Artroscopia de cadera como tratamiento del choque femoroacetabular con seguimiento mínimo de 10 años / Hip arthroscopy for femoroacetabular impingement with 10-year minimum follow-up

Objetivo: Valorar los resultados de la artroscopia de cadera (CAC) como tratamiento del choque femoroacetabular (CFA) con seguimiento mínimo de 10 años, y determinar las variables predictoras de reintervención quirúrgica. Material y métodos: Estudio retrospectivo de una base de datos prospectiva de pacientes intervenidos mediante CAC entre enero de 2010 y diciembre de 2011. Las lesiones del reborde acetabular se evaluaron según la clasificación ALAD. Se realizó valoración clínica y radiológica. La supervivencia de la técnica quirúrgica se calculó con la prueba de Kaplan-Meier y la prueba de regresión de Cox. Resultados: Se incluyeron en el estudio 74 pacientes con un seguimiento medio de 132 meses. La puntuación media en las escalas de valoración mejoró significativamente al final del seguimiento. Diecisiete pacientes (23,9%) fueron reintervenidos. El odds ratio de reintervención en un paciente mayor de 40 años fue de 8,08; en un paciente Tönnis 2-3 de 7,57; y en un paciente con lesión cartilaginosa ALAD 2-3 de 4,25. La supervivencia de la CAC en el CFA a 10 años fue del 77,8%, con un 45,4% en los pacientes con grado de Tönnis mayor de 1 frente al 85,2% en los pacientes con grado de Tönnis de 1 o menor (p<0,001). La variable predictora asociada a la necesidad de reintervención quirúrgica fue la degeneración articular radiológica preoperatoria (p=0,02). Conclusiones: La supervivencia de la CAC en el tratamiento del CFA a 10 años fue del 45,4% en los pacientes con grado de Tönnis mayor de 1 frente al 85,2% en los pacientes con grado de Tönnis 1 o menor. La edad, la lesión cartilaginosa y la degeneración articular incrementarían el riesgo de reintervención quirúrgica.(AU)

Purpose: To determine outcomes after hip arthroscopy (HA) for femoroacetabular impingement (FAI) at a minimun 10-year follow up and identified risk factors for revision surgery. Methods: Retrospective study of a prospective database of patients undergoing HA between January 2010 and December 2011. Rim chondral injuries were evaluated using the acetabular labral articular disruptions system (ALAD). Clinical and radiological data was obtained. Cumulative survival was estimated by Kaplan–Meier and a multivariate Cox proportional hazards model. Results: Seventy-four patients were included in the study. Mean follow-up was 132 months. There was statistically significant improvement from preoperative PROs at latest follow-up. Seventeen patients (23.9%) underwent revision surgery. Odds ratio for revision surgery was 8.08 in a patient above 40 years old, 7.57 in a patient Tönnis greater than 1, and 4.25 in a patient ALAD 2-3. Cumulative survivorship rate at 10 years was 77.8%, with a 45.4% for patients with Tönnis grade greater than 1 in front of 85.2% for patients with Tönnis grade of 1 or less (P<.001). Risk factor for revision surgery was preoperative degree of osteoarthrosis (P=.02). Conclusion: Cumulative survivorship rate at 10 years was 45.4% for patients with Tönnis grade greater than 1 in front of 85.2% for patients with Tönnis grade of 1 or less (P<.001). Age, chondral injuries, and degree of osteoarthrosis would increase the risk for revision surgery.(AU)

[Translated article] Hip arthroscopy for femoroacetabular impingement with 10-year minimum follow-up / Artroscopia de cadera como tratamiento del choque femoroacetabular con seguimiento mínimo de 10 años

Objetivo: Valorar los resultados de la artroscopia de cadera (CAC) como tratamiento del choque femoroacetabular (CFA) con seguimiento mínimo de 10 años, y determinar las variables predictoras de reintervención quirúrgica. Material y métodos: Estudio retrospectivo de una base de datos prospectiva de pacientes intervenidos mediante CAC entre enero de 2010 y diciembre de 2011. Las lesiones del reborde acetabular se evaluaron según la clasificación ALAD. Se realizó valoración clínica y radiológica. La supervivencia de la técnica quirúrgica se calculó con la prueba de Kaplan-Meier y la prueba de regresión de Cox. Resultados: Se incluyeron en el estudio 74 pacientes con un seguimiento medio de 132 meses. La puntuación media en las escalas de valoración mejoró significativamente al final del seguimiento. Diecisiete pacientes (23,9%) fueron reintervenidos. El odds ratio de reintervención en un paciente mayor de 40 años fue de 8,08; en un paciente Tönnis 2-3 de 7,57; y en un paciente con lesión cartilaginosa ALAD 2-3 de 4,25. La supervivencia de la CAC en el CFA a 10 años fue del 77,8%, con un 45,4% en los pacientes con grado de Tönnis mayor de 1 frente al 85,2% en los pacientes con grado de Tönnis de 1 o menor (p<0,001). La variable predictora asociada a la necesidad de reintervención quirúrgica fue la degeneración articular radiológica preoperatoria (p=0,02). Conclusiones: La supervivencia de la CAC en el tratamiento del CFA a 10 años fue del 45,4% en los pacientes con grado de Tönnis mayor de 1 frente al 85,2% en los pacientes con grado de Tönnis 1 o menor. La edad, la lesión cartilaginosa y la degeneración articular incrementarían el riesgo de reintervención quirúrgica.(AU)

Purpose: To determine outcomes after hip arthroscopy (HA) for femoroacetabular impingement (FAI) at a minimun 10-year follow up and identified risk factors for revision surgery. Methods: Retrospective study of a prospective database of patients undergoing HA between January 2010 and December 2011. Rim chondral injuries were evaluated using the acetabular labral articular disruptions system (ALAD). Clinical and radiological data was obtained. Cumulative survival was estimated by Kaplan–Meier and a multivariate Cox proportional hazards model. Results: Seventy-four patients were included in the study. Mean follow-up was 132 months. There was statistically significant improvement from preoperative PROs at latest follow-up. Seventeen patients (23.9%) underwent revision surgery. Odds ratio for revision surgery was 8.08 in a patient above 40 years old, 7.57 in a patient Tönnis greater than 1, and 4.25 in a patient ALAD 2-3. Cumulative survivorship rate at 10 years was 77.8%, with a 45.4% for patients with Tönnis grade greater than 1 in front of 85.2% for patients with Tönnis grade of 1 or less (P<.001). Risk factor for revision surgery was preoperative degree of osteoarthrosis (P=.02). Conclusion: Cumulative survivorship rate at 10 years was 45.4% for patients with Tönnis grade greater than 1 in front of 85.2% for patients with Tönnis grade of 1 or less (P<.001). Age, chondral injuries, and degree of osteoarthrosis would increase the risk for revision surgery.(AU)

Hip arthroscopy for femoroacetabular impingement with 10-year minimum follow-up. / Artroscopia de cadera como tratamiento del choque femoroacetabular con seguimiento mínimo de 10 años.

PURPOSE: To determine outcomes after hip arthroscopy (HA) for femoroacetabular impingement (FAI) at a minimun 10-year follow up and identified risk factors for revision surgery. METHODS: Retrospective study of a prospective database of patients undergoing HA between January 2010 and December 2011. Rim chondral injuries were evaluated using the acetabular labral articular disruptions system (ALAD). Clinical and radiological data was obtained. Cumulative survival was estimated by Kaplan-Meier and a multivariate Cox proportional hazards model. RESULTS: Seventy-four patients were included in the study. Mean follow-up was 132 months. There was statistically significant improvement from preoperative PROs at latest follow-up. Seventeen patients (23.9%) underwent revision surgery. Odds ratio for revision surgery was 8.08 in a patient above 40 years old, 7.57 in a patient Tönnis greater than 1, and 4.25 in a patient ALAD 2-3. Cumulative survivorship rate at 10 years was 77.8%, with a 45.4% for patients with Tönnis grade greater than 1 in front of 85.2% for patients with Tönnis grade of 1 or less (P<.001). Risk factor for revision surgery was preoperative degree of osteoarthrosis (P=.02). CONCLUSION: Cumulative survivorship rate at 10 years was 45.4% for patients with Tönnis grade greater than 1 in front of 85.2% for patients with Tönnis grade of 1 or less (P<.001). Age, chondral injuries, and degree of osteoarthrosis would increase the risk for revision surgery.

[Translated article] Hip arthroscopy for femoroacetabular impingement with 10-year minimum follow-up.

PURPOSE: To determine outcomes after hip arthroscopy (HA) for femoroacetabular impingement (FAI) at a minimun 10-year follow up and identified risk factors for revision surgery. METHODS: Retrospective study of a prospective database of patients undergoing HA between January 2010 and December 2011. Rim chondral injuries were evaluated using the acetabular labral articular disruptions system (ALAD). Clinical and radiological data was obtained. Cumulative survival was estimated by Kaplan-Meier and a multivariate Cox proportional hazards model. RESULTS: Seventy-four patients were included in the study. Mean follow-up was 132 months. There was statistically significant improvement from preoperative PROs at latest follow-up. Seventeen patients (23.9%) underwent revision surgery. Odds ratio for revision surgery was 8.08 in a patient above 40 years old, 7.57 in a patient Tönnis greater than 1, and 4.25 in a patient ALAD 2-3. Cumulative survivorship rate at 10 years was 77.8%, with a 45.4% for patients with Tönnis grade greater than 1 in front of 85.2% for patients with Tönnis grade of 1 or less (p<.001). Risk factor for revision surgery was preoperative degree of osteoarthrosis (p=.02). CONCLUSION: Cumulative survivorship rate at 10 years was 45.4% for patients with Tönnis grade greater than 1 in front of 85.2% for patients with Tönnis grade of 1 or less (p<.001). Age, chondral injuries, and degree of osteoarthrosis would increase the risk for revision surgery.

Estudio de cohortes comparativo del abordaje Superpath con abordaje convencional posterior en cirugía protésica primaria de cadera no cementada: curva de aprendizaje y resultados a corto plazo / Comparative cohort study of the SuperPath approach and the conventional posterior approach in primary cementless hip replacement surgery

Antecedentes y objetivo: En la actualidad no existe un consenso sobre cuál es el mejor abordaje de cadera para implantar una prótesis. Sin embargo, sí existe una tendencia a reducir al máximo la lesión sobre los tejidos periarticulares, lo cual puede influir en los resultados a corto plazo. El abordaje Superpath permite el acceso a la articulación manteniendo la integridad de los rotadores externos. El objetivo de nuestro estudio fue comparar los resultados a corto plazo del abordaje Superpath con el abordaje convencional posterior. Materiales y métodos: Estudio prospectivo de cohorte de 30 pacientes intervenidos mediante abordaje Superpath pareados por sexo, edad, índice de masa corporal y valoración clínica, con 60 pacientes intervenidos mediante abordaje convencional posterior. La valoración clínica se realizó mediante la escala de Harris, Merle d'Aubigné, Womac para el dolor y la función, SF-12 físico y mental, HOS-AVD e IHOT-12. Radiológicamente se determinó el ángulo de inclinación acetabular, alineación del vástago femoral e integración de los implantes. Resultados: No hubo diferencias significativas entre ambas cohortes con respecto a las variables preoperatorias. El tiempo quirúrgico, el descenso medio de Hb y Hto y la pérdida sanguínea fue mayor en la cohorte Superpath. La estancia hospitalaria fue similar. Los cuestionarios de valoración clínica mostraron incrementos significativos entre los valores preoperatorios y a los 12 meses en ambas cohortes. El cuestionario IHOT-12 a los 3 meses, el cuestionario SF-12 físico y el cuestionario SF-12 mental a los 12 meses, mostró mayores puntuaciones en la cohorte Superpath, siendo las diferencias significativas. Radiológicamente no se detectaron diferencias entre ambas cohortes. Conclusiones: La curva de aprendizaje del abordaje Superpath presenta unos resultados clínicos y radiológicos similares al abordaje posterior durante el primer año tras la prótesis total de cadera. A destacar la necesidad de un mayor tiempo quirúrgico y un mayor sangrado en los pacientes

Background and objectives: There is no current consensus on the most suitable hip approach. However, there is a trend to reduce damage to soft tissue, which may have an influence on early outcomes. The SuperPath approach accesses the capsule maintaining integrity of the external rotators. The purpose of this study was to compare the SuperPath approach with the conventional posterior approach, in terms of early outcomes and radiological results. Material and methods: A cohort of 30 patients operated using the SuperPath approach was prospectively matched for age, gender, body mass index and hip function with 60 patients operated using a conventional posterior approach. Clinical evaluation was performed by the Harris score, Merle d'Aubigné score, reduced Western Ontario and McMasters Universities (WOMAC), Short-Form 12 (SF12), IHOT-ADV and IHOT-12 questionnaires. Radiological evaluation was also performed. Results: Preoperatively, no significant differences were detected between cohorts. Skin-to-skin operation time and blood loss was higher in the SuperPath cohort. Length of stay was similar between cohorts. Clinical evaluation improved significantly from the preoperative values to the 1-year follow-up. At 3 months the SuperPath cohort showed better results for IHOT-12, and at 12 months for SF. Radiologically, there were no differences between cohorts. Conclusion: This prospective randomized study reveals that the learning curve for the SuperPath approach provides similar outcomes to the conventional posterior approach within the first year after surgery. The Superpath approach was associated with longer skin-to-skin operation time, and greater blood loss

Comparative cohort study of the SuperPath approach and the conventional posterior approach in primary cementless hip replacement surgery. / Estudio de cohortes comparativo del abordaje Superpath con abordaje convencional posterior en cirugía protésica primaria de cadera no cementada: curva de aprendizaje y resultados a corto plazo.

BACKGROUND AND OBJECTIVES: There is no current consensus on the most suitable hip approach. However, there is a trend to reduce damage to soft tissue, which may have an influence on early outcomes. The SuperPath approach accesses the capsule maintaining integrity of the external rotators. The purpose of this study was to compare the SuperPath approach with the conventional posterior approach, in terms of early outcomes and radiological results. MATERIAL AND METHODS: A cohort of 30 patients operated using the SuperPath approach was prospectively matched for age, gender, body mass index and hip function with 60 patients operated using a conventional posterior approach. Clinical evaluation was performed by the Harris score, Merle d'Aubigné score, reduced Western Ontario and McMasters Universities (WOMAC), Short-Form 12 (SF12), IHOT-ADV and IHOT-12 questionnaires. Radiological evaluation was also performed. RESULTS: Preoperatively, no significant differences were detected between cohorts. Skin-to-skin operation time and blood loss was higher in the SuperPath cohort. Length of stay was similar between cohorts. Clinical evaluation improved significantly from the preoperative values to the 1-year follow-up. At 3 months the SuperPath cohort showed better results for IHOT-12, and at 12 months for SF. Radiologically, there were no differences between cohorts. CONCLUSION: This prospective randomized study reveals that the learning curve for the SuperPath approach provides similar outcomes to the conventional posterior approach within the first year after surgery. The Superpath approach was associated with longer skin-to-skin operation time, and greater blood loss.

Arthroscopic hip surgery with a microfracture procedure of acetabular full-thickness chondral damage. Cohort study with a 3-year follow-up. / Tratamiento artroscópico mediante microfracturas de la lesión cartilaginosa acetabular de espesor completo. Estudio de cohortes con seguimiento medio a 3 años.

INTRODUCTION AND PURPOSE: Management of injuries to the articular cartilage is complex and challenging. Our purpose was to assess outcomes of a cohort of patients who underwent hip arthroscopy with full-thickness chondral damage treated with microfracture and compare these outcomes with those from a similar cohort of patients who did not. MATERIAL AND METHODS: We prospectively gathered the data of 31 hips treated with microfracture from January 2009 to January 2016. In the cohort of hips without chondral damage there were 49 hips. All patients were assessed pre- and postoperatively with 4 patient-reported outcome instruments. RESULTS: The mean follow-up was 36.2 months in the cohort of patients with full-thickness chondral damage, and 36.6 months in the cohort of patients without chondral damage. Both groups demonstrated significant improvement in all patient-reported outcome instruments between preoperative and final follow-up. There was no statistically significant difference between both cohorts at final follow-up. DISCUSSION: This study showed that patients undergoing microfracture during hip arthroscopy had significant improvement in all patient-reported outcome instruments during follow-up. The greatest improvement was noted at 6 months postoperatively. Both groups showed no significant difference in final patient-reported outcome instruments scores.

Tönnis stage 0 and 1 acetabular rim cartilage injuries: Incidence, grade, location and associated pre-surgical factors. / Lesión cartilaginosa del reborde acetabular en estadios Tönnis 0 y 1: incidencia, grado, localización y factores preoperatorios asociados.

INTRODUCTION AND PURPOSE: Articular cartilage lesions have a direct effect on the success of surgical treatment. The aim of this study was to determine the prevalence rate, location, grade, and factors associated with acetabular rim articular cartilage lesions in patients undergoing hip arthroscopy. MATERIAL AND METHODS: A prospective study was conducted by analysing the intraoperative data of 152 hips in 122 patients treated with hip arthroscopy for femoroacetabular impingement from January 2011 to May 2016. The prevalence rate, location, and grade were calculated, as well as the pre-operative factors associated with acetabular rim articular cartilage lesions. RESULTS: The mean age of the patients was 38.6 years. The Tönnis grade was 0 in 103 hips, and 1 in 52 hips. Acetabular rim articular cartilage lesions were present in 109 (70.3%) hips. The location of the lesions was superior-anterior. Independent risk factors for the presence of acetabular rim articular cartilage lesions were an alpha-angle equal or greater than 55°, duration of symptoms equal or greater than 20 months, and Tegner activity scale level equal or greater than 6. DISCUSSION: Although patients were classified as Tönnis grade 0 and 1, and 3tesla MRI reported acetabular lesions in 1.3% of cases, there was a high frequency of acetabular rim cartilage lesions. Knowledge of the independent risk factors associated with acetabular rim articular cartilage lesions may assist the orthopaedic surgeon with the decision to perform hip arthroscopy.

[Post-traumatic elbow stiffness: arthroscopic release, short-term results]. / Rigidez postraumática de codo: resultados a corto plazo de la artrólisis artroscópica.

BACKGROUND: Open «arthrolysis¼ has been the standard treatment for elbow stiffness, with good results. However, the associated complications of open arthrolysis and the advancements in arthroscopic surgery have allowed including the latter as an additional approach. MATERIAL AND METHODS: Between January 2014 and March 2016, 6 patients with posttraumatic elbow stiffness underwent arthroscopic surgery by the same surgical team. Pre- and post-operative assessment included pain with a numerical visual analogue scale, elbow joint range of motion with a goniometer and the Mayo Elbow Performance Index questionnaire. RESULTS: Mean patient follow-up was 14.5 months. The mean VAS score decreased from 4.5 to 0.3. The mean elbow range of motion increased from 55.3o to 130o, with a mean gain of 75o. The mean MEPI questionnaire score went from 46.6 to 95, with a mean gain of 48.4 points. The procedures associated with arthroscopic «arthrolysis¼ included removal of the synthesis material from the 3 olecranon fractures. No cases of heterotopic ossification, superficial infection or ulnar neuropathy were reported. None of the patients required surgical reintervention to perform a new «arthrolysis¼, whether arthroscopic or open. CONCLUSIONS: Arthroscopic release to treat posttraumatic elbow stiffness is an effective technique to restore mobility in the short term.

ANTECEDENTES: La «artrólisis¼ abierta ha sido el tratamiento estándar en la rigidez de codo, con buenos resultados; sin embargo, las complicaciones asociadas y los avances en la cirugía artroscópica han permitido incorporar esta técnica quirúrgica. MATERIAL Y MÉTODOS: Entre Enero de 2014 y Marzo de 2016, seis pacientes con rigidez postraumática de codo fueron intervenidos mediante cirugía artroscópica por el mismo equipo quirúrgico. Se registró pre- y postoperatoriamente, el nivel de dolor según escala analógica visual numérica, rango de movilidad articular del codo con el uso de un goniómetro y cuestionario Mayo Elbow Performance Index. RESULTADOS: El seguimiento medio de los pacientes fue de 14.5 meses. El valor medio en la escala analógica visual disminuyó de 4.5 a 0.3 puntos. El rango medio de movilidad del codo se incrementó de 55.3o a 130o, con una ganancia media de 75o. La puntuación media en el cuestionario MEPI pasó de 46.6 puntos a 95 puntos, con una ganancia media de 48.4 puntos. Como procedimientos asociados a la «artrólisis¼ artroscópica se realizó extracción del material de síntesis en las tres fracturas de olécranon. No hubo ningún caso de osificación heterotópica, infección superficial o neuropatía cubital. Ningún paciente precisó reintervención quirúrgica para una nueva «artrólisis¼ artroscópica o abierta. CONCLUSIONES: La liberación artroscópica en la rigidez postraumática de codo es una técnica efectiva a corto plazo para recuperar la movilidad.

Asociación de fractura de olécranon y fractura de cabeza radial / Associated fractures of the olecranon and the radial head

Objetivo. El propósito de este trabajo es comparar el resultado final entre pacientes con fractura de olécranon asociada a fractura de cabeza de radio y pacientes con fractura aislada de olécranon o cabeza de radio. Material y método. Se revisaron retrospectivamente 13 pacientes con fractura de olécranon asociada a fractura de cabeza del radio. La edad media de la serie fue de 57 años, todas mujeres. Se realizó valoración funcional según los criterios de Broberg y Morrey, y radiológicamente se registró la existencia de cambios degenerativos y osificaciones heterotópicas y se midió el ángulo de transporte. Para comparar los resultados se seleccionaron durante el mismo período y de manera consecutiva los 13 primeros pacientes con fractura aislada de olécranon o de cabeza del radio. Resultados. El seguimiento medio fue de 36 meses (rango 18 a 120). Hubo 4 pacientes con resultado excelente, 4 buenos y 5 regulares. El rango de movilidad, la fuerza y el resultado final fue peor en los pacientes con fractura asociada de olécranon y cabeza de radio. El incremento medio del ángulo de transporte fue significativamente mayor en los pacientes con fractura asociada de olécranon y cabeza de radio. Conclusiones. Al presentarse ambas fracturas asociadas, existe una mayor limitación de la movilidad y de la fuerza del codo, un resultado funcional final menos satisfactorio y un mayor incremento del ángulo de transporte

Purpose. To compare the final results seen in patients with associated fractures of the olecranon and the radial head with patients with isolated fracture of the olecranon or the radial head. Materials and methods. A retrospective review was performed of 13 patients with associated fractures of the olecranon and the radial head. The mean age of the patients in the series was 57 years, all were women. Functional assessment was performed according to Broberg and Morrey criteria. X-rays were used to determine the presence of degenerative changes or heterotopic ossifications and the carrying angle of the elbow was measured. To compare results the first 13 consecutive patients with isolated fracture of the olecranon or radial head during the same period of time were selected. Results. Mean followup was 36 months (range 18 to 120). Excellent results were seen in 4 patients, good in 4, fair in 5. Range of movement, strength and final outcome were worse in patients with associated fractures of the olecranon and the radial head. The mean increase in the carrying angle was significantly greater in patients with associated fractures of the olecranon and the radial head. Conclusions. When both fractures were associated there was a greater limitation of mobility and strength of the elbow, a less satisfactory functional result and a greater increase of the carrying angle of the elbow