Vástagos cortos versus convencionales en artroplastia total de cadera: nuestra experiencia / Short versus conventional stems in Total hipShort versus conventional stems in Total hiparthroplasty: Our experience

Objetivo: Evaluar la incidencia de complicaciones y la calidad de vida tras la cirugía en dos grupos de pacientes sometidos a artroplastia total de cadera no cementadas con vástagos corto y con vástagos estándar. Material y Métodos: Se realiza un estudio retrospectivo sobre un total de 106 artroplastias total de cadera implantadas en el Hospital Universitario de Puerto Real entre 2011 y 2015. Se comparan las siguientes variables: estancia hospitalaria, necesidad de transfusión sanguínea, complicaciones mecánicas, necesidad de revisión por cualquier causa, parámetros radiológicos (reabsorción del calcar, hundimiento, dismetría postquirúrgica, metría de cuello remanente) y dolor en cara anterior de muslo en dos grupos homogéneos de 63 vástagos convencionales anatómicos no cementados con 43 vástagos cortos de estabilización metafisaria y preservación parcial del cuello femoral ("partial collum"), implantadas por un mismo cirujano. Para el análisis estadístico se utilizó la T de Student para el análisis de variables cuantitativas y Chi cuadrado para variables cualitativas. Resultados: Los resultados muestran diferencias estadísticamente significativas (p< 0.05) en cuanto a variables estancia hospitalaria postquirúrgica, fracturas periprotésicas, dismetría, complicaciones mecánicas y metría del cuello remanente. Conclusiones: Los resultados avalan el empleo de vástagos cortos de estabilización metafisaria y preservación parcial del cuello femoral en pacientes jóvenes con adecuada calidad ósea y bien seleccionados, dadas las ventajas clínicas que suponen

Objetives: To evaluate the incidence of complications and the quality of life after surgery in two groups of patients undergoing total hip arthroplasty not cemented with a short stem and with a standard uncemented stem. Material and Methods: A retrospective study was performed in a total of 106 total hip arthroplasties implanted in the University Hospital of Puerto Real between 2011 and 2015. The following variables are compared: hospital stay, need for blood transfusion, mechanical complications, need for revision for any reason , radiological parameters (calcar resorption, subsidence, postsurgical dysmetria, remnant neck metrics) and anterior thigh pain in two homoge-nous groups of 63 conventional uncemented anatomical stems with 43 short stems of metaphyseal stabilization and partial femoral neck preservation ("Partial collum"), implanted by the same surgeon. For the statistical analysis, T Student was used for the analysis of quantitative variables and Chi-square for qualitative variables. Results: The results show statistically significant differences (p < 0.05) in terms of postsurgical hospital stay variables, periprosthetic fractures, dysmetria, mechanical complications and metrics of the remaining neck. Conclusions: The results support the use of short stems of metaphyseal stabilization and preservation of the greater trochanter in young patients with adequate bone quality given the clinical advantages they imply

Is cannulated-screw fixation an alternative to plate osteosynthesis in open book fractures? A biomechanical analysis.

OBJECTIVES: The current biomechanical work compares the symphyseal and sacroiliac stability obtained with two systems of bone osteosynthesis. The two methods of fixation compared were the 6-hole suprapubic non-locked plate and pubic fixation with two cannulated screws, a novel technique that can be applied percutaneously in the clinical practice. The aim of this study was to examine the validity of the use of two-cannulated-screws osteosynthesis in order to minimize the secondary effects of open fixation, especially in patients in whom an open reduction is contraindicated. MATERIALS AND METHODS: A biomechanical study was designed in 9 fresh, human pelvis specimens, simulating an AO B1.1 type injury, using both fixation systems sequentially in each specimen. In both parts of the test, the specimens were subjected to an axial load of 300N. Displacements and rotations between the different pelvic elements were studied by means of a discrete set of points. The absence of differences between the two systems has been set as the null hypothesis. RESULTS: There were significant differences in favor of the cross-cannulated screws in most of the displacements measured at the pubic symphysis and sacroiliac joint. CONCLUSIONS: Fixation of the AO B1.1 type fractures with cross cannulated screws restores the biomechanical behavior of the pubic symphysis, obtaining better stability than fixation with the 6-hole non-locked plate. To date, no comparative, biomechanical studies have been conducted with these two systems of osteosynthesis. This study demonstrates that cross-cannulated screws fixation of the pubic symphysis in AO B1.1 pelvic fractures should be considered as an alternative to the conventional plating system.