgenographic evaluation system was used to analyze the impact of radiolucent lines around the implants at 1, 2, 5, and more than ten years of follow-up. The reoperation and prosthetic survival rates were calculated at the end of the follow-up. RESULTS: The study series included 72 TKAs with a median follow-up of 13.2 years (range: 4.0-21.0), of which 16 (22.2%) had radiolucent lines. We did not observe aseptic failure, and prosthetic survival at the end of the study was 94.4% (n=68). The KSS improved significantly (p<0.001) between preoperative values at 2, 5, and 10 years and the end of follow-up, with no differences between patients with and without radiolucent lines. CONCLUSIONS: Our study demonstrates that the early appearance of radiolucent lines around a TKA in RA patients does not significantly impact prosthetic survival or long-term functional outcomes at 13 years of follow-up.

Early appearance of radiolucent lines around total knee arthroplasty in rheumatoid arthritis patients. How does it impact the aseptic failure rate and functional outcomes at 13 years of follow-up?

INTRODUCTION: Aseptic total knee arthroplasty (TKA) failure has been associated with radiolucent lines. This study aimed to determine the impact of the early appearance of radiolucent lines (linear images of 1, 2, or >2mm at the cement-bone interface) around the TKA on prosthetic survival and functional outcomes in rheumatoid arthritis (RA) patients during a 2-20 years follow-up. METHODS: We retrospectively analyzed a consecutive series of RA patients treated with TKA between 2000 and 2011. We comparatively analyzed patients with and without radiolucent lines around implants. Clinical outcomes were assessed with the knee society score (KSS) collected before surgery, at years 2, 5, and 10, and at the last postoperative follow-up. The knee society roentgenographic evaluation system was used to analyze the impact of radiolucent lines around the implants at 1, 2, 5, and more than ten years of follow-up. The reoperation and prosthetic survival rates were calculated at the end of the follow-up. RESULTS: The study series included 72 TKAs with a median follow-up of 13.2 years (range: 4.0-21.0), of which 16 (22.2%) had radiolucent lines. We did not observe aseptic failure, and prosthetic survival at the end of the study was 94.4% (n=68). The KSS improved significantly (p<0.001) between preoperative values at 2, 5, and 10 years and the end of follow-up, with no differences between patients with and without radiolucent lines. CONCLUSIONS: Our study demonstrates that the early appearance of radiolucent lines around a TKA in RA patients does not significantly impact prosthetic survival or long-term functional outcomes at 13 years of follow-up.

Arthroplasty as a treatment for acute and quiescent septic arthritis in native hips.

INTRODUCTION: The most feared complication in hip arthroplasty after septic arthritis is septic failure. It is considered that the two-stage treatment is the accepted treatment for acute septic hip arthritis. The objective in this work is to establish a therapeutic guideline for septic arthritis in native hips, proposing a two-stage treatment for acute, and a one-stage treatment for quiescent. MATERIAL AND METHODS: Observational, descriptive, retrospective study. We analyzed all patients who underwent total primary hip replacement between June 1997 and June 2016. We selected those patients who had a diagnosis of septic arthritis of the hip prior to surgery (group 1: acute septic arthritis; group 2: quiescent septic arthritis). RESULTS: Eight hips in group 1 with a follow-up of one to six years. Each patient fulfilled the antibiotic treatment between the placement of the spacer and the definitive prosthetic replacement, and, in all the cases, the remission of the infection was verified. On the other hand, 12 hips in group 2, the time between the treated infection and the prosthetic replacement varied between five and 46 years. The femoral heads sent to culture were in all cases negative. CONCLUSIONS: In the last 20 years, we have obtained satisfactory results, both in the treatment of acute septic arthritis and in its sequelae, interpreting them as pathologies of the same origin but with a different treatment. Both treatments are adequate, as long as the therapeutic protocol established for each of the groups is respected.

INTRODUCCIÓN: La complicación más temida en la artroplastia de cadera después de la artritis séptica (activa o sus secuelas) es el fracaso séptico. El tratamiento en dos etapas, una vez resuelto el proceso infeccioso, es el tratamiento aceptado para la etapa aguda. El objetivo de este trabajo es establecer una pauta terapéutica para la artritis séptica en las caderas nativas, proponiendo un tratamiento en dos etapas para agudos, y un tratamiento de una etapa para las secuelas. MATERIAL Y MÉTODOS: Realizamos un estudio observacional, descriptivo y retrospectivo. Analizamos a todos los pacientes que se sometieron a un reemplazo primario total de cadera en nuestra institución entre Junio de 1997 y Junio de 2016 con un diagnóstico de artritis séptica de la cadera antes de la cirugía (grupo 1: artritis séptica aguda; grupo 2: secuelas de artritis séptica). RESULTADOS: Grupo 1: ocho caderas, con un diagnóstico agudo de artritis séptica y seguimiento de uno a seis años. Se cumplió con el tratamiento antibiótico entre la colocación del espaciador y el reemplazo protésico definitivo, y, en todos los casos, se verificó la remisión de la infección. Grupo 2: 12 caderas, El tiempo entre la infección tratada y el reemplazo de prótesis varió entre cinco y 46 años. Las cabezas femorales enviadas para cultivo eran en todos los casos negativas. CONCLUSIONES: En los últimos 20 años, hemos obtenido resultados satisfactorios, tanto en el tratamiento de la artritis séptica aguda como en sus secuelas, interpretándolas como patologías del mismo origen pero con un tratamiento diferente. Ambos tratamientos son adecuados, siempre y cuando se respete el protocolo terapéutico establecido para cada uno de los grupos.