Content reporting and effectiveness of therapeutic exercise in the management of massive rotator cuff tears: A systematic review with 490 patients.

Background: Massive rotator cuff tears (MRCT) account for a substantial fraction of tears above the age of 60 years. However, there are no clear criteria for prescription parameters within therapeutic exercise treatments. The aim of this study was to evaluate the effects and characteristics of therapeutic exercise treatments in patients with MRCT. Methods: A systematic search was conducted in MEDLINE/PubMed, Web of Science, SPORTDiscus, SciELO, Scopus and EMBASE from inception to August 2022. Studies were included if they evaluated the effects of exercise on patients with MRCT. The risk of bias was evaluated and the Consensus on Exercise Reporting Template (CERT) was also used. A narrative synthesis without meta-analysis was performed. Results: One randomized controlled trial, two non-randomized studies, six non-controlled studies, one case series and four retrospective studies were included. They ranged from serious to moderate risk of bias. The CERT reflected a poor description of the exercise programmes. Studies showed a pattern of improvements in most patient-reported outcome measures (PROM) surpassing the MCID, and active elevation range of motion. Conclusions: There is limited evidence that exercise and co-interventions are effective in the management of some patients with MRCT, based on a systematic review without meta-analysis. Future research should improve content reporting. Level of evidence: IV.

Morbidity and Mortality Analysis in the Treatment of Intertrochanteric Hip Fracture with Two Fixation Systems: Dynamic Hip Screw (DHS) or Trochanteric Fixation Nail Advance (TFNA).

BACKGROUND: The aim of this study was to compare the clinical outcomes, complications, and mortality of patients with intertrochanteric hip fracture treated with dynamic hip screw (DHS) vs. trochanteric fixation nail advance (TFNA). METHODS: We evaluated 152 patients with intertrochanteric fractures concerning age, sex, comorbidity, Charlson Index, preoperative gait, OTA/AO classification, time from fracture to surgery, blood loss, amount of blood replacement, changes in gait, full weight-bearing at hospital discharge, complications, and mortality. The final indicators encompassed the adverse effects linked to implants, postoperative complications, clinical healing or bone healing duration, and functional score. RESULTS: The study included a total of 152 patients, out of which 78 (51%) received DHS treatment and 74 (49%) received TFNA treatment. The results of this study show that the TFNA group demonstrated superiority (p < 0.001). However, it should be noted that the TFNA group had a higher frequency of the most unstable fractures (AO 31 A3, p < 0.005). Full weight-bearing at discharge also decreased in patients with more unstable fractures (p = 0.005) and severe dementia (p = 0.027). Mortality was higher in the DHS group; however, a longer time from diagnosis to surgery was also observed in this group (p < 0.005). CONCLUSIONS: The TFNA group has shown a higher success rate in achieving full weight-bearing at hospital discharge when treating trochanteric hip fractures. This makes it the preferred choice for treating unstable fractures in this region of the hip. Additionally, it is important to note that a longer time to surgery is associated with increased mortality in patients with hip fractures.

Effectiveness of exercise versus arthroscopic partial meniscectomy plus exercise in the management of degenerative meniscal tears at 5-year follow-up: a systematic review and meta-analysis.

INTRODUCTION: There are no meta-analytical data in the long term for comparing surgery and exercise for meniscal tear. The aim of this study is to compare the effectiveness of exercise versus arthroscopic partial meniscectomy (APM) plus exercise for degenerative meniscal tears (DMT) in knee function at 5-year follow-up. MATERIALS AND METHODS: A systematic search of Medline, EMBASE, Web of Science, SciELO, SPORTDiscus, Scopus, and Cochrane Library was performed. The studies were included if they were randomized controlled trials performed in patients aged ≥ 18 years with DMT, that compared physical therapy to APM at 5-year follow-up, and reported at least one outcome measure of knee function/disability. Risk of bias was analyzed with the Cochrane RoB-2 tool and certainty of evidence with GRADE recommendations. A random effects model meta-analysis was performed. RESULTS: 3743 articles were identified and 4 met the criteria. Three had low risk of bias and one had some concerns. There were no significant between-group differences, in within-group changes from baseline to 5-year, on the Knee Injury and Osteoarthritis Outcome Score pain (- 2.28; 95% CI - 5.41 to 0.84), symptoms (- 0.24; 95% CI - 4.13 to 3.64), activities of daily living (- 2.16; 95% CI - 6.16 to 1.83) and quality of life (- 3.98; 95% CI - 9.05 to 1.10). There was a significant difference in support of APM plus exercise for sport/recreation (- 9.28; 95% CI - 18.28 to - 0.29). Leave-one-out sensitivity analysis revealed a non-significant difference in sport/recreation (- 5.05; 95% CI - 12.04 to 1.94). There were no differences in other patient-reported outcome measures. CONCLUSION: Moderate certainty of evidence suggests that the addition of APM to an exercise program adds no benefits in knee function at 5-year follow-up.

Midterm results of a new personalized knee implant for total knee arthroplasty: implant survivorship and patient-reported outcome after five years' follow-up.

PURPOSE: The Persona® system is a newly launched implant designed for total knee arthroplasty (TKA) with technical innovations intended for a better functional outcome and higher flexion range. The aim of this study is to evaluate midterm outcomes and survivorship of a cohort of patients with a minimum of 5-year follow-up and to confirm previous results described in the literature. METHODS: A cohort of 91 knees (85 patients) that underwent a patella-preserving TKA with the Persona® implant and who were followed for a mean of 5.9 years' period was included in the study. Functional values were measured: Oxford Knee Score (OKS), Knee Society Knee score (KSKS) and Knee Society Function score (KSFS). Range of movement (ROM), lower limb axis correction, mobilization and complications were also registered at the last follow-up and underwent statistical analysis. RESULTS: We found a low rate of complications or radiological changes with an implant-related revision rate of 2.19%. Mean results for PROMS were 44.21 ± 4 in OKS, 90.94 ± 2.4 in KSS and 97.88 ± 9.6 in KSFS. Mean postoperative ROM was 120.8º ± 12.37º. There was no change in implant positions at the final follow-up. We found radiolucent lines in 3 knees (3.29%). CONCLUSION: At a mean follow-up of 5.9 years, the implant-related cumulative percentage revision rate was 3.3% (2 of 91) at a mean follow-up of 5.9 years, with good clinical and functional results.

Effect of the Implementation of a Surgical Care Bundle in the Incidence of Surgical Site Infection in Spine Surgery: A Quasi-Experimental Study.

STUDY DESIGN: Quasi-experimental intervention study. OBJECTIVE: To assess the effect of a clinical safety and quality improvement plan for patients undergoing spinal fusion surgery on the incidence of surgical site infection (SSI). SUMMARY OF BACKGROUND DATA: In recent years, infection surveillance and control programs based on care bundles have been included in surgical protocols. These have proven to be essential tools for the prevention and control of SSI, providing indicators for improvement and allowing the characterization of related risk factors. METHODS: A quasi-experimental study was carried out with analysis before and after the introduction of a preventive care bundle (clinical safety and quality improvement plan). Patients who underwent spinal fusion surgery were included. The incidence of SSI up to 90 days after surgery (maximum incubation period) was assessed. The effect of the intervention was evaluated with the adjusted odds ratio (oR) using a logistic regression model. RESULTS: A total of 1554 patients were included, 690 in the period 2007 to 2011 (before) and 864 during 2012 to 2018 (after). SSI incidence decreased from 4.2% to 1.9% after the plan (OR: 0.43; 95% confidence interval: 0.23-0.80; P  = 0.006). There was also an improvement in the adequacy of antibiotic prophylaxis, preoperative preparation, and hair removal procedure after the introduction of the care bundle. CONCLUSION: After implementation of the care bundle, the incidence of SSI in spine fusion surgery decreased significantly. Multivariate analysis showed that the care bundle was an independent protective factor. The implementation of these measures should be reinforced on the routine medical practice to reduce the SSI incidence.Level of Evidence: 3.

Reliability and discriminative validity of real-time ultrasound elastography in the assessment of tissue stiffness after calf muscle injury.

OBJECTIVE: To investigate the reliability and discriminative validity of real-time ultrasound elastography (RTE) measures of soft-tissue elasticity after calf muscle tear. DESIGN: Cross-sectional, intra/inter-examiner reliability and comparative validity study. SETTING: Department of Physical Therapy. PARTICIPANTS: Twenty-one recreational athletes were included and examined 6 weeks after sustaining a grade I-II calf musculature tear. MAIN OUTCOME MEASURES: Soft-tissue elasticity was measured by two experienced assessors using RTE assessments in both the longitudinal and transverse planes of the athletes' injured and uninjured calf muscles. Elasticity was estimated by using the strain ratio (SR), which was calculated by dividing the strain (displacement) value taken at the medial gastrocnemius-soleus myotendinous junction (reference) by the strain value taken at the centre of the injury (index) as visualized on B-mode sonogram. Intra- and inter-observer reliability was estimated calculating intra-class correlation coefficients (ICCs) and standard error of measurement (SEM). Differences in elasticity between injured and healthy legs were assessed using t-tests or Wilcoxon tests for repeated measures. RESULTS: All RTE assessments in both planes showed ICC values ranging from 0.77 to 0.95 and SEM values ranging from 0.72 to 0.99. Additionally, RTE enabled both assessors to determine differences in elastic properties between injured and control legs (p < 0.001). CONCLUSION: RTE measures of calf muscles demonstrated good reliability and were able to differentiate injured from non-injured muscle tissue. RTE may provide a fast and objective measure in sports medicine to improve the detection of risk factors for muscle injury related to alterations of the mechanical behaviour of soft tissues during healing process.

Long-Term Outcomes of 496 Anatomical Cementless Modular Femoral Stems: Eleven to Twenty Years of Follow-Up.

BACKGROUND: The aim of the study is to assess the long-term outcomes of this specific stem (anatomical cementless modular stem ESOP), to review the survivorship, complication rate, and radiographic and clinical outcomes. METHODS: Descriptive and analytical retrospective longitudinal observational study of patients was operated on total hip arthroplasty between 1998 and 2007. Four hundred ninety-six prostheses corresponding to 447 patients were reviewed, mean age was 65.8 years (standard deviation [SD] ±11.6 years), and median follow-up time was 13.4 years (range 1-20). The most used cups were cementless (75.8%). The most frequent friction pairs were metal-polyethylene (53.1%) and ceramic-polyethylene (24.2%). Main variables analyzed were stem survival, subsidence, coronal orientation, osteolysis, reintervention, and Oxford Hip Score. RESULTS: From 496 implants, there were 22 lost to follow-up (4.4%). Stem revision was performed in 51 patients: 26 periprosthetic joint infections (2-stage revision), 16 periprosthetic fractures, and 8 one-stage revisions (6 real aseptic loosening with negative culture after revision). The stem survivorship at more than 15 years for any reason was 89.2% and for aseptic loosening 97.97%. No specific complications were found due to modularity. The mean subsidence and orientation was 2.06 mm (SD ±5.11 mm) and 0.41° varus (SD ±2.20°) respectively. Subsidence >5 mm or varus >5° was associated with a higher revision rate. Osteolysis was found in 110 patients (zone I = 79, VII = 57), associated with zirconium-polyethylene, without relationship to the stem revision rate or Oxford Hip Score. CONCLUSION: To our knowledge, this study represents the largest series of this stem, revealing an excellent survival rate and long-term clinical outcomes similar to the best results of classical cementless stems published in the literature.

Surgical site infection in hip arthroplasty in a 10-year follow-up prospective study: Risk and factors associated.

BACKGROUND: The increased demand for hip arthroplasty means a growing number of postsurgical complications. This study aims to assess the risk of surgical site infection (SSI) in a teaching hospital; develop regional, national and international external comparisons; and evaluate SSI-related risk factors, particularly according to the timing of surgery (urgent/unplanned or elective). METHODS: Prospective cohort study from January 2008 to December 2018. Patients were followed up to 90 days after surgery. Primary endpoint was SSI incidence according to the Centers for Disease Control and Prevention criteria. Multivariate analysis was conducted to find independently associated SSI risk factors. The association between risk factors and SSI incidence was assessed by reference to odds ratio (OR). Analyses were also performed among urgent/unplanned and elective patients to identify whether SSI risk factors differed between groups. RESULTS: The study population (n = 1,808) has an overall SSI rate of 3.0% (95% confidence interval [CI]: 2.4-3.9). Timing of surgery caused an effect modification, so surgery duration> 75th percentile (OR: 3.8; 95% CI: 1.5-9.8) and inadequate preparation (OR: 3.3; 95% CI: 1.1-10.0) were independent risk factors in the urgent/unplanned group; National Healthcare Safety Network risk index≥ 2 (OR: 6.3; 95% CI: 0.1-19.2) and transfusion (OR: 3.6; 95% CI: 1.1-11.9) in the elective group. CONCLUSIONS: Hospital infection surveillance systems allow identifying risk factors susceptible to change. Characterization of factors that caused an effect modification is key to identify areas of quality improvement, including reducing operating times, preventing perioperative blood transfusion, or improving patient preparation before surgery.

Rivaroxaban or Enoxaparin in Nonmajor Orthopedic Surgery.

BACKGROUND: Nonmajor orthopedic surgery of the lower limbs that results in transient reduced mobility places patients at risk for venous thromboembolism. Rivaroxaban may be noninferior to enoxaparin with regard to the prevention of major venous thromboembolism in these patients. METHODS: In this international, parallel-group, randomized, double-blind, noninferiority trial, we randomly assigned adult patients undergoing lower-limb nonmajor orthopedic surgery who were considered to be at risk for venous thromboembolism on the basis of the investigator's judgment to receive either rivaroxaban or enoxaparin. The primary efficacy outcome of major venous thromboembolism was a composite of symptomatic distal or proximal deep-vein thrombosis, pulmonary embolism, or venous thromboembolism-related death during the treatment period or asymptomatic proximal deep-vein thrombosis at the end of treatment. A test for superiority was planned if rivaroxaban proved to be noninferior to enoxaparin. For all outcomes, multiple imputation was used to account for missing data. Prespecified safety outcomes included major bleeding (fatal, critical, or clinically overt bleeding or bleeding at the surgical site leading to intervention) and nonmajor clinically relevant bleeding. RESULTS: A total of 3604 patients underwent randomization; 1809 patients were assigned to receive rivaroxaban, and 1795 to receive enoxaparin. Major venous thromboembolism occurred in 4 of 1661 patients (0.2%) in the rivaroxaban group and in 18 of 1640 patients (1.1%) in the enoxaparin group (risk ratio with multiple imputation, 0.25; 95% confidence interval, 0.09 to 0.75; P<0.001 for noninferiority; P = 0.01 for superiority). The incidence of bleeding did not differ significantly between the rivaroxaban group and the enoxaparin group (1.1% and 1.0%, respectively, for major bleeding or nonmajor clinically relevant bleeding; 0.6% and 0.7%, respectively, for major bleeding). CONCLUSIONS: Rivaroxaban was more effective than enoxaparin in the prevention of venous thromboembolic events during a period of immobilization after nonmajor orthopedic surgery of the lower limbs. (Funded by Centre Hospitalier Universitaire de Saint-Etienne and Bayer; PRONOMOS ClinicalTrials.gov number, NCT02401594.).

Eficacia y seguridad del ácido tranexámico tópico en la artroplastia de rodilla / Efficacy and safety of topical tranexamic acid in knee arthroplasty

Introducción y objetivo: La administración de ácido tranexámico (ATX) es efectiva reduciendo la pérdida de sangre en la artroplastia de rodilla. Con el fin de evitar los efectos adversos de la administración intravenosa, se ha propuesto el uso tópico del mismo. Nuestro objetivo es evaluar la eficacia y seguridad de ATX tópico para reducir la hemorragia postoperatoria en la artroplastia de rodilla. Material y métodos: Un total de 90 pacientes intervenidos de artroplastia total de rodilla unilateral fueron incluidos en un estudio prospectivo y aleatorizado. Todas las intervenciones fueron llevadas a cabo bajo anestesia espinal, con isquemia preventiva y bajo el mismo régimen postoperatorio. Los pacientes fueron divididos en 3 grupos en función de la administración del ATX: grupo A (n=30) 1g de ATX tópico; grupo B (n=30) 1g de ATX intravenoso, y grupo C o control (n=30), al que no se administró ningún fármaco. Se analizaron los parámetros de pérdida de sangre y débito de drenajes en los 3 grupos. Resultados: Los resultados mostraron que el descenso del nivel de hemoglobina fue menor en el grupo A (1,95dl) respecto el grupo B (2,25g/dl) y el grupo C (2,96g/dl), p<0,01. Respecto a la hemorragia postoperatoria, también fue inferior en el grupo A (195ml) respecto el grupo B (466ml) y el grupo C (718ml), p<0,01. No hubo diferencias en las complicaciones y la tasa de transfusiones de sangre entre los 3 grupos. Conclusiones: La aplicación tópica de 1g de ATX reduce significativamente la pérdida de sangre en pacientes intervenidos de artroplastia total de rodilla, en mayor magnitud que la aplicación intravenosa y la no administración

Introduction and objective: Tranexamic acid (TXA) is commonly used to control postoperative blood loss in total knee arthroplasty. In order to avoid adverse effects associated with intravenous administration, topical use has been proposed as an alternative. Our aim was to evaluate the efficacy and safety of topical TXA in total knee arthroplasty. Material and methods: A total of 90 patients scheduled for unilateral total knee arthroplasty were included in a prospective randomised study. All surgeries were performed under spinal anaesthesia, tourniquet and the same postoperative protocol. Patients were allocated to one of the 3 groups according to the application of TXA: group A (n=30) 1g of topical TXA; group B (n=30) 1g of TXA intravenous and in group C or the control group (n=30) no drug was administrated. Parameters related to blood loss and drain outputs were compared between the 3 groups. Results: The results revealed that post-operative decrease in haemoglobin level was significantly lower in group A (1.95g/dL) than group B (2.25g/dL) and group C (2.96g/dL), P<.01. Total postoperative blood loss was lower in group A (195mL) than group B (466mL) and group C (718mL), P<.01. There was no significant difference in complications and allogenic blood transfusion rate between the 3 groups. Conclusions: According to the results, topical application of 1g TXA significantly reduced blood loss in patients undergoing total knee arthroplasty more than intravenous or no administration of TXA

Surgical site infection incidence and risk factors in knee arthroplasty: A 9-year prospective cohort study at a university teaching hospital in Spain.

BACKGROUND: Surgical site infection (SSI) is one of the complications posed by knee replacement surgery. Hospital-based infection surveillance systems may provide indicators of improvement and allow the characterization of risk factors critical to reduce infection. The aims of this study were to compare the incidence of SSI in our center with rates in the Madrid Region, Spain, and the United States, and to evaluate any possible SSI-related risk factor in knee replacement surgery. METHODS: All patients who underwent knee replacement surgery at a tertiary hospital in 2008-2016 were included. SSI was defined according to Centers for Disease Control and Prevention criteria. Infection rate was calculated. The association between risk factors and SSI incidence was assessed by reference to odds ratio (OR) with multivariate analysis. RESULTS: The study population (n = 1969) had a global SSI risk of 1.0%. We found a declining trend in the follow-up period, from an SSI risk of 1.8% in 2009 to 0.4% in 2016. Independent risk factors included hair removal (OR: 3.09, 95% confidence interval [CI]: 1.27-7.50) and National Healthcare Safety Network risk index ≥ 2 (OR: 9.37, 95% CI: 2.90-30.26). CONCLUSION: This study identified risk factors that showed the necessity to strictly comply with wound decontamination and patient preparation protocols, reduce surgery duration, and identify patients who require comprehensive monitoring.

Antibioterapia profiláctica en la artroplastia de cadera. Estudio de cohorts / Prophylactic antibiotherapy in hip arthroplasty. Cohort study

Introducción: La infección de herida quirúrgica (IHQ) es la principal causa de infección nosocomial en pacientes quirúrgicos, siendo la profilaxis antibiótica uno de los factores más importantes para su prevención. En este trabajo se evaluó la adecuación de la profilaxis antibiótica en la artroplastia de cadera de acuerdo a la pauta establecida en nuestro centro y el efecto en la IHQ. Material y métodos. Se realizó un estudio de cohortes prospectivo entre enero de 2011 y diciembre de 2016. Se evaluó el grado de adecuación de la profilaxis antibiótica en cirugía de artroplastia de cadera. Se estudió la incidencia de IHQ tras un periodo máximo de 90 días. El efecto de la inadecuación de la profilaxis antibiótica en la incidencia de IHQ se evaluó con el riesgo relativo (RR) ajustado mediante un modelo de regresión logística. Resultados. Se incluyeron un total de 681 pacientes. La incidencia global de IHQ fue del 4% (IC 95%: 2,5-5,5). La profilaxis antibiótica se administró en el 99% de los casos, con una adecuación al protocolo del 74%. La causa más frecuente de inadecuación fue la duración de la profilaxis, con un 22,2% (149 pacientes). El efecto de la inadecuación de la profilaxis sobre la incidencia de infección fue de RR ajustado =0,47; IC95%: 0,19-1,17) (p>0,05). Conclusiones. La adecuación de la profilaxis antibiótica fue alta. No se encontró asociación entre adecuación de la profilaxis y la incidencia de infección en artroplastia de cadera. La vigilancia de la infección quirúrgica permite medir su incidencia y evaluar sus factores de riesgo

Introduction. The surgical site infection is the main cause of nosocomial infection in surgical patients, being antibiotic prophylaxis one of the most important factors for preventing it. This study evaluates adequacy of antibiotic prophylaxis in hip arthroplasty surgery as well as its effect on preventing surgical site infection. Material and methods. A prospective cohort study was carried out from January 2011 to December 2016. We assessed the degree of adequacy of antibiotic prophylaxis in hip arthroplasty. Incidence of surgical site infection was studied after a maximum incubation period of 90 days. In order to assess the effect of inadequate prophylaxis on surgical site infection we used the relative risk adjusted with a logistic regression model. Results. We studied 681 patients. Incidence of surgical site infection was 4% (95% CI 2.5-5.5). Antibiotic prophylaxis was administered in 99% of cases, with an overall protocol adequacy of 74%. The main cause of non-compliance was the length of prescription (22.2%; 149 patients). The effect of inadequate prophylaxis on surgical site infection was RR adjusted =0.47; 95%CI 0.19-1.17, (p>0.05). Conclusions. Adequacy of antibiotic prophylaxis was high. No relationship between prophylaxis adequacy and incidence of surgical site infection was founded. Surveillance allows us to assess surgical site infection and risk factors

Efficacy and safety of topical tranexamic acid in knee arthroplasty. / Eficacia y seguridad del ácido tranexámico tópico en la artroplastia de rodilla.

INTRODUCTION AND OBJECTIVE: Tranexamic acid (TXA) is commonly used to control postoperative blood loss in total knee arthroplasty. In order to avoid adverse effects associated with intravenous administration, topical use has been proposed as an alternative. Our aim was to evaluate the efficacy and safety of topical TXA in total knee arthroplasty. MATERIAL AND METHODS: A total of 90 patients scheduled for unilateral total knee arthroplasty were included in a prospective randomised study. All surgeries were performed under spinal anaesthesia, tourniquet and the same postoperative protocol. Patients were allocated to one of the 3 groups according to the application of TXA: group A (n=30) 1g of topical TXA; group B (n=30) 1g of TXA intravenous and in group C or the control group (n=30) no drug was administrated. Parameters related to blood loss and drain outputs were compared between the 3 groups. RESULTS: The results revealed that post-operative decrease in haemoglobin level was significantly lower in group A (1.95g/dL) than group B (2.25g/dL) and group C (2.96g/dL), P<.01. Total postoperative blood loss was lower in group A (195mL) than group B (466mL) and group C (718mL), P<.01. There was no significant difference in complications and allogenic blood transfusion rate between the 3 groups. CONCLUSIONS: According to the results, topical application of 1g TXA significantly reduced blood loss in patients undergoing total knee arthroplasty more than intravenous or no administration of TXA.

Cross-cultural adaptation and validation of the Spanish version of the Oxford Hip Score in patients with hip osteoarthritis.

BACKGROUND: Osteoarthritis (OA) of the hip is a disease that entails a major burden for patients and the society as a whole. One way of measuring this burden for the patient is through impact on Health-related Quality of Life (HRQL). The Oxford Hip Score (OHS) is a well-known tool to measure HRQL in patients with OA of the hip. This study aims to assess the psychometric properties of the Spanish-adapted version of the OHS, including its reliability, validity, and sensitivity to change. METHODS: Prospective observational study that included 361 patients diagnosed with hip OA (according to the criterion of the American College of Rheumatology) from 3 different Spanish regions. Their HRQL was assessed using a generic questionnaire, the EQ-5D-5 L, and two specific ones (the Western Ontario and McMaster Universities Osteoarthritis Index, WOMAC, and the OHS) adapted to Spanish. There was a follow-up period of 6 months, and the acceptability, psychometric properties, presence of ceiling and floor effects, validity, reliability, and sensitivity to changes of the OHS were measured. RESULTS: The OHS was fully answered in 99.4% of cases with no indication of ceiling or floor effects. Its factor structure can be explained in a single dimension. Its discriminative capacity was very good compared to the groups generated by the WOMAC and the EQ-5D-5 L. The correlation between the OHS and dimensions of the WOMAC or EQ-5D-5 L utilities was ≥0.7. Excellent test-retest reliability (ICC = 0.992; CI95%: 0.994-0.998) and internal consistency (Cronbach's α = 0.928) were observed. The minimal clinically important difference (MCID) was 7.0 points, and the minimum detectable change (MDC) was 5.5 points. The effect size for moderate improvement in perceived HRQL was 0.73, similar to that of WOMAC dimensions and higher than the EQ-5D-5 L. CONCLUSIONS: The Spanish-adapted version of the OHS is a useful, acceptable tool for the assessment of perceived HRQL in patients with hip OA, and has psychometric properties similar to those of the WOMAC that allow for discriminating both a patient's condition at a given moment and changes that can occur over time.

Surgical Wound Infection Rates and Risk Factors in Spinal Fusion in a University Teaching Hospital in Madrid, Spain.

STUDY DESIGN: Prospective cohort study. OBJECTIVE: To study risk factors linked to spinal fusion surgical wound infection (SWI) incidence and compare the incidence with rates in Madrid Region, Spain and United States as a whole. SUMMARY OF BACKGROUND DATA: SWI is one of the complications posed by spinal surgery. Indeed, spinal surgery has a higher infection rate than do other orthopedic surgeries such as total hip or knee arthroplasty. The study of risk factors that are susceptible to be modified will enable both the incidence of SWI and, by extension, related morbidity, mortality, and costs to be reduced. METHODS: All patients undergoing spinal fusion at a tertiary hospital from June 2011 to June 2014 were included. Infection rate was calculated, and the association between risk factors and SWI incidence was assessed by reference to odds ratio (OR) with univariate and multivariate analysis. RESULTS: The study population (n = 892) had a SWI rate of 3.9%. The standardized infection ratio of our hospital was 0.58 with respect to the Madrid Region, 0.76 with respect to Spain's national rate and 2.05 with respect to the US NHSN/CDC. The multivariate analysis showed that predictive factors of SWI were diabetes mellitus (OR 2.81, 95% confidence interval, CI: 1.18-6.72, P < 0.05), chronic obstructive pulmonary disease (COPD) (OR 5.16, 95% CI: 2.04-13.08, P < 0.05), duration of surgery higher than the 75th percentile (OR 5.39, 95% CI: 1.77-110.84, P < 0.05) and dirty surgery (OR 14.01, 95% CI: 1.01-28.88, P < 0.05). CONCLUSION: Independent risk factors for SWI in spinal fusion are existence of diabetes mellitus, COPD, duration of surgery higher than the 75th percentile and dirty surgery. Knowing these risk factors enables action to be taken to reduce the SWI rate. LEVEL OF EVIDENCE: 3.

Manual Physical Therapy Versus Surgery for Carpal Tunnel Syndrome: A Randomized Parallel-Group Trial.

UNLABELLED: This randomized clinical trial investigated the effectiveness of surgery compared with physical therapy consisting of manual therapies including desensitization maneuvers in carpal tunnel syndrome (CTS). The setting was a public hospital and 2 physical therapy practices in Madrid, Spain. One hundred twenty women with CTS were enrolled between February 2013 and January 2014, with 1-year follow-up completed in January 2015. Interventions consisted of 3 sessions of manual therapies including desensitization maneuvers of the central nervous system (physical therapy group, n = 60) or decompression/release of the carpal tunnel (surgical group, n = 60). The primary outcome was pain intensity (mean pain and the worst pain), and secondary outcomes included functional status and symptoms severity subscales of the Boston Carpal Tunnel Questionnaire and the self-perceived improvement. They were assessed at baseline and 1, 3, 6, and 12 months by a blinded assessor. Analysis was by intention to treat. At 12 months, 111 (92%) women completed the follow-up (55/60 physical therapy, 56/60 surgery). Adjusted analyses showed an advantage (all, P < .01) for physical therapy at 1 and 3 months in mean pain (Δ -2.0 [95% confidence interval (CI) -2.8 to -1.2]/-1.3 [95% CI -2.1 to -.6]), the worst pain (Δ -2.9 [-4.0 to -2.0]/-2.0 [-3.0 to -.9]), and function (Δ -.8 [-1.0 to -.6]/-.3 [-.5 to -.1]), respectively. Changes in pain and function were similar between the groups at 6 and 12 months. The 2 groups had similar improvements in the symptoms severity subscale of the Boston Carpal Tunnel Questionnaire at all follow-ups. In women with CTS, physical therapy may result in similar outcomes on pain and function to surgery. TRIAL REGISTRATION: http://www.clinicaltrials.gov, ClinicalTrials.gov, NCT01789645. PERSPECTIVE: This study found that surgery and physical manual therapies including desensitization maneuvers of the central nervous system were similarly effective at medium-term and long-term follow-ups for improving pain and function but that physical therapy led to better outcomes in the short term.

Activation in the hypothalamic-pituitary-adrenocortical axis and sympathetic nervous system in women with carpal tunnel syndrome.

OBJECTIVE: The aim of this study is to investigate the differences in salivary cortisol (hypothalamic-pituitary-adrenocortical [HPA] axis), α-amylase activity (sympathetic nervous system [SNS]), and immunoglobulin A (IgA; immune system) concentrations between women with carpal tunnel syndrome (CTS) and healthy women. DESIGN: A cross-sectional study. SETTING: Activation of HPA, SNS, and immune system in CTS has not been clearly determined. PATIENTS: One hundred two women (age: 45 ± 7 years) with electrodiagnostic and clinical diagnosis of CTS and 102 matched healthy women. OUTCOME MEASURES: The intensity of the pain was assessed with a Numerical Pain Rating Scale (0-10), and disability was determined with Boston Carpal Tunnel Questionnaire. Salivary cortisol concentration, α-amylase activity, salivary flow rate, and IgA concentration were collected from nonstimulated saliva. RESULTS: Women with CTS exhibited lower salivary flow rate (P < 0.001) and higher α-amylase activity (P < 0.01) than controls. No significant differences for cortisol and IgA concentrations (P > 0.2) were found between groups as a total. Women with severe CTS exhibited lower salivary flow rate (P < 0.001), higher α-amylase activity (P = 0.002), and higher cortisol concentration (P = 0.03) than healthy women and than those with minimal/moderate CTS (P < 0.05). Within women with CTS, significant positive associations between α-amylase activity and the intensity of pain were found: the highest the level of pain, the higher the α-amylase activity, i.e., higher SNS activation. CONCLUSIONS: These results suggest that women with severe CTS exhibit changes in activation in the HPA axis and SNS but not in the humoral immune system. Activation of the SNS was associated with the intensity of pain. Future studies are needed to elucidate the direction of this relationship.

Compliance with antibiotic prophylaxis in spinal fusion surgery and surgical wound infection.

BACKGROUND: Surgical wound infection is an important complication of spinal surgery. Antibiotic prophylaxis has served to decrease its rates significantly, with the ensuing reduction in hospital stay, costs, and morbidity and mortality. To date, a large assessment of the degree of compliance with antibiotic prophylaxis in spinal fusion surgery has not been undertaken in Spain with large prospective studies. We sought to assess the degree of compliance with our antibiotic prophylaxis protocol among patients who underwent spinal fusion surgery and its effect on surgical wound infection. MATERIAL AND METHODS: A prospective cohort study was carried out. Six hundred and forty patients with at least 1-year clinical followup who underwent spinal fusion surgery were included. Percentage of administration and degree of compliance with protocol was studied. Both overall and the different aspects of prophylaxis received by patients to those stipulated in the protocol in force at our hospital were compared. Percentages of compliance were assessed and the effect of prophylaxis compliance on the incidence of infection was estimated using the Relative Risk. RESULTS: The study covered 640 patients. Overall compliance with the protocol was 71.5% (95% CI = 67.9- 75.1). The most frequent cause of non-compliance with the protocol was the duration of recommended antibiotic prophylaxis (77.8%). Incidence of surgical wound infection was 4.1% (95% CI: 2.5-5.5). No relationship was found between surgical wound infection and antibiotic prophylaxis non-compliance (RR 0.92, 95% CI = 0.38-2.22). CONCLUSIONS: Compliance and administration of antibiotic prophylaxis were high. Surgical wound infection rate was similar to those found in the literature although there is always room for improvement.

Catechol-O-methyltransferase Val158Met polymorphism is associated with pain and disability, but not widespread pressure pain sensitivity, in women with carpal Tunnel syndrome.

BACKGROUND: The genetic influence of Val158Met polymorphisms, one of the potential genetic determinants for nociceptive processing, has not been previously investigated in women with carpal tunnel syndrome (CTS). OBJECTIVES: To investigate the association between the Val158Met polymorphism with CTS and to assess the relationship between the Val158Met polymorphism and the clinical outcomes and widespread pressure pain hypersensitivity in women with CTS. STUDY DESIGN: Case control study. SETTING: Neurology department at an urban hospital. METHOD: One hundred nine (n = 109) women (mean age: 47 ± 9 years) with a clinical and electrodiagnostic diagnosis of CTS and 109 matched healthy women participated. After amplifying the Val158Met polymorphism by polymerase chain reactions, rs4680 genotype frequencies and allele distributions were calculated. We classified individuals according to their Val158Met polymorphism: Val/Val, Val/Met, Met/Met. The intensity of the pain was assessed with a numeric rating scale (0-10) and disability was determined with the Boston Carpal Tunnel Questionnaire. Pressure pain thresholds were bilaterally assessed over median, radial, and ulnar nerve trunks; C5-C6 facet joints; and carpal tunnel and tibialis anterior muscles.Institutional Review Board: The study project was approved by the local human research committee (HUFA-12/14). All participants signed an informed consent prior to their inclusion in the study. RESULTS: The distribution of the 3 Val158Met genotypes (Val/Val, Val/Met, Met/Met) and alleles was not significantly different between women with CTS and healthy women (Chi-Square = 0.498; P = 0.780). Women with CTS carrying the Met/Met genotype showed higher levels of pain and disability than those with the Val/Met genotype (P < 0.01) and with the Val/Val genotype (P < 0.001). No differences in the years with pain (P = 0.954), age (P = 0.740), depression (P = 0.530), severity of CTS (P = 0.744) or presence of unilateral-bilateral symptoms (P = 0.279) existed depending on the rs4680 Val158Met genotype. No significant differences in widespread pressure pain sensitivity were observed in any of the points depending on the rs4680 Val158Met genotype (P > 0.315). LIMITATIONS: We only recruited women from a specialized department. CONCLUSION: Current results indicated that the Val158Met polymorphism seems not to be a risk factor for the development of CTS; however, it was associated with increased perception of pain and higher disability scores.

Evaluación de la adecuación de la profilaxis antibiótica en cirugía ortopédica y traumatológica / Adequacy Assessment of Antibiotic prophylaxis in orthopedic and traumatologic surgery

La profilaxis antibiótica es una estrategia fundamental en el control de la infección de la herida quirúrgica. Este estudio evalúa la adecuación de la profilaxis antibiótica prequirúrgica en pacientes a los que se les realiza cirugía ortopédica y traumatológica. Métodos Estudio descriptivo transversal. Se incluyeron pacientes a los que se les realizaron implantes de prótesis de cadera, de rodilla y cirugía de columna por inclusión consecutiva. Se hizo una estimación muestral teniendo en cuenta un intervalo de confianza del 95%, una precisión del 5%, una adecuación global del 85% y unas pérdidas del 5%. Así, se estimaron necesarios 206 pacientes. Se evaluó la adecuación de la indicación, del tiempo de administración, de la vía y de la dosis de antibiótico al protocolo del Centro. Se estudió la incidencia acumulada al alta de infección de herida quirúrgica. Resultados Se estudiaron 221 pacientes. El porcentaje de varones fue del 33,5% y 66,5% el de mujeres. La edad media fue de 61,1 años (desviación estándar [DE] de 14,1) y 67,1 años (DE de 12,4), respectivamente (p<0,05). En todos los pacientes estudiados estaba indicada la administración de profilaxis antibiótica. La adecuación global al protocolo fue del 89,1%. La incidencia acumulada de infección de la herida quirúrgica al alta fue del 3,2%. No se encontró relación entre la adecuación de la profilaxis y la infección (p>0,05).Conclusiones La adecuación de la profilaxis antibiótica ha sido alta, pero se puede mejorar (AU)

Antibiotic prophylaxis is an essential strategy for preventing surgical wound infection. This study assesses the adequacy of surgical antibiotic prophylaxis in trauma and orthopedic patients. Methods Cross-sectional study including consecutive patients who underwent hip or knee replacement, or spinal surgery. Sample estimation was based on 95% confidence, 5% precision, an overall adequacy of 85%, and assuming a loss of 5%. Thus, 206 patients were required. The appropriateness of the indication, time of administration, administration route, and dose according to the hospital protocol was assessed. The cumulative incidence of surgical site infection at discharge was determined. Results A total of 221 patients were included, 33.5% men and 66.5% women; mean age was 61.1 (SD=14.1) for men and 67.1 (SD=12.4) for woman (P<0.05). Antibiotic prophylaxis was indicated in all patients. Overall adequacy of prophylaxis according to the hospital protocol was 89.1%. Cumulative incidence of surgical wound infection at discharge was 3.2%. There was no association between the adequacy of antibiotic prophylaxis and surgical site infection (P>0.05).Conclusions The adequacy of postoperative antibiotic prophylaxis was high in this study, but it can be improved (AU)