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.

Primera serie de casos de alargamiento femoral mediante clavo intramedular Precice® en nuestro centro / First case series of femoral lengthening using a Precice® intramedullary nail in our center

Resumen: Introducción: el alargamiento femoral mediante clavo intramedular es una de las opciones quirúrgicas en el tratamiento de las dismetrías severas de miembros inferiores en la práctica clínica habitual. Material y métodos: se realizó un estudio descriptivo retrospectivo de una serie de cinco pacientes con una media de edad de 15.4 años, intervenidos de alargamiento femoral mediante clavo intramedular Precice®. La etiología en todos los casos fue idiopática. Se midió la dismetría o alargamiento teórico prequirúrgico y el definitivo postquirúrgico, así como la precisión del alargamiento, la tasa y el índice de distracción (mm/día y días/cm respectivamente) y el índice de consolidación (días/cm). Se identificaron las complicaciones intra y postoperatorias en todos los casos. Resultados: la media de seguimiento fue de 21 meses (12-42), sin pérdidas en el seguimiento. La duración media del procedimiento quirúrgico fue de 126 minutos (105-160). La dismetría teórica prequirúrgica fue de 38 ± 2.7 mm. El alargamiento medio final fue de 41 ± 7.5 mm. La precisión media fue de 108% (91-125) y la tasa de distracción de 0.9 ± 0.4 mm/día. El índice de distracción fue de 13.9 ± 5.1 días/cm y el índice de consolidación, de 26.6 ± 9.1 días/cm. La consolidación ósea se observó en la totalidad de los pacientes con una media de 113 ± 58 días. Con respecto a las complicaciones, se encontraron un total de cuatro complicaciones menores de índole muscular. Conclusión: el clavo intramedular Precice® es una buena opción de tratamiento para casos de acortamiento femoral severo aportando buenos resultados clínicos y radiológicos con una baja tasa de complicaciones y fallo del implante.

Abstract: Introduction: femoral lengthening using an intramedullary nail is one of the surgical options in the treatment of severe lower limb dysmetria in routine clinical practice. Material and methods: a retrospective descriptive study was carried out on a series of five patients with a mean age of 15.4 years, who underwent femoral lengthening surgery using a Precice® intramedullary nail. The etiology in all cases was idiopathic. Preoperative and definitive postoperative theoretical lengthening or dysmetry was measured, as well as lengthening accuracy, distraction rate and index (mm/day and days/cm, respectively) and consolidation index (days/cm). Intraoperative and postoperative complications were identified in all cases. Results: mean follow-up was 21 months (12-42), with no loss to follow-up. The mean duration of the surgical procedure was 126 minutes (105-160). The preoperative theoretical dysmetry was 38 ± 2.7 mm. The final mean lengthening was 41 ± 7.5 mm. The mean accuracy was 108% (91-125) and the distraction rate was 0.9 ± 0.4 mm/day. The distraction rate was 13.9 ± 5.1 days/cm and the consolidation rate was 26.6 ± 9.1 days/cm. Bone consolidation was observed in all patients with a mean of 113 ± 58 days. Regarding complications, a total of four minor muscular complications were found. Conclusion: the Precice® intramedullary nail is a good treatment option for cases of severe femoral shortening, providing good clinical and radiological results with a low rate of complications and implant failure.

Tratamiento quirúrgico de las dismetrías y deformidades angulares de miembros inferiores mediante epifisiodesis con tornillos transfisarios (técnica de Metaizeau) / Surgical treatment of lower limb length discrepancy and angular deformity by epiphysiodesis with transphyseal screw (Metaizeau technique) / Tratamento cirúrgico das dismetrias e deformidades angulares de membros inferiores mediante epifisiodese com parafusos transfisários (técnica de Metaizeau)

Evaluamos los niños con dismetrías y deformidades angulares operados mediante la Técnica de Metaizeau en el período 2010-2014, mediante un estudio retrospectivo de 11 pacientes, analizados en 2 Grupos. Grupo 1 (Dismetrías), formado por 5 pacientes, de los cuales 3 fueron operados solamente mediante esta técnica, mientras que 2 requirieron adicionalmente procedimientos de alargamiento femoral, valoramos dismetría inicial, dismetría por predicción para el último control y para el final de la madurez, y dismetría final. Grupo 2 (Deformidades Angulares), formado por 6 pacientes, de los cuales 1 presentaba genu varo, 4 genu valgo y 1 valgo de tobillo, valoramos el ángulo femorotibial anatómico, ángulo femoral distal lateral anatómico, ángulo tibial proximal medial, y ángulo tibioastragalino. En ambos Grupos se valoraron las complicaciones. El seguimiento promedio fue de 2 años y 5 meses. En el Grupo 1 obtuvimos dismetría promedio inicial 7,64 cm., dismetría promedio por predicción para el último control 8,54 cm., dismetría promedio final 7,62 cm., corrección promedio lograda 0,91 cm. En el Grupo 2 el promedio de corrección del ángulo femorotibial anatómico 16,85˚, promedio de corrección del ángulo femoral distal lateral anatómico 16,85˚, promedio de corrección del ángulo tibial proximal medial 7,62˚. No detectamos complicaciones en ningún paciente. En 8 (72,72%) pacientes la Técnica fue efectiva, mientras que en 3 (27,27%) los resultados fueron malos por errores técnicos o error en la predicción. La Técnica de Metaizeau, respetando los detalles quirúrgicos y realizando una adecuada predicción, es una buena opción para el tratamiento de dismetrías y deformidades angulares.

We evaluated children with lower limb length discrepancy and angular deformity operated by the Metaizeau technique in the 2010-2014 period through a retrospective study of 11 patients analyzed in 2 groups. Group 1 (Lower limb length discrepancy), consisted of 5 patients, among whom 3 were operated only by Metaizeau technique, whereas the other 2 additionally required procedures for femoral elongation. We evaluated initial discrepancy, predicted discrepancy for ultimate control and at maturity, and final discrepancy. Group 2 (Angular deformity), consisted of 6 patients, among whom 1 had genu varum, 4 genu valgum and, 1 ankle valgus. We evaluated anatomic femorotibial angle, anatomic lateral distal femoral angle, medial proximal tibial angle, and tibio talar angle. In both groups the complications were assessed. The average follow-up was 2 years and 5 months. In Group 1 we obtained the following values: average initial discrepancy, 7.64 cm; average discrepancy predicted for ultimate control, 8.54 cm; average final discrepancy, 7.62 cm and average correction achieved, 0.91 cm. In Group 2 the values were: average correction anatomic femorotibial angle, 16.85˚; average correction anatomic lateral distal femoral angle, 16.85˚ and average correction medial proximal tibial angle, 7.62˚. We found no complications in any patient. In 8 patients (72.72%) the technique was effective, while in 3 (27.27%) the results were poor due to technical errors or prediction errors . Metaizeau Technique, respecting the surgical details and making an accurate prediction is an effective, simple and uncomplicated procedure.

Avaliamos as crianças com dismetrias e deformidades angulares operadas pela técnica de Metaizeau no período de 2010 até 2014, mediante um estudo retrospectivo de 11 pacientes analisados em dois grupos. Grupo 1 (Dismetrias), constituído por cinco pacientes, dos quais 3 foram operados apenas por esta técnica, enquanto que os outros dois precisaram de procedimentos adicionais de alongamento femoral. Avaliamos a dismetria inicial, a dismetria por predição para o último controle e para o final da maturação, e a dismetria final. Grupo 2 (deformidades angulares), constituído por 6 pacientes, entre os quais um apresentava genu varo, 4 genu valgo e um, valgo do tornozelo. Avaliamos o ângulo femorotibial anatômico, o ângulo femoral distal anatômico o ângulo femoral distal lateral anatômico, o ângulo tibial proximal medial, e o ângulo tibioastragalino. Em ambos os grupos foram avaliadas as complicações. O seguimento médio foi de 2 anos e 5 meses. No Grupo 1, obtivemos dismetría inicial média de 7,64 cm, dismetria média por previsão para o último controle de 8,54 cm, dismetría final média de 7,62 cm e correcção média atingida de 0,91 cm. No Grupo 2, a correção de ângulo tibiofemoral anatómica média 16,85˚, correção média do ângulo femoral distal lateral anatómico 16,85˚, e correção média de ângulo tibial proximal medial de 7,62˚. Não detectamos complicações em nenhum paciente. A técnica foi efetiva em 8 (72,72%) pacientes, mas em 3 (27,27%) os resultados foram insatisfatórios por erros técnicos ou na predicção. A técnica de Metaizeau, desde que sejam respeitados os detalhes cirúrgicos e seja feita uma predicção adequada, é uma boa escolha para o tratamento de dismetrías e deformidades angulares.

[Cerebellar cognitive affective syndrome secondary to a cerebellar tumour]. / Síndrome afectivo-cognitivo cerebeloso secundario a tumor cerebeloso.

Cerebellar cognitive affective syndrome is characterized by disturbances of executive function, impaired spatial cognition, linguistic difficulties, and personality change. The case of an 11 year old boy is presented, with behavior problems, learning difficulties and social interaction problems. In the physical examination he had poor visual contact, immature behavior, reduced expressive language and global motor disability with gait dyspraxia, with no defined cerebellar motor signs. In the neuropsychological evaluation he has a full scale overall intellectual quotient of 84, with signs of cerebellar cognitive affective syndrome. A tumour affecting inferior cerebellar vermis was observed in the magnetic resonance imaging, which had not significantly grown during 5 years of follow up. The cerebellum participates in controlling cognitive and affective functions. Cerebellar pathology must be considered in the differential diagnosis of children with cognitive or learning disorder with associated behavioral and emotional components.