Two-stage bone and meniscus allograft and autologous chondrocytes implant for unicompartmental osteoarthritis: midterm results.

BACKGROUND: We analyzed the clinical and radiographic evolution of patients with knee unicompartmental osteoarthritis and axis alteration and osteochondral lesions in the femoral condyle, treated with tibial plateau and meniscus allograft and cultured autologous chondrocyte implantation in the femur in two steps. PURPOSE: To analyze the clinical results with the first patients treated with this two-stage technique to avoid knee prosthesis in patients with unicompartmental osteoarthritis. MATERIAL AND METHODOLOGY: Sixteen patients, average age 56 years, were included in a cohort study. We performed an osteotomy with tibia plateau allograft, including the meniscus. In a second surgery, the chondrocyte fibrin scaffold was placed in the femur. Clinical symptoms and function were measured using KSSR and KOOS scores. Wilcoxon's test was performed to compare the results over the 2-year follow-up period. RESULTS: Mean KSSR before surgery was 35.69 (SD: 3.75) points, rising to 67 (SD: 15.42) at 3 months, 95.88 at 12 months (SD: 2.68) and 96.31 at 24 months (SD: 2.24). The KOOS before surgery was 65.14 (SD: 16.34), rising to 72.68 after 3 months (SD: 19.15), 76.68 at 12 months (SD: 18.92) and 64.28 at 24 months (SD: 11.79). Four of 5 patients returned to engaging in the activity that they had stopped practicing. Three patients experienced collapse of the tibia allograft, and they needed later a prosthesis. CONCLUSIONS: Simultaneous tibia plateau allograft and autologous chondrocyte implantation in the femur, after correction of the angular deformity, were performed, restoring the anatomy of the medial compartment and knee function in 82% of the patients 2 years after the operation. LEVEL OF EVIDENCE: IV.

Prevalencia de fracturas de cadera, fémur y rodilla en la Unidad Médica de Alta Especialidad Hospital de Traumatología y Ortopedia "Lomas Verdes" del Instituto Mexicano del Seguro Social / Prevalence of hip, femur and knee fractures at the High Specialty Medical Unit, Hospital de Traumatología y Ortopedia "Lomas Verdes", Instituto Mexicano del Seguro Social

Antecedentes: Las fracturas de la extremidad inferior ocurren más frecuentemente en los pacientes de edad avanzada con osteopenia después de una caída de baja energía y/o en los pacientes más jóvenes involucrados en traumatismos de alta energía. En la Unidad Médica de Alta Especialidad Hospital de Traumatología y Ortopedia "Lomas Verdes" se desconoce la prevalencia de fracturas de cadera, fémur y rodilla. Material y métodos: Diseño transversal, descriptivo y retrospectivo. Se revisaron los casos con fracturas de la extremidad inferior tratados durante el 01 de enero del 2012 al 31 de diciembre de 2013 en el Servicio de Cirugía de Cadera, Fémur y Rodilla de la Unidad Médica de Alta Especialidad Hospital de Traumatología y Ortopedia "Lomas Verdes". Resultados: La mayoría de los pacientes (52.2%) fueron del sexo femenino, siendo 64.1% de los pacientes mayor de 60 años de edad. La distribución de las fracturas de acuerdo al segmento afectado: 73.4% (n = 1,327) correspondieron a fracturas de fémur, 13.5% (n = 244) a fracturas de la meseta tibial y 13.2% (n = 238) fracturas de patela. En 66.8% (n = 1,209) de los pacientes tuvieron una estancia intrahospitalaria prolongada (mayor a 10 días). De acuerdo con la localización anatómica ósea más frecuente, las fracturas transtrocantéricas (49.1%) fueron las más frecuentes, seguidas por las fracturas de patela (13.2%) y las diafisarias del fémur (12.7%). Conclusiones: La prevalencia de las fracturas de la extremidad inferior en nuestro hospital corresponde con lo reportado a nivel internacional.

Background: Lower limb fractures are more frequent among older patients with osteopenia after a low energy fall and/or among young patients who sustain a high energy trauma. The prevalence of hip, femur and knee fractures at the High Specialty Medical Unit, Hospital de Traumatología y Ortopedia "Lomas Verdes" is unknown. Material and methods: Cross-sectional study, descriptive and retrospective design. Cases with low extremity fractures treated from January 1st, 2012 to December 31st, 2013 at the Hip, Femur and Knee Service, High Specialty Medical Unit, Hospital de Traumatología y Ortopedia "Lomas Verdes", were reviewed. Results: Most patients (52.2%) were females; 64.1% of patients were over 60 years of age. Fracture distribution according to the segment involved was as follows: 73.4% (n = 1,327) were femur fractures, 13.5% (n = 244) tibial plateau fractures, and 13.2% (n = 238) patellar fractures. 66.8% (n = 1,209) of patients had a long hospital stay (more than 10 days). According to the anatomical location of fractures, transtrochanteric fractures (49.1%) were the most frequent ones, followed by patellar fractures (13.2%), and femur shaft fractures (12.7%). Conclusions: The prevalence of lower limb fractures at our hospital corresponds to what has been reported internationally.

[Prevalence of hip, femur and knee fractures at the High Specialty Medical Unit, Hospital de Traumatología y Ortopedia "Lomas Verdes", Instituto Mexicano del Seguro Social]. / Prevalencia de fracturas de cadera, fémur y rodilla en la Unidad Médica de Alta Especialidad Hospital de Traumatología y Ortopedia "Lomas Verdes" del Instituto Mexicano del Seguro Social.

BACKGROUND: Lower limb fractures are more frequent among older patients with osteopenia after a low energy fall and/or among young patients who sustain a high energy trauma. The prevalence of hip, femur and knee fractures at the High Specialty Medical Unit, Hospital de Traumatología y Ortopedia "Lomas Verdes" is unknown. MATERIAL AND METHODS: Cross-sectional study, descriptive and retrospective design. Cases with low extremity fractures treated from January 1st, 2012 to December 31st, 2013 at the Hip, Femur and Knee Service, High Specialty Medical Unit, Hospital de Traumatología y Ortopedia "Lomas Verdes", were reviewed. RESULTS: Most patients (52.2%) were females; 64.1% of patients were over 60 years of age. Fracture distribution according to the segment involved was as follows: 73.4% (n = 1,327) were femur fractures, 13.5% (n = 244) tibial plateau fractures, and 13.2% (n = 238) patellar fractures. 66.8% (n = 1,209) of patients had a long hospital stay (more than 10 days). According to the anatomical location of fractures, transtrochanteric fractures (49.1%) were the most frequent ones, followed by patellar fractures (13.2%), and femur shaft fractures (12.7%). CONCLUSIONS: The prevalence of lower limb fractures at our hospital corresponds to what has been reported internationally.

Haemophilic arthropathy: the usefulness of intra-articular oxytetracycline (synoviorthesis) in the treatment of chronic synovitis in children.

Synoviorthesis is already widely used in the treatment of chronic haemophilic synovitis. The aim of this study was evaluate the effectiveness of oxytetracicline synoviorthesis on the frequency of haemarthrosis in haemophilic children with chronic synovitis and its impact on joint function. Between January 2001 and October 2006, we performed 34 synoviorthesis in 28 paediatric patients (6-16 years old) with diagnosis of haemophilic arthropathy stage I-II. At each joint were administered five doses of oxytetracycline for five consecutive weeks at doses of 100 mg in elbow and ankle and 250 mg in the knee. The frequency of haemarthrosis and range of joint mobility were evaluated before and after of treatment. The results were analysed with Student t-test and descriptive statistics. Thirty-four joints were treated, including 20 knees (58.8%), eight elbows (23.5%) and six ankles (17.6%). Median follow-up was 46.3 months (range 12-71 months). The frequency of haemarthrosis was recorded before treatment 47.3 year(-1) (range 12-96, P < 0.0001) and decreased to 3.5 year(-1) (range 0-15, P = 0.0119) after treatment. The range of joint motion in flexion-extension before treatment was 84.9°, while after this was 97.5° (P = 0.0119). The synoviorthesis with oxytetracycline has shown a favourable effect in the treatment of chronic haemophilic synovitis in reducing the frequency of haemarthrosis and improvement was observed consistently in the range of motion.

[Comparison of patellar dislocation recurrence in patients ages 9 to 16 years treated surgically with the green technique versus an arthroscopic approach]. / Comparación de la recurrencia de la luxación de patela en pacientes de 9 a 16 años operados con técnica tipo Green contra vía artroscópica.

OBJECTIVE: To report the patellar dislocation recurrence in patients ages 9 to 16 years treated surgically with the Green technique or an arthroscopic approach. MATERIAL AND METHODS: A prospective, longitudinal study was conducted with patients ages 9 to 16 years who presented at the pediatric orthopedics and arthroscopy service at IMSS "Lomas Verdes" UMAE Orthopedics and Traumatology Hospital with a diagnosis of patellar dislocation from January 1st 2003 to December 31st 2006. The patellar dislocation recurrences were recorded. RESULTS: Twenty patients and 24 knees were included; 13 females and 7 males; mean age was 14.3 years +/- 1.75. The dislocations prior to surgical treatment occurred at a mean of 5.5 +/- 2.57 dislocation events, with a range of 2 to 10 events. As regards the side involved, 40% had involvement of the left side, 40% of the right side, with 8 patients each, and 20% were bilateral dislocations. No significant differences were found in the clinical course of the patients treated with the Green technique compared with the arthroscopic surgery group (p = 0.371). CONCLUSIONS: The number of dislocation recurrences after the surgical procedure was not related with the age, gender, number of prior dislocations or surgical technique. No significant difference was found between both groups.

[Pre- and postoperative functional status of patients subjected to anterior cruciate ligament reconstruction associated with knee dislocation]. / Estado funcional pre y postoperado de pacientes con reconstrucción de ligamento cruzado anterior asociado a luxación de rodilla.

INTRODUCTION: The injury of the cruciate ligaments secondary to knee dislocation is caused by high energy trauma; its incidence rate is less than 0.02%; there are multiple treatments, with surgery being the most common one. OBJECTIVE: To determine the functional characteristics of patients who underwent cruciate ligament plasty and sustained knee dislocation. MATERIAL AND METHODS: An observational, prospective, cross-sectional study was conducted including all adult patients with a diagnosis of cruciate ligament injury resulting from knee dislocation who were surgically treated from January 2006 to December 2007. Two knee functional assessment scales were used. RESULTS: A total of 16 patients were included, 12 males and 4 females; mean age was 32.1 years. The Knee Society Clinical Rating Scale had a positive correlation with the Lysholm Knee Scoring Scale (r = 0.836) with p = 0.001. DISCUSSION: The functional results of patients treated surgically are diverse. This study was not conducted as a controlled clinical trial due to the absence of randomization, which was not possible due to the infrequency of the condition. CONCLUSIONS: It will be necessary to confirm the results after a longer follow-up and in a comparative, double-blind study of patients undergoing surgery.