Eficacia y seguridad de la aplicación del ácido tranexámico tópico en la artroplastia primaria no cementada de cadera: estudio prospectivo, aleatorizado, doble ciego y controlado / Efficacy and safety of the topical application of tranexamic acid in primary cementless hip arthroplasty: prospective, randomised, double-blind and controlled study

Objetivo. Evaluar la eficacia del ácido tranexámico tópico en la artroplastia total de cadera no cementada desde el punto de vista del sangrado, las necesidades transfusionales y la estancia media, así como describir las complicaciones derivadas de su uso respecto a un grupo control. Material y métodos. Estudio prospectivo, aleatorizado, controlado y doble ciego que incluye todos los pacientes intervenidos de artroplastia total de cadera no cementada en nuestro centro entre junio de 2014 y julio de 2015. La pérdida de sangre se estimó mediante la fórmula descrita por Nadler y Good. Resultados. El análisis final incluyó 119 pacientes. El descenso de hemoglobina tras la cirugía fue menor en el grupo del ácido tranexámico (3,28±1,13g/dL) que en el control (4,03±1,27g/dL, p=0,001), así como el volumen estimado de sangre perdida (1.216,75±410,46mL vs. 1.542,12±498,97mL, p<0,001), el porcentaje de pacientes transfundidos (35,9% vs. 19,3%, p<0,05) y el número de unidades de hematíes transfundidas por paciente (0,37±0,77 vs. 0,98±1,77, p<0,05). No hubo diferencias entre los grupos en la aparición de complicaciones ni en la estancia media. Conclusiones. El uso de ácido tranexámico tópico en la artroplastia total de cadera no cementada produce una disminución en las necesidades transfusionales y el sangrado sin aumentar la incidencia de las complicaciones (AU)

Objective. To evaluate the efficacy of topical tranexamic acid topical in cementless total hip arthroplasty from the point of view of bleeding, transfusion requirements and length of stay, and describe the complications of use compared to a control group. Material and methods. A prospective, randomised, double-blinded and controlled study including all patients undergoing cementless total hip arthroplasty in our centre between June 2014 and July 2015. Blood loss was estimated using the formula described by Nadler and Good. Results. The final analysis included 119 patients. The decrease in haemoglobin after surgery was lower in the tranexamic acid group (3.28±1.13g/dL) than in the controls (4.03±1.27g/dL, P=.001) and estimated blood loss (1,216.75±410.46mL vs. 1,542.12±498.97mL, P<.001), the percentage of transfused patients (35.9% vs. 19.3%, P<.05) and the number of transfused red blood cell units per patient (0.37±0.77 vs. 0.98±1.77; P<.05). There were no differences between groups in the occurrence of complications or length of stay. Conclusions. The use of topical tranexamic acid in cementless total hip arthroplasty results in a decrease in bleeding and transfusion requirements without increasing the incidence of complications (AU)

Efficacy and safety of the topical application of tranexamic acid in primary cementless hip arthroplasty: prospective, randomised, double-blind and controlled study. / Eficacia y seguridad de la aplicación del ácido tranexámico tópico en la artroplastia primaria no cementada de cadera: estudio prospectivo, aleatorizado, doble ciego y controlado.

OBJECTIVE: To evaluate the efficacy of topical tranexamic acid topical in cementless total hip arthroplasty from the point of view of bleeding, transfusion requirements and length of stay, and describe the complications of use compared to a control group. MATERIAL AND METHODS: A prospective, randomised, double-blinded and controlled study including all patients undergoing cementless total hip arthroplasty in our centre between June 2014 and July 2015. Blood loss was estimated using the formula described by Nadler and Good. RESULTS: The final analysis included 119 patients. The decrease in haemoglobin after surgery was lower in the tranexamic acid group (3.28±1.13g/dL) than in the controls (4.03±1.27g/dL, P=.001) and estimated blood loss (1,216.75±410.46mL vs. 1,542.12±498.97mL, P<.001), the percentage of transfused patients (35.9% vs. 19.3%, P<.05) and the number of transfused red blood cell units per patient (0.37±0.77 vs. 0.98±1.77; P<.05). There were no differences between groups in the occurrence of complications or length of stay. CONCLUSIONS: The use of topical tranexamic acid in cementless total hip arthroplasty results in a decrease in bleeding and transfusion requirements without increasing the incidence of complications.

Artrodiastasis de cadera en la enfermedad de Legg-Calvé-Perthes / Hip arthrodiastasis in Legg-Calvé-Perthes disease

Introducción y objetivo. La artrodiastasis consiste en la movilización de la cadera mediante la distracción por medio de un fijador externo articulado. El objetivo de nuestro estudio es mostrar los resultados obtenidos en nuestro centro en el tratamiento de la enfermedad de Perthes de inicio tardío o de mal pronóstico con esta técnica quirúrgica. Material y métodos. Revisión ambispectiva de todos los casos intervenidos en nuestro servicio de ortopedia infantil entre los años 2010 y 2014 con los siguientes criterios de inclusión: pacientes mayores de 8 años, con mínima deformidad y pronóstico desfavorable. Se evalúan movilidad, dolor, Trendelenburg, esfericidad radiológica y complicaciones. Resultados. Se incluyeron 13 pacientes, 9 de ellos varones, con una edad media de 11,93 años. Siete casos presentaron signos radiológicos de riesgo. La disminución del dolor mediante EVA tras la cirugía fue cuantificada en 3,83 puntos (p < 0,05). Once casos mantuvieron la esfericidad cefálica durante el seguimiento (1,75 años). Las complicaciones observadas ascendieron al 84,6% de los casos, siendo la más frecuente la infección del trayecto de los tornillos, si bien fueron todas de sencillo manejo. Conclusiones. La artrodiastasis constituye una técnica mínimamente invasiva y útil en el tratamiento de Perthes de inicio tardío o de mal pronóstico, mejorando la clínica y manteniendo la esfericidad cefálica, siendo recomendable el tratamiento de estos pacientes al inicio de la enfermedad. Sin embargo, no está exenta de complicaciones, que pueden afectar a 8 de cada 10 pacientes tratados (AU)

Introduction and objective. Arthrodiastasis consists of the mobilisation of the hip while distracted by a hinged distractor. The aim of our study is to show the results of the treatment of late-onset Perthes disease with this technique in our institution. Material and methods. Ambispective review of all the cases that underwent this surgery in our Department of Paediatric Orthopaedics between 2010 and 2014 with the following inclusion criteria: patients over 8 years old, with minimal deformity, and poor prognosis. Mobility, pain, Trendelenburg sign, radiographic sphericity, and complications were assessed. Results. A total of 13 patients (9 male, 4 female) were included. The mean age was 11.93 years. Radiographic risk signs were present in 7 cases. The mean decrease in pain measured with a visual analogue scale (VAS) after the surgery was 3.83 points (P < .05). Cephalic sphericity was maintained in 11 cases during follow up (1.75 years). Complications were observed complications in 84.6% of the patients, with infection of the screw tract being the most frequent. All of them were easy to treat. Conclusions. Arthrodiastasis is a minimally invasive technique, useful in the treatment of late onset Perthes disease. It improves clinical results and maintains cephalic shape when applied in early stages. However, it is not free of complications, which can involve as many as 8 out of 10 patients treated with the technique (AU)

Hip arthrodiastasis in Legg-Calvé-Perthes disease. / Artrodiastasis de cadera en la enfermedad de Legg-Calvé-Perthes.

INTRODUCTION AND OBJECTIVE: Arthrodiastasis consists of the mobilisation of the hip while distracted by a hinged distractor. The aim of our study is to show the results of the treatment of late-onset Perthes disease with this technique in our institution. MATERIAL AND METHODS: Ambispective review of all the cases that underwent this surgery in our Department of Paediatric Orthopaedics between 2010 and 2014 with the following inclusion criteria: patients over 8 years old, with minimal deformity, and poor prognosis. Mobility, pain, Trendelenburg sign, radiographic sphericity, and complications were assessed. RESULTS: A total of 13 patients (9 male, 4 female) were included. The mean age was 11.93 years. Radiographic risk signs were present in 7 cases. The mean decrease in pain measured with a visual analogue scale (VAS) after the surgery was 3.83 points (P<.05). Cephalic sphericity was maintained in 11 cases during follow up (1.75 years). Complications were observed complications in 84.6% of the patients, with infection of the screw tract being the most frequent. All of them were easy to treat. CONCLUSIONS: Arthrodiastasis is a minimally invasive technique, useful in the treatment of late onset Perthes disease. It improves clinical results and maintains cephalic shape when applied in early stages. However, it is not free of complications, which can involve as many as 8 out of 10 patients treated with the technique.