RESUMEN
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)
Asunto(s)
Humanos , Masculino , Femenino , Lesiones de la Cadera , Cadera , Artroplastia , Osteoartritis de la Cadera , Ataxia Cerebelosa , Estudios de Cohortes , Estudios Retrospectivos , Ortopedia , Heridas y Lesiones , TraumatologíaRESUMEN
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)
Asunto(s)
Humanos , Masculino , Femenino , Lesiones de la Cadera , Cadera , Artroplastia , Osteoartritis de la Cadera , Ataxia Cerebelosa , Estudios de Cohortes , Estudios Retrospectivos , Ortopedia , Heridas y Lesiones , TraumatologíaRESUMEN
Background: Within a timeframe of 8 years (2008-2016), 38 patients have undergone total hip replacement surgery for coxarthrosis or aseptic necrosis secondary to acetabulum fractures. Materials and Methods: The study included 27 males and 11 females between 42 and 70 years of age, all of whom came from other institutions. The follow-up period ranged between a minimum of 4.6 and a maximum of 9.7 years. Results: At the final follow-up, all patients were evaluated using the Merle D'Aubigne and Pastel model. Optimal results were found in all the cases. Three patients benefited from surgical revisitation with implant exchange following infection and one/two state reimplatation at seven, fourtheen et twenty-seven months respectively. Two patients benefited from cotyle revision due to chronic instability of the implant. Conclusions: The scope of the study was to present all the possible surgical difficulties that can come up with prosthetic implants. More particularly, hip implants after acetabulum fractures qualifies as a "difficult primary implant".
RESUMEN
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.
RESUMEN
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.
RESUMEN
INTRODUCTION AND OBJECTIVE: Dual modularity stems were introduced with the theoretical advantage of restoring hip anatomy more precisely through femoral offset and limb length adjustment. Interchangeable necks allow for intraoperative angulation, anteversion and length changes. Our objective is to study whether a better femoral offset correction is achieved with the H MAX-M® prosthesis (Limacorporate, San Daniele, Italy) compared to its monoblock counterpart. MATERIAL AND METHODS: A prospective cohort study was conducted by means of consecutive sampling on adult patients undergoing total hip arthroplasty with the diagnosis of coxarthrosis between January 2011 and December 2015. This cohort has two arms, one arm included patients who underwent modular neck arthroplasty and the other included patients who underwent monoblock total hip arthroplasty. Radiographic offset measurement of the operated hip and the contralateral hip was performed, and the difference between both values was calculated. 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 difference in offset between the operated hip and the contralateral hip (P=.323). No statistically significant differences were observed in the correction of the femoral offset, determined as the difference between the operated hip and the contralateral hip (P=.323). Nor were differences observed in the postoperative offset values (P=.097). It should be noted that for both designs, the majority group is the one with restored offset (P=.001).
RESUMEN
Introducción y objetivos: Los vástagos con doble modularidad fueron introducidos con la ventaja teórica de restaurar de forma más precisa la anatomía de la cadera a través del ajuste del offset femoral y la longitud de miembros. Los cuellos intercambiables permiten cambios intraoperatorios de angulación, anteversión y longitud. Nuestro objetivo es estudiar si se consigue una mejor corrección del offset femoral con la prótesis H MAX-M® (Limacorporate, San Daniele, Italia) frente a su homólogo monobloque. Material y métodos: Se realizó un estudio de cohortes prospectivo mediante muestreo consecutivo sobre pacientes intervenidos de artroplastia total de cadera con el diagnóstico de coxartrosis desde enero de 2011 hasta diciembre 2015. Esta cohorte posee 2 brazos, un brazo incluyó a los pacientes intervenidos mediante vástago con cuello modular y el otro a los pacientes intervenidos mediante vástago monobloque. Se realizó la medición radiográfica del offset de la cadera intervenida, la cadera contralateral y se calculó la diferencia entre ambos valores. 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 del offset femoral entre el grupo modular y monobloque, determinado como la diferencia de offset entre la cadera operada y la cadera contralateral (p=0,323). Tampoco se observaron diferencias en los valores de offset postoperatorio (p=0,097). Cabe decir que tanto para la prótesis modular como para la prótesis monobloque el grupo mayoritario es aquel con offset restaurado (p=0,001).(AU)
Introduction and objective: Dual modularity stems were introduced with the theoretical advantage of restoring hip anatomy more precisely through femoral offset and limb length adjustment. Interchangeable necks allow for intraoperative angulation, anteversion and length changes. Our objective is to study whether a better femoral offset correction is achieved with the H MAX-M® prosthesis (Limacorporate, San Daniele, Italy) compared to its monoblock counterpart. Material and methods: A prospective cohort study was conducted by means of consecutive sampling on adult patients undergoing total hip arthroplasty with the diagnosis of coxarthrosis between January 2011 and December 2015. This cohort has two arms, one arm included patients who underwent modular neck arthroplasty and the other included patients who underwent monoblock total hip arthroplasty. Radiographic offset measurement of the operated hip and the contralateral hip was performed, and the difference between both values was calculated. 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 difference in offset between the operated hip and the contralateral hip (P=.323). No statistically significant differences were observed in the correction of the femoral offset, determined as the difference between the operated hip and the contralateral hip (P=.323). Nor were differences observed in the postoperative offset values (P=.097). It should be noted that for both designs, the majority group is the one with restored offset (P=.001).(AU)
Asunto(s)
Humanos , Masculino , Femenino , Artroplastia de Reemplazo de Cadera , Prótesis de Cadera , Osteoartritis de la Cadera , Articulación de la Cadera , Cadera/cirugía , Estudios Prospectivos , Estudios de Cohortes , Ortopedia , Traumatología , 28599RESUMEN
Introduction and objective: Dual modularity stems were introduced with the theoretical advantage of restoring hip anatomy more precisely through femoral offset and limb length adjustment. Interchangeable necks allow for intraoperative angulation, anteversion and length changes. Our objective is to study whether a better femoral offset correction is achieved with the H MAX-M® prosthesis (Limacorporate, San Daniele, Italy) compared to its monoblock counterpart. Material and methods: A prospective cohort study was conducted by means of consecutive sampling on adult patients undergoing total hip arthroplasty with the diagnosis of coxarthrosis between January 2011 and December 2015. This cohort has two arms, one arm included patients who underwent modular neck arthroplasty and the other included patients who underwent monoblock total hip arthroplasty. Radiographic offset measurement of the operated hip and the contralateral hip was performed, and the difference between both values was calculated. 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 difference in offset between the operated hip and the contralateral hip (P=.323). No statistically significant differences were observed in the correction of the femoral offset, determined as the difference between the operated hip and the contralateral hip (P=.323). Nor were differences observed in the postoperative offset values (P=.097). It should be noted that for both designs, the majority group is the one with restored offset (P=.001).(AU)
Introducción y objetivos: Los vástagos con doble modularidad fueron introducidos con la ventaja teórica de restaurar de forma más precisa la anatomía de la cadera a través del ajuste del offset femoral y la longitud de miembros. Los cuellos intercambiables permiten cambios intraoperatorios de angulación, anteversión y longitud. Nuestro objetivo es estudiar si se consigue una mejor corrección del offset femoral con la prótesis H MAX-M® (Limacorporate, San Daniele, Italia) frente a su homólogo monobloque. Material y métodos: Se realizó un estudio de cohortes prospectivo mediante muestreo consecutivo sobre pacientes intervenidos de artroplastia total de cadera con el diagnóstico de coxartrosis desde enero de 2011 hasta diciembre 2015. Esta cohorte posee 2 brazos, un brazo incluyó a los pacientes intervenidos mediante vástago con cuello modular y el otro a los pacientes intervenidos mediante vástago monobloque. Se realizó la medición radiográfica del offset de la cadera intervenida, la cadera contralateral y se calculó la diferencia entre ambos valores. 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 del offset femoral entre el grupo modular y monobloque, determinado como la diferencia de offset entre la cadera operada y la cadera contralateral (p=0,323). Tampoco se observaron diferencias en los valores de offset postoperatorio (p=0,097). Cabe decir que tanto para la prótesis modular como para la prótesis monobloque el grupo mayoritario es aquel con offset restaurado (p=0,001).(AU)
Asunto(s)
Humanos , Masculino , Femenino , Artroplastia de Reemplazo de Cadera , Prótesis de Cadera , Osteoartritis de la Cadera , Articulación de la Cadera , Cadera/cirugía , Estudios Prospectivos , Estudios de Cohortes , Ortopedia , Traumatología , 28599RESUMEN
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.
Asunto(s)
Humanos , Masculino , Adulto , Persona de Mediana Edad , Artroplastia de Reemplazo de Cadera , Osteoartritis de la Cadera , Calidad de Vida , PacientesRESUMEN
Osteoarthritis of the hip is a common pathology and involves forms of disability and need for treatments that affect the quality of life of patients and their families, and in general of the whole society. It should be considered as such degenerative joint disease is increasing as the increase in life expectancy and musculoskeletal trauma, the latter responsible for secondary forms of osteoarthritis. The treatment of osteoarthritis of the hip has changed a lot over the years, since the earlier diagnosis and, before, with prevention through proper lifestyle. More in-depth knowledge of the biology of the tissues involved, first of all hyaline cartilage, has lead to non-surgical treatments such as infiltration with hyaluronic acid (viscosupplementation) and autologous growth factors derived from platelets (platelet rich plasma). Surgical therapy with prosthetic replacement is finally a choice to share with the patient based on pain and functional limitation, bearing in mind always the best technology and tribology and the possibility of less invasive surgical access, while recognizing that there are not still eternal prosthesis. Of particular importance then is the age of the patient. There are also other types of surgery (hip arthroscopy, forage) for other pathologies of the hip which can be resolutive, or, in a sense, can delay the arrival to the prosthetic replacement. We will discuss below the decision-making process that leads the surgeon with the patient to the surgery option.
