[Translated article] Study of femoral component malrotation as a cause of pain after total knee arthroplasty.

INTRODUCTION: The total knee arthroplasty (TKA) has been shown to be a successful and cost-benefit procedure in terms of pain improvement in patient with symptomatic knee osteoarthritis. However, almost a 20% of the patients are not satisfied with the result of the surgery. MATERIAL AND METHOD: We have carried out a transversal unicentric cases controls study with clinical cases of the own hospital, obtained by a clinical records revision. A total of 160 patients with a TKA with at least 1 year of follow-up were selected. Demographic variables, functional scales (WOMAC and VAS) and rotation of the femoral component through the analysis of the images obtained by CT scan were collected. RESULTS: The total was 133 patients that was divided in two groups. A control group and pain group. The Control group was made up of 70 patients with a mean age of 69.59 years (23 men and 47 women) and the pain group was made up of 63 patients with a mean age of 69.48 years (13 men and 50 women). We didn't find difference regarding the analysis of the rotation of the femoral component. In addition, we were not found significant differences when applying a stratification by sex. And, the analysis of the malrotation of the femoral component, previously defining limits of value rotation considered as extreme, in any of the case did not show significant differences. CONCLUSION: The results of the study confirm that malrotation of the femoral component had no influence on the presence of pain at a minimum of one year of follow-up after TKA implantation.

Study of femoral component malrotation as a cause of pain after total knee arthroplasty. / Estudio de la malrotación del componente femoral como causa de dolor tras la implantación de una artroplastia total de rodilla.

INTRODUCTION: The total knee arthroplasty (TKA) has been shown to be a successful and cost-benefit procedure in terms of pain improvement in patient with symptomatic knee osteoarthritis. However, almost a 20% of the patients are not satisfied with the result of the surgery. MATERIAL AND METHOD: We have carried out a transversal unicentric cases controls study with clinical cases of the own hospital, obtained by a clinical records revision. A total of 160 patients with a TKA with at least 1year of follow-up were selected. Demographic variables, functional scales (WOMAC and VAS) and rotation of the femoral component through the analysis of the images obtained by CT scan were collected. RESULTS: The total was 133 patients that was divided in two groups. A control group and pain group. The control group was made up of 70 patients with a mean age of 69.59years (23 men and 47 women) and the pain group was made up of 63 patients with a mean age of 69.48years (13 men and 50 women). We did not found difference regarding the analysis of the rotation of the femoral component. In addition, we were not found significant differences when applying a stratification by sex. The analysis of the malrotation of the femoral component, previously defining limits of value rotation considered as extreme, in any of the case did not show significant differences. CONCLUSION: The results of the study confirm that malrotation of the femoral component had no influence on the presence of pain at a minimum of one year of follow-up after TKA implantation.

¿Publicamos lo que predicamos? Tasa de publicación de los congresos de la Sociedad Española de Cirugía de Hombro y Codo / Do we publish what we preach? Analysis of Spanish Shoulder and Elbow Surgery Society publication rates

Introducción. El propósito de este estudio es analizar la tasa de publicación de los estudios presentados como comunicaciones orales en los congresos de la Sociedad Española de Cirugía de Hombro y Codo (SECHC). Métodos. Se incluyeron 122 resúmenes presentados en los congresos SECHC celebrados en 2007, 2009 y 2011. Se categorizaron las comunicaciones orales por tipo de estudio, muestra incluida y seguimiento. En junio de 2017 se buscaron posibles publicaciones de estos trabajos en PubMed. El tiempo para la publicación, revista y factor de impacto fueron registrados. Se analizó la concordancia entre la información presentada en el congreso y las publicaciones posteriores. Resultados. Veintiuno de los 122 resúmenes analizados (17,21%) fueron publicados después de 6 años de seguimiento mínimo, con un tiempo medio empleado para las publicaciones de 36,71 meses y con un factor de impacto medio de 1,51. No se observaron diferencias significativas entre los datos expuestos inicialmente en el congreso y los posteriormente publicados (p>0,05). Conclusiones. La mayoría de los trabajos presentados en congresos SECHC no acaban siendo publicados. Aquellos trabajos que logran publicarse no suelen presentar diferencias significativas respecto a lo que se expuso previamente en el congreso (AU)

Introduction. The purpose of this study is to analyse the publication rate of studies presented as podium presentations in the Spanish Society of Shoulder and Elbow Surgery (SECHC) congresses. Methods. One hundred and twenty-two abstracts presented at the SECHC congresses held in 2007, 2009 and 2011 were included for the purpose of the study. The oral communications were categorized by study type, sample included and follow-up. In June 2017, possible publications of these studies were searched in PubMed. Type of study, delay in publication, journal and impact factor obtained were recorded. The concordance between the information presented at the congress and their subsequent full-text publications was analysed. Results. The publication rate was 17.21% (21 of the 122 abstracts studied) after 6 years, with a mean time spent for publications of 36.71 months, and a mean impact factor of 1.51. There were no differences between results initially presented at the congresses and those subsequently published (P>0.05). Discussion. The majority of papers presented at SECHC congresses do not end up with a publication. The papers that are published do not usually contain significant differences compared to the content delivered at the congress (AU)

Pressure algometry is an excellent tool to measure knee pain relief after a closing-wedge high tibial osteotomy.

PURPOSE: The aim of this study was to assess the utility of pressure algometry (PA) to measure pain relief in the medial part of the knee after a closing-wedge high tibial osteotomy (CWHTO). METHODS: Prospective study including 44 CWHTO. Pain relief was evaluated with the visual analogue scale (VAS) and PA, a radiological study was done and a functional assessment was carried out with the KSS preoperatively, at 6-months and at 1-year after the surgery. PA was applied to the medial and lateral part of the knee and to the infra-clavicular fossa as a control point. RESULTS: The mechanical femorotibial angle was changed from 172.2° (SD2.2) to 180.6° (SD2.6) (p=0.00). KSS Knee improved from 53.4 (SD11.2) to 92.8 (SD7.3) (p=0.00), KSS Function from 69.4 (SD9.3) to 93.1 (SD8) (p=0.00). The VAS went from 6.84 (SD1.5) to 2.5 (SD2.1) (p=0.00) at the 1-year follow-up. The pressure pain threshold (PPT), measured with PA in the medial part of the knee also improved from 348.8kPa (SD159.3) to 447.1kPa (SD218.8) (p=0.01). However, the PPT in the lateral part of the knee and in the sub-clavicular fossa remained the same from the preoperative period to 6-months and 1-year, postoperatively. Neither were there any differences between the 6-month and 1-year postoperative values in terms of the different functional, radiological and pain relief obtained. CONCLUSION: The pain relief obtained after a CWHTO in the medial part of the knee can be measured by using PA. Furthermore, the functional and pain improvement obtained at 1-year follow-up is no better than those obtained at 6-months postoperatively.

Do we publish what we preach? Analysis of Spanish Shoulder and Elbow Surgery Society publication rates. / ¿Publicamos lo que predicamos? Tasa de publicación de los congresos de la Sociedad Española de Cirugía de Hombro y Codo.

INTRODUCTION: The purpose of this study is to analyse the publication rate of studies presented as podium presentations in the Spanish Society of Shoulder and Elbow Surgery (SECHC) congresses. METHODS: One hundred and twenty-two abstracts presented at the SECHC congresses held in 2007, 2009 and 2011 were included for the purpose of the study. The oral communications were categorized by study type, sample included and follow-up. In June 2017, possible publications of these studies were searched in PubMed. Type of study, delay in publication, journal and impact factor obtained were recorded. The concordance between the information presented at the congress and their subsequent full-text publications was analysed. RESULTS: The publication rate was 17.21% (21 of the 122 abstracts studied) after 6 years, with a mean time spent for publications of 36.71 months, and a mean impact factor of 1.51. There were no differences between results initially presented at the congresses and those subsequently published (P>0.05). DISCUSSION: The majority of papers presented at SECHC congresses do not end up with a publication. The papers that are published do not usually contain significant differences compared to the content delivered at the congress.

Técnica de recuperación acelerada (fast-track) aplicada a cirugía protésica primaria de rodilla y cadera. Análisis de costos y complicaciones / Fast-track recovery technique applied to primary total hip and knee replacement surgery. Analysis of costs and complications

Objetivo. Determinar el ahorro económico que supone la implantación de un sistema de recuperación rápida (fast-track) al compararlo con el método de recuperación convencional en artroplastia primaria de cadera (ATC) y rodilla (ATR). Asimismo, determinar si existen diferencias entre ambos en el índice de complicaciones. Material y métodos. Estudio retrospectivo descriptivo, incluyendo 100 artroplastias primarias utilizando el método fast-track y 100 utilizando recuperación convencional. Las variables comparadas entre ambos grupos fueron edad, sexo, índice de comorbilidad de Charlson, ASA, estancia media, complicaciones intrahospitalarias y durante los primeros seis meses e índice de reingresos y transfusiones. Se determinó el coste global para cada procedimiento y por día de ingreso, y el ahorro se calculó según la reducción de la estancia media. Resultados. Ambos grupos fueron comparables en cuanto a edad, sexo, ASA e índice de Charlson. La reducción de la estancia media hospitalaria fue de 4,5 días para el grupo de ATR y 2,1 días para el de ATC. El ahorro calculado fue de 1.266 euros para el grupo de ATR y de 583 euros en el de ATC. No se observaron diferencias significativas en cuanto a complicaciones intrahospitalarias, necesidad de transfusiones, reingresos y complicaciones durante los primeros 6 meses. Discusión. Existen pocos trabajos de análisis de costos en relación con la implantación de sistemas de recuperación rápida en cirugía protésica. Diversas series publicadas tampoco observaron un mayor índice de complicaciones utilizando este método. La utilización del método fast-track representó un ahorro de 1.266 euros para el grupo de ATR y de 583 euros para el grupo de ATC sin aparente repercusión sobre el índice de complicaciones (AU)

Purpose. To determine the cost reduction and complication rates of using an enhanced recovery pathway (Fast-track) when compared to traditional recovery in primary total hip replacement (THR) and total knee replacement (TKR), as well as to determine if there were significant differences in complication rates. Material and methods. Retrospective review of 100 primary total arthroplasties using the Fast-track recovery system and another 100 using conventional recovery. Gender, Charlston comorbidity index, ASA score, length of stay and early complications were measured, as well in-hospital complications and those in the first six months, re-admissions and transfusion rates. The total and daily cost of stay was determined and the cost reduction was calculated based on the reduction in the length of stay found between the groups. Results. Both groups where comparable as regards age, gender, ASA score, and Charlston index. The mean reduction in length of stay was 4.5 days for TKR and 2.1 days for THR. The calculated cost reduction was 1266 euros for TKR and 583 euros for THR. There were no statistically significant differences between groups regarding in-hospital complications, transfusion requirements, re-admissions and complication rates in the first six months. Discussion. There are few publications in the literature reviewed that analyse the cost implications of using fast-track recovery protocols in arthroplasty. Several published series comparing recovery protocols found no significant differences in complication rates either. The use of a fast-track recovery protocol resulted in a significant cost reduction of 1266 euros for the TKR group and 583 for the THR group, without affecting complication rates (AU)

Fast-track recovery technique applied to primary total hip and knee replacement surgery. Analysis of costs and complications. / Técnica de recuperación acelerada (fast-track) aplicada a cirugía protésica primaria de rodilla y cadera. Análisis de costos y complicaciones.

PURPOSE: To determine the cost reduction and complication rates of using an enhanced recovery pathway (Fast-track) when compared to traditional recovery in primary total hip replacement (THR) and total knee replacement (TKR), as well as to determine if there were significant differences in complication rates. MATERIAL AND METHODS: Retrospective review of 100 primary total arthroplasties using the Fast-track recovery system and another 100 using conventional recovery. Gender, Charlston comorbidity index, ASA score, length of stay and early complications were measured, as well in-hospital complications and those in the first six months, re-admissions and transfusion rates. The total and daily cost of stay was determined and the cost reduction was calculated based on the reduction in the length of stay found between the groups. RESULTS: Both groups where comparable as regards age, gender, ASA score, and Charlston index. The mean reduction in length of stay was 4.5 days for TKR and 2.1 days for THR. The calculated cost reduction was 1266 euros for TKR and 583 euros for THR. There were no statistically significant differences between groups regarding in-hospital complications, transfusion requirements, re-admissions and complication rates in the first six months. DISCUSSION: There are few publications in the literature reviewed that analyse the cost implications of using fast-track recovery protocols in arthroplasty. Several published series comparing recovery protocols found no significant differences in complication rates either. The use of a fast-track recovery protocol resulted in a significant cost reduction of 1266 euros for the TKR group and 583 for the THR group, without affecting complication rates.

Alta recidiva y buenos resultados funcionales tras la resección artroscópica de la sinovitis villonodular pigmentaria de la rodilla / High recurrence and good functional results after arthroscopic resection of pigmented villonodular synovitis

Introducción. La sinovitis villonodular pigmentaria (SVP) es un trastorno de la proliferación sinovial de etiología incierta, con un tratamiento controvertido. El objetivo del estudio es valorar los resultados funcionales y la tasa de recurrencia en una serie de pacientes diagnosticados de SVP de rodilla, tanto en su forma difusa como en su forma localizada, tratados mediante resección artroscópica. Material y métodos. Estudio retrospectivo de 24 pacientes diagnosticados por resonancia magnética de SVP local/difusa entre 1996 y 2011. Se trataron 11 casos de forma localizada y 13 de forma difusa. Tras un seguimiento medio de 60 meses (rango: 34-204). Se intervinieron mediante sinovectomía artroscópica y se valoraron funcionalmente en el postoperatorio con los test IKDC, WOMET, Kujala y Tegner. Resultados. Ocho pacientes afectados de SVP difusa recidivaron (un 61,5% de las formas difusas). De ellos 2 requirieron radioterapia, uno cirugía abierta por afectación extraarticular y 5 nueva resección artroscópica sin detectarse posteriormente nueva recidiva. En 6 pacientes se observaron lesiones asociadas (en 3 meniscopatía y en 3 lesiones condrales). No hubo recidivas en la forma localizada. El IKDC mejoró de media 30,6 puntos, el WOMET 37,4 puntos y Kujala 34,03 puntos. Discusión. La SVP resecada mediante técnica artroscópica presenta buenos resultados funcionales y curativos a medio plazo con una baja morbilidad. La forma difusa de la SVP requiere con frecuencia una segunda intervención quirúrgica por su alta tasa de recidiva tras su resección artroscópica (AU)

Introduction. Pigmented villonodular synovitis (PVS) is a synovial proliferation disorder of uncertain aetiology, with some controversy as regards its proper treatment. The purpose of the study was to evaluate the functional outcome and recurrence rate in a series of patients diagnosed with both the diffuse and the localised type of PVS and treated by arthroscopic resection. Material and methods. Twenty-four patients diagnosed with PVS were retrospectively assessed. There were 11 cases with the diffuse type, and 13 cases with the localised type of PVS. They were followed-up for a median of 60 months (range, 34-204). They underwent arthroscopic synovectomy, and were functionally evaluated with IKDC, WOMET, and Kujala scores. Results. There was recurrence in 8 out of 13 (61.5%) cases with the diffuse type of PVS. Two of these patients were treated with radiation. One patient underwent surgical resection with an open procedure due to extra-articular involvement. The remaining 5 patients underwent a second arthroscopic resection, and no recurrence was subsequently observed. Cases with localised PVS did not recur after a single arthroscopic resection. IKDC, WOMET and Kujala scores improved by 30.6, 37.4 and 34.03 points, respectively. Discussion. Pigmented villonodular synovitis treated by arthroscopic resection showed good functional results at mid-term follow-up. A single arthroscopic resection was sufficient to treat the localised PVS, whereas the diffuse type of PVS required a second arthroscopic resection in most cases, due to its high rate of recurrence (AU)

[High recurrence and good functional results after arthroscopic resection of pigmented villonodular synovitis]. / Alta recidiva y buenos resultados funcionales tras la resección artroscópica de la sinovitis villonodular pigmentaria de la rodilla.

INTRODUCTION: Pigmented villonodular synovitis (PVS) is a synovial proliferation disorder of uncertain aetiology, with some controversy as regards its proper treatment. The purpose of the study was to evaluate the functional outcome and recurrence rate in a series of patients diagnosed with both the diffuse and the localised type of PVS and treated by arthroscopic resection. MATERIAL AND METHODS: Twenty-four patients diagnosed with PVS were retrospectively assessed. There were 11 cases with the diffuse type, and 13 cases with the localised type of PVS. They were followed-up for a median of 60 months (range, 34-204). They underwent arthroscopic synovectomy, and were functionally evaluated with IKDC, WOMET, and Kujala scores. RESULTS: There was recurrence in 8 out of 13 (61.5%) cases with the diffuse type of PVS. Two of these patients were treated with radiation. One patient underwent surgical resection with an open procedure due to extra-articular involvement. The remaining 5 patients underwent a second arthroscopic resection, and no recurrence was subsequently observed. Cases with localised PVS did not recur after a single arthroscopic resection. IKDC, WOMET and Kujala scores improved by 30.6, 37.4 and 34.03 points, respectively. DISCUSSION: Pigmented villonodular synovitis treated by arthroscopic resection showed good functional results at mid-term follow-up. A single arthroscopic resection was sufficient to treat the localised PVS, whereas the diffuse type of PVS required a second arthroscopic resection in most cases, due to its high rate of recurrence.

Pressure algometry is a useful tool to quantify pain in the medial part of the knee: an intra- and inter-reliability study in healthy subjects.

PURPOSE: Pain quantification is essential for diagnostic and pain monitoring purposes in disorders around the knee. Pressure algometry is a method described to determine pressure pain threshold (PPT) by applying controlled pressure to a given body point. The purpose of this study was to determine the reliability of this method when it was applied to the medial part of the proximal tibia metaphysis and to evaluate the PPT levels between genders. METHODS: Fifty healthy (mean age; 46.9) volunteers were recruited, 25 men and 25 women. Pressure algometry was applied to a 1 cm(2)-probe area on the medial part of the knee by 2 raters. Intra- and interclass correlation (ICC) was obtained and differences between genders were evaluated. Bland-Altman plots were performed to evaluate the variability of the measures. RESULTS: The mean values of PPT obtained by rater 1 and 2 were 497.5 Kpa and 489 Kpa respectively. The intrarater reliability values (95% IC) for rater 1 and 2 were 0.97 (0.95-0.98) and 0.84 (0.73-0.90) respectively. With regard to interrater reliability, the ICC (95% IC) for the first measurement was 0.92 (0.87-0.95) and 0.86 (0.78-0.92) for the second one. Women showed significant lower values of PPT than men. The Bland-Altmand plots showed excellent agreement. CONCLUSIONS: Pressure algometry has excellent reliability when it is applied to the medial part of the proximal metaphysis of the tibia. Women have lower values of PTT than men. The high reliability of the PA in an individual volunteer makes it a more valuable tool for longitudinal assessment of a given patient than for comparison between them. LEVEL OF EVIDENCE: Level III. Prospective study.

Topical and intravenous tranexamic acid reduce blood loss compared to routine hemostasis in total knee arthroplasty: a multicenter, randomized, controlled trial.

INTRODUCTION: Tranexamic acid (TXA) is becoming widely used in orthopedic surgery to reduce blood loss and transfusion requirements, but consensus is lacking regarding the optimal route and dose of administration. The aim of this study was to compare the efficacy and safety of topical and intravenous routes of TXA with routine hemostasis in patients undergoing primary total knee arthroplasty (TKA). MATERIALS AND METHODS: We performed a randomized, multicenter, parallel, open-label clinical trial in adult patients undergoing primary TKA. Patients were divided into three groups of 50 patients each: Group 1 received 1 g topical TXA, Group 2 received 2 g intravenous TXA, and Group 3 (control group) had routine hemostasis. The primary outcome was total blood loss. Secondary outcomes were hidden blood loss, blood collected in drains, transfusion rate, number of blood units transfused, adverse events, and mortality. RESULTS: One hundred and fifty patients were included. Total blood loss was 1021.57 (481.09) mL in Group 1, 817.54 (324.82) mL in Group 2 and 1415.72 (595.11) mL in Group 3 (control group). Differences in total blood loss between the TXA groups and the control group were clinically and statistically significant (p < 0.001). In an exploratory analysis differences between the two TXA groups were not statistically significant (p = 0.073) Seventeen patients were transfused. Transfusion requirements were significantly higher in Group 3 (p = 0.005). No significant differences were found between groups regarding adverse events. CONCLUSION: We found that 1 g of topical TXA and 2 g of intravenous TXA were both safe strategies and more effective than routine hemostasis to reduce blood loss and transfusion requirements after primary TKA. LEVEL OF EVIDENCE: I.

Técnica de microindentación ósea y algometría de presión aplicada al recambio protésico de rodilla y dolor en punta de vástago tibial. Resultados preliminares en un grupo de 20 pacientes / Bone microindentation and pressure algometry applied to revision total knee replacement and tibial end-of-stem pain. Preliminary results in a group of twenty patients

Objetivos. Valorar la relación entre la aparición de dolor en punta de vástago tibial con una disminución de la resistencia ósea preoperatoria mediante microindentación ósea. En segundo lugar, conocer la utilidad potencial de la algometría de presión en el diagnóstico y seguimiento de este grupo de pacientes. Material y método. Se realizó un estudio de correlación intra- e interobservador preliminar, para validar el método de la algometría en un grupo de 50 voluntarios sanos. Posteriormente se realizó un estudio prospectivo en un grupo de 20 pacientes con una media de edad de 74 años (57-84), sometidos a cirugía protésica de rodilla con utilización de un vástago tibial no cementado. Se realizaron mediciones de microindentación y algometría preoperatoriamente y después de un año. Para el análisis estadístico se utilizó el coeficiente de correlación intraclase y la t de Student para datos apareados. Resultados. En el trabajo preliminar, los valores de correlación intra- e interobservador obtenidos fueron excelentes; 0,91 (0,84-0,95) y 0,86 (0,74-0,92), respectivamente. En el grupo prospectivo no se observaron modificaciones significativas en los valores de microindentación (p = 0,11) ni algometría (p = 0,6) después de un año. Se observó una correlación significativa entre los valores de la algometría y las escalas de EVA (p = 0,002) y funcional (p = 0,02) en el control anual. Conclusiones. La algometría de presión fue una herramienta útil en el seguimiento de estos pacientes. La microindentación no fue adecuada para identificar pacientes en situación de riesgo de presentar dolor en punta de vástago tibial (AU)

Objectives. To study the relationship between the appearance of end-of-stem pain with a preoperative decrease in local bone strength by using the bone microindentation technique. The potential usefulness of pressure algometry in the diagnosis and monitoring of this group of patients is also determined. Material and method. A preliminary intra- and inter-rater correlation study was performed in a group of 50 healthy volunteers in order to validate the algometry technique. A prospective study was then conducted on 20 patients with a mean age of 74 years (range 57-84) undergoing knee prosthetic surgery with use of a cementless tibial stem. Bone microindentation and pressure algometry measurements were made preoperatively, and after one year of follow-up. The statistical analysis was performed using the Intraclass correlation coefficient and the Student t test for paired data. Results. The intra and inter-rater correlation values were excellent; 0.91 (0.84-0.95) and 0.86 (0.74-0.92), respectively. No significant variations were found in the microindentation (P=.11) or in the pressure algometry (P=.6) values after one year of follow-up. Nevertheless, a significant correlation was observed between the values for pressure algometry and the EVA (P=.002) and functional scale (P=.02) at the end of follow-up. Conclusions. Pressure Algometry is a useful tool to evaluate this group of patients. Bone microindentation does not seem to be useful in identifying patients with increased risk of developing tibial end-of-stem pain (AU)

[Bone microindentation and pressure algometry applied to revision total knee replacement and tibial end-of-stem pain. Preliminary results in a group of twenty patients]. / Técnica de microindentación ósea y algometría de presión aplicada al recambio protésico de rodilla y dolor en punta de vástago tibial. Resultados preliminares en un grupo de 20 pacientes.

OBJECTIVES: To study the relationship between the appearance of end-of-stem pain with a preoperative decrease in local bone strength by using the bone microindentation technique. The potential usefulness of pressure algometry in the diagnosis and monitoring of this group of patients is also determined. MATERIAL AND METHOD: A preliminary intra- and inter-rater correlation study was performed in a group of 50 healthy volunteers in order to validate the algometry technique. A prospective study was then conducted on 20 patients with a mean age of 74 years (range 57-84) undergoing knee prosthetic surgery with use of a cementless tibial stem. Bone microindentation and pressure algometry measurements were made preoperatively, and after one year of follow-up. The statistical analysis was performed using the Intraclass correlation coefficient and the Student t test for paired data. RESULTS: The intra and inter-rater correlation values were excellent; 0.91 (0.84-0.95) and 0.86 (0.74-0.92), respectively. No significant variations were found in the microindentation (P=.11) or in the pressure algometry (P=.6) values after one year of follow-up. Nevertheless, a significant correlation was observed between the values for pressure algometry and the EVA (P=.002) and functional scale (P=.02) at the end of follow-up. CONCLUSIONS: Pressure Algometry is a useful tool to evaluate this group of patients. Bone microindentation does not seem to be useful in identifying patients with increased risk of developing tibial end-of-stem pain.

Implant sonication increases the diagnostic accuracy of infection in patients with delayed, but not early, orthopaedic implant failure.

The purpose of this study was to compare the diagnostic accuracy for the detection of infection between the culture of fluid obtained by sonication (SFC) and the culture of peri-implant tissues (PITC) in patients with early and delayed implant failure, and those with unsuspected and suspected septic failure. It was hypothesised that SFC increases the diagnostic accuracy for infection in delayed, but not early, implant failure, and in unsuspected septic failure. The diagnostic accuracy for infection of all consecutive implants (hardware or prostheses) that were removed for failure was compared between SFC and PITC. This prospective study included 317 patients with a mean age of 62.7 years (9 to 97). The sensitivity for detection of infection using SFC was higher than using PITC in an overall comparison (89.9% versus 67%, respectively; p < 0.001), in unsuspected septic failure (100% versus 48.5%, respectively; p < 0.001), and in delayed implant failure (88% versus 58%, respectively; p < 0.001). PITC sensitivity dropped significantly in unsuspected compared with suspected septic failure (p = 0.007), and in delayed compared with early failure (p = 0.013). There were no differences in specificity. Sonication is mainly recommended when there is implant failure with no clear signs of infection and in patients with delayed implant failure. In early failure, SFC is not superior to PITC for the diagnosis of infection and, therefore, is not recommended as a routine diagnostic test in these patients.

Knee joint infection after ACL reconstruction: prevalence, management and functional outcomes.

PURPOSE: Septic arthritis after an ACL reconstruction is a rare but serious complication. Functional outcomes of these patients have not been studied in depth in large series. The aim of this study was to determine the prevalence and management of knee joint infection following ACL reconstruction and to assess the functional outcomes. METHODS: A retrospective assessment of knee joint infections occurring after arthroscopically assisted ACL reconstructions done from 2006 to 2009 in two hospitals by the same surgical team is presented. Patients with signs and symptoms of joint infection along with blood and synovial effusion laboratory parameters suggestive of infection were considered as septic arthritis. All the patients were treated with antibiotic therapy according to antibiotic sensitivity and had at least one arthroscopic lavage. Final outcomes were assessed and compared with a control group using the KT-1000 arthrometer, functional testing and radiological examination. RESULTS: Fifteen (1.8 %) out of 810 patients included in the study were considered as a joint infection. Microbiology showed that coagulase-negative Staphylococcus was present in 10 patients, Staphylococcus Aureus in three patients (2 MSSA and 1 MRSA) and Propinebacterium sp. in one patient. In one patient, the micro-organism was unknown. At a mean follow-up of 39.3 ± 13 months, the Lysholm score was 77.7 ± 15.3, the IKDC score was 70.4 ± 19.5, and the KT-1000 compared to the non-injured contralateral knee showed a mean difference of 1.3 ± 2 mm. Functional outcomes in the control group were slightly better than those obtained in the infected group (Lysholm score; 90.7 ± 9.4, p = 0.007. IKDC score; 86.6 ± 6.8, p = 0.004). All but one patient retained their reconstructed ACL. CONCLUSIONS: The prevalence of septic arthritis after an ACL reconstruction in this series was 1.8 %. Arthroscopic lavages along with antibiotic treatment led us to preserve all but one graft. Functional outcomes in the infected patients were not as good as those obtained in patients without infection.

Situación actual de la reconstrucción del ligamento cruzado anterior en nuestro país. Encuesta mediante formato electrónico / Update on anterior cruciate ligament reconstruction in Spain. Survey using an electronic questionnaire

Objetivo. Conocer cuáles son las preferencias de los cirujanos de nuestro país en referencia a algunos aspectos técnicos y epidemiológicos de la reconstrucción del ligamento cruzado anterior (LCA). Material y método. Durante el mes de febrero del 2009, se realizó una encuesta mediante el envío de 910 correos electrónicos a cirujanos de nuestro país que realizan de forma habitual reconstrucciones del LCA. Constaba de 8 preguntas en relación a los años de experiencia, número de reconstrucciones realizadas, técnica de elección en 2 casos clínicos ejemplo, tipo de injerto preferido, técnica con fascículo simple o doble, fuerza y tiempo de pretensado en el caso de los isquiotibiales y técnica de realización del túnel femoral. Resultados. Se obtuvo respuesta de 102 cirujanos. Un 66% de ellos tenían una experiencia entre 5–20 años. El 60,3% de ellos realizaba entre 10–50 reconstrucciones de LCA por año. El injerto de primera elección para los 2 casos clínicos propuestos fueron los tendones isquiotibiales con un 62–64%. Asimismo, predominaron las técnicas con fascículo simple (79,1%) y transtibial (71,8%). Discusión. El tratamiento de las lesiones de LCA sigue siendo controvertido. Parece que como ha sucedido en otros países que disponen de sistemas de registro adecuados, la técnica de reconstrucción con isquiotibiales ha aumentado su popularidad. No obstante, sigue existiendo una gran falta de consenso en algunos aspectos importantes de la técnica. Conclusiones. La técnica de reconstrucción con isquiotibiales, fascículo simple y transtibial fue la predominante en esta muestra (AU)

Objective. The aim of this study was to know what were the preferences of the Spanish surgeons about different aspects of anterior cruciate ligament (ACL) reconstruction. Material and methods. In February 2009, 910 surveys regarding some technical aspects of ACL reconstruction was mailed to surgeons who perform this kind of surgery in Spain. The survey had 8 questions: number of ACL reconstructions per year, two clinical cases, what kind of graft was preferred, the use of simple or double bundle reconstruction, the time and the amount of tension to apply to the hamstrings during ACL reconstruction and finally, some aspects about the creation of the femoral tunnel. Results. A total of 102 responses were received. Most of them (66%) had between 5-20 years of experience. A 60.3% of them performed between 10–50 procedures per year. The first choice graft in both clinical cases was autologous hamstring tendons (62% and 64%). The transtibial technique (71.8%) and the single bundle technique (79.1%) were preferred. Discussion. The management of the ACL injuries remains unclear. Like in other countries with available ACL registries, autologous hamstrings have increased their use for ACL reconstruction. However, there is not consensus in some aspects of the technique. Conclusion. The preferred technique for ACL reconstruction in this group was the transtibial technique with single bundle and using autologous hamstring tendons (AU)

Cirugía del ligamento cruzado anterior sin ingreso hospitalario / Surgery of the anterior cruciate ligament without hospitalization

Objetivo. Analizar de forma prospectiva la eficacia, seguridad y coste-efectividad del procedimiento de reconstrucción artroscópica del ligamento cruzado anterior en régimen de cirugía mayor ambulatoria. Material y método. Entre noviembre de 2001 y diciembre de 2002 se realizaron 96 reconstrucciones del ligamento cruzado anterior, utilizando autoinjertos hueso-tendón-hueso o isquiotibiales en 4 haces. Se realizaron gestos quirúrgicos adicionales en 39 pacientes. Los resultados se valoraron a los 5 días del postoperatorio mediante la escala de dolor visual analógica (EVA) y encuesta de control del dolor, y se reevaluaron a los 6 meses estudiando el resultado clínico según el cuestionario del International Knee Documentation Committee (IKDC), tasa de complicaciones, satisfacción de los pacientes y coste-efectividad del proceso. Resultados. A los 5 días postoperatorios el 88,5 por ciento de pacientes refirieron un buen nivel analgésico (EVA de 1,9 ñ 0,4). Ningún paciente requirió reingreso para control del dolor. A los 6 meses el IKDC era normal o casi normal en el 90,6 por ciento de pacientes y un 89,5 por ciento se mostraron satisfechos con el procedimiento ambulatorio. El ahorro económico por paciente fue del 7,9 por ciento cuando se comparó con la cirugía con ingreso. Conclusiones. Los resultados sugieren que la reconstrucción del ligamento cruzado anterior puede realizarse con seguridad de forma ambulatoria. Los analgésicos orales han resultado adecuados para el control domiciliario del dolor postoperatorio. El análisis económico demostró el costeefectividad del procedimiento (AU)

Combined fracture of the talus: Arthroscopic treatment.

The purpose of this article is to report the treatment and short-term results of a combined fracture of the talus treated arthroscopically. A 29-year-old man sustained an anterolateral osteochondral grade III fracture of the talus dome associated with a coronal fracture of the body of the talus. This injury was reduced and fixed arthroscopically using cannulated screws. The patient returned to his daily style of living after 3 months time. One year later, the patient remains asymptomatic. Radiography showed neither signs of osteonecrosis nor osteoarthritis of the talus at the 1-year follow-up. Therefore, arthroscopic surgery could be an alternative treatment for this kind of talus fracture.