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)

Use of barbed suture in total hip prosthesis. Prospective randomized study. / Utilización de sutura barbada en prótesis total de cadera. Estudio prospectivo aleatorizado.

INTRODUCTION: The correct closure of the surgical wound is an important step in the procedure of a total hip prosthesis implantation (total hip arthroplasty, THA), which aims to a correct healing of the wound and minimize the risk of complications. The objective of our study is to determine if the use of a bidirectional barbed suture decreases the closing time after THA, in the fascial and subcutaneous plane, when compared to the conventional suture polyglactin 910. The hypothesis is that there is no difference in closing time when comparing both sutures. MATERIAL AND METHOD: Prospective single blind randomized study comparing two groups: study group with the use of bidirectional continuous barbed suture (Quill™) (Gr. Q) and a control group (Gr. V) using discontinuous polyglactin 91 suture (Vicryl™). Closure was performed in two planes (fascial and subcutaneous) simultaneously by two surgeons. The exclusion criteria were: previous surgeries on the same hip, revision surgeries, major deformities and allergies to suture components. The variables under study were: 1) fascia closure time, subcutaneous and global; 2) surgical wound infection; and 3) dehiscence. RESULTS: 82 patients (39 Gr. Q, 43 Gr. V) were included. The global closing time was shorter in Gr. Q (5 min 59 sec) compared to Gr. V (7.01 min), (p < 0.04). They showed differences in subcutaneous closure: Gr. Q shorter time with a 37 seconds difference (p = 0.048). Differences in fascial plane were not observed. Superficial infection was observed in one Gr. Q patient and another in Gr. V; one case of deep infection in Gr. Q (p = 0.29). One patient presented dehiscence of the wound in Gr. Q (p = 0.3). However, these differences did not show statistical significance. CONCLUSIONS: The use of a barbed suture allows a shorter closing time compared to the conventional one. However, despite this decrease in time, no differences were found in terms of the appearance of infection or wound dehiscence.

Vástagos modulares de anclaje diafisario con tornillos de bloqueo en la revisión de cadera con defectos femorales masivos / Modular diaphyseal anchor stems with locking screws in the hip revision with massive femoral defects

INTRODUCCIÓN: Los defectos femorales complejos con istmo insuficiente (Paprosky III y IV) y fracturas periprotésicas B3 de Vancouver condicionan la fijación de los vástagos de revisión. El objetivo es evaluar los resultados de los vástagos de revisión modular de anclaje diafisario con bloqueo distal (Sistema Revitan Zimmer Biomet GmbH, Winterthur, Suiza). Nuestra hipótesis es que ofrecen una fijación primaria estable en casos de afectación del istmo femoral. MATERIAL Y MÉTODOS: Estudio de cohortes retrospectivo de 38 pacientes, seguimiento mínimo de 12 meses (12-94) y defectos femorales severos tratados con vástagos Revitan encerrojados. Realizamos una vía endofemoral o una transfemoral. Valoramos el hundimiento según el método de Callahan y la neoformación ósea según Barnett y Nordin. Se utilizó la escala Merle d'Aubigné-Postel y se recogieron las complicaciones y reintervenciones. Se realizó un análisis estadístico con SPSS y un nivel de significación p < 0,05. RESULTADOS: Entre 2009 y 2017 se realizaron 147 revisiones con vástago Revitan, 38 encerrojados, 23 hombres y 15 mujeres, edad media de 74 años y seguimiento medio de 64 meses. Las causas de revisión fueron: 15 aflojamientos sépticos, 14 asépticos, dos fracturas y siete fijaciones fibrosas estables. Obtuvimos una correcta fijación en 27 casos; hubo cuatro aflojamientos, tres roturas de tornillos, tres infecciones, una luxación y una lesión del nervio femoral. El MDP mejoró de forma significativa de 11,26 a 14,98. CONCLUSIONES: Los vástagos modulares cónicos encerrojados son una buena alternativa en los defectos femorales con afectación ístmica si se consigue un correcto relleno del canal y una fijación bicortical de los tornillos

INTRODUCTION: Complex femoral defects with insufficient isthmus (Paprosky III and IV) and Vancouver B3 periprosthetic fractures determines the fixation of the revision stems. The objective is to evaluate the results of the modular revision stems with diaphyseal anchor and distal block (Revitan Zimmer Biomet GmbH, Winterthur, Switzerland). Our hypothesis is that this procedure offers a stable primary fixation in cases of alteration of the femoral isthmus. MATERIAL AND METHODS: Retrospective cohort study of 38 patients, minimum follow-up of 12 months (12-94) with severe femoral defects treated with Revitan stems distally blocked. An endofemoral or transfemoral approach was used. The subsidence was assessed according to Callahan's method and bone neoformation according to Nordin. Merle d'Aubigné-Postel was used and complications and reoperations were collected. A statistical analysis was performed with SPSS and a significance level p < 0.05 was considered. RESULTS: Between 2009 and 2017, 147 revisions were carried out with Revitan stem, 38 locked, 23 men and 15 women, with an average age of 74 years and an average follow-up of 64 months. The cause of the review was: 15 septic loosenings, 14 aseptic, two fractures and seven stable fibrous unions. Right fixation was obtained in 27 cases, there were four loosenings, three screw breakages, three infections, one of dislocation and one of femoral nerve injury. The MDP increased significantly from 11.26 to 14.98. CONCLUSIONS: Distally locked conical modular stems are a good alternative in femoral defects with isthmus involvement if proper canal filling and bicortical screw fixation are achieved

Modular diaphyseal anchor stems with locking screws in the hip revision with massive femoral defects. / Vástagos modulares de anclaje diafisario con tornillos de bloqueo en la revisión de cadera con defectos femorales masivos.

INTRODUCTION: Complex femoral defects with insufficient isthmus (Paprosky III and IV) and Vancouver B3 periprosthetic fractures determines the fixation of the revision stems. The objective is to evaluate the results of the modular revision stems with diaphyseal anchor and distal block (Revitan Zimmer Biomet GmbH, Winterthur, Switzerland). Our hypothesis is that this procedure offers a stable primary fixation in cases of alteration of the femoral isthmus. MATERIAL AND METHODS: Retrospective cohort study of 38 patients, minimum follow-up of 12 months (12-94) with severe femoral defects treated with Revitan stems distally blocked. An endofemoral or transfemoral approach was used. The subsidence was assessed according to Callahan's method and bone neoformation according to Nordin. Merle d'Aubigné-Postel was used and complications and reoperations were collected. A statistical analysis was performed with SPSS and a significance level p < 0.05 was considered. RESULTS: Between 2009 and 2017, 147 revisions were carried out with Revitan stem, 38 locked, 23 men and 15 women, with an average age of 74 years and an average follow-up of 64 months. The cause of the review was: 15 septic loosenings, 14 aseptic, two fractures and seven stable fibrous unions. Right fixation was obtained in 27 cases, there were four loosenings, three screw breakages, three infections, one of dislocation and one of femoral nerve injury. The MDP increased significantly from 11.26 to 14.98. CONCLUSIONS: Distally locked conical modular stems are a good alternative in femoral defects with isthmus involvement if proper canal filling and bicortical screw fixation are achieved.

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.

[Case report: total hip replacement in osteogenesis imperfecta]. / Artroplastía total de cadera en osteogénesis imperfecta. A propósito de un caso.

We study, apropos of a case, a total hip arthroplasty in a patient with osteogenesis imperfecta. The characteristics of this disease, such as high risk of fracture and the presence of deformities, make this surgery a challenge for the orthopedic surgeon. In this manuscript, we review for the first time in this indication the preoperative planning and the selection of implants, with special emphasis on measures for the prevention of complications.

En este trabajo se ha estudiado, a propósito de un caso, la cirugía de artroplastía total de cadera en un paciente con osteogénesis imperfecta. Las características propias de esta enfermedad, como son el elevado riesgo de fractura y la presencia de deformidades, convierten esta cirugía en un reto para el cirujano ortopédico. En este manuscrito se revisa, de forma inédita para esta indicación, la planificación preoperatoria y la elección del tipo de implantes, con especial interés en las medidas para la prevención de complicaciones.

Artroplastía total de cadera en osteogénesis imperfecta. A propósito de un caso / Case report: total hip replacement in osteogenesis imperfecta

Resumen: En este trabajo se ha estudiado, a propósito de un caso, la cirugía de artroplastía total de cadera en un paciente con osteogénesis imperfecta. Las características propias de esta enfermedad, como son el elevado riesgo de fractura y la presencia de deformidades, convierten esta cirugía en un reto para el cirujano ortopédico. En este manuscrito se revisa, de forma inédita para esta indicación, la planificación preoperatoria y la elección del tipo de implantes, con especial interés en las medidas para la prevención de complicaciones.

Abstract: We study, apropos of a case, a total hip arthroplasty in a patient with osteogenesis imperfecta. The characteristics of this disease, such as high risk of fracture and the presence of deformities, make this surgery a challenge for the orthopedic surgeon. In this manuscript, we review for the first time in this indication the preoperative planning and the selection of implants, with special emphasis on measures for the prevention of complications.

Impacto del hundimiento en vástagos de revisión rectos y curvos modulares en cirugía de revisión de cadera / The impact of subsidence on straight and curved modular cementless revision stems in hip revision surgery

El hundimiento protésico es una de las potenciales complicaciones de los vástagos femorales de anclaje diafisario no cementado en las cirugías de revisión protésica, lo cual puede afectar a la estabilidad y a la osteointegración del componente. En este estudio retrospectivo evaluamos los resultados al año y a los 5 años (especialmente el hundimiento y la relevancia clínica) de 40 revisiones de vástago femoral consecutivas, comparando 2 vástagos de revisión modulares no cementados rectos vs. curvos, con 20 pacientes en cada grupo. No se observó ningún fracaso mecánico y se obtuvo una mejoría en cuanto a resultados funcionales en la totalidad de los casos. El hundimiento radiológico medio fue de 9,9±4,9mm (p=0,076); 14 pacientes (35%) tuvieron ≥10mm de hundimiento, con un máximo de 22mm en un caso. Nuestros resultados son similares a las series publicadas en la literatura, sin manifestaciones clínicas a corto-medio plazo ni incremento del número de complicaciones o aflojamiento del vástago en ninguno de los 2 grupos. No se observaron diferencias en cuanto al hundimiento protésico al año y a los 5 años posteriores a la cirugía entre los 2 tipos de vástagos (AU)

Subsidence is one of the potential complications in femoral stem revision total hip arthroplasty surgery, and can affect stability and osseointegration. A retrospective study was conducted on the outcomes at one year and 5 years (specifically subsidence and clinical relevance) of 40 consecutive femoral total hip arthroplasty revisions, comparing two modular cementless revision stems, Straight vs. Curved, with 20 patients in each group. No mechanical failure was observed, and there was an improvement in functional outcomes. Mean radiological subsidence was 9.9±4.9mm (straight=10.75mm vs. curved=9.03mm), with no statistically significant difference between groups (p=0,076). Fourteen patients (35%) had ≥10mm of subsidence, up to a maximum of 22mm. The subsidence found in this study is similar to published series, with no short-term clinical manifestations, or an increased number of complications or stem loosening in either the Straight or Curved group. No differences in subsidence were observed at one year and 5 years after surgery between the 2 types of stems (AU)

The impact of subsidence on straight and curved modular cementless revision stems in hip revision surgery. / Impacto del hundimiento en vástagos de revisión rectos y curvos modulares en cirugía de revisión de cadera.

Subsidence is one of the potential complications in femoral stem revision total hip arthroplasty surgery, and can affect stability and osseointegration. A retrospective study was conducted on the outcomes at one year and 5 years (specifically subsidence and clinical relevance) of 40 consecutive femoral total hip arthroplasty revisions, comparing two modular cementless revision stems, Straight vs. Curved, with 20 patients in each group. No mechanical failure was observed, and there was an improvement in functional outcomes. Mean radiological subsidence was 9.9±4.9mm (straight=10.75mm vs. curved=9.03mm), with no statistically significant difference between groups (p=0,076). Fourteen patients (35%) had ≥10mm of subsidence, up to a maximum of 22mm. The subsidence found in this study is similar to published series, with no short-term clinical manifestations, or an increased number of complications or stem loosening in either the Straight or Curved group. No differences in subsidence were observed at one year and 5 years after surgery between the 2 types of stems.

[Evaluation of the organisation of care for patients without appointment]. / Evaluación de la organización en la atención a pacientes sin cita.

OBJECTIVES: To calculate the improvement achieved in organising care for patients without appointments after introducing corrective measures. Second, to study the reasons for consultation, the duration of the symptoms because of which consultations without appointment take place, and the assessment by health personnel of the relevance of the emergency. DESIGN: Before-and-after study.Setting. Health Area 9, urban health centre, Leganés, Madrid. PATIENTS: All the patients attending consecutively without appointment in the study periods (assessment: November 1998; reassessment: November-December 1999). MAIN RESULTS: 588 patients were included in the assessment and 562 in the reassessment. They belonged to general practice and paediatrics. 5 quality criteria were set: recording of basic details; recording of reason for consultation; assessment in under ten minutes; attempt at prior appointment; and record in the clinical notes. As there were no references in the bibliography, they were agreed by the team. After corrective measures were taken, all criteria except the fourth improved significantly. Nonetheless, the previously set norm was only achieved in the second. The professionals thought 27% of the consultations without appointment in paediatrics were urgent, and 30% in general medicine. Mean duration of symptoms in non-urgent pathologies was 1.5 days in paediatrics and 13.4 in general medicine. The most common reasons for consultation were prescriptions (20%) in general medicine and digestive pathology (20.4%) in paediatrics. CONCLUSIONS: Setting up an improvement cycle at our health centre managed to raise the quality of care given to patients without appointment, although there are still some facets that could be improved so as to reach, at least, the standards set.

Evaluación de la organización en la atención a pacientes sin cita / Evaluation of the organisation of care for patients without appointment

Objetivo. Estimar la mejora alcanzada en la organización de la atención a pacientes sin cita tras la instauración de medidas correctoras. Secundariamente nos propusimos estudiar los motivos de consulta, el tiempo de duración de los síntomas por los que se consulta sin cita y la valoración por personal sanitario sobre la pertinencia de la urgencia. Diseño. Estudio antes-después. Emplazamiento. Área de Salud 9, centro de salud urbano. Leganés, Madrid. Pacientes. Todos los pacientes que de forma consecutiva acudieron sin cita en los períodos de estudio (evaluación: noviembre de 1998; reevaluación: noviembre-diciembre de 1999).Resultados principales. Se incluyeron 588 pacientes en la evaluación y 562 en la reevaluación, pertenecientes a medicina general y pediatría. Se establecieron 5 criterios de calidad relacionados con: registro de datos de filiación; registro del motivo de consulta; valoración en menos de 10 minutos; intento de cita previa y registro en la historia clínica. Ante la ausencia de referencias en la bibliografía, fueron consensuados por el equipo. Tras la instauración de medidas correctoras, todos mejoraron de forma significativa excepto el cuarto. No obstante, sólo se alcanzó el estándar previamente fijado en el segundo. Los profesionales consideraron urgentes un 27 por ciento de las consultas sin cita en pediatría y el 30 por ciento en medicina general. La duración media de los síntomas en las patologías no urgentes fue 1,5 días en pediatría y 13,4 en medicina general. Los motivos de consulta más frecuentes fueron recetas (20 por ciento) en medicina general y patología digestiva (20,4 por ciento) en pediatría. Conclusiones. La puesta en marcha de un ciclo de mejora en nuestro centro de salud ha conseguido elevar la calidad de la atención que se presta a los pacientes sin cita, si bien aún quedan algunos aspectos susceptibles de mejorar hasta alcanzar, al menos, los estándares establecidos. (AU)

Enterocolitis por Staphylococcus aureus meticilín-resistente

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Information loss recovery for block-based image coding techniques-a fuzzy logic approach.

A new technique to recover the information loss in a block-based image coding system is developed in this paper. The proposed scheme is based on fuzzy logic reasoning and can be divided into three main steps: (1) hierarchical compass interpolation/extrapolation (HCIE) in the spatial domain for initial recovery of lost blocks that mainly contain low-frequency information such as smooth background (2) coarse spectra interpretation by fuzzy logic reasoning for recovery of lost blocks that contain high-frequency information such as complex textures and fine features (3) sliding window iteration (SWI), which is performed in both spatial and spectral domains to efficiently integrate the results obtained in steps (1) and (2) such that the optimal result can be achieved in terms of surface continuity on block boundaries and a set of fuzzy inference rules. The proposed method, which is suitable for recovering both isolated and contiguous block losses, provides a new approach for error concealment of block-based image coding systems such as the JPEG coding standard and vector quantization-based coding algorithms. The principle of the proposed scheme can also be applied to block-based video compression schemes such as the H.261, MPEG, and HDTV standards. Simulation results are presented to illustrate the effectiveness of the proposed method.