Bone remodeling, around an anatomical hip stem: a one year prospective study using DEXA. / Estudio prospectivo del remodelado óseo femoral alrededor de un vástago anatómico de cadera: un año de seguimiento densitométrico.

INTRODUCTION: The loss of bone mass, as a consequence of bone remodelling, in the proximal third of the femur, is a factor that contributes to the failure of hip prostheses in the medium to long term. This periprosthetic remodelling occurs mainly during the first 12 months after the operation. The aim is to evaluate the behaviour at one year of a new anatomical stem, the ANATO® stem (2015-Stryker®), which is a redesign of its predecessor (ABG-ii®-Stryker stem) by means of bone densitometry. METHOD: Prospective, controlled study in which the changes in bone mineral density (BMD) observed around the seven areas of Gruen in a group of 61 patients affected by primary coxarthrosis, in whom an ANATO® stem was implanted, are analysed densitometrically. The healthy hip was taken as the control group. The existence of differences in the remodelling pattern according to sex, age and body mass index (BMI) was compared. The follow-up was during the first year after the intervention. RESULTS: After one year of follow-up, decreases of bone mineral density in zone seven of -5.9% were observed, being this decrease statistically significant. No differences were found in the remodelling pattern according to age, sex and body mass index. CONCLUSION: The ANATO® stem allows an efficient transmission of loads from the stem to the proximal femur. Only in zone seven significant bone atrophy is observed. Differences in age, BMI and sex do not seem to influence the bone remodelling around this new stem.

Comparison of the open versus the arthroscopic approach in the treatment of femoroacetabular shock. / Comparación del abordaje abierto frente al artroscópico en el tratamiento del choque femoroacetabular.

OBJECTIVE: To compare clinical and imaging results and complications between patients treated for femoroacetabular impingement who underwent either open surgery or an arthroscopic approach. METHODS: This retrospective study included patients who underwent femoroacetabular impingement surgical treatment between June 2009 and January 2018. Patients treated with open surgery were compared with those treated with arthroscopy. Patients were radiographically and clinically assessed by alpha angle, degree of arthritis, Harris Hip Score, hospital stay and complications, as well as progression to total hip arthroplasty. RESULTS: 57 patients with FAI were included; 27 (45.6%) underwent open surgery and 31 (54.4%) underwent arthroscopy. Statistically significant differences were observed in hospital stay, where the patients who underwent arthroscopic surgery showed better outcomes. There were no other statistically significant differences, the results were similar in both groups. CONCLUSIONS: Arthroscopy and open surgery treatments for femoroacetabular impingement provided comparable clinical and radiographic results. However, the latter surgery provides better results in surgery time, hospital stay and postoperative recovery.

Influencia de la masa ósea preoperatoria en la remodelación femoral periprotésica tras la implantación de una prótesis ABG-II: resultados tras 10 años de seguimiento / Influence of preoperative bone mass density in periprosthetic bone remodeling after implantation of ABG-II prosthesis: a 10-year follow-up

Introducción. El índice de masa ósea preoperatoria ha demostrado ser un factor importante en la remodelación ósea periprotésica en estudios a corto plazo. Material y métodos. Se utilizó DEXA para realizar un estudio de seguimiento de 10 años a 39 pacientes con una artroplastia de cadera no cementada unilateral. Las mediciones de densidad de masa ósea (DMO) se realizaron a los 6 meses, un año, 3 años, 5 años y 10 años después de la cirugía. El coeficiente de correlación de Pearson se utilizó para cuantificar las correlaciones entre DMO preoperatoria y la densidad mineral ósea periprotésica en las 7 zonas de Gruen a los 6 meses, un año, 3 años, 5 años y 10 años. Resultados. La DMO preoperatoria fue un buen predictor de DMO periprotésica un año después de la cirugía en las zonas 1, 2, 4, 5 y 6 (índice de Pearson 0,61-0,75). Tres años después de la cirugía mantiene un buen poder predictivo en las zonas 1, 4 y 5 (0,71-0,61), aunque en las zonas 3 y 7 se observó baja correlación un año después de la cirugía (0,51 y 0,57 respectivamente). Al final del seguimiento se evidenció baja correlación en las 7 zonas de Gruen. El sexo y el IMC no tuvieron una influencia estadísticamente significativa en la remodelación ósea periprotésica. Conclusión. Aunque la DMO preoperatoria parece ser un factor importante en la remodelación periprotésica un año después de la implantación de una artroplastia, este factor va perdiendo progresivamente poder predictivo; no siendo un factor determinante en la remodelación periprotésica 10 años después de la cirugía (AU)

Introduction. Preoperative bone mass index has shown to be an important factor in peri-prosthetic bone remodelling in short follow-up studies. Material and methods. Bone density scans (DXA) were used to perform a 10-year follow-up study of 39 patients with a unilateral, uncemented hip replacement. Bone mass index measurements were made at 6 months, one year, 3 years, 5 years, and 10 years after surgery. Pearson coefficient was used to quantify correlations between preoperative bone mass density (BMD) and peri-prosthetic BMD in the 7 Gruen zones at 6 months, one year, 3 years, 5 years, and 10 years. Results. Pre-operative BMD was a good predictor of peri-prosthetic BMD one year after surgery in zones 1, 2, 4, 5 and 6 (Pearson index from 0.61 to 0.75). Three years after surgery it has good predictive power in zones 1, 4 and 5 (0.71-0.61), although in zones 3 and 7 low correlation was observed one year after surgery (0.51 and 0.57, respectively). At the end of the follow-up low correlation was observed in the 7 Gruen zones. Sex and BMI were found to not have a statistically significant influence on peri-prosthetic bone remodelling. Conclusion. Although preoperative BMD seems to be an important factor in peri-prosthetic remodelling one year after hip replacement, it loses its predictive power progressively, until not being a major factor in peri-prosthetic remodelling ten years after surgery (AU)

[Influence of preoperative bone mass density in periprosthetic bone remodeling after implantation of ABG-II prosthesis: A 10-year follow-up]. / Influencia de la masa ósea preoperatoria en la remodelación femoral periprotésica tras la implantación de una prótesis ABG-II: resultados tras 10 años de seguimiento.

INTRODUCTION: Preoperative bone mass index has shown to be an important factor in peri-prosthetic bone remodelling in short follow-up studies. MATERIAL AND METHODS: Bone density scans (DXA) were used to perform a 10-year follow-up study of 39 patients with a unilateral, uncemented hip replacement. Bone mass index measurements were made at 6 months, one year, 3 years, 5 years, and 10 years after surgery. Pearson coefficient was used to quantify correlations between preoperative bone mass density (BMD) and peri-prosthetic BMD in the 7 Gruen zones at 6 months, one year, 3 years, 5 years, and 10 years. RESULTS: Pre-operative BMD was a good predictor of peri-prosthetic BMD one year after surgery in zones 1, 2, 4, 5 and 6 (Pearson index from 0.61 to 0.75). Three years after surgery it has good predictive power in zones 1, 4 and 5 (0.71-0.61), although in zones 3 and 7 low correlation was observed one year after surgery (0.51 and 0.57, respectively). At the end of the follow-up low correlation was observed in the 7 Gruen zones. Sex and BMI were found to not have a statistically significant influence on peri-prosthetic bone remodelling. CONCLUSION: Although preoperative BMD seems to be an important factor in peri-prosthetic remodelling one year after hip replacement, it loses its predictive power progressively, until not being a major factor in peri-prosthetic remodelling ten years after surgery.

Efectividad de la cirugía mínimamente invasiva de incisión única postero-lateral en artroplastia total de cadera / Effectiveness of minimally invasive surgery for total hip replacement performed through a single postero-lateral Incision

Objetivo. Determinar la efectividad de la cirugía mínimamente invasiva (CMI) en prótesis de cadera, como factor aislado, en los resultados clínicos y radiológicos obtenidos en un hospital de nuestro entorno. Material y método. Estudio prospectivo, controlado, con dos grupos de 40 pacientes. Un grupo intervenido mediante CMI por vía postero-lateral de incisión única, y otro mediante abordaje postero-externo clásico. Se realizó se-guimiento clínico y radiológico durante el primer año postoperatorio. Resultados. A lo largo del primer año postoperatorio, únicamente se apreciaron diferencias significativas a favor de la CMI en el sangrado per-operatorio y las necesidades transfusionales. La evolución clínica, radiológica, estancia hospitalaria, incidencia de complicaciones y satisfacción del paciente fueron semejante entre grupos. Conclusiones. La introducción de técnicas CMI en artroplastia de cadera aporta, por sí misma, menor cuantía de pérdida hemática. La mejora de los resultados clínicos asociada a esta técnica pasa por incluir cambios en el manejo analgésico, anestésico y rehabilitador

Aim. To determine the effectiveness, by means of clinical and X-ray studies, of minimally invasive surgery (MIS) for total hip replacement performed as an isolated procedure in a Spanish hospital. Materials and methods. This was a prospective, controlled study that comprised two groups of 40 patients. One group underwent MIS through a single postero-lateral incision and the other by means of a classical postero-external approach. Patients were followed up clinically and radiographically during the first postoperative year. Results. During the first postoperative year the only significant differences in favor of MIS were a lower amount of perioperative bleeding and the less need of transfusions. The evolution, determined both clinically and by X-rays, days in hospital, incidence of complications and patient satisfaction were similar in both groups. Conclusions. The use of MIS techniques in hip replacement causes less blood loss. The improvement in clinical results associated with this technique depends on changes in analgesia, anesthesia and rehabilitation

Traumatismos de diagnóstico difícil en Atención Primaria

Dentro del variado conjunto de lesiones traumáticas con que podemos encontrarnos en la práctica diaria hay un grupo de ellas que se distinguen por las dificultades de diagnóstico que pueden plantear. La revisión de la casuística de nuestro servicio de Urgencias nos ha permitido caracterizar un grupo de diez lesiones traumáticas que pueden pasar inadvertidas.La importancia de conocer estas lesiones para el médico de Atención Primaria, que ha de prestar la primera asistencia a un paciente traumatizado, radica en poder sospechar su existencia.Y, como en cualquier actuación médica, la herramienta fundamental para establecer la sospecha diagnóstica será el interrogatorio y la exploración física.Este artículo pretende recopilar los conocimientos mínimos necesarios sobre tales lesiones para evitar que pasen inadvertidas durante la atención urgente (AU)

[Tetraplegia in the immediate postoperative period of stapedectomy]. / Tetraplejía en el postoperatorio inmediato de una estapedectomía.

Management of the cervical spine in orotracheal intubation for general anesthesia is an important aspect of daily practice in anesthesiology. Also important are the requirements, techniques and consequences of patient position during surgery. We report a case of tetraplegia during the early postoperative period after stapedectomy for otosclerosis. After surgery, the spontaneously breathing patient was transferred to the recovery room, where a clinical picture of anesthesia and paralysis of all four limbs was evident. We ordered an emergency magnetic resonance image of the cervical spine, which revealed a massive acutely herniated disk at C6-C7 with signs of ischemia or necrosis of the medulla at the same level. After eight months, the patient was still paraplegic and lacked sensation in the lower limbs. Sensation and motor function in the upper limbs was nearly normal. We review the etiopathogenetic mechanisms that might be responsible for this clinical profile.