Influence of total hip arthroplasty and physicians advices in the sports activity performed after the surgery. / Influencia de la artroplastia total de cadera y el consejo médico en la actividad deportiva realizada después de la intervención.

BACKGROUND AND OBJECTIVES: There are no randomized prospective studies that evaluate sports activity after total hip arthroplasty (THA). The objective of this study is to assess the level and type of sports activity in patients undergoing THA and to assess the recommendations given by physicians. MATERIALS AND METHODS: We performed a descriptive study that analyzes 46 patients (the average age was 41 years, range 37 - 48) under 50 years of age who underwent THA (58 hips) in our center. The average follow-up was 7.5 (1 - 11) years. Age, sex, sports activity according to the UCLA scale, sports activities practiced before and after the intervention, complications and recommendations given by doctors were evaluated. RESULTS: The average time to resume sport activity after the surgery was 5 (3-10) months. There were no differences in the UCLA scale before and after the operation (P> 0.05). The most practiced sport before the surgery was swimming (17%). The 31% of patients did not receive advice from their physician and the 65.2% were dissuaded from playing sports after ATC. The recommended sports were swimming (44%) and the static bicycle (17.5%), correlating with the most practiced sports after the operation. CONCLUSION: The patients modified their sport activity after having undergone a total hip arthroplasty. The surgery and the physician's advice were the ones that influenced the choice of the sports activity performed after being operated on.

Rivaroxaban is as efficient and safe as bemiparin as thromboprophylaxis in knee arthroscopy.

PURPOSE: The aim of this study is to compare effectiveness and safety profile of rivaroxaban with bemiparin in 3-week extended prophylaxis after knee arthroscopy. METHODS: Four hundred and sixty-seven patients were included in this review divided in two groups. One followed prophylaxis with rivaroxaban and the other one with bemiparin. All patients were interviewed and explored at 1 and 3 months postoperatively, looking for symptomatic signs of deep-vein thrombosis (DVT). In case of suspicion, diagnostic tests were performed. Collected data were age, sex, gender, diagnosis, time with ischemia, body mass index, concomitant diseases, concomitant therapy, DVT signs, treatment satisfaction, minor and major complications, treatment adherence and tolerability. RESULTS: No thromboembolic events were observed in any of the groups. In one case treated with rivaroxaban, the drug had to be withdrawn due to epistaxis. CONCLUSIONS: Our study showed that extended prophylaxis with 10 mg of rivaroxaban once daily for 3 weeks resulted as effective as bemiparin in knee arthroscopy thromboprophylaxis.

Inferior Lateral Genicular Artery Injury during Anterior Cruciate Ligament Reconstruction Surgery.

We report a case of inferior lateral genicular artery (ILG) injury during anterior cruciate ligament (ACL) reconstruction surgery with lateral partial meniscectomy. This is a rare arthroscopy complication. A review of the literature has been made with the aim to define the anatomy of ILG across the lateral articular line and the risk of lesion during knee arthroscopy. We propose embolization as a good treatment option for this type of injuries.

Idiopathic osteonecrosis of the medial tibial plateau.

Osteonecrosis of the medial tibial plateau is characterized by acute pain on the medial aspect of the knee. Progression can lead to articular collapse and requires early diagnosis and treatment. We studied seven patients affected of idiopathic osteonecrosis of the tibial plateau. The mean age was 62 years and the mean follow-up 42 months. We performed roentgenograms in all patients, bone scans in three patients and magnetic resonance image (MRI) in five. MRI shows T1-weighted low-intensity signal and T2-weighted high-intensity signal with a surrounding area of intermediate low-intensity signal. An increased focal uptake was seen at bone scan. Histological findings showed necrotic bone with empty lacunae. Surgical treatment consisted of tibial subchondral drilling in four patients-two of them by failure of conservative treatment, and a total knee arthroplasty in other two. One patient had a satisfactory evolution with conservative treatment. Idiopathic osteonecrosis of the tibial plateau must be considered in elderly patients with knee pain over the medial tibial plateau. At early stages, decompression with tibial drilling must be considered. This procedure allows a prompt and effective relief of symptoms.

Positive culture in allograft ACL-reconstruction: what to do?

The transmission of disease or infection from the donor to the recipient is always a risk with the use of allografts. We carried out a research study on the behavioural pattern of implanted allografts, which were initially stored in perfect conditions (all cultures being negative) but later presented positive cultures at the implantation stage. Because there is no information available on how to deal with this type of situation, our aim was to set guidelines on the course of action which would be required in such a case. We conducted a retrospective study of 181 patients who underwent an ACL reconstruction using BPTB allografts. All previous bone and blood cultures and tests for hepatitis B and C, syphilis and HIV were negative. An allograft sample was taken for culture in the operating theatre just before its implantation. The results of the cultures were obtained 3-5 days after the operation. We had 24 allografts with positive culture (13.25%) after the implantation with no clinical infection in any of these patients. Positive cultures could be caused by undetected contamination while harvesting, storing or during manipulation before implantation. The lack of clinical signs of infection during the follow-up of our patients may indicate that no specific treatment-other than an antibiotic protocol-would be required when facing a case of positive culture of a graft piece after its implantation.

[Levofloxacin. Clinical experience with long-term treatment of osteoarticular infections]. / Levofloxacino. Experiencia clínica en tratamientos de larga duración de infecciones osteoarticulares.

We evaluated the efficacy and safety profile of the long-term administration of levofloxacin in osteoarticular infections. For this purpose, 50 patients were included during the years 1999 to 2001 on an initial estimation to be under treatment with this antibiotic for at least 4 weeks. Forty six percent (46%) of patients were male and received treatment during a mean-time of 122.8 days. In forty one of a total of forty nine evaluable patients (83.7%) outcome was considered satisfactory with a total recovery or improvement of disease. Clinical and analytical series of examinations were performed, with no significant abnormalities being observed. Five (5) patients presented a total of 7 adverse events: gastrointestinal intolerance (3), oral mycosis (1), petechia (1), parestesia (1) and pruriginous rash(1). Only in three cases interruption of therapy was considered necessary. In conclusion, levofloxacin presents an adequate efficacy and is a well-tolerated therapy; both characteristics make it an appropriate treatment for those infections that require long-term therapy.

Hemostatic markers in surgery: a different fibrinolytic activity may be of pathophysiological significance in orthopedic versus abdominal surgery.

Without prophylaxis, patients subjected to major abdominal surgery have a risk of deep vein thrombosis of approximately 30%, while the rate varies between 40% and 60% in orthopedic surgery. The reasons for this discrepancy are not completely understood. The present study was designed to compare the pre- and postoperative behavior of different coagulation and fibrinolysis parameters in patients undergoing both types of surgery, receiving low molecular weight heparin prophylaxis. Samples were taken before operation and on postoperative days 1, 3, and 7. The following parameters were assessed: prothrombin fragment 1 + 2, thrombin-antithrombin III complexes, fibrinopeptide A, tissue plasminogen activator, plasminogen activator inhibitor, plasmin-alpha 2-antiplasmin complexes, and fibrin degradation products. We found a significant increase in the clotting markers postoperatively compared with preoperative values (P < 0.05), both in abdominal and orthopedic surgery, indicating a marked hemostatic activation which remained until postoperative day 7. A significant increase in plasminogen activator inhibitor (P < 0.01) and a decrease in tissue plasminogen activator and plasmin-alpha 2-antiplasmin complexes was also observed early after operation. The plasminogen activator inhibitor activity decreased, while tissue plasminogen activator and plasmin-alpha 2-antiplasmin levels increased significantly on days 3 and 7 (P < 0.05). Fibrin degradation products significantly increased throughout the postoperative period (P < 0.01). Preoperatively, we found higher plasminogen activator inhibitor activity and lower tissue plasminogen activator and plasmin-alpha 2-antiplasmin complexes (P < 0.05) in patients undergoing hip replacement compared with abdominal surgery. Fibrin degradation products were also significantly lower on postoperative day 3 in patients undergoing hip replacement (P < 0.01). We suggest that the lower preoperative fibrinolytic activation observed in patients undergoing orthopedic surgery compared with abdominal surgery might have pathophysiological consequences. Our results also indicate that the hemostatic activation persists beyond the 7th postoperative day despite prophylaxis.

[Transplantation in orthopedic surgery and traumatology]. / Los trasplantes en cirugía ortopédica y traumatología.

Clinical applications of the musculoskeletal system tissue bank are currently enlarging in areas such as tumour surgery, spine surgery and arthrodesis, reconstructive procedures of the hip joint and ligament repair. We report our experience about the use of more than 1,000 grafts utilize from 1987 to 1992. We concluded that a bone bank or a musculoskeletal system tissue bank has a great usefulness in different reconstructive surgery technics and arthrodesis. They are used more frequently in orthopaedic and traumatology surgery improving the development of this surgery.

[Sugioka rotational osteotomy in ischemic osteonecrosis of the femoral head]. / Osteotomia di rotazione secondo Sugioka nella osteonecrosi ischemica della testa femorale.

The treatment of ischemic necrosis of the femoral head depends on the stage and the age of the patient. Sugioka's rotational osteotomy is an alternative between the different conservative techniques. We have used this technique in 12 patient and 13 hips. The mean age of the patients was 31.8 ranging from 20 to 40. In the first 4 patients we performed the classic technique, as described by Sugioka. In the rest of the patients we used a DHS to stabilize the rotation and a maleolar screw for trochanteric osteotomy. The follow-up ranged between 24 and 67 months, average 42.46 months. The main complications were: 1 embolism, 1 trochanteric pseudoarthrosis and 1 common personal nerve lesion. The radiologic study showed progression in the majority of the cases. Clinical examination was performed following Merle D'Aubigné criteria pre and post surgery. We found 1 excellent result, 3 good, 3 fair and 6 poor (four of them needed a T.H.R.). Based on our experience, we have suggested a protocol for the treatment of ischemic necrosis of the femoral head. We believe that Sugioka's osteotomy can be indicated in patients younger than 50 and with less than 200 degrees affected (Stage III). The modifications we have made may be useful to achieve a better stabilization of the osteotomy and to improve the postoperative period. We have observed an improvement in the pain and gait in 60% of the patients. The radiologic study showed a progressive deterioration but there was no correlation between the clinical and radiological findings. Sugioka's technique allows the preservation of the femoral head delaying the total hip replacement.

Anterior cruciate ligament reconstruction with fresh-frozen patellar tendon allografts.

A prospective study was performed on 30 patients who underwent an anterior cruciate ligament reconstruction with fresh-frozen patellar tendon allograft. An arthroscopic technique alone was used in 10 patients, and in the other 20 patients this was combined with a miniarthrotomy. After a mean follow up of 35 months, the overall functional results were satisfactory in 85%. There were no cases of infection, disease transmission or tissue rejection. Fresh-frozen patellar tendon allografts are a good method of anterior cruciate reconstruction.

[Tissue bank for the musculoskeletal system. Clinical applications]. / Banco de tejidos del sistema musculoesquelético. Aplicaciones clínicas.

From June 1987 to June 1990, the musculoskeletal system tissues bank of the Orthopaedics and Traumatology Department of the University Clinic of Navarra has used 310 allografts. Of this, 219 has been used in our Department, 142 of cancellous bone and 42 of cortical bone. 24 of patellar tendon and 11 of fascia lata. The other 91 grafts have been sent to other hospitals in the country. In the present work we make a retrospective study that included the patients who were operate with allograft. We observe the differences between several types of allografts comparing them with conventional surgery technics. Within the complications we distinguished a 10.52% of infection in cortical bone allografts used in patients with neoplastic treatment. In the other type of allograft we didn't present this complication. We concluded that a bone bank or a musculoskeletal system tissues bank has a great usefulness in different reconstructive surgery technics and arthrodesis. They are used more frequent in orthopaedics and traumatology surgery improving the development of this surgery.

Long term evaluation of high tibial valgus osteotomy.

We present a long term evaluation of 100 high valgus tibial osteotomies with a mean follow up of 11 years. Knees with slight or moderate osteoarthritis had the best results. Slight overcorrection was beneficial, but gross overcorrection was not. There were few complications and the overall long term results were good.

The place of intertrochanteric osteotomy in the treatment of idiopathic necrosis of the head of the femur.

The authors present their experience of the use of intertrochanteric osteotomy for the treatment of idiopathic necrosis of the head of the femur. The results obtained from 102 osteotomies performed on 81 patients with the disease are analysed. The mean follow-up is 4.2 years. The results show a statistically significant clinical improvement after operation. Patients presenting with Ficat and Arlet Stage II involvement fared much better than those with more severe changes. Better results were also seen in those with a necrosis angle of less than 200 degrees. No radiological improvement was seen although a high percentage showed no deterioration. The choice of treatment for the condition is discussed in the light of these results.

Treatment of infected tibial pseudarthrosis by external fixation with the Wagner device.

We analyzed our experience with infected tibial pseudoarthrosis which resulted in a therapeutic plan for a radical operation or a step-by-step method, depending on the type of pseudarthrosis (PS), the severity of the infection, and the skin damage. We think that external fixation with the Wagner device is the procedure of choice. Owing to its simplicity and good stability, it is possible to treat the PS and the infection and to obtain good final results.

Aseptic diaphyseal pseudarthrosis: treatment by rigid internal fixation.

The authors define their concepts with regard to nonunion of fractures and study the possible causes of aseptic diaphyseal pseudarthrosis in the 182 cases in their casuistics. They have found that the indication for osteosynthesis was incorrect in 34% of the cases and when it was correct, the technique was poor in 58%. The authors conclude that the risk of nonunion in fractures and nonconsolidation of pseudarthrosis can be minimished if there is: (1) correct indication with respect to type and level of fracture or pseudarthrosis; (2) choice of an appropriate internal fixation method; and (3) good achievement of the selected osteosynthesis.

[The influence of age on the end-results of the total surgical replacement of the hip]. / Influencia de la edad en el resultado de la cirugía sustitutiva total de la cadera.

A revision of the first 700 total hip prostheses (operated on in the period 1969-1980) is carried out with the purpose to establish the influence of the age on the evolution of the arthroplasty. The results are very satisfactory but it is younger patients that complications related to loosening are more frequent. This fact can be explained by a longer period of evolution and a major prosthetic stress in these patients. By this reason, we do not use actually cement to fix the implants in those patients younger than sixty.

Chronic lateral instability of the ankle.

The authors present 14 cases of chronic lateral instability of the ankle in 13 patients, in whom we performed ligamentoplasty using peroneus lateral brevis. The importance of careful preoperative evaluation of clinical findings as well as stress-roentgenograms and arthrographies is emphasized and a simple surgical technique is presented. We also realize an assessment of the results obtained which are very encouraging at the present.

Osteotomies in the treatment of gonarthrosis.

The indications to perform an osteotomy of the knee in cases of a degenerative osteoarthritis are reviewed. The pre-, intra- and postoperative management is explained and the results of a hundred valgus osteotomies are evaluated. Our conclusions are based on the numerous indications for an osteotomy and its satisfactory results.