La técnica de superposición de cúspides en TAVI con dispositivo autoexpandible optimiza la profundidad del implante y reduce la necesidad de marcapasos permanente / Cusp-overlapping TAVI technique with a self-expanding device optimizes implantation depth and reduces permanent pacemaker requirement

Introducción y objetivos: Una profundidad más alta del implante percutáneo de una válvula aórtica autoexpandible minimiza el daño en el sistema de conducción y puede reducir las tasas de marcapasos permanente a 30 días. El objetivo es determinar la seguridad y la eficacia de modificar la técnica de implante clásica para el reemplazo percutáneo de la válvula aórtica a una técnica de proyección de superposición de cúspides (PSC) para lograr una profundidad más alta del implante y reducir la necesidad de marcapasos permanente. Métodos: Desde marzo de 2017 se incluyó a 226 pacientes consecutivos: 113 tratados con técnica de implante PSC frente a 113 casos consecutivos previos con implante clásico. La profundidad del implante se evaluó mediante 3 métodos en todos los pacientes (cúspide no coronaria a válvula cardiaca percutánea (VCP); media de cúspide no coronaria y cúspide coronaria izquierda a VCP y el borde más profundo de cúspide coronaria izquierda y cúspide no coronaria a VCP). Resultados: El grupo de PSC presentó una profundidad del implante menor que el del grupo de implante clásico (4,8±2,2 frente a 5,7±3,1 mm; p=0,011; 5,8±3,1 frente a 6,5±2,4 mm; p=0,095; 7,1±2,8 frente a 7,4±3,2 mm; p=0,392). A los 30 días de seguimiento, 40 pacientes (17,7%) requirieron el implante de marcapasos permanente, menos en el grupo de PSC (el 12,4 frente al 23%; p=0,036). La técnica de implante PSC protegió contra el evento principal (OR=0,45; IC95%, 0,21-0,97; p=0,043), con parecidos éxito del procedimiento y complicaciones. Conclusiones: La técnica de implante PSC es una simple modificación en el protocolo que proporciona una profundidad del implante más alta de la prótesis valvular autoexpandible con menores alteraciones de la conducción y tasas de marcapasos permanente (AU)

Introduction and objectives: This study aimed to determine the safety and efficacy of modifying the classic implantation technique for aortic transcatheter heart valve (THV) implantation to a cusp-overlap-projection (COP) technique to achieve a higher implantation depth and to reduce the burden of new permanent pacemaker implantation (PPMI) at 30 days. Aortic self-expanding THV carries an elevated risk for PPMI. A higher implantation depth minimizes the damage in the conduction system and may reduce PPMI rates. Methods: From March 2017, 226 patients were consecutively included: 113 patients were treated using the COP implantation technique compared with the previous 113 consecutive patients treated using the classic technique. In all patients, implantation depth was assessed by 3 methods (noncoronary cusp to the THV, mean of the noncoronary cusp and the left coronary cusp to the THV, and the deepest edge from the left coronary cusp and the noncoronary cusp to the THV). Results: The COP group had a lower implantation depth than the group treated with the classic technique (4.8 mm± 2.2 vs 5.7 mm± 3.1; P=.011; 5.8 mm± 3.1 vs 6.5 mm± 2.4; P=.095; 7.1 mm± 2.8 vs 7.4 mm±3.2; P=.392). Forty patients (17.7%) required a new PPMI after the 30-day follow-up but this requirement was significantly lower in the COP group (12.4% vs 23%, P=.036). The COP implantation technique consistently protected against the main event (OR, 0.45; 95%CI, 0.21-0.97; P=.043), with similar procedural success rates and complications. Conclusions: The COP implantation technique is a simple modification of the implantation protocol and provides a higher implantation depth of self-expanding-THV with lower conduction disturbances and PPMI rates (AU)

Esperanza de vida tras el reemplazo de válvula aórtica en pacientes jóvenes / Life expectancy after aortic valve replacement in young patients

Introducción y objetivos: Se desconoce si los pacientes jóvenes con estenosis aórtica grave tienen una esperanza de vida restaurada tras el reemplazo de la válvula aórtica (RVAo). Métodos: Se incluyó a todos los pacientes entre 50 y 65 años sometidos a RVAo en 27 centros españoles durante 18 años. Se comparó la supervivencia observada y la esperada a los 15 años de seguimiento. Se repitieron todos los análisis con los pacientes sin complicaciones durante el posoperatorio inmediato. Resultados: Se analizó a 5.084 pacientes. En la muestra total, la supervivencia observada a los 10 y los 15 años fue del 85,3% (IC95%, 84,1-86,4%) y el 73,7% (IC95%, 71,6-75,6%). Las supervivencias esperadas fueron del 90,1 y el 82,1%. La supervivencia relativa acumulada a 1, 5, 10 y 15 años de seguimiento fue del 97,4% (IC95%, 96,9-97,9%), el 96,5% (IC95%, 95,7-97,3%), el 94,7% (IC95%, 93,3-95,9%) y el 89,8% (IC95%, 87,3-92,1%). Para los pacientes sin complicaciones, la supervivencia relativa acumulada a 1, 5, 10 y 15 años fue del 100,3% (IC95%, 99,8-100,5%), el 98,9% (IC95% 97,6-99,9%), el 97,3% (IC95%, 94,9-99,4%) y el 91,9% (IC95%, 86,5-96,8%). Conclusiones:La esperanza de vida de los pacientes jóvenes con estenosis aórtica grave intervenidos para RVAo es menor que la de la población general. La esperanza de vida de los pacientes sin complicaciones durante el posoperatorio inmediato también está reducida. Por lo tanto, las características basales probablemente sean los principales factores que explican la reducción de la esperanza de vida (AU)

Introduction and objectives: In young patients with severe aortic stenosis, it is unknown whether their life expectancy restored after aortic valve replacement (AVR) is unknown. Methods: We analyzed all patients aged between 50 and 65 years who underwent isolated AVR in 27 Spanish centers during an 18-year period. We compared observed and expected survival at 15 years of follow-up. We repeated all analyses for patients without complications in the postoperative period. Results: A total of 5084 patients were analyzed. For the overall sample, observed survival at 10 and 15 years was 85.3% (95%CI, 84.1%-86.4%) and 73.7% (95%CI, 71.6%-75.6%), respectively. Expected survival was 90.1% and 82.1%. Cumulative relative survival for 1, 5, 10 and 15 years of follow-up was 97.4% (95%CI, 96.9%-97.9%), 96.5% (95%CI, 95.7%-97.3%), 94.7% (95%CI, 93.3%-95.9%), and 89.8% (95%CI, 87.3%-92.1%). For patients without complications, cumulative relative survival for 1, 5, 10 and 15 years was 100.3% (95%CI, 99.8%-100.5%), 98.9% (95%CI 97.6% -99.9%), 97.3% (95%CI, 94.9%-99.4%), and 91.9% (95%CI, 86.5%-96.8%). Conclusions: Life expectancy in young patients who have severe aortic stenosis and undergo AVR is lower than that of the general population. Life expectancy of individuals without complications during the postoperative period is also reduced. Therefore, baseline characteristics are likely the main factors that explain the reduction in life expectancy (AU)

Artroplastias de superficie metal-metal en cadera. ¿Es necesario realizar seguimiento anual mediante determinación de metales en sangre? / Metal-on-metal surface hip arthroplasties. Is annual monitoring of blood metal levels necessary?

Introducción: La determinación periódica de los niveles de cromo (Cr) y cobalto (Co) en sangre ha sido utilizada para evaluar las reacciones adversas secundarias al desgaste metal-metal en las artroplastias de superficie de cadera. El objetivo de nuestro estudio es evaluar los niveles de Cr y Co en sangre en una serie de pacientes asintomáticos con artroplastias de superficie con un seguimiento de 7 a 13 años. Material y métodos: Hemos analizado la evolución de los niveles metálicos en sangre en una serie de 52 artroplastias de superficie metal-metal. Se realizó un control anual de Co y Cr en sangre. En 16 pacientes fue preciso realizar una cirugía de revisión, por lo que salieron del estudio. Los niveles de iones metálicos en sangre fueron analizados en 31 pacientes asintomáticos. Resultados: En ninguno de los pacientes asintomáticos aparecieron cifras elevadas de Cr o Co de manera continuada. La mediana de Cr en sangre se mantuvo entre 1,3 y 5,4μg/L y la de Co entre 0,5 y 1,2μg/L. Después de 7 años tras la cirugía no se han apreciado cambios en los niveles referidos. Conclusión: A medio plazo y en pacientes asintomáticos, los niveles metálicos en sangre se mantienen sin cambios, por lo que no parece adecuado repetir anualmente estas determinaciones de manera permanente

Introduction: Blood cobalt (Co) and chromium (Cr) ion levels have been used as surveillance tools for adverse reaction to metal debris in metal-on-metal (MoM) hip arthroplasty. The aim of our study was to present serial 7-13 year blood Co and Cr levels in a cohort of MoM total hip arthroplasties in asymptomatic patients. Material and methods: A total of 52 MoM surface total hip arthroplasties were included in this study with data collected prospectively. Annual follow-up with blood Co and Cr measurements was performed. Revision surgery was necessary for 16 patients and therefore they dropped out of the study. The metal ion levels were analyzed separately in 31 asymptomatic patients. Results: High Cr or Co levels were not found continuously in any of the asymptomatic patients. The median Cr in blood was maintained between 1.3 and 5.4μg/L and that of Co between 0.5 and 1.2μg/L. After 7 years, there was no significant change in Co and Cr values. Conclusion: In the medium term and in asymptomatic patients, the metallic blood levels remained unchanged; therefore, it does not seem appropriate to repeat these tests on a permanent basis in annual controls

Metal-on-metal surface hip arthroplasties. Is annual monitoring of blood metal levels necessary? / Artroplastias de superficie metal-metal en cadera. ¿Es necesario realizar seguimiento anual mediante determinación de metales en sangre?

INTRODUCTION: Blood cobalt (Co) and chromium (Cr) ion levels have been used as surveillance tools for adverse reaction to metal debris in metal-on-metal (MoM) hip arthroplasty. The aim of our study was to present serial 7-13 year blood Co and Cr levels in a cohort of MoM total hip arthroplasties in asymptomatic patients. MATERIAL AND METHODS: A total of 52 MoM surface total hip arthroplasties were included in this study with data collected prospectively. Annual follow-up with blood Co and Cr measurements was performed. Revision surgery was necessary for 16 patients and therefore they dropped out of the study. The metal ion levels were analyzed separately in 31 asymptomatic patients. RESULTS: High Cr or Co levels were not found continuously in any of the asymptomatic patients. The median Cr in blood was maintained between 1.3 and 5.4µg/L and that of Co between 0.5 and 1.2µg/L. After 7 years, there was no significant change in Co and Cr values. CONCLUSION: In the medium term and in asymptomatic patients, the metallic blood levels remained unchanged; therefore, it does not seem appropriate to repeat these tests on a permanent basis in annual controls.

Navigated versus conventional total knee arthroplasty: A prospective study at three years follow-up. / Artroplastia total de rodilla navegada versus convencional; estudio prospectivo a 3 años de seguimiento.

OBJECTIVE: Computer-assisted surgery application in total knee arthroplasty (TKA) has shown more accurate implant alignment compared with conventional instrumentation and is associated with more homogeneous alignment results. Although longer implant survival and superior clinical outcomes should be expected from navigated TKA, currently available evidence does not support this hypothesis. The aim of this study was to compare navigated TKA with conventional TKA regarding clinical and radiological outcomes after a 3-year follow-up under the hypothesis that navigated TKA would provide better outcomes than conventional TKA. MATERIAL AND METHOD: In a prospective multicentre study, 119 patients underwent navigated TKA and 80 patients received conventional instrumentation. Patients were evaluated at the baseline and at postoperative months 3, 12, 24, and 36. Analysis included the American Knee Society Score (KSS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Short Form-12 (SF12) Health Survey, and radiographic assessment. RESULTS: All clinical scores improved significantly for all patients during the follow-up but were significantly better in the navigation group. The percentage of patients showing a mechanical axis between 3° of varus and 3° of valgus was significantly higher in the ATR group (93%) than in the conventional TKA group (71%) (P<.01). CONCLUSIONS: The use of computer-assisted surgery in TKA provides more accurate mechanical alignment and superior short-term functional outcomes compared to conventional TKA.

Alineación frontal en la artroplastia total de rodilla. Estudio comparativo entre medición radiográfica y con navegación quirúrgica / Frontal alignment in total knee arthroplasty. Comparative study between radiographic measurement and surgical navigation

Objetivo. Conocer la concordancia entre el ángulo del eje mecánico femorotibial medido en radiografías y en navegación quirúrgica, tanto en el pre como en el postoperatorio al implantar una artroplastia total de rodilla. Material y método. Se analizaron las mediciones pre y postoperatorias en 88 artroplastias totales del mismo modelo y realizadas todas con el mismo sistema de navegación quirúrgica. Se valoró el ángulo frontal mecánico (AMFFT) y anatómico femorotibial pre y posquirúrgico. Para ello se utilizó una telerradiografía en bipedestación, donde se midió el ángulo mediante técnicas digitalizadas. En la navegación se recogió el ángulo femorotibial en reposo y en varo-valgo forzado, hallándose la media de estos 3 valores. Resultados. La media del AMFFT preoperatorio medido en la radiografía fue 4,55°. La media del mismo ángulo medido en la radiografía postoperatoria fue de 1,72°, con diferencias estadísticamente significativas. La media del AMFFT medido con la navegación antes de iniciar la técnica quirúrgica fue de 3,12° y tras el implante con navegación fue de 0,53°, también con diferencias estadísticamente significativas (p=0,013). El coeficiente de concordancia entre el AMFFT preoperatorio en telerradiografía y en navegación fue de 0,869 (p<0,001) y en el postoperatorio de 0,709 (p=0,017). Conclusiones. Hemos encontrado una fuerte concordancia en el AMFFT entre la medición con radiografías y con navegación quirúrgica. Ello puede suponer que no es necesaria la realización de una telerradiografía cuando se utiliza navegación en el implante de una artroplastia total de rodilla (AU)

Objective. To establish the concordance between angulation of the femoro-tibial mechanical axis measured with x-rays and surgical navigation in both the pre and postoperative period after a total knee arthroplasty (TKA) was implanted. Material and method. Pre and postoperative measurements were analyzed in 88 TKA of the same model and all performed with the same surgical navigation system. The mechanical frontal angle (MFA) and femoro-tibial anatomic angle were measured before and after the TKA. The angulation was digitally measured with a teleradiography. In the navigation, the femoro-tibial angle at rest, forced varus and valgus were registered and the average of these three measurements was calculated. Results. The mean preoperative MFA measured on the radiograph was 4.55°. The mean of the same angle measured on the postoperative radiograph was 1.72°, (p=0.05). The mean of the MFA measured with navigation before TKA was 3.12° and after the implant with navigation was 0.53 (P=.013). The concordance coefficient between the MFA in teleradiography and in navigation was 0.869 (P<.001) preoperatively and 0.709 postoperatively (P=.017). Conclusions. We found a strong concordance between radiographic and surgical navigation measurements of the MFA. This may imply that teleradiography is not necessary when using surgical navigation in TKA (AU)

Fever, Malaise, and Dyspnea in a Diabetic Heart Transplant Patient: A Case Report.

Patients with solid-organ transplants usually present at the emergency department with nonspecific symptoms. The physician should consider a great variety of syndromes and diseases, given the greater risk that solid-organ transplant patients carry because of immunosuppression and transplant-related conditions. Myocardial infarction caused by cardiac allograft vasculopathy must be always suspected and ruled out, even when initial symptoms do not orientate in that direction. We present a case that conjugates signs that can be present in different pathologies. It shows that fever is not always related to infection or rejection but could also appear in acute cardiac allograft vasculopathy. It emphasizes the need of a multi-disciplinary team led by a heart transplant specialist when dealing with this sort of clinical case.

Frontal alignment in total knee arthroplasty. Comparative study between radiographic measurement and surgical navigation. / Alineación frontal en la artroplastia total de rodilla. Estudio comparativo entre medición radiográfica y con navegación quirúrgica.

OBJECTIVE: To establish the concordance between angulation of the femoro-tibial mechanical axis measured with x-rays and surgical navigation in both the pre and postoperative period after a total knee arthroplasty (TKA) was implanted. MATERIAL AND METHOD: Pre and postoperative measurements were analyzed in 88 TKA of the same model and all performed with the same surgical navigation system. The mechanical frontal angle (MFA) and femoro-tibial anatomic angle were measured before and after the TKA. The angulation was digitally measured with a teleradiography. In the navigation, the femoro-tibial angle at rest, forced varus and valgus were registered and the average of these three measurements was calculated. RESULTS: The mean preoperative MFA measured on the radiograph was 4.55°. The mean of the same angle measured on the postoperative radiograph was 1.72°, (p=0.05). The mean of the MFA measured with navigation before TKA was 3.12° and after the implant with navigation was 0.53 (P=.013). The concordance coefficient between the MFA in teleradiography and in navigation was 0.869 (P<.001) preoperatively and 0.709 postoperatively (P=.017). CONCLUSIONS: We found a strong concordance between radiographic and surgical navigation measurements of the MFA. This may imply that teleradiography is not necessary when using surgical navigation in TKA.

Constrained acetabular liners in hip revision surgery. A low-cost solution for senile patients.

The objective of this study was to analyze the results of a cemented polyethylene model that captures the hip prosthetic head. In a retrospective study we reviewed 36 cemented constrained acetabular liners implanted in patients older than 75 years (mean 83, SD : 4.4), of which 30 patients were aged 80-90 years and 26 were women. The average period of follow-up of our patients was 25.4 months (12-39 months, SD : 7.3). In 26 patients this model was implanted due to recurrent dislocation or instability, in 8 other cases this model was implanted during revision surgery for periprosthetic fractures, aseptic loosening of the -acetabular component, wear of the polyethylene or replacement of the implant because of infection. There was a single case of recurrent dislocation (2.8%). Cemented acetabular constrained liners are a good option in revision surgery in senile patients in which the femoral stem is firmly fixed to the bone.

Complicación vascular tras fractura de ramas pélvicas / Vascular complications after pelvic rami fracture

Paciente de 78 años que sufre fractura de ramas ilio e isquipubiana derechas tras caída casual. A las pocas horas presenta un cuadro de dolor abdominal brusco e hipotensión, siendo diagnosticada de hemorragia extraperitoneal con sangrado activo y repercusión hemodinámica. Ante el progresivo empeoramiento, con anemización e inestabilidad hemodinámica, es remitido al hospital de referencia, donde se realiza embolización selectiva del vaso sangrante. Tras la embolización, la paciente se estabiliza y permanece ingresada, comenzando sedestación una semana más tarde y con consolidación de las fracturas a los 3 meses. Las fracturas pélvicas de baja energía por compresión lateral suelen presentar escasas complicaciones, aunque precisan un control exhaustivo por el riesgo potencial de lesiones vasculares. Es estos casos suponen un riesgo vital, siendo la embolización selectiva del punto sangrante un método de control eficaz, que tampoco está exento de complicaciones graves (AU)

The case is presented of a 78 year-old patient who suffered a right ileo- and ischiopubic rami fracture after a casual fall. A few hours later, she presented with sudden abdominal pain and hypotension. Imaging test showed extraperitoneal hemorrhage with active bleeding and hemodynamic compromise. The progressive worsening, with anemia and hemodynamic instability, required her being sent to the reference hospital for selective embolization of the bleeding point. After embolization, the patient́s situation stabilized, and she was then able to sit down one week later. The fracture consolidated 3 months later. Although low-energy pelvic fractures by lateral compression do not usually present with complications, sometimes they require a strict control due to the potential risk of vascular injuries (AU)

Detección de iones metálicos en cabello tras artroplastia de cadera metal-metal / Detection of metal ions in hair after metal-metal hip arthroplasty

Objetivo. Tras el implante de algunos modelos de prótesis de cadera metal-metal se produce una elevación de los niveles de metales en suero y orina. Recientemente se ha demostrado que hay concordancia entre estas cifras y los niveles encontrados en el cabello. Nuestro objetivo ha sido estudiar la presencia de metales en cabello y conocer si ello se modifica con el paso del tiempo o con la extracción del implante. Material y método. En 45 pacientes con una artroplastia de superficie se ha realizado una determinación de los niveles de cromo, cobalto y molibdeno en cabello a los 3, 4, 5 y 6 años desde el implante. La edad media fue de 57,5 años, 2 eran mujeres. En 11 pacientes, en 5 de ellos por metalosis y quiste periarticular, fue necesaria una reintervención para extracción de la artroplastia e implante de un nuevo modelo con fricción metal-polietileno. Resultados. Las cifras medias de metales en cabello fueron cromo 163,27 ppm, cobalto 61,98 ppm y molibdeno 31,36 ppm, muy por encima de los niveles referidos en la población general. En los pacientes reintervenidos para extracción de la artroplastia se observó al año de la intervención una disminución del 43,8% en los niveles de cromo, del 51,1% en molibdeno y del 90,3% en cobalto. Conclusiones. En las artroplastias de cadera con fricción metal-metal se aprecia una alta concentración de metales en el cabello, que disminuye cuando dicho implante es extraído. La determinación de iones en cabello puede ser un buen marcador de la intoxicación por metales que sucede en estos modelos artroplásticos (AU)

Objective. There is an increase in the levels of metals in the serum and urine after the implantation of some models of metal-metal hip prosthesis. It has recently been demonstrated that there is an association between these levels and the levels found in hair. The aim of this study is to determine the presence of metals in hair, and to find out whether these change over time or with the removal of the implant. Material and method. The levels of chromium, cobalt and molybdenum were determined in the hair of 45 patients at 3, 4, 5, and 6 years after a hip surface replacement. The mean age was 57.5 years, and two were female. Further surgery was required to remove the replacement and implant a new model with metal-polyethylene friction in 11 patients, 5 of them due to metallosis and a periarticular cyst. Results. The mean levels of metals in hair were chromium 163.27 ppm, cobalt 61.98 ppm, and molybdenum 31.36 ppm, much higher than the levels found in the general population. A decrease in the levels of chromium (43.8%), molybdenum (51.1%), and cobalt (91.1%) was observed at one year in the patients who had further surgery to remove the prosthesis. Conclusions. High concentrations of metals in the hair are observed in hip replacements with metal-metal friction, which decrease when that implant is removed. The determination of metal ions in hair could be a good marker of the metal poisoning that occurs in these arthroplasty models (AU)

[Vascular complications after pelvic rami fracture]. / Complicación vascular tras fractura de ramas pélvicas.

The case is presented of a 78 year-old patient who suffered a right ileo- and ischiopubic rami fracture after a casual fall. A few hours later, she presented with sudden abdominal pain and hypotension. Imaging test showed extraperitoneal hemorrhage with active bleeding and hemodynamic compromise. The progressive worsening, with anemia and hemodynamic instability, required her being sent to the reference hospital for selective embolization of the bleeding point. After embolization, the patient́s situation stabilized, and she was then able to sit down one week later. The fracture consolidated 3 months later. Although low-energy pelvic fractures by lateral compression do not usually present with complications, sometimes they require a strict control due to the potential risk of vascular injuries.

¿Influye la estabilidad mediolateral de las artroplastias totales de rodilla en la evolución clínica a corto plazo? Estudio multicéntrico a un año con cirugía asistida por ordenador / Does the medial-lateral stabilty of total knee replacements have an effect on short-term clinical outcomes? One-year results of a multicentre study with computer assisted surgery

Objetivo: Evaluar la influencia de la estabilidad mediolateral de las artroplastias totales de rodilla implantadas con navegación quirúrgica en sus resultados clínicos a corto plazo. Material y métodos: Estudio prospectivo multicéntrico de 111 pacientes intervenidos con artroplastia total de rodilla mediante cirugía asistida por ordenador. Los resultados clínicos y funcionales se evaluaron a los 3 y seis meses mediante las escalas KSS, WOMAC y SF-12 y se correlacionaron con la información que mostraba el sistema de navegación intraoperatoriamente en cuanto a la estabilidad mediolateral en extensión, a los 20° y a los 90° de flexión. Resultados: No se encontró relación entre los resultados clínicos y funcionales y la estabilidad mediolateral medida intraoperatoriamente. Conclusiones: Las variaciones en la estabilidad mediolateral de las artroplastias de rodilla no han mostrado una influencia significativa en los resultados clínicos a corto plazo (AU)

Objective: To evaluate the influence of the medial-lateral stability of the joint on the short-term clinical outcomes after performing navigation in total knee replacement. Material and methods: A multicentre prospective study was conducted on 111 consecutive total knee replacements performed with computer assisted surgery. The study included the evaluation of KSS, WOMAC, and SF-12 preoperatively, and at 3 and 12 months of follow-up, and correlation with stability data obtained during surgery, in extension and at 20° and 90° of flexion. Results: No differences were found in WOMAC, KSS and SF-12 relative to coronal stability during surgery. Conclusions: Variations in coronal stability were shown to have no influence on the short-term clinical results of navigated total knee replacement (AU)

[Detection of metal ions in hair after metal-metal hip arthroplasty]. / Detección de iones metálicos en cabello tras artroplastia de cadera metal-metal.

OBJECTIVE: There is an increase in the levels of metals in the serum and urine after the implantation of some models of metal-metal hip prosthesis. It has recently been demonstrated that there is an association between these levels and the levels found in hair. The aim of this study is to determine the presence of metals in hair, and to find out whether these change over time or with the removal of the implant. MATERIAL AND METHOD: The levels of chromium, cobalt and molybdenum were determined in the hair of 45 patients at 3, 4, 5, and 6 years after a hip surface replacement. The mean age was 57.5 years, and two were female. Further surgery was required to remove the replacement and implant a new model with metal-polyethylene friction in 11 patients, 5 of them due to metallosis and a periarticular cyst. RESULTS: The mean levels of metals in hair were chromium 163.27 ppm, cobalt 61.98 ppm, and molybdenum 31.36 ppm, much higher than the levels found in the general population. A decrease in the levels of chromium (43.8%), molybdenum (51.1%), and cobalt (91.1%) was observed at one year in the patients who had further surgery to remove the prosthesis. CONCLUSIONS: High concentrations of metals in the hair are observed in hip replacements with metal-metal friction, which decrease when that implant is removed. The determination of metal ions in hair could be a good marker of the metal poisoning that occurs in these arthroplasty models.

[Does the medial-lateral stability of total knee replacements have an effect on short-term clinical outcomes? One-year results of a multicentre study with computer assisted surgery]. / Influye la estabilidad mediolateral de las artroplastias totales de rodilla en la evolución clínica a corto plazo? Estudio multicéntrico a un año con cirugía asistida por ordenador.

OBJECTIVE: To evaluate the influence of the medial-lateral stability of the joint on the short-term clinical outcomes after performing navigation in total knee replacement. MATERIAL AND METHODS: A multicentre prospective study was conducted on 111 consecutive total knee replacements performed with computer assisted surgery. The study included the evaluation of KSS, WOMAC, and SF-12 preoperatively, and at 3 and 12 months of follow-up, and correlation with stability data obtained during surgery, in extension and at 20° and 90° of flexion. RESULTS: No differences were found in WOMAC, KSS and SF-12 relative to coronal stability during surgery. CONCLUSIONS: Variations in coronal stability were shown to have no influence on the short-term clinical results of navigated total knee replacement.

Cirugía de mínima invasión frente a cirugía convencional. Una aproximación desde la evidencia científica / Minimally invasive surgery versus conventional surgery. A review of the scientific evidence

En los últimos años se ha extendido en las áreas quirúrgicas, entre ellas la cirugía ortopédica, el concepto de que las incisiones pequeñas facilitan una mejor evolución en múltiples procesos. Sin embargo, no existe en algunos casos una evidencia científica (EC) suficiente para recomendar estos procedimientos. Este artículo pretende realizar una revisión actualizada de los trabajos publicados con EC suficiente sobre las ventajas de la cirugía de mínima invasión (MIS) en comparación con las vías de acceso convencionales. A través de un orden topográfico se revisan los trabajos publicados con nivel de evidencia i o ii y los meta-análisis y revisiones sistemáticas de la literatura médica. Cuando ha sido posible también se ha revisado la información disponible sobre el coste-beneficio de este tipo de cirugía (AU)

The concept that small incisions lead to a better outcome in many procedures has extended into most surgical areas, orthopaedic surgery among them. However, in some cases there is not enough scientific evidence to recommend these procedures. This article attempts to provide an updated review of the works published with sufficient scientific evidence on the advantages of minimally invasive surgery (MIS) compared to conventional access approaches. The published articles, meta-analyses and systematic literature reviews with level I or II evidence are reviewed in topographic order. Wherever possible, the information available on the costs-benefits of this type of surgery is also reviewed (AU)

Computer-assisted navigation in total knee arthroplasty without femoral hardware removal.

PURPOSE OF THE STUDY: The use of navigation applied to total knee arthroplasty in knees with femoral hardware retained has not been studied. MATERIAL AND METHODS: We use navigation in six patients to implant a total knee arthroplasty while retaining the femoral hardware. The retained materials were screws in two cases, diaphyseal plates in another two, intramedullary nails in one and supracondylar tube/plate in another one. Preoperative knee scores were within the 46-66 range, whereas the functional scores were within 40-68. The coronal deformity varied between 30° varus and 5° valgus. RESULTS: The final femoral mechanical axis was between 2° valgus and 3° varus; the axis of the limb was between 4° valgus and 3° varus. Knee scores improved in all cases, with scores between 75 and 90 points (p = 0.028); functional scores were between 64 and 90 points (p = 0.043).The final range of mobility was within the 70°-110° range, with a slight improvement over the preoperative status (p = 0.042). No complications have arisen throughout the follow-up (mean 16 months). CONCLUSIONS: The use of navigation constitutes a good option in the treatment with total arthroplasties for patients with femoral hardware retained.

Posición rotacional del componente tibial en las artroplastias de rodilla. Estudio comparativo entre instrumentación estándar y cirugía asistida con ordenador / Rotational position of the tibial component in knee arthroplasties. Comparative study between standard instrumentation and computer-assisted surgery

Objetivo: Conocer las diferencias en la posición rotacional del componente tibial de las artroplastias de rodilla utilizando la navegación quirúrgica. Material y método: Estudio aleatorizado de dos grupos de artroplastias totales de rodilla: en 24 implantes mediante cirugía estándar con instrumentación mecánica y en 34 con un sistema de navegación quirúrgica inalámbrico. A los pacientes se les realizó una tomografía computada de rodilla y tobillo en el pre y en el postoperatorio para calcular la rotación tibial y la posición final de la artroplastia. Resultados: No se encontraron diferencias estadísticamente significativas en la rotación del implante tibial entre ambos grupos. En los pacientes del grupo de navegación la posición de la artroplastia en el eje frontal fue mejor que en el grupo estándar, pero no hubo diferencias en la rotación tibial. Conclusión: La navegación quirúrgica en las artroplastias de rodilla facilita la colocación del implante en el eje frontal pero no en el rotacional. Es posible que la navegación aporte más ventajas en rodillas con deformidades o cuando no puede utilizarse la instrumentación convencional por ocupación del canal intramedular (AU)

Objective: To establish the differences in the rotational position of tibial component in knee arthroplasties using surgical navigation. Material and methods: Randomized study of two groups of total knee arthroplasties: in 24 implants using standard surgery with mechanical instrumentation and 34 with a wireless surgical navigation system. Patients underwent computed tomography of the knee and ankle pre-and postoperatively to calculate tibial rotation and final position of the arthroplasty. Results: There were no statistically significant differences in rotation of the tibial implant between the two groups. In surgical navigation group patients, arthroplasty position in the frontal axis was better than in the standard group, but there were no differences in tibial rotation. Conclusion: Surgical navigation in knee arthroplasties facilitates placement of the implant in frontal axis but not rotational positioning. It is possible that the navigation provides more advantages in knees with deformities or when conventional instrumentation cannot be used due to occupation of the intramedullary canal (AU)

[Minimally invasive surgery versus conventional surgery. A review of the scientific evidence]. / Cirugía de mínima invasión frente a cirugía convencional. Una aproximación desde la evidencia científica.

The concept that small incisions lead to a better outcome in many procedures has extended into most surgical areas, orthopaedic surgery among them. However, in some cases there is not enough scientific evidence to recommend these procedures. This article attempts to provide an updated review of the works published with sufficient scientific evidence on the advantages of minimally invasive surgery (MIS) compared to conventional access approaches. The published articles, meta-analyses and systematic literature reviews with level I or II evidence are reviewed in topographic order. Wherever possible, the information available on the costs-benefits of this type of surgery is also reviewed.