Resultados funcionales y supervivencia a ocho años de la artroscopia de cadera en pacientes con patología degenerativa de cadera / Functional outcomes and 8-year survival after hip arthroscopy in patients with degenerative hip disease

ANTECEDENTES Y OBJETIVOS: El objetivo de este estudio es evaluar qué factores pueden influir en la supervivencia de la artroscopia de cadera a medio plazo en el contexto de patología degenerativa. MATERIAL Y MÉTODOS: Llevamos a cabo un estudio retrospectivo de 40 casos de una serie de 102 pacientes intervenidos de artroscopia de cadera en nuestro centro, desde agosto de 2007 a octubre de 2011. Al final del seguimiento, todos los pacientes cumplimentaron tres escalas funcionales: Hip Outcome Score-Activites of Daily Life (HOS-ADL), Hip Outcome Score-Sport (HOS-S) y Harris Hip Score modificado (HHSm). RESULTADOS: Finalmente se incluyó un total de 39 pacientes (40 caderas), con una edad media de 43,1 años y un tiempo de seguimiento medio de 6 años (43-130 meses). Los pacientes intervenidos con una edad inferior a 50 años obtuvieron mejor puntuación en las escalas HOS-S (25,2 puntos) y HHS-m (84,1 puntos) en comparación con aquellos intervenidos a partir de dicha edad (HOS-S [25,2 puntos]; HHS-m [84,1 puntos]). El tiempo de evolución también influyó significativamente en el resultado de nuestros pacientes, siendo mejor en aquellos en los que éste era menor a 12 meses (26,6 meses), en comparación con aquellos en los que era mayor (21,3 meses). Por otro lado, aquellos que presentaban una intervención quirúrgica lumbar previa obtuvieron peores resultados de HOS-ADL (49,3 puntos), respecto a aquellos que no presentaban este antecedente (56,5 puntos). El Patient acceptable symptom state (PASS) fue superado por 23 pacientes (57,5%), 22 pacientes (55%) y 25 pacientes (62,5%) en las escalas HHSm, HOS-ADL y HOS-S respectivamente. Ningún paciente presentó ninguna complicación mayor. Cuatro pacientes presentaron complicaciones menores. La supervivencia media obtenida fue de 97,1 meses (IC 95%, 85,1-109,1 meses), asociado con un 81% de pacientes (IC 95%, 69%-93%) que no precisó rescate quirúrgico a los 10 años. CONCLUSIONES: Creemos que los datos obtenidos en nuestra serie sugieren que la artroscopia de cadera en el contexto de patología degenerativa es una intervención quirúrgica segura con un resultado funcional fiable a corto-medio plazo. Por otro lado, dicha indicación debería hacerse con mayor precaución en pacientes sometidos previamente a cirugía lumbar. NIVEL DE EVIDENCIA: Nivel IV. Serie de casos

BACKGROUND AND PURPOSE: The purpose of this study is to identify which variables may have a significant impact in mid-term survivorship following hip arthroscopy. METHODS: This a single-centre single-surgeon retrospective study including 102 patients who underwent a hip arthroscopy procedure between August 2007 and October 2011. Each subject completed three questionnaires at final follow- up: Hip Outcome Score-Activities of Daily Living (HOS-ADL), Hip Outcome Score-Sport (HOS-S) and Modified Harris Hip Score (m-HHS). RESULTS: Thirty-nine patients (40 hips) were finally included in our study. Mean age was 43.1 ± 9.9 years with a three-year minimum follow-up (75.43 ± 25.2 months). Younger patients and those with a shorter duration of symptoms obtained significantly higher HOS-S and m-HSS scores. Patients who had undergone previous lumbar spinal surgery obtained significantly worse HOS-ADL scores. Patient acceptable symptom state (PASS) was achieved in 23 patients (57.5%) for m-HHS, 22 patients (55%) for HOS-ADL and 25 patients for HOS-S scores. No major complication was observed. Only four patients had minor complications. Mean survival time was 97.1 months (95% CI, 85.1 to 109.1 months), with a survival at 8 years of 69% (95% CI, 53% to 85%). CONCLUSIONS: Our findings suggest that hip arthroscopy is a safe procedure with acceptable functional outcomes after a long follow-up. Care should be taken when treating patients with prior lumbar surgery. LEVEL OF EVIDENCE: Level IV. Case series

Functional outcomes and 8-year survival after hip arthroscopy in patients with degenerative hip disease. / Resultados funcionales y supervivencia a ocho años de la artroscopia de cadera en pacientes con patología degenerativa de cadera.

BACKGROUND AND PURPOSE: The purpose of this study is to identify which variables may have a significant impact in mid-term survivorship following hip arthroscopy. METHODS: This a single-centre single-surgeon retrospective study including 102 patients who underwent a hip arthroscopy procedure between August 2007 and October 2011. Each subject completed three questionnaires at final follow- up: Hip Outcome Score-Activities of Daily Living (HOS-ADL), Hip Outcome Score-Sport (HOS-S) and Modified Harris Hip Score (m-HHS). RESULTS: Thirty-nine patients (40 hips) were finally included in our study. Mean age was 43.1 ± 9.9 years with a three-year minimum follow-up (75.43 ± 25.2 months). Younger patients and those with a shorter duration of symptoms obtained significantly higher HOS-S and m-HSS scores. Patients who had undergone previous lumbar spinal surgery obtained significantly worse HOS-ADL scores. Patient acceptable symptom state (PASS) was achieved in 23 patients (57.5%) for m-HHS, 22 patients (55%) for HOS-ADL and 25 patients for HOS-S scores. No major complication was observed. Only four patients had minor complications. Mean survival time was 97.1 months (95% CI, 85.1 to 109.1 months), with a survival at 8 years of 69% (95% CI, 53% to 85%). CONCLUSIONS: Our findings suggest that hip arthroscopy is a safe procedure with acceptable functional outcomes after a long follow-up. Care should be taken when treating patients with prior lumbar surgery. LEVEL OF EVIDENCE: Level IV.

Rodilla en resorte interno por engrosamiento de la pata de ganso / Snapping knee caused by the thickening of the medial hamstrings

Presentamos el caso clínico de una paciente con rodilla en resorte, sintomática por subluxación de los tendones de la pata de ganso (semitendinoso y grácil) sobre el cóndilo medial de la tibia, debido al engrosamiento de los mismos. La clínica se reproducía durante la extensión activa de la rodilla por parte de la paciente. Para llevar a cabo al diagnóstico, a parte de la exploración física, la ecografía dinámica fue clave, ya que el resto de pruebas de imagen fueron normales. Debido al fallo del tratamiento conservador con fisioterapia e infiltraciones, se llevó a cabo tratamiento quirúrgico mediante desinserción y escisión de 8cm distales del semitendinoso y del grácil. La paciente lleva actualmente 6 meses intervenida y se encuentra asintomática, llevando a cabo con total normalidad sus actividades de la vida diaria (AU)

We report a case of symptomatic subluxation of the semitendinosus and gracilis over the medial condyle of the tibia caused by the thickening of its tendons. Snapping was reproduced on active extension. Clinical examination and, above all, dynamic ultrasound were the key for the diagnosis because other imaging tests were normal. Due to failure of conservative treatment with physiotherapy and infiltrations, surgery was undertaken, involving desinsertion and excision of distal 8cm segment of the semitendinosus and gracilis tendons. At the present time (6 months postoperatively), the patient is symptom-free and has returned to the previous normal life activities (AU)

Snapping knee caused by the thickening of the medial hamstrings. / Rodilla en resorte interno por engrosamiento de la pata de ganso.

We report a case of symptomatic subluxation of the semitendinosus and gracilis over the medial condyle of the tibia caused by the thickening of its tendons. Snapping was reproduced on active extension. Clinical examination and, above all, dynamic ultrasound were the key for the diagnosis because other imaging tests were normal. Due to failure of conservative treatment with physiotherapy and infiltrations, surgery was undertaken, involving desinsertion and excision of distal 8cm segment of the semitendinosus and gracilis tendons. At the present time (6 months postoperatively), the patient is symptom-free and has returned to the previous normal life activities.