Artroplastia total de cadera primaria en pacientes con secuelas de poliomielitis / Primary total hip arthroplasty in patients with sequelae of poliomyelitis

Introducción: La prótesis total de cadera (PTC) en pacientes con secuelas de poliomielitis (SP) supone un reto quirúrgico. La morfología displásica, la osteoporosis y la debilidad glútea dificultan la orientación, incrementan el riesgo de fractura y reducen la estabilidad del implante. El objetivo de este estudio es describir una serie de pacientes con SP tratados mediante PTC. Material y métodos: Estudio descriptivo retrospectivo de pacientes con SP intervenidos mediante PTC entre 1999 y 2021 en un hospital de tercer nivel, con seguimiento clínico y radiológico y evaluación funcional y de las complicaciones hasta el presente o hasta el fallecimiento, con un mínimo de 12meses. Resultados: Se intervinieron 16 pacientes, implantándose 13PTC en el miembro parético, 6 por fractura y 7 por coxartrosis, mientras que las otras 3PTC se implantaron en el miembro contralateral. Se implantaron 4 cotilos de doble movilidad como medida antiluxante. Al año postoperatorio, 11 presentaban un balance articular completo sin aumentar los casos de Trendelenburg. El Harris Hip Score (HHS) mejoró 32,1puntos, la escala visual analógica (EVA), 5,25puntos, y la escala de Merlé-d’Augbiné-Poste, 6puntos. La corrección de la discrepancia de longitud fue de 13,77mm. La mediana del seguimiento fue de 3,5años (1-24). Dos casos se revisaron por usura del polietileno y 2 por inestabilidad, sin registrarse infecciones, fracturas periprotésicas o aflojamiento del cotilo o vástago. Conclusiones: La PTC en pacientes con SP permite mejorar la situación clínico-funcional con una tasa de complicaciones aceptable. El riesgo de luxación podría minimizarse con cotilos de doble movilidad.(AU)

Introduction: Total hip arthroplasty (THA) in patients with residual poliomyelitis (RP) is a surgical challenge. Dysplastic morphology, osteoporosis and gluteal weakness hinder orientation, increase fracture risk and reduce implant stability. The aim of this study is to describe a series of patients with RP treated by THA. Material and methods: Retrospective descriptive study of patients with RP treated with THA between 1999 and 2021 in a tertiary hospital, with clinical and radiological follow-up and functional and complication evaluation until present or death, with a minimum of 12months. Results: Sixteen patients underwent surgery, with 13THA implanted in the paretic limb, 6 for fracture and 7 for osteoarthritis, while the remaining 3 were implanted in the contralateral limb. Four dual mobility cups were implanted as an antiluxation measure. At 1year postoperatively, 11 had complete range of motion with no increase in Trendelenburg cases. The Harris hip score (HHS) improved 32.1points, the visual analog scale (VAS) 5.25 points, and the Merlé-d’Augbiné-Poste scale 6 points. The length discrepancy correction was 13.77mm. Median follow-up was 3.5years (1-24). Two cases were revised for polyethylene wear and two for instability, with no infections, periprosthetic fractures, or cup or stem loosening. Conclusions: THA in patients with RP allows improvement of the clinico-functional situation with an acceptable complication rate. The risk of dislocation could be minimized with dual mobility cups.(AU)

[Translated article] Primary total hip arthroplasty in patients with sequelae of poliomyelitis / Artroplastia total de cadera primaria en pacientes con secuelas de poliomielitis

Introducción: La prótesis total de cadera (PTC) en pacientes con secuelas de poliomielitis (SP) supone un reto quirúrgico. La morfología displásica, la osteoporosis y la debilidad glútea dificultan la orientación, incrementan el riesgo de fractura y reducen la estabilidad del implante. El objetivo de este estudio es describir una serie de pacientes con SP tratados mediante PTC. Material y métodos: Estudio descriptivo retrospectivo de pacientes con SP intervenidos mediante PTC entre 1999 y 2021 en un hospital de tercer nivel, con seguimiento clínico y radiológico y evaluación funcional y de las complicaciones hasta el presente o hasta el fallecimiento, con un mínimo de 12meses. Resultados: Se intervinieron 16 pacientes, implantándose 13PTC en el miembro parético, 6 por fractura y 7 por coxartrosis, mientras que las otras 3PTC se implantaron en el miembro contralateral. Se implantaron 4 cotilos de doble movilidad como medida antiluxante. Al año postoperatorio, 11 presentaban un balance articular completo sin aumentar los casos de Trendelenburg. El Harris Hip Score (HHS) mejoró 32,1puntos, la escala visual analógica (EVA), 5,25puntos, y la escala de Merlé-d’Augbiné-Poste, 6puntos. La corrección de la discrepancia de longitud fue de 13,77mm. La mediana del seguimiento fue de 3,5años (1-24). Dos casos se revisaron por usura del polietileno y 2 por inestabilidad, sin registrarse infecciones, fracturas periprotésicas o aflojamiento del cotilo o vástago. Conclusiones: La PTC en pacientes con SP permite mejorar la situación clínico-funcional con una tasa de complicaciones aceptable. El riesgo de luxación podría minimizarse con cotilos de doble movilidad.(AU)

Introduction: Total hip arthroplasty (THA) in patients with residual poliomyelitis (RP) is a surgical challenge. Dysplastic morphology, osteoporosis and gluteal weakness hinder orientation, increase fracture risk and reduce implant stability. The aim of this study is to describe a series of patients with RP treated by THA. Material and methods: Retrospective descriptive study of patients with RP treated with THA between 1999 and 2021 in a tertiary hospital, with clinical and radiological follow-up and functional and complication evaluation until present or death, with a minimum of 12months. Results: Sixteen patients underwent surgery, with 13THA implanted in the paretic limb, 6 for fracture and 7 for osteoarthritis, while the remaining 3 were implanted in the contralateral limb. Four dual mobility cups were implanted as an antiluxation measure. At 1year postoperatively, 11 had complete range of motion with no increase in Trendelenburg cases. The Harris hip score (HHS) improved 32.1points, the visual analog scale (VAS) 5.25 points, and the Merlé-d’Augbiné-Poste scale 6 points. The length discrepancy correction was 13.77mm. Median follow-up was 3.5years (1-24). Two cases were revised for polyethylene wear and two for instability, with no infections, periprosthetic fractures, or cup or stem loosening. Conclusions: THA in patients with RP allows improvement of the clinico-functional situation with an acceptable complication rate. The risk of dislocation could be minimized with dual mobility cups.(AU)

[Translated article] Primary total hip arthroplasty in patients with sequelae of poliomyelitis.

INTRODUCTION: Total hip arthroplasty (THA) in patients with residual poliomyelitis (RP) is a surgical challenge. Dysplastic morphology, osteoporosis and gluteal weakness hinder orientation, increase fracture risk and reduce implant stability. The aim of this study is to describe a series of patients with RP treated by THA. MATERIAL AND METHODS: Retrospective descriptive study of patients with RP treated with THA between 1999 and 2021 in a tertiary hospital, with clinical and radiological follow-up and functional and complication evaluation until present or death, with a minimum of 12 months. RESULTS: Sixteen patients underwent surgery, with 13 THA implanted in the paretic limb, 6 for fracture and 7 for osteoarthritis, while the remaining 3 were implanted in the contralateral limb. Four dual mobility cups were implanted as an antiluxation measure. At 1 year postoperatively, 11 had complete range of motion with no increase in Trendelenburg cases. The Harris hip score (HHS) improved 32.1 points, the visual analogue scale (VAS) 5.25 points, and the Merlé-d'Augbiné-Poste scale 6 points. The length discrepancy correction was 13.77mm. Median follow-up was 3.5 years (1-24). Two cases were revised for polyethylene wear and two for instability, with no infections, periprosthetic fractures, or cup or stem loosening. CONCLUSIONS: THA in patients with RP allows improvement of the clinico-functional situation with an acceptable complication rate. The risk of dislocation could be minimised with dual mobility cups.

Primary total hip arthroplasty in patients with sequelae of poliomyelitis. / Artroplastia total de cadera primaria en pacientes con secuelas de poliomielitis.

INTRODUCTION: Total hip arthroplasty (THA) in patients with residual poliomyelitis (RP) is a surgical challenge. Dysplastic morphology, osteoporosis and gluteal weakness hinder orientation, increase fracture risk and reduce implant stability. The aim of this study is to describe a series of patients with RP treated by THA. MATERIAL AND METHODS: Retrospective descriptive study of patients with RP treated with THA between 1999 and 2021 in a tertiary hospital, with clinical and radiological follow-up and functional and complication evaluation until present or death, with a minimum of 12months. RESULTS: Sixteen patients underwent surgery, with 13THA implanted in the paretic limb, 6 for fracture and 7 for osteoarthritis, while the remaining 3 were implanted in the contralateral limb. Four dual mobility cups were implanted as an antiluxation measure. At 1year postoperatively, 11 had complete range of motion with no increase in Trendelenburg cases. The Harris hip score (HHS) improved 32.1points, the visual analog scale (VAS) 5.25 points, and the Merlé-d'Augbiné-Poste scale 6 points. The length discrepancy correction was 13.77mm. Median follow-up was 3.5years (1-24). Two cases were revised for polyethylene wear and two for instability, with no infections, periprosthetic fractures, or cup or stem loosening. CONCLUSIONS: THA in patients with RP allows improvement of the clinico-functional situation with an acceptable complication rate. The risk of dislocation could be minimized with dual mobility cups.

¿Se puede predecir el pronóstico de la cadera contralateral tras una artroplastia total de cadera? / Prognosis of the contralateral hip after primary total hip replacement: Can it be predicted?

Introducción: La coxartrosis es una de las patologías más frecuentes e incapacitantes. El 20% de los mayores de 60 años desarrollará coxartrosis sintomática y el 10% requerirá una prótesis total de cadera. La artroplastia total de cadera es uno de los procedimientos quirúrgicos que más aumenta la calidad de vida de estos pacientes. Cuando recomendamos la artroplastia en la práctica clínica, los pacientes a menudo preguntan sobre el pronóstico de su otra cadera: ¿Se deteriorará de la misma forma? ¿Será necesario operarla? ¿Cuándo? El objetivo es determinar si existe alguna variable o signo radiológico que prediga el pronóstico a medio plazo de la cadera contralateral tras una artroplastia total de cadera. Material y métodos: Se realizó un estudio retrospectivo de pacientes intervenidos de artroplastia total de cadera en nuestro hospital durante los años 2011 y 2012, con un total de 543 pacientes. Se determinó el grado de coxartrosis, según las clasificaciones JOA y Tönnis, en la radiografía de ambas caderas en el momento de la primera artroplastia y a intervalos regulares durante el seguimiento, analizando cada uno de los ítems incluidos en estas clasificaciones. Se estableció la relación de estos hallazgos radiográficos con la progresión de la artrosis y la necesidad de artroplastia contralateral. Resultados y conclusiones: Podría esperarse una progresión de la artrosis de la cadera contralateral en los próximos 3 años en el 10% de los pacientes. Esta progresión será mayor y más rápida en aquellos con grado JOA III-IV/Tönnis II-III y, especialmente, en aquellos con mayor estrechamiento articular y mayor alteración de la cabeza femoral, pudiendo alcanzar entre el 25 y el 30% de los pacientes. El grado de JOA/Tönnis inicial es un factor predictor de necesitar una prótesis de cadera contralateral.

Introduction: Coxarthrosis is one of the most frequent and disabling pathologies. 20% of individuals over 60 years of age will develop symptomatic coxarthrosis and 10% of them will need a hip replacement; it is probably one of the orthopaedic procedures that most increases quality of life. When we recommend arthroplasty in clinical practice, patients often ask about the prognosis of their other hip. Will it deteriorate in the same way? Will it be necessary to replace it? When? The aim of the study is to determine if there is any variable or radiological sign that predicts the medium-term prognosis of the contralateral hip after total hip arthroplasty. Material and methods: A retrospective review of patients who underwent total hip arthroplasty in our hospital during 2011 and 2012 was carried out, with a total of 543 patients. The coxarthrosis degree at X-ray was determined at the time of the first arthroplasty and at regular intervals during follow-up, according to the JOA and Tönnis classifications, analyzing each of the items included in these classifications. Its relation with the progression of osteoarthritis and the need of contralateral hip replacement was established. Results and conclusions: A progression of osteoarthritis of the contralateral hip could be expected in the next 3 years in 10% of patients. This progression will be greater and faster in those with JOA grade III–IV/Tönnis grade II–III, especially, in those with greater joint narrowing and femoral head shape score, and can reach between 25 and 30% of patients. The initial JOA/Tönnis degree is a predictive factor for requiring a hip replacement on the contralateral side.(AU)

[Translated article] Prognosis of the contralateral hip after primary total hip replacement: Can it be predicted? / ¿Se puede predecir el pronóstico de la cadera contralateral tras una artroplastia total de cadera?

Introduction: Coxarthrosis is one of the most frequent and disabling pathologies. 20% of individuals over 60 years of age will develop symptomatic coxarthrosis and 10% of them will need a hip replacement; it is probably one of the orthopaedic procedures that most increases quality of life. When we recommend arthroplasty in clinical practice, patients often ask about the prognosis of their other hip. Will it deteriorate in the same way? Will it be necessary to replace it? When? The aim of the study is to determine if there is any variable or radiological sign that predicts the medium-term prognosis of the contralateral hip after total hip arthroplasty. Material and methods: A retrospective review of patients who underwent total hip arthroplasty in our hospital during 2011 and 2012 was carried out, with a total of 543 patients. The coxarthrosis degree at X-ray was determined at the time of the first arthroplasty and at regular intervals during follow-up, according to the JOA and Tönnis classifications, analyzing each of the items included in these classifications. Its relation with the progression of osteoarthritis and the need of contralateral hip replacement was established. Results and conclusions: A progression of osteoarthritis of the contralateral hip could be expected in the next 3 years in 10% of patients. This progression will be greater and faster in those with JOA grade III–IV/Tönnis grade II–III, especially, in those with greater joint narrowing and femoral head shape score, and can reach between 25 and 30% of patients. The initial JOA/Tönnis degree is a predictive factor for requiring a hip replacement on the contralateral side.(AU)

Introducción: La coxartrosis es una de las patologías más frecuentes e incapacitantes. El 20% de los mayores de 60 años desarrollará coxartrosis sintomática y el 10% requerirá una prótesis total de cadera. La artroplastia total de cadera es uno de los procedimientos quirúrgicos que más aumenta la calidad de vida de estos pacientes. Cuando recomendamos la artroplastia en la práctica clínica, los pacientes a menudo preguntan sobre el pronóstico de su otra cadera: ¿Se deteriorará de la misma forma? ¿Será necesario operarla? ¿Cuándo? El objetivo es determinar si existe alguna variable o signo radiológico que prediga el pronóstico a medio plazo de la cadera contralateral tras una artroplastia total de cadera. Material y métodos: Se realizó un estudio retrospectivo de pacientes intervenidos de artroplastia total de cadera en nuestro hospital durante los años 2011 y 2012, con un total de 543 pacientes. Se determinó el grado de coxartrosis, según las clasificaciones JOA y Tönnis, en la radiografía de ambas caderas en el momento de la primera artroplastia y a intervalos regulares durante el seguimiento, analizando cada uno de los ítems incluidos en estas clasificaciones. Se estableció la relación de estos hallazgos radiográficos con la progresión de la artrosis y la necesidad de artroplastia contralateral. Resultados y conclusiones: Podría esperarse una progresión de la artrosis de la cadera contralateral en los próximos 3 años en el 10% de los pacientes. Esta progresión será mayor y más rápida en aquellos con grado JOA III-IV/Tönnis II-III y, especialmente, en aquellos con mayor estrechamiento articular y mayor alteración de la cabeza femoral, pudiendo alcanzar entre el 25 y el 30% de los pacientes. El grado de JOA/Tönnis inicial es un factor predictor de necesitar una prótesis de cadera contralateral.

Prognosis of the contralateral hip after primary total hip replacement: Can it be predicted? / ¿Se puede predecir el pronóstico de la cadera contralateral tras una artroplastia total de cadera?

INTRODUCTION: Coxarthrosis is one of the most frequent and disabling pathologies. 20% of individuals over 60 years of age will develop symptomatic coxarthrosis and 10% of them will need a hip replacement; it is probably one of the orthopaedic procedures that most increases quality of life. When we recommend arthroplasty in clinical practice, patients often ask about the prognosis of their other hip. Will it deteriorate in the same way? Will it be necessary to replace it? When? The aim of the study is to determine if there is any variable or radiological sign that predicts the medium-term prognosis of the contralateral hip after total hip arthroplasty. MATERIAL AND METHODS: A retrospective review of patients who underwent total hip arthroplasty in our hospital during 2011 and 2012 was carried out, with a total of 543 patients. The coxarthrosis degree at X-ray was determined at the time of the first arthroplasty and at regular intervals during follow-up, according to the JOA and Tönnis classifications, analyzing each of the items included in these classifications. Its relation with the progression of osteoarthritis and the need of contralateral hip replacement was established. RESULTS AND CONCLUSIONS: A progression of osteoarthritis of the contralateral hip could be expected in the next 3 years in 10% of patients. This progression will be greater and faster in those with JOA grade III-IV/Tönnis grade II-III, especially, in those with greater joint narrowing and femoral head shape score, and can reach between 25 and 30% of patients. The initial JOA/Tönnis degree is a predictive factor for requiring a hip replacement on the contralateral side.

[Translated article] Prognosis of the contralateral hip after primary total hip replacement: Can it be predicted?

INTRODUCTION: Coxarthrosis is one of the most frequent and disabling pathologies. 20% of individuals over 60 years of age will develop symptomatic coxarthrosis and 10% of them will need a hip replacement; it is probably one of the orthopaedic procedures that most increases quality of life. When we recommend arthroplasty in clinical practice, patients often ask about the prognosis of their other hip. Will it deteriorate in the same way? Will it be necessary to replace it? When? The aim of the study is to determine if there is any variable or radiological sign that predicts the medium-term prognosis of the contralateral hip after total hip arthroplasty. MATERIAL AND METHODS: A retrospective review of patients who underwent total hip arthroplasty in our hospital during 2011 and 2012 was carried out, with a total of 543 patients. The coxarthrosis degree at X-ray was determined at the time of the first arthroplasty and at regular intervals during follow-up, according to the JOA and Tönnis classifications, analyzing each of the items included in these classifications. Its relation with the progression of osteoarthritis and the need of contralateral hip replacement was established. RESULTS AND CONCLUSIONS: A progression of osteoarthritis of the contralateral hip could be expected in the next 3 years in 10% of patients. This progression will be greater and faster in those with JOA grade III-IV/Tönnis grade II-III, especially, in those with greater joint narrowing and femoral head shape score, and can reach between 25 and 30% of patients. The initial JOA/Tönnis degree is a predictive factor for requiring a hip replacement on the contralateral side.

Parámetros radiográficos y funcionales de pacientes con coxartrosis secundaria a displasia de desarrollo de cadera sometidos a artroplastia total de cadera, en el servicio de traumatología y ortopedia del Hospital Obrero Nº1 durante las gestiones 2018 ­ 2020 / Radiographic and functional parameters of patients with coxarthrosis secondary to developmental dysplasia of the hip undergoing total hip arthroplasty, in the traumatology and orthopedics service of Hospital Obrero Nº1 during the management 2018-2020

La displasia del desarrollo de cadera del adulto (D.D.C.) es una patología que sin un manejo adecuado temprano llega a una artrosis en tiempo corto, culminando en prótesis de cadera (P.T.C.) Revisar los parámetros radiográficos y funcionales pre y postquirúrgicos que presentan los pacientes con D.D.C. que fueron sometidos (P.T.C.) Se trata de un estudio descriptivo, retrospectivo y cohorte transversal de pacientes con antecedente de coxartrosis secundaria a (D.D.C.) sometido a tratamiento quirúrgico (P.T.C.), se encontraron 45 pacientes de los cuales 29 casos cumplieron con los criterios del estudio, se realizó medición de los parámetros radiográficos pre y postquirugicos, además de utilizar el Score Harris Hip modificado y la escala analógica visual de dolor EVA. Según el género encontramos 27 mujeres y 2 varones, media de edad de 51 años, no existió diferencia significativa en lado afectado, los grados que encontramos según clasificación Crowe fueron grado 1 y 2, y según Hartofilakidis en grados Tipo A, Tipo B1 y B2, de acuerdo a la mediciones radiográficas en preoperatorio la mayoría se encontraban alteradas y se aprecia la corrección en las mediciones radiográficas postoperatorias y se encontró datos favorables en Score Harris Hip modificado, como en el EVA. Los parámetros radiográficos y funciones son datos importantes en el pre y post-quirúrgico para una adecuada planificación quirúrgica y hacer un seguimiento adecuado nuestros resultados, llegando a corregir las deficiencias encontradas.

Developmental dysplasia of the hip in adults (D.D.C.) is a pathology that, without proper early management, leads to osteoarthritis in a short time, culminating in hip prostheses (P.T.C.) To review the pre- and post-surgical radiographic and functional parameters presented by patients with D.D.C. that were subjected (P.T.C.) This is a descriptive, retrospective and cross-sectional cohort study of all patients with a history of coxarthrosis secondary to (DDC) undergoing surgical treatment (PTC). Pre- and post-surgical radiographic parameters were measured, in addition to using the Harris Hip Score. modified visual analog scale of pain VAS.45 patients were found, of which 29 cases met the study criteria, 27 women and 2 men, mean age 51 years, there was no significant difference on the affected side, the grades found according to Crowe classification were grade 1 and 2, and according to Hartofilakidis in Type A, Type B1 and B2 grades, according to the preoperative radiographic measurements, most were altered and the correction in the postoperative radiographic measurements is appreciated, favorable data are found in the modified Harris Hip Score, as in VAS .Radiographic parameters and functions are important pre- and post-surgical data for proper surgical planning and adequate follow-up of our results, correcting the deficiencies found.

Comparación de la corrección de la discrepancia de longitud de miembros tras el empleo de un vástago con cuello modular y su homólogo monobloque en la artroplastia total de cadera primaria / Comparison of leg length discrepancy correction after the use of a modular neck stem and its monoblock homologue in total primary hip arthroplasty

Introducción y objetivos: Los vástagos con doble modularidad buscan restaurar de forma más precisa la anatomía al permitir ajustes intraoperatorios gracias a los cuellos modulares. Nuestro objetivo es comparar la corrección radiográfica de la longitud con el vástago H MAX-M® frente a su homólogo monobloque H MAX-S®. Material y métodos: Se realizó un estudio de cohortes prospectivo mediante muestreo consecutivo sobre pacientes intervenidos de artroplastia total de cadera primaria con el diagnóstico de coxartrosis entre el año 2011 y 2015. Un brazo de la cohorte incluyó a los pacientes intervenidos con vástago modular y el otro con vástago monobloque. Se midió la longitud en la radiografía anteroposterior de pelvis en carga a los seis meses. Las medias de las mediciones obtenidas para cada brazo de la cohorte se compararon entre sí. Resultados: No se han observado diferencias estadísticamente significativas en la corrección de la disimetría entre ambos grupos determinada como la diferencia de longitud entre la cadera operada y la cadera contralateral (p=0,106). Tampoco se observaron diferencias en los valores postoperatorios de longitud (p=0,053). Cabe decir que tanto para el vástago modular como para el vástago monobloque el grupo mayoritario es aquel con longitud restaurada (84,1 y 80,4%, respectivamente; p=0,001). Conclusión: A pesar de la ventaja teórica de la modularidad y que disponer de piezas intercambiables podría ser de gran interés, en nuestro estudio no hemos podido demostrar que exista una superioridad de los diseños modulares frente al monoblock para control de la disimetría postoperatoria.(AU)

Introduction and objective: Dual modularity stems seek to more precisely restore anatomy by allowing intraoperative adjustments thanks to modular necks. Our aim is to compare the radiographic length correction with the H MAX-M® Stem versus its monoblock counterpart H MAX-S®. Material and methods: A prospective cohort study was carried out through consecutive sampling on patients who underwent primary total hip arthroplasty with coxarthrosis diagnosis between 2011 and 2015. One arm of the cohort included patients who were operated with a modular stem and the other with a monobloc stem. Length was measured on the anteroposterior pelvic-bearing radiograph at six months. The mean of the measurements obtained for each arm of the cohort were compared with each other. Results: No statistically significant differences were observed in the correction of asymmetry between both groups, determined as the difference in length between the operated hip and the contralateral hip (P=.106). Nor were differences observed in postoperative length values (P=.053). It should be noted that for both the modular stem and the monobloc stem, the majority group is the one with restored length (84.1% and 80.4%, respectively; P=.001). Conclusion: Despite the theoretical advantage of modularity and that having interchangeable parts could be of great interest, in our study, we have not been able to demonstrate a superiority of modular designs compared to monoblock for control of postoperative leg length discrepancy.(AU)

[Translated article] Comparison of leg length discrepancy correction after the use of a modular neck stem and its monoblock homologue in total primary hip arthroplasty / Comparación de la corrección de la discrepancia de longitud de miembros tras el empleo de un vástago con cuello modular y su homólogo monobloque en la artroplastia total de cadera primaria

Introducción y objetivos: Los vástagos con doble modularidad buscan restaurar de forma más precisa la anatomía al permitir ajustes intraoperatorios gracias a los cuellos modulares. Nuestro objetivo es comparar la corrección radiográfica de la longitud con el vástago H MAX-M® frente a su homólogo monobloque H MAX-S®. Material y métodos: Se realizó un estudio de cohortes prospectivo mediante muestreo consecutivo sobre pacientes intervenidos de artroplastia total de cadera primaria con el diagnóstico de coxartrosis entre el año 2011 y 2015. Un brazo de la cohorte incluyó a los pacientes intervenidos con vástago modular y el otro con vástago monobloque. Se midió la longitud en la radiografía anteroposterior de pelvis en carga a los seis meses. Las medias de las mediciones obtenidas para cada brazo de la cohorte se compararon entre sí. Resultados: No se han observado diferencias estadísticamente significativas en la corrección de la disimetría entre ambos grupos determinada como la diferencia de longitud entre la cadera operada y la cadera contralateral (p=0,106). Tampoco se observaron diferencias en los valores postoperatorios de longitud (p=0,053). Cabe decir que tanto para el vástago modular como para el vástago monobloque el grupo mayoritario es aquel con longitud restaurada (84,1 y 80,4%, respectivamente; p=0,001). Conclusión: A pesar de la ventaja teórica de la modularidad y que disponer de piezas intercambiables podría ser de gran interés, en nuestro estudio no hemos podido demostrar que exista una superioridad de los diseños modulares frente al monoblock para control de la disimetría postoperatoria.(AU)

Introduction and objective: Dual modularity stems seek to more precisely restore anatomy by allowing intraoperative adjustments thanks to modular necks. Our aim is to compare the radiographic length correction with the H MAX-M® Stem versus its monoblock counterpart H MAX-S®. Material and methods: A prospective cohort study was carried out through consecutive sampling on patients who underwent primary total hip arthroplasty with coxarthrosis diagnosis between 2011 and 2015. One arm of the cohort included patients who were operated with a modular stem and the other with a monobloc stem. Length was measured on the anteroposterior pelvic-bearing radiograph at six months. The mean of the measurements obtained for each arm of the cohort were compared with each other. Results: No statistically significant differences were observed in the correction of asymmetry between both groups, determined as the difference in length between the operated hip and the contralateral hip (P=.106). Nor were differences observed in postoperative length values (P=.053). It should be noted that for both the modular stem and the monobloc stem, the majority group is the one with restored length (84.1% and 80.4%, respectively; P=.001). Conclusion: Despite the theoretical advantage of modularity and that having interchangeable parts could be of great interest, in our study, we have not been able to demonstrate a superiority of modular designs compared to monoblock for control of postoperative leg length discrepancy.(AU)

[Translated article] Comparison of leg length discrepancy correction after the use of a modular neck stem and its monoblock homologue in total primary hip arthroplasty.

INTRODUCTION AND OBJECTIVE: Dual modularity stems seek to more precisely restore anatomy by allowing intraoperative adjustments thanks to modular necks. Our aim is to compare the radiographic length correction with the H MAX-M® Stem versus its monoblock counterpart H MAX-S®. MATERIAL AND METHODS: A prospective cohort study was carried out through consecutive sampling on patients who underwent primary total hip arthroplasty with coxarthrosis diagnosis between 2011 and 2015. One arm of the cohort included patients who were operated with a modular stem and the other with a monobloc stem. Length was measured on the anteroposterior pelvic-bearing radiograph at 6 months. The mean of the measurements obtained for each arm of the cohort were compared with each other. RESULTS: No statistically significant differences were observed in the correction of asymmetry between both groups, determined as the difference in length between the operated hip and the contralateral hip (p=.106). Nor were differences observed in postoperative length values (p=.053). It should be noted that for both the modular stem and the monobloc stem, the majority group is the one with restored length (84.1% and 80.4%, respectively; p=.001). CONCLUSION: Despite the theoretical advantage of modularity and that having interchangeable parts could be of great interest, in our study, we have not been able to demonstrate a superiority of modular designs compared to monoblock for control of postoperative leg length discrepancy.

Comparison of leg length discrepancy correction after the use of a modular neck stem and its monoblock homologue in total primary hip arthroplasty. / Comparación de la corrección de la discrepancia de longitud de miembros tras el empleo de un vástago con cuello modular y su homólogo monobloque en la artroplastia total de cadera primaria.

INTRODUCTION AND OBJECTIVE: Dual modularity stems seek to more precisely restore anatomy by allowing intraoperative adjustments thanks to modular necks. Our aim is to compare the radiographic length correction with the H MAX-M® Stem versus its monoblock counterpart H MAX-S®. MATERIAL AND METHODS: A prospective cohort study was carried out through consecutive sampling on patients who underwent primary total hip arthroplasty with coxarthrosis diagnosis between 2011 and 2015. One arm of the cohort included patients who were operated with a modular stem and the other with a monobloc stem. Length was measured on the anteroposterior pelvic-bearing radiograph at six months. The mean of the measurements obtained for each arm of the cohort were compared with each other. RESULTS: No statistically significant differences were observed in the correction of asymmetry between both groups, determined as the difference in length between the operated hip and the contralateral hip (P=.106). Nor were differences observed in postoperative length values (P=.053). It should be noted that for both the modular stem and the monobloc stem, the majority group is the one with restored length (84.1% and 80.4%, respectively; P=.001). CONCLUSION: Despite the theoretical advantage of modularity and that having interchangeable parts could be of great interest, in our study, we have not been able to demonstrate a superiority of modular designs compared to monoblock for control of postoperative leg length discrepancy.

Inyección intrarticular única ecoguiada de ácido hialurónico en la coxartrosis sintomática: estudio retrospectivo de la eficacia de dos presentaciones / Single eco-guided intra-articular injection of hyaluronic acid in symptomatic coxarthrosis: retrospective study of the efficacy of two presentations

Introducción: La viscosuplementación ecoguiada con ácido hialurónico en la coxartrosis sintomática se ha extendido como tratamiento seguro con eficacia demostrada, aunque con falta de consenso en su uso como práctica habitual. Pocos estudios han comparado la eficacia de dos productos de inyección única. Objetivo: Evaluar la eficacia en pacientes infiltrados con dos ácidos hialurónicos de inyección única comparando Adant One® (A) a seis meses con Hyalone® (H) anual.Material y método: Estudio observacional retrospectivo sobre cohorte de pacientes con coxartrosis sintomática, tratados mediante viscosuplementación intrarticular ecoguiada de cadera con dos tipos de inyección única de ácido hialurónico. Su eficacia fue evaluada de acuerdo con las escalas WOMAC y EVA a los 6 y 12 meses. Resultados: Fueron tratados 144 pacientes con una dosis única de A y 84 con H. A los 6 meses aquellos tratados con A mostraron mejoras en relación con disminución del dolor en la EVA (p < 0,001) y en el WOMAC dolor (p = 0,003), así como en WOMAC global (p = 0,027). No hubo cambios en WOMAC rigidez y función. A los 12 meses los tratados con H mostraron mejorías en los parámetros EVA (p < 0,001) y WOMAC global (p = 0,010) y en todas sus dimensiones de manera significativa. Conclusiones: Una inyección única de H anual fue más efectiva para mejorar el dolor y la funcionalidad de la cadera con artrosis a 1 año comparado con A semestral. Es posible establecer protocolos anuales de viscosuplementación para la artrosis de cadera con ácido hialurónico usando H.(AU)

Introduction: Ultrasound-guided viscosupplementation with hyaluronic acid in symptomatic hip osteoarthritis is widely used as a safe treatment with proven efficacy, although there is a lack of consensus on its use as routine practice. Few studies have compared the efficacy of two single injection products. Objetive: To evaluate the efficacy in infiltrated patients with two single injection hyaluronic acids comparing Adant One® (A) at six months with annual Hyalone® (H).Material and method: Restrospective observational study on a cohort of patients with symptomatic hip osteoarthritis, treated by ultrasound-guided intra-articular viscossuplementation with two types of single injection of hyaluronic acid. Its efficacy was evaluated according to the WOMAC and VAS scales at 6 and 12 months. Results: 144 patients were treated with a single dose of A and 84 with H. At 6 months, those treated with A showed improvements in relation to pain reduction in the VAS (p < 0.001) and in the WOMAC pain (p = 0.003), as well as in global WOMAC (p = 0.027). There were no changes in WOMAC stiffness and function. At 12 months, those treated with H showed significant improvements in the VAS (p < 0.001) and global WOMAC (p = 0.010) parameters and in all their dimensions. Conclusions: A single injection of annual H was more effective in improving pain and function of the hip with osteoarthritis at 1 year compared to A at 6 months. It is possible to establish annual viscossuplementation protocols for hip osteoarthritis with hyaluronic acid using H.(AU)

Concentración preoperatoria de fibrinógeno plasmático como predictor de sangrado en artroplastía total de cadera / Preoperative concentration of plasma fibrinogen as a predictor of bleeding in total hip arthroplasty

Resumen: Introducción: La artroplastía total de cadera tiene popularidad debido al éxito en el tratamiento de coxartrosis; son procedimientos asociados a la pérdida de sangre. Un sangrado importante provoca complicaciones como aumento en días de estancia intrahospitalaria, mayor costo de la enfermedad, exponiendo al paciente a complicaciones asociadas a transfusión sanguínea. El objetivo del estudio es investigar asociación entre concentración de fibrinógeno plasmático preoperatorio con sagrado transquirúrgico y determinar el nivel de corte de fibrinógeno para presentar mayor sangrado transquirúrgico. Material y métodos: Estudio retrospectivo, observacional, analítico, de Junio a Diciembre de 2020, incluyendo 227 pacientes con coxartrosis IV de la escala de Kellgren y Lawrence sometidos a artroplastía total primaria de cadera, derechohabientes, mayores de 18 años, en ausencia de enfermedades hepáticas o hematológicas y antecedente de sangrado quirúrgico importante. Resultados: El valor promedio de hemoglobina preoperatoria fue 14.6 ± 1.3 g/dl, posterior a cirugía (48 horas) 10.5 ± 1.4 g/dl; observando descenso de 4.1 ± 1.2 g/dl (p ≤ 0.0001). Valor promedio del hematocrito prequirúrgico 43% [41-45], posterior al procedimiento 32% [29-35]; se observó descenso de 11% [8-14] (p ≤ 0.0001); 98 pacientes presentaron sangrado transquirúrgico ≥ 300 ml; 129 tuvieron sangrado ≤ 300 ml; 61.2% de pacientes con sangrado mayor de 300 ml mostraron valores de fibrinógeno debajo del punto de corte (388 mg/dl). Conclusión: En pacientes postoperados los niveles preoperatorios de fibrinógeno ≤ 388 mg/dl y edad ≥ 58 años se asociaron al aumento en el riesgo del OR = 0.18 (IC 95% 0.10-0.32) de presentar sangrado transquirúrgico ≥ 300 ml, con descenso de la Hb de 4.1 ± 1.2 g/dl (p = 0.0001) y Hto de 11% [8-14] (p = 0.0001) entre el preoperatorio y el postoperatorio en 48 horas.

Abstract: Introduction: Total hip arthroplasty is popular for its success in treating coxarthrosis, its associated with substantial blood loss. Significant bleeding causes complications such as increase in hospitalization days, higher costs, exposing the patient to complications associated with blood transfusion. The aim of the study is to investigate the association between preoperative plasma fibrinogen concentration and trans-surgical bleeding and determine fibrinogen level cut-off to present greater trans-surgical bleeding. Material and methods: Retrospective, observational, analytical study, from June to December 2020, including 227 patients with Kellgren and Lawrence scale IV coxarthrosis undergoing primary total hip arthroplasty, beneficiaries, older than 18 years, without liver or hematological diseases, and history of significant surgical bleeding. Results: Mean preoperative hemoglobin value was 14.6 ± 1.3 g/dl, after surgery (48 hours) 10.5 ± 1.4 g/dl; decrease of 4.1 ± 1.2 g/dl (p ≤ 0.0001). Mean preoperative hematocrit value 43% [41-45], after the procedure; 32% [29-35]; decrease of 11% [8-14] (p ≤ 0.0001). 98 patients had intraoperative bleeding ≥ 300 ml, 129 had ≤ 300 ml; 61.2% of patients with bleeding greater than 300 ml had fibrinogen values below the cut-off point (388 mg/dl). Conclusion: In postoperative patients, preoperative fibrinogen levels ≤ 388 mg/dl and age ≥ 58 years were associated with an increased risk of OR = 0.18 (95% CI 0.10-0.32) of presenting trans-surgical bleeding ≥ 300 ml, with a decrease in Hb of 4.1 ± 1.2 g/dl (p = 0.0001) and Hto of 11% [8-14] (p = 0.0001) between the pre and postoperative period in 48 hours.

Tratamiento de las fracturas trocántero-subtrocantéricas asociadas a coxartrosis ipsilateral en pacientes mayores de 65 años / Treatment of trochanteric and subtrochanteric fractures associated to ipsilateral coxarthrosis in patients older than 65 years old / Tratamento de fraturas trocantéricas-subtrocantéricas associadas a coxartrose ipsilateral em pacientes com mais de 65 anos

Resumen: Introducción: las fracturas de cadera y la coxartrosis son patologías con alta incidencia en la población anciana. A pesar de esto es una observación clínica frecuente que no se presenten asociadas. No existe consenso de cuál es la mejor opción terapéutica para esta asociación. El objetivo del estudio es actualizar el conocimiento acerca del tratamiento de fracturas trocántero-subtrocantéricas asociadas a coxartrosis ipsilateral en pacientes mayores de 65 años. Materiales y métodos: se realizó una búsqueda sistematizada a través de los buscadores electrónicos PubMed y Ovid. La búsqueda alcanzó un total de 2,499 artículos, de acuerdo a los criterios de inclusión y exclusión se seleccionaron 12 trabajos para realizar nuestra revisión bibliográfica. Resultado: la mayoría de los trabajos analizados son estudios tipo serie de casos retrospectivos. Se realizaron tres subgrupos según tipo de tratamiento para analizar los resultados. Discusión: la asociación entre fracturas de fémur proximal y coxartrosis ipsilateral es poco frecuente. Dentro de este grupo de fracturas las de tipo trocantérico son las que muestran con mayor frecuencia esta asociación. Se plantean dos opciones terapéuticas para resolver esta asociación: tratar la fractura y la patología articular en un mismo acto quirúrgico mediante una artroplastia, o tratar primero la fractura mediante osteosíntesis y en una segunda cirugía la patología articular. El tratamiento mediante artroplastia disminuye el tiempo para la deambulación postoperatoria evitando así complicaciones médicas relacionadas a la enfermedad fracturaria, obteniendo mejores resultados funcionales a corto plazo. La osteosíntesis requiere un menor tiempo quirúrgico y una perdida sanguínea menor, siendo un procedimiento menos demandante técnicamente. La tasa de mortalidad no depende de la opción terapéutica, pero sí de la presencia de 3 o más comorbilidades y edad mayor a 80 años. Resulta importante conocer el tratamiento más adecuado para esta asociación de patologías, ello contribuiría a disminuir los efectos de la enfermedad fracturaria sobre este grupo de pacientes vulnerables. Conclusión: no existe la suficiente evidencia científica para afirmar que una opción terapéutica sea superior a la otra en estos pacientes.

Summary: Introduction: hip fractures and hip joint arthrosis are highly prevalent conditions among older adults. However, according to clinical examination, they are seldom seen together and today there is no general consensus on the best therapy for these associated conditions. The study aims to update existing knowledge on the treatment of trochanteric and subtrochanteric fractures that are associated to ipsilateral coxarthrosis in patients older than 65 years old. Method: we conducted a systematized search on Pubmed and Ovid including 2,499 articles and selected 12 studies to perform our bibliographic review based on inclusion and exclusion criteria. Result: most studies analysed are series of retrospective cases. Cases were classified them into three subgroups to analyse results. Discussion: the association between proximal femur fractures and ipsilateral coxarthrosis is rather unusual. When seen, trochanteric fractures are the most frequent ones. There are two therapeutic options to treat this condition: treating the fracture and the articulation in the same surgery, by means of an arthroplasty, or treating the fracture first with osteosynthesis and operating afterwards to treat the articulation condition. Arthroplasty reduces the time of postoperative ambulation and thus avoids medical complications in connection with the fracture disease, what results in better functional outcome in the short term. Osteosynthesis requires a shorter surgery and implies smaller blood loss, what makes it less technically demanding as a procedure. The mortality rate does not depend on the therapy chosen, but on the presence of three or more comorbilities, or the patient being older than 80 years old. It is important to define what the most appropriate treatment is for these associated conditions, what would contribute to reducing the effects of the fracture on this group of vulnerable patients. Conclusion: there is no sufficient scientific evidence to state whether one therapy is better than the other one in these patients.

Resumo: Introdução: as fraturas de quadril e coxartrose são patologias com alta incidência na população idosa. Apesar disso, é frequente a observação clínica de que não estão associados. Não há consenso sobre qual a melhor opção terapêutica para essa associação. O objetivo deste estudo é atualizar o conhecimento sobre o tratamento das fraturas trocantéricas-subtrocantéricas associadas à coxartrose ipsilateral em pacientes com mais de 65 anos. Materiais e métodos: foi realizada uma busca sistemática nas bases PubMed e Ovid. Foram encontrados 2.499 artigos; após aplicação dos critérios de inclusão e exclusão, foram selecionados 12 artigos para realização de nossa revisão bibliográfica. Resultado: a maioria dos estudos analisados são séries de casos retrospectivos. Para análise dos resultados, foram divididos em três subgrupos de acordo com o tipo de tratamento. Discussão: a associação entre fratura de fêmur proximal e coxartrose ipsilateral é rara. Dentro desse grupo de fraturas, as do tipo trocantérica são as que mais frequentemente apresentam essa associação. Duas opções terapêuticas são propostas para resolver essa associação: tratar a fratura e a patologia articular no mesmo ato cirúrgico por meio de uma artroplastia, ou tratar a fratura primeiro por osteossíntese e em uma segunda cirurgia a patologia articular. O tratamento por artroplastia reduz o tempo de deambulação pós-operatória, evitando complicações médicas relacionadas à doença da fratura, obtendo melhores resultados funcionais em curto prazo. A osteossíntese requer menos tempo cirúrgico e menos perda sanguínea, sendo um procedimento menos exigente tecnicamente. A taxa de mortalidade não depende da opção terapêutica, mas sim da presença de 3 ou mais comorbidades e idade superior a 80 anos. É importante identificar o tratamento mais adequado para esta associação de patologias, o que ajudaria a reduzir os efeitos da patologia da fratura neste grupo de pacientes vulneráveis. Conclusão: não há evidências científicas suficientes para afirmar que uma opção terapêutica seja superior a outra nestes pacientes.

Randomized, double-blind, controlled trial, phase III, to evaluate the use of platelet-rich plasma versus hyaluronic acid in hip coxarthrosis. / Ensayo clínico fase III para evaluar la eficacia y seguridad del uso de plasma rico en plaquetas frente a ácido hialurónico en coxartrosis.

AIMS OF THE STUDY: To compare efficacy and safety of a home-made platelet-rich plasma (PRP) solution versus hyaluronic acid in patients with hip osteoarthritis not responding to conservative treatment and to correlate cellular composition of PRP to clinical outcomes. MATERIAL AND METHODS: This is a phase III clinical trial, double-blinded, controlled and randomised into two treatment groups (PRP and hyaluronic acid). Patients received one hip ultrasound-guided injection. Follow up was 12 months. Pain was assessed using VAS score, HHS and WOMAC were used as functional scores, analgesia, adverse events, cellular components (PRP group) in peripheral blood and in PRP were recorded. Clinical response was assessed using OARSI criteria. RESULTS: Seventy-four patients were included. Both groups improved in VAS, WOMAC and HHS score and reduced the amount of analgesia (p<.05). Significant differences were seen at 1 year post-treatment in HHS score (PRP 70.9 [3.7-58], hyaluronic acid 60.2[43-74.2] p<.05). No adverse events were observed in none of the groups. Platelet concentration was different between responders and non-responders (at 1 month, non-responders 449[438-578] x103 platelets/µl versus responders 565 [481-666] x103 platelets/µl, p<.044). There was a correlation between leukocytes concentration and clinical scores (VAS at six months, r=0.748, p<.013, WOMAC at 6 months r=0.748, p <.013). Patients with early stage hip OA showed higher response rate to PRP compared with late stage (11.51 OR, 95%CI 2.34-50.65, p<.03). CONCLUSIONS: Platelet-rich plasma injection improved hip function, reduced pain and the use of analgesia. It is important to bear in mind the cellular composition in order to achieve a better clinical response.

Claudicación, resultados funcionales y calidad de vida en artroplastía total de cadera primaria con abordaje anterolateral mínimamente invasivo / Claudication, functional outcomes and quality of life in primary Total hip arthroplasty with minimally invasive anterolateral approach

Resumen: Introducción: La coxartrosis tiene incidencia de 88 casos por 100,000 personas/año y prevalencia sintomática de 16% para hombres y 6% para mujeres en edades de 65-74 años e incrementa con la edad. Representa una enfermedad de salud pública que va en aumento, la mujer es quien presenta padecimiento más grave. La ATC (artroplastía total de cadera) se ha convertido en el procedimiento más exitoso para mejorar la calidad de vida de pacientes con coxartrosis. Objetivo: Determinar la claudicación, calidad de vida y resultados funcionales de la ATC mediante abordaje mínimo invasivo en pacientes con coxartrosis primaria. Material y métodos: Estudio longitudinal y prospectivo en pacientes con coxartrosis primaria unilateral postoperados de ATC primaria con técnica mínimamente invasiva en el período comprendido de Marzo de 2015 a Febrero de 2016, se analizó a cada paciente con somatometría, calidad de vida (WOMAC), funcionalidad en pacientes con coxartrosis (HHS) y funcionalidad en pacientes con cirugía de cadera (OHS) de manera prequirúrgica y postquirúrgica con seguimiento a un año. Resultados: Se incluyeron 21 pacientes, 17 femeninos y cuatro masculinos que corresponde a 80.95 y 19.05%, respectivamente, edad promedio de 59.95 años (DE = 9.64), con resultados funcionales excelentes a un año, según escalas de HHS y OHS, calidad de vida alta en 100% de los casos según WOMAC, con índice de claudicación bajo de 4.76%. Discusión: El abordaje mínimo invasivo es una técnica quirúrgica reproducible con resultados funcionales excelentes, índice de claudicación baja y alta calidad de vida en pacientes postoperados de ATC primaria durante el primer año de seguimiento.

Abstract: Introduction: The coxarthrosis has incidence of 88 cases per 100,000 people/year and symptomatic prevalence of 16% men and 6% women aged 65-74 years and increases with age. It is a growing public health disease. Total hip arthroplasty (THA) has become the most successful procedure to increase the quality of life of patients with coxarthrosis. Our objective was to determine the claudication, quality of life and functional results of THA through minimal invasive approach in patients with primary coxarthrosis. Material and methods: Prospective longitudinal study in patients with unilateral primary coxarthrosis postop of THA with minimally invasive approach from March 2015-February 2016, each patient was analyzed with quality of Life instrument (WOMAC), Functional test for coxarthrosis (HHS) and functional test in patients with hip surgery (OHS) with follow-up of one year. Results: We included 21 patients, 17 female and 4 males corresponding to 80.95% and 19.05% respectively, average age of 59.95 years (ED = 9.64), with excellent functional results to one year according to HHS and OHS, quality of life high in 100% of cases according to WOMAC, with claudication rate of 4.76%. Discussion: The minimal invasive approach is a reproducible surgical technique, with excellent functional results, low claudication rate and high quality of life in postoperative patients of primary ATC at only one year of follow-up.

Coxartrosis resueltas quirúrgicamente: experiencia local en un hospital de segundo nivel / Surgically resolved coxarthrosis: local experience in a second level hospital

Contexto: la osteoartritis (OA) es la más común de las enfermedades reumáticas crónicas, causada mayoritariamente por sobrecarga excesiva a una articulación normal, carga normal sobre una articulación anatómicamente malformada o bien por carga normal asociada a una enfermedad ósea metabólica. Objetivo: estudiar la prevalencia de coxartrosis en pacientes tratados quirúrgicamente en el Servicio de Traumatología y Ortopedia del Hospital del Instituto Ecuatoriano de Seguridad Social de Ambato. Sujetos y métodos: se analizó la base de datos de 1969 pacientes intervenidos quirúrgicamente entre 2014 (985 pacientes) y 2015 (984 pacientes). Los criterios de inclusión son edad (25 a 98 años) y sexo (masculino y femenino). Resultados: se detectaron 1969 cirugías entre enero 2014 a diciembre 2015; por coxartrosis grado III-IV (n=65), fracturas de fémur (n=19) y otras (n=8). Del grupo coxopatías, 65 casos fueron diagnosticados de coxartrosis grado III-IV que ameritaron la colocación de una prótesis de cadera. En el 2014 predominaron pacientes del sexo masculino diagnosticados de coxartrosis (n= 20/39; p=0,51) en relación al sexo femenino (n=19/39; p=0,49) mientras que en el año 2015, aumentó la prevalencia de coxoartrosis en el sexo femenino (n=14/26; p=0,54) en relación al sexo masculino (n=12/26; p=0,46). Conclusión: la coxartrosis es un problema de importante prevalencia entre los pacientes del hospital del IESS de Ambato, a mayor edad cursa con más gravedad y resulta de forma necesaria realizar intervención quirúrgica, además las mujeres luego de los 60 años sufren coxartrosis de mayor gravedad. (AU)

Background: osteoarthritis (OA) is the most common of chronic rheumatic diseases. There are many forms can produce osteoarthritis such as excessive overload on the normal joint, normal loading in an anatomically malformed joint, and normal loading in conjunction with metabolic diseases. Objective: study the prevalence of coxarthrosis in patients of the traumatology and orthopedic department of the IESS Hospital in the city of Ambato, who required surgical treatment. Subjects and methods: we analyzed a universe of 1969 patients who underwent surgery between 2014 (985 patients) and 2015 (984 patients) at the Trauma and Orthopedic Service of the IESS Hospital in the city of Ambato, in addition to inclusion criteria Age (25 to 98 years) and sex (male and female). Results: 1969 surgeries were performed from January 2014 to December 2015, coxarthrosis grade 3-4 (n = 65), femoral fractures (n = 19), others (n = 8). Of the groups for coxopathies, 65 cases were diagnosed with coxarthrosis grade 3-4, which warranted a hip prosthesis placement. In 2014, it was determined that the patients with the highest prevalence of being diagnosed with coxarthrosis were male patients (n = 20/39; p = 0.51) in relation to the female sex (n = 19/39; p = 0.49), an increase in prevalence was noticed in 2015, since it was foundto be higher in females (n = 14/26, p = 0.54) than males (n = 12/26; P = 0.46). Conclusion: coxarthrosis is a problem of major prevalence among patients at the IESS Ambato hospital, the older it is, the more severe it is and surgical intervention is necessary, in addition women after 60 years suffer from more severe coxarthrosis. (AU)

Evaluación de la calidad de vida en pacientes intervenidos de artroplastia total de cadera / Evaluating quality of life in total hip arthroplasty patients

Objetivo: Determinar el estado de salud general percibida por los pacientes jóvenes sometidos a artroplastia total de cadera con el implante tipo minivástago. Material y método: Se administró el cuestionario de salud SF-36 para evaluar el estado de salud percibido por 13 pacientes varones, con una media de edad de 46.62 (34 a 53) años, en los que se realizó una artroplastia total de cadera no cementada tipo MiniHip (CorinMedical) tras un seguimiento medio de 23.2 (12 a 47) meses. Los resultados obtenidos se compararon con los valores de referencia de la población española en varones de 45 a 54 años. Resultados: En las respuestas del cuestionario SF-36 se hallaron diferencias en aspectos como rol físico y rol emocional, desempeño físico, desempeño social y dolor; mientras que en el resto de los ítems la puntuación obtenida fue similar a la de la población de referencia. Discusión: Existe la necesidad de conocer en qué grado nuestras intervenciones afectan la calidad de vida de los pacientes y la manera en que son percibidas por ellos mismos para complementar la valoración de los resultados de nuestrasintervenciones. Conclusión: Es necesaria una nueva perspectiva para la valoración funcional y de calidad de vida de los pacientes jóvenes sometidos a una artroplastia total de cadera.

Objective: To determine the general health status perceived by patients undergoing total hip arthro-plasty with a mini-stem implant. Material and Methods: SF-36 health questionnaire was used to assess perceived health status in 13 male patients with a mean age of 46.62 (34-53) years after the implanta-tion of an uncemented, MiniHip® (CorinMedical) total hip arthroplasty, with a mean follow-up of 23.2 (12-47) months. Results were compared with the reference values for Spanish males aged from 45 to 54 years. Results: In the responses to the SF-36 questionnaire differences were found in areas such as physi-cal and emotional role, physical function, social function and pain; while scores for the remaining items were similar to those of the reference population. Discussion: It is important to know to what extent our surgical actions affect the quality of life of patients and how it is perceived by them to complement the results of our surgeries. Conclusion: A new perspective of function and quality of life evaluation is required in young patients undergoing total hip arthroplasty.