The young patient and the medial unicompartmental knee replacement.

PURPOSE: Younger patients with unicompartmental degenerative knee joint diseases present a therapeutic dilemma. The purpose of this study is to evaluate the long-term results of the Oxford phase III unicompartmental knee replacement through a minimally invasive approach in the young patient. METHODS: We have studied a total of 51 patients (59 interventions) who underwent the Oxford Phase III Unicompartmental Knee Replacement. A clinical, radiographical and functional evaluation was performed twelve years after intervention. RESULTS: According to the American Knee Society Score using Insall's criteria overall results of unicompartmental knee arthroplasty showed an excellent or good outcome for 53 knees (96.36%), fair for 1 (1.81%) and poor for 1 (1.81%) in the postoperative long term. The survival rate of the implants was close to 95% at follow-up. CONCLUSIONS: Twelve years follow-up results of UKA through a minimally invasive exposure in young patients demonstrate predictably good outcomes.

Utilidad de una vía clínica en el manejo del anciano con fractura de cadera / Clinical pathway for hip fracture patients

Introducción. La fractura de cadera del anciano se asocia con elevada comorbilidad, por lo que requiere un enfoque integral y multidisciplinar. Objetivo. Evaluar el efecto de una intervención de mejora de calidad en la detección y tratamiento de complicaciones del anciano que ingresa por fractura de cadera. Material y métodos. Estudio comparativo entre dos cohortes de pacientes ingresados por fractura de cadera antes (2010) y después de instaurar una vía clínica (2013). La intervención consistió en la implantación de protocolos para el manejo de los problemas más prevalentes, según la evidencia científica actual y se evaluó el grado de cumplimiento de las medidas implementadas. Resultados. Las características de los pacientes ingresados por fractura de cadera en 2010 (216 pacientes) y 2013 (196 pacientes) fueron similares en edad, sexo, índice de Barthel e índice de Charlson abreviado, aunque con mayor número de comorbilidades en el 2013. Tras la implantación de los protocolos, se incrementó la detección de delirium, desnutrición, anemia y trastornos electrolíticos, aumentando la prescripción de hierro por vía intravenosa (en un 24%) y de tratamiento para la osteoporosis (61,3%). La estancia media se redujo un 45,3% y la demora quirúrgica un 29,4%, consiguiéndose una mejor eficiencia funcional. Conclusión. La aplicación de una vía clínica en el proceso asistencial del paciente geriátrico con fractura de cadera es útil no solo para detectar y tratar de forma precoz las complicaciones sino también para reducir la estancia prequirúrgica y global, todo ello sin repercusión negativa en el aspecto clínico y funcional (AU)

Introduction. Hip fracture in the elderly often occurs in patients with high co-morbidity. Effective management requires a comprehensive and multidisciplinary approach. Purpose. To evaluate the effect of a quality improvement intervention in the detection and treatment of complications in elderly patients admitted for hip fracture. Material and methods. A comparative study was conducted between two groups of patients admitted for hip fracture prior to 2010, and after a quality improvement intervention in 2013. The intervention consisted of implementing improved multidisciplinary measures in accordance with recent scientific evidence. The degree of compliance of the implemented measures was quantified. Results. Patients admitted due to hip fracture in 2010 (216 patients) and 2013 (196 patients) were similar in age, sex, Barthel Index, and a reduced Charlson Index, although there were more comorbidities in 2013. After implementation of the protocols, the detection of delirium, malnutrition, anemia, and electrolyte disturbances increased. A larger number of patients in 2013 were precribed intravenous iron (24% more) and osteoporosis treatment (61.3% more). The average stay was reduced by 45.3% and surgical delay by 29.4%, achieving better functional efficiency. Conclusion. The implementation of a clinical pathway in geriatric patients with hip fracture is useful to detect and treat complications at an early stage, and to reduce pre-operative and overall stay, all without a negative clinical or functional impact (AU)

[Clinical pathway for hip fracture patients]. / Utilidad de una vía clínica en el manejo del anciano con fractura de cadera.

INTRODUCTION: Hip fracture in the elderly often occurs in patients with high co-morbidity. Effective management requires a comprehensive and multidisciplinary approach. PURPOSE: To evaluate the effect of a quality improvement intervention in the detection and treatment of complications in elderly patients admitted for hip fracture. MATERIAL AND METHODS: A comparative study was conducted between two groups of patients admitted for hip fracture prior to 2010, and after a quality improvement intervention in 2013. The intervention consisted of implementing improved multidisciplinary measures in accordance with recent scientific evidence. The degree of compliance of the implemented measures was quantified. RESULTS: Patients admitted due to hip fracture in 2010 (216 patients) and 2013 (196 patients) were similar in age, sex, Barthel Index, and a reduced Charlson Index, although there were more comorbidities in 2013. After implementation of the protocols, the detection of delirium, malnutrition, anemia, and electrolyte disturbances increased. A larger number of patients in 2013 were precribed intravenous iron (24% more) and osteoporosis treatment (61.3% more). The average stay was reduced by 45.3% and surgical delay by 29.4%, achieving better functional efficiency. CONCLUSION: The implementation of a clinical pathway in geriatric patients with hip fracture is useful to detect and treat complications at an early stage, and to reduce pre-operative and overall stay, all without a negative clinical or functional impact.

Rhizarthrosis fourth grade of eaton with hyperextension of the metacarpophalangeal joint.

INTRODUCTION: Restoration of thumb function with a painfree, stable, and mobile joint with preserved strength are the main goals of treatment of painful arthritis of the thumb. We present our clinical experience in surgical treatment of this disease, in its highest degree of affectation. PRESENTATION OF CASE: A 57-year-old woman presents with a 2-year history of worsening pain at the base of her right, dominant, trapezial-metacarpal (TM) joint. Her thumb metacarpophalangeal (MCP) joint hyperextends 30° with lateral pinch. Radiographs demonstrate Eaton stage IV degenerative changes of her TM joint and no arthritis of her thumb MCP joint. She was successfully treated with a modified Burton-Pellegrini arthroplasty and sesamoidesis to the metacarpal head. DISCUSSION: In cases of advanced rhizarthrosis conventional surgery does not serve to correct deformities of the metacarpophalangeal joint that may affect to the postsurgical outcomes. CONCLUSION: rhizarthrosis management must be carried out in a global way. When a surgical treatment is planned, all deformities must be taken into account.

Long-term results of the retrocapital metatarsal percutaneous osteotomy for hallux valgus.

PURPOSE: The current trend in hallux valgus surgery is directed toward percutaneous procedures. However, no evidence that any of these methods of treatment are superior to the others has been described, excepting studies in the long term. The aim of this study was to analyse a series of patients who had undergone a percutaneous distal retrocapital osteotomy of the first metatarsal, and had been followed up for ten years. METHODS: We carried out a clinical and radiological evaluation of 115 feet ten years after surgery. RESULTS: The AOFAS scale results in the tenth postoperative year remained significantly favourable compared to their corresponding values in the preoperative period, yielding an improvement of 42.2 points overall on average. In relation to radiological findings, the mean hallux angle was maintained below 20 °, with a mean intermetatarsal angle of 8.1 °. CONCLUSION: Percutaneous retrocapital metatarsal osteotomy for treatment of mild to moderate hallux valgus is effective in the long term, with the advantages of a minimally invasive procedure.

Long-term effects of preserving or splitting the carpal ligament in carpal tunnel operation.

Carpal tunnel syndrome is treated very successfully by surgical release of the flexor retinaculum. However, in some patients, all symptoms are not resolved. Weakness in grip strength and pain in the thenar and hypothenar areas corresponding to the end of the transverse ligament after its complete section have been described as common complications of classical neurolysis of the median nerve. This study presents here the long-term results of decompression operation of the median nerve at the wrist, conserving the transverse ligament, as well as its comparison with the classical open neurolysis with a complete section of the ligament. This is an analysis of a retrospective cohort of 114 patients, who were operated on for carpal tunnel syndrome. A clinical, electromyographic, and dynamometric evaluation of the patients studied was carried out in a comparative analysis of the surgical techniques used (flexor retinaculum lengthening according to the Simonetta technique and classical open neurolysis of the median nerve), in a period of 10 years after the operation. The ligamentoplasty technique, in the long-term, contributes to better results of manual force, with a smaller resolution of tingling sensations than the neurolysis with complete section of the transverse ligament. For those patients who do not present a severe clinical or electromyographic syndrome, and in addition require manual effort for their daily activities, the technique of ligamentoplasty, according to Simonetta, is a surgical option to be taken into account.

La neurólisis del nervio mediano en el paciente anciano: evaluación a largo plazo / Neurolysis of the median nerve in the elderly: a long term evaluation

Objetivos. La descompresión del nervio mediano mediante la apertura del retináculo flexor se considera un tratamiento satisfactorio en pacientes afectos del síndrome del túnel carpiano. No obstante, diversos factores como la edad, pueden influir en los resultados postoperatorios. Presentamos los resultados a largo plazo de la cirugía de descompresión del nervio mediano en la muñeca en pacientes de edad avanzada. Métodos. Se trata de un estudio prospectivo histórico, a largo plazo, sobre 52 pacientes intervenidos a una edad de 65 años o superior del síndrome del túnel carpiano. Hemos llevado a cabo una valoración clínico-funcional (cuestionario de Levine et al.), electromiográfica y dinamométrica de los pacientes estudiados, referida a un tiempo postoperatorio medio de 10 años. Resultados. Los valores del cuestionario de Levine revelaron resultados favorables en el postoperatorio, a un seguimiento medio de 10,35 años, con una mejoría media en la escala clínica del cuestionario de 1,93 puntos (intervalo de confianza [IC] del 95%: 1,72-2,17) y en la escala funcional de 0,83 puntos (IC del 95%: 0,68-0,99). De igual modo, los valores electromiográficos presentaron una mejoría significativa respecto a sus valores preoperatorios (mejoría media de velocidad sensitiva 8,43m/s, IC del 95%: 8,17-11,63; mejoría media de latencia motora 1,65ms, IC del 95%: 1,24-2,25). Los datos de fuerza de presión manual no alcanzaron significación estadística. Conclusiones. En pacientes de edad avanzada, la sección completa del ligamento transverso del carpo permite mantener diferencias favorables en la mayoría de los parámetros estudiados tras 10 años desde la cirugía, siendo el tratamiento quirúrgico una opción recomendable(AU)

Purpose. Carpal tunnel release by opening the flexor retinaculum is considered a satisfactory treatment. However, several factors, like ageing, may influence postoperative results. We present the long term outcomes in elderly patients. Methods. This is an historical prospective long term study of 52 patients who received surgical treatment of carpal tunnel syndrome when they were 65 or older. We have carried out a clinical-functional (with the Levine questionnaire), electromyographic and dynamometric valuation of the patients studied, up to ten years from the surgery. Results. The results of Levine's questionnaire, revealed favourable data for a mean follow-up of 10.35 years, with a mean improvement in the clinical score of 1.93 points (95% confidence interval [CI]: 1.72-2.17) and in the functional score of 0.83 points (95% CI: 0.68-0.99). Similarly, the electromyographic values showed a significant improvement compared to preoperative ones (mean difference of sensory velocity of 8.43m/s, 95% CI: 8.17-11.63; mean difference of motor latency of 1.65ms, 95% CI: 1.24-2.25). The data on grip strength did not reach statistical significance. Conclusions. In elderly patients, complete section of the carpal transverse ligament, allows maintaining favourable differences in most of the parameters studied, ten years after surgery, making the surgical treatment a recommendable option(AU)

Oxford phase 3 unicondylar knee arthroplasty through a minimally invasive approach: long-term results.

PURPOSE: Surgical treatment options for medial compartment osteoarthritis of the knee include high tibial osteotomy, total knee arthroplasty or unicompartmental knee arthroplasty (UKA), depending on the patient's age, level of physical activity and the degree of deformity. METHODS: In this study, we evaluated the long-term results of patients who underwent the Oxford cemented meniscal-bearing unicondylar knee prosthesis through a minimally invasive approach including a clinical, functional and radiographic assessment. RESULTS: Favourable clinical and radiological outcomes were registered overall at ten years after surgery. Overall results of UKA according to the American Knee Society (AKS) using Insall's criteria showed an excellent or good outcome for 492 knees (96.28 %), fair for 11 (2.15 %) and poor for eight (1.57 %) in the post-operative long term. CONCLUSIONS: We believe that with appropriate surgical technique, patient selection, prosthetic design and specific training, surgeons should achieve good outcomes with the added advantages of a minimally invasive approach. High volume for this technique is important in our opinion.

[Neurolysis of the median nerve in the elderly: a long term evaluation]. / La neurólisis del nervio mediano en el paciente anciano: evaluación a largo plazo.

PURPOSE: Carpal tunnel release by opening the flexor retinaculum is considered a satisfactory treatment. However, several factors, like ageing, may influence postoperative results. We present the long term outcomes in elderly patients. METHODS: This is an historical prospective long term study of 52 patients who received surgical treatment of carpal tunnel syndrome when they were 65 or older. We have carried out a clinical-functional (with the Levine questionnaire), electromyographic and dynamometric valuation of the patients studied, up to ten years from the surgery. RESULTS: The results of Levine's questionnaire, revealed favourable data for a mean follow-up of 10.35 years, with a mean improvement in the clinical score of 1.93 points (95% confidence interval [CI]: 1.72-2.17) and in the functional score of 0.83 points (95% CI: 0.68-0.99). Similarly, the electromyographic values showed a significant improvement compared to preoperative ones (mean difference of sensory velocity of 8.43m/s, 95% CI: 8.17-11.63; mean difference of motor latency of 1.65ms, 95% CI: 1.24-2.25). The data on grip strength did not reach statistical significance. CONCLUSIONS: In elderly patients, complete section of the carpal transverse ligament, allows maintaining favourable differences in most of the parameters studied, ten years after surgery, making the surgical treatment a recommendable option.