Bone remodeling, around an anatomical hip stem: a one year prospective study using DEXA. / Estudio prospectivo del remodelado óseo femoral alrededor de un vástago anatómico de cadera: un año de seguimiento densitométrico.

INTRODUCTION: The loss of bone mass, as a consequence of bone remodelling, in the proximal third of the femur, is a factor that contributes to the failure of hip prostheses in the medium to long term. This periprosthetic remodelling occurs mainly during the first 12 months after the operation. The aim is to evaluate the behaviour at one year of a new anatomical stem, the ANATO® stem (2015-Stryker®), which is a redesign of its predecessor (ABG-ii®-Stryker stem) by means of bone densitometry. METHOD: Prospective, controlled study in which the changes in bone mineral density (BMD) observed around the seven areas of Gruen in a group of 61 patients affected by primary coxarthrosis, in whom an ANATO® stem was implanted, are analysed densitometrically. The healthy hip was taken as the control group. The existence of differences in the remodelling pattern according to sex, age and body mass index (BMI) was compared. The follow-up was during the first year after the intervention. RESULTS: After one year of follow-up, decreases of bone mineral density in zone seven of -5.9% were observed, being this decrease statistically significant. No differences were found in the remodelling pattern according to age, sex and body mass index. CONCLUSION: The ANATO® stem allows an efficient transmission of loads from the stem to the proximal femur. Only in zone seven significant bone atrophy is observed. Differences in age, BMI and sex do not seem to influence the bone remodelling around this new stem.

Tibial tray cementation is not necessary for knee revision with titanium metaphyseal sleeves: a mid-term prospective study in AORI 2B defects.

PURPOSE: Metaphyseal fixation with porous titanium sleeves in revision knee surgery provides mechanical support to the implant, promotes biological fixation, and has shown satisfactory short- and mid-term results. Cement is commonly used to fix the tibial tray to the epiphyseal area. The objective of this study is to determine whether cement should be used to achieve fixation of the tibial tray with the hypothesis that metaphyseal sleeves would provide enough axial and rotational stability making cementation unnecessary. MATERIAL AND METHODS: Prospective study of 60 patients undergoing knee replacement surgery with metaphyseal sleeves in type 2B defects in femur and tibia. Patients were divided into two groups according to the use of cement on the tibial component. Analysis included the American Knee Society Score (KSS) knee and functional scales, the Western Ontario and McMaster Universities (WOMAC) index, the Short Form 12 (SF-12) health survey, and radiographic assessment with a maximum follow-up of 5 years. RESULTS: No statistically significant differences were found between the two groups in any of the parameters assessed. CONCLUSION: Metaphyseal sleeves showed a 100% survivorship at five years of followup. There were no differences in clinical and radiographic outcomes at five years of follow-up depending on whether or not cement was used for tibial platform fixation. Cementation of the tibial tray would therefore not be required to achieve satisfactory mid-term results. LEVEL OF EVIDENCE: Level II: prospective cohort study. Therapeutic.

[Epidemiology, clinical results and success rate in hip preservation surgery in avascular osteonecrosis of the femoral head]. / Epidemiología, resultados clínicos y tasa de éxito en cirugía preservadora de cadera en la necrosis avascular de cabeza femoral.

INTRODUCTION: Avascular osteonecrosis of the femoral head (ONFH) is a frequent pathology with an insidious and asymptomatic presentation in early stages, so the diagnosis is often made in advanced stages, where the only effective solution is total hip arthroplasty (THA). Diagnosis in early stages will allow the use of therapeutic options that avoid or delay ATC. Our objective is to evaluate the demographic, clinical results and the success rate in our center of patients diagnosed with ONFH and who have been subsidiary of hip preservation surgery. MATERIAL AND METHODS: Unicentric, prospective, uncontrolled clinical study of patients diagnosed with ONFH between January 2012 and September 2017 with a Steinberg IIIA stage. The surgical technique used is decompressive forage, associated with bone allograft and bone marrow aspiration. RESULTS: 26 hips were operated on with our surgical technique. The success rate obtained is 61.54%, since 10 cases have required THA during the study (38.46%). CONCLUSIONS: The therapeutic success in ONFH is directly related to the degree of the disease, which is why early diagnosis is important. The decompressive forage with bone allograft that associates bone marrow aspiration is an option to be taken into account, since in early stages it shows a high success rate.

INTRODUCCIÓN: La necrosis avascular de cabeza femoral (NACF) es una patología frecuente que en sus inicios es asintomática y se manifiesta de forma insidiosa, por lo que a menudo el diagnóstico se realiza en estadios avanzados, donde la única solución eficaz es la artroplastía total de cadera (ATC). El diagnóstico en fases precoces permitirá utilizar opciones terapéuticas que eviten o retrasen la ATC. Nuestro objetivo es valorar los resultados demográficos, clínicos y la tasa de éxito en nuestro centro de pacientes con diagnóstico de NACF y que han sido subsidiarios de cirugía de preservación de cadera. MATERIAL Y MÉTODOS: Estudio clínico unicéntrico, prospectivo, no controlado de pacientes con diagnóstico de NACF entre Enero de 2012 y Septiembre de 2017 con un estadio Steinberg IIIA. La técnica quirúrgica utilizada es el forage descompresivo, asociado a relleno con aloinjerto y aspirado de médula ósea. RESULTADOS: Se intervinieron 26 caderas con nuestra técnica quirúrgica. La tasa de éxito obtenida es de 61.54%, ya que 10 casos han precisado ATC durante el estudio (38.46%). CONCLUSIÓN: El éxito terapéutico en la NACF está directamente relacionado con el grado de la enfermedad, por lo que es importante el diagnóstico precoz. El forage descompresivo con relleno de aloinjerto que asocia aspirado de médula ósea es una opción a tener en cuenta, ya que en estadios iniciales muestra una elevada tasa de éxito.

Comparación del abordaje abierto frente al artroscópico en el tratamiento del choque femoroacetabular / Comparison of the open versus the arthroscopic approach in the treatment of femoroacetabular shock

OBJETIVOS: Comparar clínica y radiográficamente los resultados y complicaciones del tratamiento quirúrgico del choque femoroacetabular, mediante cirugía abierta o abordaje artroscópico. MÉTODOS: Estudio retrospectivo en el que se incluye a los pacientes intervenidos entre junio de 2009 y enero de 2018 de choque femoroacetabular mediante abordaje abierto o artroscópico. De dichos pacientes se obtuvieron datos diagnósticos, resultados pre- y postoperatorios del ángulo α, escala Tönnis, valoración clínica mediante Harris Hip Score, estancia hospitalaria y posibles complicaciones así como evolución a prótesis total de cadera. RESULTADOS: Fueron incluidos en el estudio 57 pacientes, de los cuales 27 fueron sometidos a femoroplastia abierta (45,6%) y 31 a cirugía artroscópica de cadera (54,4%). A la hora de comparar los resultados obtenidos en cuanto corrección de ángulo α y de la puntuación del Harris Hip Score, no se obtuvieron diferencias estadísticamente significativas. Donde sí se encontraron diferencias estadísticamente significativas fue en la estancia hospitalaria, siendo aquí superior aquellas femoroplastias realizadas mediante cirugía artroscópica. CONCLUSIÓN: Ambas técnicas quirúrgicas para el tratamiento del choque femoroacetabular son válidas y obtienen resultados satisfactorios, si bien es cierto que la artroscopia está demostrando resultados superiores respecto a la cirugía abierta en el acortamiento de los tiempos quirúrgicos, estancia hospitalaria y recuperación postoperatoria

OBJECTIVE: To compare clinical and imaging results and complications between patients treated for femoroacetabular impingement who underwent either open surgery or an arthroscopic approach. METHODS: This retrospective study included patients who underwent femoroacetabular impingement surgical treatment between June 2009 and January 2018. Patients treated with open surgery were compared with those treated with arthroscopy. Patients were radiographically and clinically assessed by alpha angle, degree of arthritis, Harris Hip Score, hospital stay and complications, as well as progression to total hip arthroplasty. RESULTS: 57 patients with FAI were included; 27 (45.6%) underwent open surgery and 31 (54.4%) underwent arthroscopy. Statistically significant differences were observed in hospital stay, where the patients who underwent arthroscopic surgery showed better outcomes. There were no other statistically significant differences, the results were similar in both groups. CONCLUSIONS: Arthroscopy and open surgery treatments for femoroacetabular impingement provided comparable clinical and radiographic results. However, the latter surgery provides better results in surgery time, hospital stay and postoperative recovery

Epidemiología, resultados clínicos y tasa de éxito en cirugía preservadora de cadera en la necrosis avascular de cabeza femoral / Epidemiology, clinical results and success rate in hip preservation surgery in avascular osteonecrosis of the femoral head

Resumen: Introducción: La necrosis avascular de cabeza femoral (NACF) es una patología frecuente que en sus inicios es asintomática y se manifiesta de forma insidiosa, por lo que a menudo el diagnóstico se realiza en estadios avanzados, donde la única solución eficaz es la artroplastía total de cadera (ATC). El diagnóstico en fases precoces permitirá utilizar opciones terapéuticas que eviten o retrasen la ATC. Nuestro objetivo es valorar los resultados demográficos, clínicos y la tasa de éxito en nuestro centro de pacientes con diagnóstico de NACF y que han sido subsidiarios de cirugía de preservación de cadera. Material y métodos: Estudio clínico unicéntrico, prospectivo, no controlado de pacientes con diagnóstico de NACF entre Enero de 2012 y Septiembre de 2017 con un estadio Steinberg ≤ IIIA. La técnica quirúrgica utilizada es el forage descompresivo, asociado a relleno con aloinjerto y aspirado de médula ósea. Resultados: Se intervinieron 26 caderas con nuestra técnica quirúrgica. La tasa de éxito obtenida es de 61.54%, ya que 10 casos han precisado ATC durante el estudio (38.46%). Conclusión: El éxito terapéutico en la NACF está directamente relacionado con el grado de la enfermedad, por lo que es importante el diagnóstico precoz. El forage descompresivo con relleno de aloinjerto que asocia aspirado de médula ósea es una opción a tener en cuenta, ya que en estadios iniciales muestra una elevada tasa de éxito.

Abstract: Introduction: Avascular osteonecrosis of the femoral head (ONFH) is a frequent pathology with an insidious and asymptomatic presentation in early stages, so the diagnosis is often made in advanced stages, where the only effective solution is total hip arthroplasty (THA). Diagnosis in early stages will allow the use of therapeutic options that avoid or delay ATC. Our objective is to evaluate the demographic, clinical results and the success rate in our center of patients diagnosed with ONFH and who have been subsidiary of hip preservation surgery. Material and methods: Unicentric, prospective, uncontrolled clinical study of patients diagnosed with ONFH between January 2012 and September 2017 with a Steinberg ≤ IIIA stage. The surgical technique used is decompressive forage, associated with bone allograft and bone marrow aspiration. Results: 26 hips were operated on with our surgical technique. The success rate obtained is 61.54%, since 10 cases have required THA during the study (38.46%). Conclusions: The therapeutic success in ONFH is directly related to the degree of the disease, which is why early diagnosis is important. The decompressive forage with bone allograft that associates bone marrow aspiration is an option to be taken into account, since in early stages it shows a high success rate.

Comparison of the open versus the arthroscopic approach in the treatment of femoroacetabular shock. / Comparación del abordaje abierto frente al artroscópico en el tratamiento del choque femoroacetabular.

OBJECTIVE: To compare clinical and imaging results and complications between patients treated for femoroacetabular impingement who underwent either open surgery or an arthroscopic approach. METHODS: This retrospective study included patients who underwent femoroacetabular impingement surgical treatment between June 2009 and January 2018. Patients treated with open surgery were compared with those treated with arthroscopy. Patients were radiographically and clinically assessed by alpha angle, degree of arthritis, Harris Hip Score, hospital stay and complications, as well as progression to total hip arthroplasty. RESULTS: 57 patients with FAI were included; 27 (45.6%) underwent open surgery and 31 (54.4%) underwent arthroscopy. Statistically significant differences were observed in hospital stay, where the patients who underwent arthroscopic surgery showed better outcomes. There were no other statistically significant differences, the results were similar in both groups. CONCLUSIONS: Arthroscopy and open surgery treatments for femoroacetabular impingement provided comparable clinical and radiographic results. However, the latter surgery provides better results in surgery time, hospital stay and postoperative recovery.

Mortalidad de una cohorte de hombres con fractura de cadera por fragilidad en un sector sanitario: factores asociados / Mortality in a cohort of men with fragility hip fracture in a health area: associated factors

FUNDAMENTOS: Una cuarta parte de los pacientes con fractura de cadera por fragilidad (FCF) son hombres, y estos presentan una mortalidad mayor que las mujeres. El objetivo de este trabajo es estudiar la mortalidad consecuencia de la FCF en hombres ≥65años, tanto intrahospitalaria como al año y a los 3años, y los posibles factores asociados. MATERIAL Y MÉTODOS: Estudio observacional analítico de una cohorte histórica de 182 pacientes varones con FCF ≥65años ingresados en un servicio de Cirugía Ortopédica y Traumatología (COT) entre enero de 2009 y diciembre de 2014. RESULTADOS: La mortalidad intrahospitalaria fue del 10,9% (6% en el servicio COT y 8,6% en el centro sociosanitario). Se encontró asociación entre la mortalidad intrahospitalaria y la edad (p = 0,039). Veinte pacientes murieron durante su estancia en ambos hospitales. Cuarenta y dos (25,9%) murieron un año después y 95 (58,6%) murieron 3años después. La demencia/deterioro cognitivo se relacionó con un riesgo relativo de mortalidad a un año de 2,2, y de mortalidad a 3años de 1,6. Encontramos asociación entre la edad y la mortalidad y entre el índice de Barthel al inicio y la mortalidad en ambos períodos. Las causas más frecuentes de muerte fueron cardiovasculares (15,7%) y tumores (13,6%). CONCLUSIONES: Los varones con FCF presentaron una mortalidad elevada tanto intrahospitalaria, como al año y a los 3años. El factor de riesgo más determinante de mortalidad al año es la demencia/deterioro cognitivo, y el de mortalidad a los 3años, la HTA

BACKGROUND: A quarter of the patients with fragility hip fracture (FHF) are men, and they have higher mortality rates than women. The objective of this study is to analyse the mortality, as well as associated factors, due to FHF in men aged ≥65years, while in hospital and at one and three years of follow-up. MATERIAL AND METHODS: An analytical observational study was conducted on a historical cohort of 182 male patients equal or older than 65 years that were admitted to an Orthopaedic Surgery and Traumatology (OST) Department between January 2009 and December 2014. RESULTS: Within-hospital mortality was 10.9% (6% in the OST Department, and 8.6% in a Social-Health centre). A relationship (P=.039) was found between within-hospital mortality and age. A total of 20 patients died during their stay in both units, 42 (25.9%) died one year later, and 95 (58.6%) died three years later. Dementia/cognitive impairment was associated with a relative risk of one-year mortality of 2.2, and 1.6 of three-year mortality. An association was observed between age and mortality and between Barthel Index at baseline and mortality at both periods. The most frequent causes of death were cardiovascular (15.7%) and tumours (13.6%). CONCLUSIONS: Male patients with FHF showed high mortality rates in hospital, and at one-year and three-years follow-up. The most important risk factor of mortality was dementia/cognitive deterioration at one year, and high blood pressure at three years

[Mortality in a cohort of men with fragility hip fracture in a health area: Associated factors]. / Mortalidad de una cohorte de hombres con fractura de cadera por fragilidad en un sector sanitario: factores asociados.

BACKGROUND: A quarter of the patients with fragility hip fracture (FHF) are men, and they have higher mortality rates than women. The objective of this study is to analyse the mortality, as well as associated factors, due to FHF in men aged ≥65years, while in hospital and at one and three years of follow-up. MATERIAL AND METHODS: An analytical observational study was conducted on a historical cohort of 182 male patients equal or older than 65 years that were admitted to an Orthopaedic Surgery and Traumatology (OST) Department between January 2009 and December 2014. RESULTS: Within-hospital mortality was 10.9% (6% in the OST Department, and 8.6% in a Social-Health centre). A relationship (P=.039) was found between within-hospital mortality and age. A total of 20 patients died during their stay in both units, 42 (25.9%) died one year later, and 95 (58.6%) died three years later. Dementia/cognitive impairment was associated with a relative risk of one-year mortality of 2.2, and 1.6 of three-year mortality. An association was observed between age and mortality and between Barthel Index at baseline and mortality at both periods. The most frequent causes of death were cardiovascular (15.7%) and tumours (13.6%). CONCLUSIONS: Male patients with FHF showed high mortality rates in hospital, and at one-year and three-years follow-up. The most important risk factor of mortality was dementia/cognitive deterioration at one year, and high blood pressure at three years.

Resultados medidos con captura de movimiento en las fracturas de húmero proximal tratadas mediante osteosíntesis con placa bloqueada / Results measured by means of a motion capture system in proximal humerus fractures treated by osteosynthesis with locking plate

Objetivo: Evaluar los resultados de las fracturas de húmero proximal tratadas mediante osteosíntesis con placa empleando captura de movimiento y escalas funcionales. Material y método: Estudio retrospectivo de 47 pacientes mayores de 65 años, tratados mediante osteosíntesis con placa bloqueada en el mismo centro, desde enero de 2010 a diciembre de 2014. Tras un seguimiento mínimo de 2 años, se realizó una evaluación de los resultados obtenidos mediante 2 escalas funcionales (Constant-Murley y Quick DASH) y una escala de calidad de vida (EQ-5D). Para analizar el balance articular de forma objetiva se empleó un sistema de análisis cinemático con cámaras y sin marcadores. Resultados: La edad media fue 74,85 años. Los resultados funcionales expresados mediante la puntuación media fueron: Constant-Murley, 70,06 puntos; Quick DASH, 35,74 puntos; y EQ-5D, 6,79 puntos. Los arcos de movilidad medios fueron: flexión, 111,49°; extensión: 24,13°; abducción: 109,40°; aducción: 15,13°; rotación externa: 38,96° y rotación interna: 49,28°. Se encontró correlación estadística entre las 2 escalas funcionales y de ambas con la EQ-5D. También se advirtió correlación estadística entre los movimientos estudiados con las escalas funcionales (excepto rotación externa) y con la escala de calidad de vida (excepto flexión y rotación externa). Conclusión: La osteosíntesis con placa bloqueada en las fracturas de húmero proximal del anciano obtiene unos buenos resultados funcionales y de calidad de vida. El uso de sistemas de captura de movimiento permite una medición más objetiva de estos resultados y puede ser una herramienta útil en la valoración funcional de esta patología

Objective: To evaluate the results after locking plate internal fixation of proximal humerus fractures by means of a motion capture system, and functional scales. Material and method: Retrospective study of a cohort of 47 elderly patients undergoing surgery from January 2010 to December 2014. After a minimum follow-up of two years, two functional scales (Constant-Murley and Quick DASH), and a quality of life scale (EQ-5D) were used for clinical evaluation. For objective evaluation of the range of motion a kinematic marker-free analysis with cameras was performed. Results: The average age was 74.85 years. Average functional scores were: Constant-Murley 70.06 points, Quick DASH 35.74 points and EQ-5D 6.79 points. The average range of motion was: flexion, 111.49°; extension: 24.13°; abduction: 109.40°; adduction: 15.13°; external rotation: 38.96°, and internal rotation: 49.28°. Correlation was found between the two functional scales, between them and the EQ-5D, and between range of motion and functional scales (except for external rotation) as well as between range of motion and EQ-5D (except for flexion and external rotation). Conclusion: Locking plate osteosynthesis in proximal humerus fragility fractures achieved good functional and quality of life scores. Motion capture systems can be a useful tool for the functional assessment of shoulder pathology allowing an objective evaluation of range of motion

The impact of hip fracture on health-related quality of life and activities of daily living: the SPARE-HIP prospective cohort study.

PURPOSE: The medical morbidity and mortality associated with neck of femur fractures is well-documented, whereas there is limited data for patient-reported outcomes. The aim of this study was to characterize the impact of neck of femur fractures on activities of daily living and patient-reported health-related quality of life. METHODS: Design and participants: Multicentric prospective cohort study. Consecutive sample patients with fragility hip fracture over 50 years old admitted in 48 hospitals in Spain. OUTCOMES: daily living activity function (Barthel Index) and health-related quality of life (EQ-5D) pre-fracture, admission to hospital and at 1- and 4-month follow-up post-fracture. STATISTICS: Barthel and EQ-5D over time are described as mean (SD) and median (interquartile range). RESULTS: A total of 997 patients were recruited at baseline with 4-month outcomes available for, and 856 patients (89.5%). Barthel Index fell from 78.77 (23.75) at baseline to 43.62 (19.86) on admission to hospital with the fracture. Scores partially recovered to 54.89 (25.40) and 64.09 (21.35) at 1- and 4-month post-fracture, respectively. EQ-5D fell from a median of 0.75 (0.47-0.91) to - 0.01 (- 0.03 to 0.51) on admission. Partial recovery was observed again to (0.51 (- 0.06 to 0.67)) and (0.60 (0.10 to 0.80)) at 1- and 4-month post-fracture, respectively. CONCLUSIONS: Hip fracture results in a large decline in the ability to perform activities of daily living and patient-reported health-related quality of life with only partial recovery amongst survivors 4-month post-fracture.

Results measured by means of a motion capture system in proximal humerus fractures treated by osteosynthesis with locking plate. / Resultados medidos con captura de movimiento en las fracturas de húmero proximal tratadas mediante osteosíntesis con placa bloqueada.

OBJECTIVE: To evaluate the results after locking plate internal fixation of proximal humerus fractures by means of a motion capture system, and functional scales. MATERIAL AND METHOD: Retrospective study of a cohort of 47 elderly patients undergoing surgery from January 2010 to December 2014. After a minimum follow-up of two years, two functional scales (Constant-Murley and Quick DASH), and a quality of life scale (EQ-5D) were used for clinical evaluation. For objective evaluation of the range of motion a kinematic marker-free analysis with cameras was performed. RESULTS: The average age was 74.85 years. Average functional scores were: Constant-Murley 70.06 points, Quick DASH 35.74 points and EQ-5D 6.79 points. The average range of motion was: flexion, 111.49°; extension: 24.13°; abduction: 109.40°; adduction: 15.13°; external rotation: 38.96°, and internal rotation: 49.28°. Correlation was found between the two functional scales, between them and the EQ-5D, and between range of motion and functional scales (except for external rotation) as well as between range of motion and EQ-5D (except for flexion and external rotation). CONCLUSION: Locking plate osteosynthesis in proximal humerus fragility fractures achieved good functional and quality of life scores. Motion capture systems can be a useful tool for the functional assessment of shoulder pathology allowing an objective evaluation of range of motion.

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.

Resultados de un implante de poliuretano para el tratamiento del dolor persistente de rodilla tras meniscectomía parcial con un mínimo de dos años de seguimiento / Results of polyurethane implant for persistent knee pain after partial meniscectomy with a minimum of two years follow-up

Objetivo. Evaluar los resultados de un implante de poliuretano en 10 pacientes con dolor persistente tras meniscectomía parcial. Material y métodos. Estudio prospectivo descriptivo de 10 pacientes que fueron intervenidos para colocación artroscópica de un implante meniscal de poliuretano. Se realizó evaluación funcional, de resonancia magnética y radiología simple antes de la intervención, a los 6 meses, un año, y en el seguimiento final con un mínimo de dos años. La evaluación clínica incluyó las escalas de Lysholm, KOOS y EVA. En resonancia magnética (RM) se evaluó la morfología y la intensidad de la señal del implante según los criterios de Genovese et al. Resultados. Se encontraron diferencias significativas entre la media de puntuación de Lysholm antes de la cirugía (63,5 puntos), a los 6 meses (76,8 puntos) (p = 0,001), al año (83,3 puntos) (p < 0,001) y al final del seguimiento (84,4 puntos) (p < 0,001). En la puntuación del KOOS se hallaron diferencias significativas entre las medias en el preoperatorio (64,23 puntos) y 6 meses (73,66 puntos) (p = 0,001), un año (81,39 puntos) (p < 0,001) y el seguimiento final (83,34 puntos) (p < 0,001). Los valores promedio de la EVA fueron de 5,7 puntos en el preoperatorio, 3,6 puntos a los 6 meses (p < 0,001), 1,9 puntos al año (p < 0,001) y 1,9 puntos al final del seguimiento (p < 0,001). La radiología mostró cambios degenerativos en un caso. En la RM, el tamaño del implante y la intensidad de la señal de RM disminuyeron progresivamente, no llegando a alcanzar nunca los de un menisco normal. Conclusiones. Veinticuatro meses después de la cirugía se ha encontrado una mejora significativa en todos los parámetros clínicos, salvo en un paciente que precisó reintervención. El tamaño del implante se redujo y en ningún caso se alcanzó una imagen de RM similar a la de un menisco normal. El procedimiento demostró ser seguro y útil para el tratamiento del dolor persistente tras meniscectomía (AU)

Purpose. To present the results of a polyurethane meniscal scaffold implant in 10 patients with persistent pain after meniscectomy. Methods. Prospective, descriptive study of ten patients who underwent arthroscopic implantation of a polyurethane meniscal scaffold. Functional, MRI, and radiography assessment was performed pre-operatively and at 6-months, 1-year, and a final follow-up at a minimum of two years. Clinical evaluation included Lysholm score, KOOS and VAS. The MRI morphology and signal intensity of the implant were evaluated according to the criteria of Genovese et al. Results. Statistically significant differences were found between the mean Lysholm score before surgery (63.5 points), and that at 6 months (76.8 points) (p = .001), one year (83.3 points) (p < .001) and final follow-up (84.4 points) (p < .001). KOOS showed significant differences between before surgery (64.23 points), 6 months (73.66 points) (p = .001), one year (81.39 points) (p < .001) and final follow-up (83.34 points) (p < .001). The mean values for VAS were 5.7 points in the pre-operative evaluation, 3.6 points at 6 months-follow-up (p < .001), 1.9 points at one year (p < .001), and 1.9 points at final follow-up (p < .001). Radiology showed degenerative changes in one case. In MRI, the size of the implant and the intensity of the MRI signal gradually decreased, but it never changed to that of a normal meniscus. Conclusion. A significant improvement was found in all the clinical parameters 24 months after the surgery, except in one patient who underwent furher surgery. The scaffold reduced its size and but never achieved an MRI image similar to that of a normal meniscus (AU)

The procedure proved to be safe and useful for the treatment of persistent pain after meniscectomy (AU)

[Results of polyurethane implant for persistent knee pain after partial meniscectomy with a minimum of two years follow-up]. / Resultados de un implante de poliuretano para el tratamiento del dolor persistente de rodilla tras meniscectomía parcial con un mínimo de dos años de seguimiento.

PURPOSE: To present the results of a polyurethane meniscal scaffold implant in 10 patients with persistent pain after meniscectomy. METHODS: Prospective, descriptive study of ten patients who underwent arthroscopic implantation of a polyurethane meniscal scaffold. Functional, MRI, and radiography assessment was performed pre-operatively and at 6-months, 1-year, and a final follow-up at a minimum of two years. Clinical evaluation included Lysholm score, KOOS and VAS. The MRI morphology and signal intensity of the implant were evaluated according to the criteria of Genovese et al. RESULTS: Statistically significant differences were found between the mean Lysholm score before surgery (63.5 points), and that at 6 months (76.8 points) (p=.001), one year (83.3 points) (p<.001) and final follow-up (84.4 points) (p<.001). KOOS showed significant differences between before surgery (64.23 points), 6 months (73.66 points) (p=.001), one year (81.39 points) (p<.001) and final follow-up (83.34 points) (p<.001). The mean values for VAS were 5.7 points in the pre-operative evaluation, 3.6 points at 6 months-follow-up (p<.001), 1.9 points at one year (p<.001), and 1.9 points at final follow-up (p<.001). Radiology showed degenerative changes in one case. In MRI, the size of the implant and the intensity of the MRI signal gradually decreased, but it never changed to that of a normal meniscus. CONCLUSION: A significant improvement was found in all the clinical parameters 24 months after the surgery, except in one patient who underwent furher surgery. The scaffold reduced its size and but never achieved an MRI image similar to that of a normal meniscus. The procedure proved to be safe and useful for the treatment of persistent pain after meniscectomy.

¿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)

[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.

Artritis brucelósica de rodilla: 2 casos clínicos / Brucellar knee arthritis: report on two cases

Objetivo: Se presentan 2 casos de artritis séptica por Brucella. El objetivo es llamar la atención sobre una enfermedad que por ser de diagnóstico a veces difícil y cada vez menos frecuente no debe pasar desapercibida. Material y método: En ambos casos se realizó radiología simple y analítica hemática. En el primer caso se realizó resonancia magnética, serología, bioquímica y cultivos de líquido sinovial, que fueron negativos. El diagnóstico definitivo se realizó mediante cultivo del tejido sinovial obtenido por artroscopia. En el segundo caso no se realizaron más pruebas complementarias por su presentación como artritis séptica aguda, y se realizó el diagnóstico por cultivo de líquido sinovial. Tras el diagnóstico, se inició pauta antibiótica con rifampicina (300mg cada 12h) y doxiciclina (100mg cada 12h) durante un mínimo de 6 semanas. Resultados: En ambos casos se obtuvo la curación. Conclusiones: La artritis séptica por Brucella es actualmente poco frecuente en los países de Europa occidental. Sin embargo, España y otros países de la zona mediterránea continúan presentando tasas endémicas de la enfermedad. La brucelosis debe incluirse en el diagnóstico diferencial de toda monoartritis de rodilla (AU)

Purpose: We present 2 cases of septic arthritis caused by brucella. The purpose of the study is to post a warning about a condition that may be unusual and difficult to diagnose but which should not go unnoticed. Materials and methods: In both cases we performed plain films and blood tests. In the first case, we performed an MRi, serological and biochemical tests and synovial fluid cultures, which returned a negative result. Final diagnosis was made by means of an arthroscopic synovial tissue culture. No additional tests were carried out in the second case because it presented as an instance of acute septic arthritis. Diagnosis was made on the basis of a synovial fluid culture. After diagnosis, antibiotic treatment was initiated with rifampicin (300mg every 12h) and doxiciclin (100mg every 12h) for at least 6 weeks. Results: Healing occurred in both cases. Conclusions: Brucellar septic arthritis is currently rather unusual in Western European countries. However, Spain and other countries in the Mediterranean region are still characterized by endemic levels of the disease. Brucellosis should invariably be included in the differential diagnosis of knee arthritis (AU)

Tratamiento de las fracturas en dos y tres partes de la extremidad proximal del húmero mediante fijación externa / Treatment by external fixation of 2-part and 3-part proximal humeral fractures

Objetivo. Revisar los resultados del tratamiento de las fracturas en dos y tres partes del extremo proximal de húmero mediante fijación externa. Material y método. Estudio retrospectivo con evaluación clínica y radiológica de 62 fracturas de tercio proximal de húmero en 2 y 3 partes en 62 pacientes intervenidos mediante osteotaxis con fijador Hoffmann II. Resultados. Las puntuaciones medias obtenidas en la escala de Constant fueron de 84 puntos, con un 80% de resultados satisfactorios. No influyeron en los resultados las variables sexo (p = 0,25), edad (p = 0,31), lateralidad (p = 0,33), ni tipo de fractura (p = 0,60). Todos los casos consolidaron. La reducción fue considerada como buena en 50 casos, 8 consolidaron en varo y 4 casos en valgo. Conclusiones. Este procedimiento permite obtener resultados funcionales satisfactorios precozmente, facilita la rehabilitación al limitar la movilidad posoperatoria en menor grado que otras técnicas, es menos agresivo que las técnicas de reducción abierta y osteosíntesis, y ofrece un bajo porcentaje de complicaciones

Purpose. To review the results of treatment by external fixation of two-part and three-part proximal humeral fractures. Materials and methods. A retrospective study using a clinical and X-ray assessment of 62 two-and three-part fractures of the proximal third of the humerus in 62 patients that underwent external fixation using a Hoffmann II fixation system. Results. Mean scores of 84 points were obtained using the Constant scale, with 80% satisfactory results. The following variables did not influence results: sex (p = 0.25), age (p = 0.31), laterality (p = 0.33), nor type of fracture (p = 0.60). Union was obtained in all cases. Reduction was considered good in 50 cases, there were 8 cases of union in varus and 4 in valgus. Conclusions. This procedure makes it possible to obtain early satisfactory functional results and helps rehabilitation as it limits postoperative mobility to a lesser degree than other techniques; it is also less aggressive than open reduction and osteosynthesis and has a low complication rate

[Atypical epidemic outbreak of gastroenteritis caused by rotavirus]. / Brote epidémico atípico de gastroenteritis por rotavirus.

An outbreak of Rotavirus gastroenteritis in children from 1 month to 7 years of age, detected during the summer months with the highest incidence being in August, is described here. After studying the different factors which may be related to this outbreak, it appears that the humid climatic characteristics together with the social habits of our region may have been the causes which unleashed the epidemic.