Midterm results of a new personalized knee implant for total knee arthroplasty: implant survivorship and patient-reported outcome after five years' follow-up.

PURPOSE: The Persona® system is a newly launched implant designed for total knee arthroplasty (TKA) with technical innovations intended for a better functional outcome and higher flexion range. The aim of this study is to evaluate midterm outcomes and survivorship of a cohort of patients with a minimum of 5-year follow-up and to confirm previous results described in the literature. METHODS: A cohort of 91 knees (85 patients) that underwent a patella-preserving TKA with the Persona® implant and who were followed for a mean of 5.9 years' period was included in the study. Functional values were measured: Oxford Knee Score (OKS), Knee Society Knee score (KSKS) and Knee Society Function score (KSFS). Range of movement (ROM), lower limb axis correction, mobilization and complications were also registered at the last follow-up and underwent statistical analysis. RESULTS: We found a low rate of complications or radiological changes with an implant-related revision rate of 2.19%. Mean results for PROMS were 44.21 ± 4 in OKS, 90.94 ± 2.4 in KSS and 97.88 ± 9.6 in KSFS. Mean postoperative ROM was 120.8º ± 12.37º. There was no change in implant positions at the final follow-up. We found radiolucent lines in 3 knees (3.29%). CONCLUSION: At a mean follow-up of 5.9 years, the implant-related cumulative percentage revision rate was 3.3% (2 of 91) at a mean follow-up of 5.9 years, with good clinical and functional results.

Long-Term Outcomes of 496 Anatomical Cementless Modular Femoral Stems: Eleven to Twenty Years of Follow-Up.

BACKGROUND: The aim of the study is to assess the long-term outcomes of this specific stem (anatomical cementless modular stem ESOP), to review the survivorship, complication rate, and radiographic and clinical outcomes. METHODS: Descriptive and analytical retrospective longitudinal observational study of patients was operated on total hip arthroplasty between 1998 and 2007. Four hundred ninety-six prostheses corresponding to 447 patients were reviewed, mean age was 65.8 years (standard deviation [SD] ±11.6 years), and median follow-up time was 13.4 years (range 1-20). The most used cups were cementless (75.8%). The most frequent friction pairs were metal-polyethylene (53.1%) and ceramic-polyethylene (24.2%). Main variables analyzed were stem survival, subsidence, coronal orientation, osteolysis, reintervention, and Oxford Hip Score. RESULTS: From 496 implants, there were 22 lost to follow-up (4.4%). Stem revision was performed in 51 patients: 26 periprosthetic joint infections (2-stage revision), 16 periprosthetic fractures, and 8 one-stage revisions (6 real aseptic loosening with negative culture after revision). The stem survivorship at more than 15 years for any reason was 89.2% and for aseptic loosening 97.97%. No specific complications were found due to modularity. The mean subsidence and orientation was 2.06 mm (SD ±5.11 mm) and 0.41° varus (SD ±2.20°) respectively. Subsidence >5 mm or varus >5° was associated with a higher revision rate. Osteolysis was found in 110 patients (zone I = 79, VII = 57), associated with zirconium-polyethylene, without relationship to the stem revision rate or Oxford Hip Score. CONCLUSION: To our knowledge, this study represents the largest series of this stem, revealing an excellent survival rate and long-term clinical outcomes similar to the best results of classical cementless stems published in the literature.

Granular Cell Tumor of the Hand: Unusual Malignancy of a Previous Benign Lesion: A Case Report.

CASE: Malignant granular cell tumors are uncommon soft-tissue tumors. We describe a granular cell tumor that presented as a benign hand nodule diagnosed by biopsy and image. The patient refused local excision. After 15 years, the patient came back because of symptomatic growth, and a malignant granular cell tumor was diagnosed, with metastatic disease. Despite surgical disarticulation and adjuvant treatment, she died after 8 months. The pathological examination revealed the tumor had progressed to malignant behavior. CONCLUSIONS: Our findings highlight the importance of a closer follow-up. Although unusual, we must be aware of the possibility of a change of behavior from benign to malignant granular cell tumor.

Eficacia y seguridad del ácido tranexámico tópico en la artroplastia de rodilla / Efficacy and safety of topical tranexamic acid in knee arthroplasty

Introducción y objetivo: La administración de ácido tranexámico (ATX) es efectiva reduciendo la pérdida de sangre en la artroplastia de rodilla. Con el fin de evitar los efectos adversos de la administración intravenosa, se ha propuesto el uso tópico del mismo. Nuestro objetivo es evaluar la eficacia y seguridad de ATX tópico para reducir la hemorragia postoperatoria en la artroplastia de rodilla. Material y métodos: Un total de 90 pacientes intervenidos de artroplastia total de rodilla unilateral fueron incluidos en un estudio prospectivo y aleatorizado. Todas las intervenciones fueron llevadas a cabo bajo anestesia espinal, con isquemia preventiva y bajo el mismo régimen postoperatorio. Los pacientes fueron divididos en 3 grupos en función de la administración del ATX: grupo A (n=30) 1g de ATX tópico; grupo B (n=30) 1g de ATX intravenoso, y grupo C o control (n=30), al que no se administró ningún fármaco. Se analizaron los parámetros de pérdida de sangre y débito de drenajes en los 3 grupos. Resultados: Los resultados mostraron que el descenso del nivel de hemoglobina fue menor en el grupo A (1,95dl) respecto el grupo B (2,25g/dl) y el grupo C (2,96g/dl), p<0,01. Respecto a la hemorragia postoperatoria, también fue inferior en el grupo A (195ml) respecto el grupo B (466ml) y el grupo C (718ml), p<0,01. No hubo diferencias en las complicaciones y la tasa de transfusiones de sangre entre los 3 grupos. Conclusiones: La aplicación tópica de 1g de ATX reduce significativamente la pérdida de sangre en pacientes intervenidos de artroplastia total de rodilla, en mayor magnitud que la aplicación intravenosa y la no administración

Introduction and objective: Tranexamic acid (TXA) is commonly used to control postoperative blood loss in total knee arthroplasty. In order to avoid adverse effects associated with intravenous administration, topical use has been proposed as an alternative. Our aim was to evaluate the efficacy and safety of topical TXA in total knee arthroplasty. Material and methods: A total of 90 patients scheduled for unilateral total knee arthroplasty were included in a prospective randomised study. All surgeries were performed under spinal anaesthesia, tourniquet and the same postoperative protocol. Patients were allocated to one of the 3 groups according to the application of TXA: group A (n=30) 1g of topical TXA; group B (n=30) 1g of TXA intravenous and in group C or the control group (n=30) no drug was administrated. Parameters related to blood loss and drain outputs were compared between the 3 groups. Results: The results revealed that post-operative decrease in haemoglobin level was significantly lower in group A (1.95g/dL) than group B (2.25g/dL) and group C (2.96g/dL), P<.01. Total postoperative blood loss was lower in group A (195mL) than group B (466mL) and group C (718mL), P<.01. There was no significant difference in complications and allogenic blood transfusion rate between the 3 groups. Conclusions: According to the results, topical application of 1g TXA significantly reduced blood loss in patients undergoing total knee arthroplasty more than intravenous or no administration of TXA

Efficacy and safety of topical tranexamic acid in knee arthroplasty. / Eficacia y seguridad del ácido tranexámico tópico en la artroplastia de rodilla.

INTRODUCTION AND OBJECTIVE: Tranexamic acid (TXA) is commonly used to control postoperative blood loss in total knee arthroplasty. In order to avoid adverse effects associated with intravenous administration, topical use has been proposed as an alternative. Our aim was to evaluate the efficacy and safety of topical TXA in total knee arthroplasty. MATERIAL AND METHODS: A total of 90 patients scheduled for unilateral total knee arthroplasty were included in a prospective randomised study. All surgeries were performed under spinal anaesthesia, tourniquet and the same postoperative protocol. Patients were allocated to one of the 3 groups according to the application of TXA: group A (n=30) 1g of topical TXA; group B (n=30) 1g of TXA intravenous and in group C or the control group (n=30) no drug was administrated. Parameters related to blood loss and drain outputs were compared between the 3 groups. RESULTS: The results revealed that post-operative decrease in haemoglobin level was significantly lower in group A (1.95g/dL) than group B (2.25g/dL) and group C (2.96g/dL), P<.01. Total postoperative blood loss was lower in group A (195mL) than group B (466mL) and group C (718mL), P<.01. There was no significant difference in complications and allogenic blood transfusion rate between the 3 groups. CONCLUSIONS: According to the results, topical application of 1g TXA significantly reduced blood loss in patients undergoing total knee arthroplasty more than intravenous or no administration of TXA.