[Use of ischemia in total knee arthroplasty. Is there a difference?]. / Uso de isquemia en la artroplastía total de rodilla. ¿Existe diferencia?

In Mexico, aging has become the daily routine of millions. Total Knee Arthroplasty is a procedure that is doing more and more with satisfactory results and survival of the implant up to 20 years in 90%. The tourniquet is a useful tool to the orthopedic surgeons to minimize blood loss and make the placement of implants easier, because it enhances the vision of the surgical field. We report the results of 75 total knee arthroplasties performed in January 2007 to January 2010, in terms of bleeding, duration of procedure and Haemoglobin levels with and without tourniquet, the patients were distributed in 3 different groups, In group 1 the tourniquet was kept inflated until the placement of the femoral and tibial components, in group 2 the tourniquet was kept inflated until the wound dressing and finally in group 3 we did not use tourniquet. We performed hematic biometry 24 hours after surgery and if the patient's hemoglobin was less than 9.0 g/dl or the patient had low cardiac output symptoms, regardless of hemoglobin level, blood transfusion was indicated. The results demonstrate that there significant differences between the amount of blood loss among the 3 groups (1:1.157 ml, 2:709 ml, 3:1.493 ml) and surgical time (1:100, 2:110, 3:135). So that demonstrates that tourniquet use has a direct relation to blood loss and surgical time.

[Surgical treatment of carpal tunnel syndrome and its correlation with preoperative nerve conduction tests]. / El tratamiento quirúrgico del síndrome del túnel del carpo y su correlación con estudios prequirúrgicos de conducción nerviosa.

INTRODUCTION: Carpal tunnel syndrome is the most prevalent compressive neuropathy and its medical costs in the United States exceed one billion dollars per year. Occurrence increases with age; prevalence is 0.6% in males and as much as 5.8% in females, in ages between 45 and 54 years. Besides a thorough case history, there are other more reliable diagnostic methods such as electrophysiological tests that include electromyography and conduction velocity tests. MATERIAL AND METHODS: A prospective, longitudinal analysis was conducted of patients with a diagnosis of Carpal tunnel syndrome confirmed with electromyography and evoked potentials. They were treated at Hospital Español de México in 2008-2009. RESULTS: Forty-seven patients were detected, representing 60 cases of carpal tunnel syndrome; 36 females, 11 males. In forty-seven percent of patients the right hand was involved; in 15% the left hand; 38% of patients had bilateral involvement. They underwent medical treatment and the results of the electrodiagnostic tests were good (61%), moderate (33%), and poor (6%). DISCUSSION: Isolated electromyography does not measure the true magnitude of the damage; however, motor conduction velocity becomes a relevant diagnostic method as it detects almost 50% of the patients at the time diagnosis. Patients with motor abnormalities had very favorable postoperative results compared to those with sensory abnormalities.

[Infection prevention during the perioperative period of primary hip and knee arthroplasty]. / Prevención de infecciones en el perioperatorio de la artroplastía primaria de cadera y rodilla.

All surgical wounds are at risk of contamination by pathogens that may get in through the incision. The pre-surgical bath with a skin antiseptic agent 24 hours prior to the surgery, the timing of administration of prophylactic antibiotics, the choice and postoperative duration of the latter, the number of individuals within the OR and the movement inside it, the choice of chlorhexidine gluconate for its long duration against gram-positive and gram-negative organisms, and the use of a hair remover or an electric razor, all of the former concepts, some new and others not so new, led to performing an extensive bibliographic review with the idea of starting a standardization process that could change the way in which institutions operate when performing primary joint replacement, trying to reduce the annual infection rate and upgrade the quality of life of patients.

[Periprosthetic femur fractures. Experience at hospital Español de México with a 2-year follow-up]. / Fracturas periprotésicas del fémur. Experiencia en el hospital Español de México a 2 años de seguimiento.

UNLABELLED: Periprosthetic fractures have had an increasing incidence in the past decades; their resolution is a difficult challenge even for the most experienced orthopedist surgeons. The Vancouver classification has contributed to a great extent to their better characterization and therapeutic guidance. The purpose of this paper is to make a review of the most recent advances on the topic and present our experience in the treatment of these fractures. MATERIAL AND METHODS: We describe the characteristics of a sample of 20 patients with periprosthetic femur fractures treated at our hospital from March 2008 to March 2010 and typed according to the Vancouver classification. RESULTS: Mean age was 74.5 years with a range of 65-87 years. Females were predominant (70%). Five cases were type A in the classification, 10 cases type B, and 5 cases type C. Nineteen underwent surgical treatment. The mean total length of stay was 7 days, with a range of 5-12. The mean healing time for types B and C was 4 months (range 3-6 months). Four patients had complications. The resolution was assessed as excellent in 5 cases (25%), good in 11 cases (55%), and poor in 4 cases (20%). CONCLUSIONS: A thorough individual assessment based on the Vancouver classification, age and the patient's functional requirements are the major parameters for treatment success.

[Comparison of the postoperative intraarticular use of RV023 and hyaluronate G-F20 in knee arthroscopy. Experience at Hospital Español de México]. / Comparación del uso intraarticular postoperatorio de RV023 y hialuronato G-F20 en artroscopía de rodilla. Experiencia en el Hospital Español de México.

For the past two decades arthroscopic surgery has revolutionized the treatment of acute traumatic knee injuries with patients returning sooner to activities of daily living. However, there are factors that delay this goal, such as postoperative intraarticular bleeding, and the swelling and pain that restrain immediate articular mobility. This paper analyzes such factors and their pathophysiologic processes. This led us to formulating a preparation for intraarticular use called RV023. The report of an original, prospective, longitudinal trial is presented herein, assessing the functional results of preparation RV023 in a 60-patient sample selected based on the following inclusion criteria: knee pain lasting 2 years and unresponsive to NSAID treatment, an MRI showing an Outerbridge grade I chondral injury without evidence of ligament or meniscal injury or fracture, and having undergone arthroscopic knee surgery. A significant difference was found in the articular function of subjects treated with the preparation as compared with those in whom it was not used. The articular function recovery curves of individuals treated with the preparation were virtually symmetrical to the curves for healthy controls. On the other hand, no allergic reactions, unwanted or side effects were reported. We therefore conclude that the safety and the benefits seen with preparation RV023 in experimental models are enough to support its use in humans.

[Percutaneous distal metatarsal osteotomy for the correction of hallux valgus]. / Osteotomía metatarsiana distal percutánea para corrección del hallux valgus.

OBJECTIVE: To evaluate the experience acquired in hallux valgus correction with percutaneous distal metatarsal osteotomy. MATERIAL AND METHODS: Retrospective study including patients who underwent percutaneous distal metatarsal osteotomy between May 2005 and May 2007. The age, sex, and number of feet operated on were recorded. The clinical evaluation of results 6 months after surgery using the AOFAS scale, the intermetatarsal angle and the hallux valgus angle were also recorded. RESULTS: A total of 40 patients were included; 38 females and 2 males; mean age was 49 years (28-73 years). Fifty-eight osteotomies were performed. According to the AOFAS scale, 28 patients (41/58 feet) had no pain. The mean functional capacity score was 41 points, and an excellent alignment was achieved in 74% of cases. The mean intermetatarsal angle was 7.5 degrees. Complications occurred in 2 patients (2 feet). CONCLUSIONS: The appropriate treatment for the correction of hallux valgus consists of minimally invasive procedures, except for the cases in which the metatarsophalangeal joint shows signs of arthrosis.