Improvement of survival after 10 years with the Durom-type hip resurfacing prosthesis in selected patients: Experience of a public university hospital. / Mejoría de la supervivencia a los 10 años con la prótesis de recubrimiento de cadera tipo Durom en pacientes seleccionados. Experiencia de un hospital público universitario.

INTRODUCTION: Hip resurfacing arthroplastys are a valid alternative for the treatment of degenerative hip disorders in young adults. Poor results and adverse soft tissue effects have been reported with high levels of chromium and cobalt, limiting its indications. Objective is to analyze clinical and functional survival results of the Durom system 10 years after its implementation in a public hospital. The hypothesis is that better results and survival are obtained in patients selected according to FDA criteria. MATERIAL AND METHODS: Retrospective cohort study of 83 patients, 91 hips in 76 men and 7 women operated between 2005 and 2013 with Durom-type prostheses. Demographic study, diagnosis, BMI, radiological study, serum chromium cobalt levels, functional assessment according to MPD and HSS, complications and survival at 10 years of follow-up. A cohort of active men under 65 years of age and heads over 48mm is selected. RESULTS: Follow-up time of 121 months with a range from 84 to 176 months. With a mean age of 52.78 years, with 4 deaths and loss of follow-up of 3 cases. There are 12 complications that require reoperation (14.45%) with 2 chronic infections, 4 femoral neck fractures, 4 acetabular loosening and 2 cases of pseudotumors. With an overall survival of 85.4% (71-91.9) and 87.85% (85.5-91.1) in the absence of infection. No statistical relationship between complications and neck narrowing and the angles of inclination of the components. In selected patients, 69 men and 73 hips, we obtained an overall survival of 91.82% and excluding infection of 93.18% at 10 years. CONCLUSIONS: The indication of the Durom system in the treatment of degenerative processes in selected active young patients presents better results and survival at 10 years, although somewhat lower than other highly indicated veneering models.

Mejoría de la supervivencia a los 10 años con la prótesis de recubrimiento de cadera tipo Durom en pacientes seleccionados. Experiencia de un hospital público universitario / Improvement of survival after 10 years with the Durom-type hip resurfacing prosthesis in selected patients: Experience of a public university hospital

Introducción: Las prótesis de recubrimiento son una alternativa válida para el tratamiento de los trastornos degenerativos de cadera del adulto joven, pero han sido reportados malos resultados y efectos adversos en partes blandas con niveles altos de cromo y cobalto, limitándose sus indicaciones. Nuestro objetivo es analizar resultados clínicos, funcionales y de supervivencia del modelo Durom a los 10 años de su implantación en un hospital público. La hipótesis es que se obtienen mejores resultados y supervivencia en pacientes seleccionados según criterios de la FDA. Material y métodos: Estudio retrospectivo de cohortes con 83 pacientes, 91 caderas en 76 hombres y 7 mujeres operados entre 2005 y 2013 con prótesis tipo Durom. Estudio demográfico, diagnóstico, IMC, radiológico con posición de implantes, estrechamiento del cuello y tipo de unión ósea, niveles de cromo y cobalto en suero, valoración funcional según MPD y HSS, complicaciones y supervivencia a los 10 años de seguimiento. Se selecciona una cohorte de varones activos menores de 65 años y cabezas superiores a 48mm para la misma valoración. Resultados: El tiempo de seguimiento fue de 121 meses, con un rango de 84 a 176 meses. Con una edad media de 52,78 años, con 4 defunciones y pérdida de seguimiento de 3 casos. Se producen 12 complicaciones que precisan reintervención (14,45%) con 2 infecciones crónicas, 4 fracturas del cuello femoral, 4 aflojamientos acetabulares y 2 casos de pseudotumores. La supervivencia global fue del 85,4% (71-91,9), y del 87,85% (85,5-91,1) en ausencia de infección a los 10 años. No hubo relación estadística entre las complicaciones y el estrechamiento de cuello y los ángulos de inclinación de los componentes. En pacientes seleccionados, en 69 hombres y 73 caderas obtenemos una supervivencia global del 91,82% y, excluyendo la infección, del 93,18% a los 10 años.(AU)

Introduction: Hip resurfacing arthroplastys are a valid alternative for the treatment of degenerative hip disorders in young adults. Poor results and adverse soft tissue effects have been reported with high levels of chromium and cobalt, limiting its indications. Objective is to analyze clinical and functional survival results of the Durom system 10 years after its implementation in a public hospital. The hypothesis is that better results and survival are obtained in patients selected according to FDA criteria. Material and methods: Retrospective cohort study of 83 patients, 91 hips in 76 men and 7 women operated between 2005 and 2013 with Durom-type prostheses. Demographic study, diagnosis, BMI, radiological study, serum chromium cobalt levels, functional assessment according to MPD and HSS, complications and survival at 10 years of follow-up. A cohort of active men under 65 years of age and heads over 48mm is selected. Results: Follow-up time of 121 months with a range from 84 to 176 months. With a mean age of 52.78 years, with 4 deaths and loss of follow-up of 3 cases. There are 12 complications that require reoperation (14.45%) with 2 chronic infections, 4 femoral neck fractures, 4 acetabular loosening and 2 cases of pseudotumors. With an overall survival of 85.4% (71-91.9) and 87.85% (85.5-91.1) in the absence of infection. No statistical relationship between complications and neck narrowing and the angles of inclination of the components. In selected patients, 69 men and 73 hips, we obtained an overall survival of 91.82% and excluding infection of 93.18% at 10 years. Conclusions: The indication of the Durom system in the treatment of degenerative processes in selected active young patients presents better results and survival at 10 years, although somewhat lower than other highly indicated veneering models.(AU)

Improvement of survival after 10 years with the Durom-type hip resurfacing prosthesis in selected patients: Experience of a public university hospital / Mejoría de la supervivencia a los 10 años con la prótesis de recubrimiento de cadera tipo Durom en pacientes seleccionados. Experiencia de un hospital público universitario

Introduction: Hip resurfacing arthroplastys are a valid alternative for the treatment of degenerative hip disorders in young adults. Poor results and adverse soft tissue effects have been reported with high levels of chromium and cobalt, limiting its indications. Objective is to analyze clinical and functional survival results of the Durom system 10 years after its implementation in a public hospital. The hypothesis is that better results and survival are obtained in patients selected according to FDA criteria. Material and methods: Retrospective cohort study of 83 patients, 91 hips in 76 men and 7 women operated between 2005 and 2013 with Durom-type prostheses. Demographic study, diagnosis, BMI, radiological study, serum chromium cobalt levels, functional assessment according to MPD and HSS, complications and survival at 10 years of follow-up. A cohort of active men under 65 years of age and heads over 48mm is selected. Results: Follow-up time of 121 months with a range from 84 to 176 months. With a mean age of 52.78 years, with 4 deaths and loss of follow-up of 3 cases. There are 12 complications that require reoperation (14.45%) with 2 chronic infections, 4 femoral neck fractures, 4 acetabular loosening and 2 cases of pseudotumors. With an overall survival of 85.4% (71-91.9) and 87.85% (85.5-91.1) in the absence of infection. No statistical relationship between complications and neck narrowing and the angles of inclination of the components. In selected patients, 69 men and 73 hips, we obtained an overall survival of 91.82% and excluding infection of 93.18% at 10 years. Conclusions: The indication of the Durom system in the treatment of degenerative processes in selected active young patients presents better results and survival at 10 years, although somewhat lower than other highly indicated veneering models.(AU)

Introducción: Las prótesis de recubrimiento son una alternativa válida para el tratamiento de los trastornos degenerativos de cadera del adulto joven, pero han sido reportados malos resultados y efectos adversos en partes blandas con niveles altos de cromo y cobalto, limitándose sus indicaciones. Nuestro objetivo es analizar resultados clínicos, funcionales y de supervivencia del modelo Durom a los 10 años de su implantación en un hospital público. La hipótesis es que se obtienen mejores resultados y supervivencia en pacientes seleccionados según criterios de la FDA. Material y métodos: Estudio retrospectivo de cohortes con 83 pacientes, 91 caderas en 76 hombres y 7 mujeres operados entre 2005 y 2013 con prótesis tipo Durom. Estudio demográfico, diagnóstico, IMC, radiológico con posición de implantes, estrechamiento del cuello y tipo de unión ósea, niveles de cromo y cobalto en suero, valoración funcional según MPD y HSS, complicaciones y supervivencia a los 10 años de seguimiento. Se selecciona una cohorte de varones activos menores de 65 años y cabezas superiores a 48mm para la misma valoración. Resultados: El tiempo de seguimiento fue de 121 meses, con un rango de 84 a 176 meses. Con una edad media de 52,78 años, con 4 defunciones y pérdida de seguimiento de 3 casos. Se producen 12 complicaciones que precisan reintervención (14,45%) con 2 infecciones crónicas, 4 fracturas del cuello femoral, 4 aflojamientos acetabulares y 2 casos de pseudotumores. La supervivencia global fue del 85,4% (71-91,9), y del 87,85% (85,5-91,1) en ausencia de infección a los 10 años. No hubo relación estadística entre las complicaciones y el estrechamiento de cuello y los ángulos de inclinación de los componentes. En pacientes seleccionados, en 69 hombres y 73 caderas obtenemos una supervivencia global del 91,82% y, excluyendo la infección, del 93,18% a los 10 años.(AU)

Reconstrucción acetabular con el sistema Cup-Cage para discontinuidades pélvicas y defectos acetabulares masivos / Reconstruction for pelvic discontinuity and massive acetabular defects

INTRODUCCIÓN: La reconstrucción acetabular con defectos óseos masivos y discontinuidades pélvicas es un procedimiento quirúrgico complejo que presenta importantes dificultades para el cirujano ortopédico. El objetivo de este estudio es presentar los resultados a corto y medio plazo de la revisión acetabular con el sistema de reconstrucción Cup-Cage en una serie consecutiva de casos. MATERIAL Y MÉTODOS: Retrospectivamente revisamos 22 casos consecutivos de defectos acetabulares masivos (8 Paprosky IIIA y 9 IIIB); 5 discontinuidades pélvicas; 2 fracturas pélvicas durante la implantación de la prótesis primaria, y una seudoartrosis pélvica. Todos fueron revisados con un cotilo de metal trabecular y una caja de reconstrucción tipo Cup-Cage. Se realizó seguimiento clínico y radiográfico de los pacientes para detectar fallos mecánicos o aflojamientos del implante. RESULTADOS: En un tiempo de seguimiento medio de 45,06 meses (12-73 meses) no se objetivó ningún fracaso radiográfico del implante (migración del componente, osteólisis ni rotura de tornillos). Las complicaciones (13,63%) incluyeron una luxación recidivante, una infección y una subluxación recidivante; todos precisaron reintervención quirúrgica. El Merle d'Aubigné-Postel mejoró de 6,91 a 14,36 y la puntuación del rango de movilidad, de 2,91 a 4,36 en promedio de los valores preoperatorios y postoperatorios, respectivamente, así como una mejoría del Harris Hip Score de 30 (16-55) a 72 (40-90) en el último control. CONCLUSIÓN: La reconstrucción acetabular con el sistema Cup-Cage es una alternativa válida para la reconstrucción de pérdidas óseas acetabulares masivas (Paprosky tipo IIIA y IIIB) y discontinuidades pélvicas que ofrece buenos resultados a corto y medio plazo

OBJECTIVE: The acetabular reconstruction with massive acetabular defects and pelvic discontinuity is a complex surgery with important difficulties for the orthopaedic surgeon. The objective of this study is to show the short and midterm results of the acetabular revision with the Cup-Cage construct in a consecutive serie of cases. MATERIAL AND METHODS: Retrospectively we reviewed 22 consecutive patients with massive acetabular defects (8 Paprosky IIIa and 9 IIIB); 5 pelvic discontinuities; 2 pelvic fractures during the implantation of primary artroplasty, and one pelvic pseudoarthrosis. All were reoperated with a trabecular metal acetabular component and a Cup-Cage. We did clinical and radiological follow-up to detect machanical failures and loosening of the implant. RESULTS: With a middle follow-up of 45.06 months (12-73 months) we did not see any radiographic failure of the implant (component migration, osteolysis neither rupture of the implant or screws). The complications (13,63%) included one recurrent luxation, one infection and one recurrent subluxation. The Merle d'Aubigné-Postel score improved from 6.91 to 14.36 and the punctuation in the range of motion from 2.91 to 4.36 on average of the values preoperatively and postoperatively respectively and improvement in Harris Hip Score 30 (16-55) to 72 (40-90) in the latest follow up. CONCLUSION: The acetabular reconstruction with the Cup-Cage system is a valid alternative for the reconstruction of massive acetabular defects (Paprosky type IIIA and IIIB) and pelvic discontinuities offering good results at short and midterm follow-up

Reconstruction for pelvic discontinuity and massive acetabular defects. / Reconstrucción acetabular con el sistema Cup-Cage para discontinuidades pélvicas y defectos acetabulares masivos.

OBJECTIVE: The acetabular reconstruction with massive acetabular defects and pelvic discontinuity is a complex surgery with important difficulties for the orthopaedic surgeon. The objective of this study is to show the short and midterm results of the acetabular revision with the Cup-Cage construct in a consecutive serie of cases. MATERIAL AND METHODS: Retrospectively we reviewed 22 consecutive patients with massive acetabular defects (8 Paprosky IIIa and 9 IIIB); 5 pelvic discontinuities; 2 pelvic fractures during the implantation of primary artroplasty, and one pelvic pseudoarthrosis. All were reoperated with a trabecular metal acetabular component and a Cup-Cage. We did clinical and radiological follow-up to detect machanical failures and loosening of the implant. RESULTS: With a middle follow-up of 45.06 months (12-73 months) we did not see any radiographic failure of the implant (component migration, osteolysis neither rupture of the implant or screws). The complications (13,63%) included one recurrent luxation, one infection and one recurrent subluxation. The Merle d'Aubigné-Postel score improved from 6.91 to 14.36 and the punctuation in the range of motion from 2.91 to 4.36 on average of the values preoperatively and postoperatively respectively and improvement in Harris Hip Score 30 (16-55) to 72 (40-90) in the latest follow up. CONCLUSION: The acetabular reconstruction with the Cup-Cage system is a valid alternative for the reconstruction of massive acetabular defects (Paprosky type IIIA and IIIB) and pelvic discontinuities offering good results at short and midterm follow-up.

Análisis funcional comparativo entre la prótesis de carbón pirolítico y la artroplastia de suspensión-reconstrucción ligamentosa para el tratamiento de la rizartrosis del pulgar / Comparative functional analysis between pyrolytic carbon prostheses and ligamentous suspension/reconstruction in the treatment of rhizarthrosis

Objetivo: Evaluar el resultado funcional a medio plazo de la utilización del implante de carbón pirolítico (PyroDisk) en el tratamiento de la rizartrosis del pulgar, comparando sus resultados con la artroplastia de resección-suspensión-reconstrucción ligamentosa. Material y método: Estudio transversal que compara de forma retrospectiva 2grupos de pacientes entre 40 y 65 años con rizartrosis del pulgar. Los 32 pacientes intervenidos entre 2009 y 2013 se distribuyeron entre el grupo I (artroplastia de interposición con el implante PyroDisk y el grupo II (artroplastia de resección-suspensión-reconstrucción ligamentosa). En 2015 se recogieron el dolor, la funcionalidad (cuestionario Quick-Dash) y el balance articular. Además, se realizó un estudio radiológico con radiografías y TC. Resultados: Se siguió a 32 pacientes, 16 en cada grupo, con un seguimiento medio de 35 meses (23-47). El dolor al final del seguimiento fue mayor en el grupo intervenido con la prótesis de carbón pirolítico (p=0,000). En la funcionalidad según el test de QuickDash, los pacientes del grupo i obtuvieron una media de 31,14 (0-70) puntos frente a 15,81 (8-24) puntos del grupo ii (p=0,027). No se encontraron diferencias en el grado de movilidad al final del seguimiento (p=0,46). En 6 casos fue necesario retirar la prótesis. Discusión: La prótesis de carbón pirolítico se ha presentado como alternativa para el tratamiendo de la rizartrosis del pulgar. En los trabajos publicados hasta el momento destaca la discrepancia en los resultados funcionales a medio plazo. Conclusiones: La prótesis de carbón pirolítico ha mostrado resultados funcionales inferiores a medio plazo comparada con la artroplastia de resección-suspensión-reconstrucción ligamentosa

Objective: To evaluate midterm functional outcome after pyrolytic carbon prosthesis (PyroDisk) implantation in the treatment of rhizarthrosis of the thumb, comparing outcomes with those of ligamentous resection/suspension/reconstruction. Material and methods: A cross-sectional study retrospectively comparing 2patient groups aged between 40 and 65 years with rhizarthrosis of the thumb. Thirty-two patients operated between 2009 and 2013 were distributed between group I (interposition arthroplasy with PyroDisk implant) and group II (ligamentous resection/suspension/reconstruction arthroplasty). Data on pain, functionality (Quick-Dash questionnaire) and articular movement were collected in 2015. In addition, a radiological study was undertaken using radiographs and CT. Results: Thirty-two patients, 16 in each group with mean follow-up of 35 months (23-47). Pain at the end of follow-up was greater in the group with the pyrolytic carbon prosthesis (p=0.000). According to the QuickDash questionnaire, the patients in group i achieved a mean functionality of 31.14 (0-70) points compared to 15.81 (8-24) points for group ii (p=0.027). No differences were found in degree of mobility at the end of follow-up (p=0.46). The prosthesis had to be removed in 6 cases. Discussion: The pyrolytic carbon prosthesis has been presented as an alternative treatment for rhizarthrosis of the thumb. The papers pubslished to date highlight the discrepancies in midterm functional outcomes. Conclusions: Pyrolitic carbon prostheses have shown inferior functional outcomes, compared with resection/suspension/reconstruction arthroplasties

Comparative functional analysis between pyrolytic carbon prostheses and ligamentous suspension/reconstruction in the treatment of rhizarthrosis. / Análisis funcional comparativo entre la prótesis de carbón pirolítico y la artroplastia de suspensión-reconstrucción ligamentosa para el tratamiento de la rizartrosis del pulgar.

OBJECTIVE: To evaluate midterm functional outcome after pyrolytic carbon prosthesis (PyroDisk) implantation in the treatment of rhizarthrosis of the thumb, comparing outcomes with those of ligamentous resection/suspension/reconstruction. MATERIAL AND METHODS: A cross-sectional study retrospectively comparing 2patient groups aged between 40 and 65 years with rhizarthrosis of the thumb. Thirty-two patients operated between 2009 and 2013 were distributed between group i (interposition arthroplasy with PyroDisk implant) and group ii (ligamentous resection/suspension/reconstruction arthroplasty). Data on pain, functionality (Quick-Dash questionnaire) and articular movement were collected in 2015. In addition, a radiological study was undertaken using radiographs and CT. RESULTS: Thirty-two patients, 16 in each group with mean follow-up of 35 months (23-47). Pain at the end of follow-up was greater in the group with the pyrolytic carbon prosthesis (p=0.000). According to the QuickDash questionnaire, the patients in group i achieved a mean functionality of 31.14 (0-70) points compared to 15.81 (8-24) points for group ii (p=0.027). No differences were found in degree of mobility at the end of follow-up (p=0.46). The prosthesis had to be removed in 6 cases. DISCUSSION: The pyrolytic carbon prosthesis has been presented as an alternative treatment for rhizarthrosis of the thumb. The papers pubslished to date highlight the discrepancies in midterm functional outcomes. CONCLUSIONS: Pyrolitic carbon prostheses have shown inferior functional outcomes, compared with resection/suspension/reconstruction arthroplasties.