¿Cómo seleccionar una prótesis para un reemplazo primario de cadera? Mínima supervivencia aceptable: resultados de un consenso de expertos / How to select a prosthesis for a primary hip replacement? Minimum acceptable survival: results of a consensus of experts

Resumen: Introducción: Uno de los puntos más críticos en la planeación de las artroplastías de cadera es la selección del implante, puesto que su supervivencia impacta significativamente la salud de los pacientes. Sin embargo, hasta el momento no se ha definido cuál es la supervivencia ideal que debe demostrar un implante para ser seleccionado. El objetivo de este consenso es definir los estándares mínimos de desempeño para la selección de prótesis en reemplazo primario convencional de cadera. Material y métodos: El consenso se realizó mediante la metodología de «grupo nominal¼. Esto incluyó: 1. Revisión de la evidencia disponible y definición de los temas a evaluar, 2. Reunión para la votación y discusión y 3. Análisis estadístico cuantitativo con medianas (M) y rangos intercuartílicos (RIC) y cualitativo con proporciones de los resultados obtenidos para generar recomendaciones. Resultados: La fuente primaria de información para la selección de prótesis (M: 8; RIC: 7-9) y de elección en caso de evidencia contradictoria (M: 8; RIC: 7-9) o limitada en la literatura (M: 7; RIC: 4.75-825) son los registros nacionales. El mínimo seguimiento aceptable es 10 años (M: 9; RIC: 8-9) y el mínimo de supervivencia aceptable es 90% a 10 años (M: 8; RIC: 5-8.5). Discusión: De acuerdo con estos resultados, el consenso de expertos propone que la selección del implante en el reemplazo articular primario convencional de cadera se realice con base en la información publicada en los registros nacionales y que dicha prótesis tenga un seguimiento mínimo de 10 años y demuestre una supervivencia mínima de 90%.

Abstract: Background: One of the most critical points in the planning of hip replacement surgeries is the selection of the implant, since its survival significantly impacts the patients' health. However, the ideal survival time that an implant must prove to be selected has not been defined. The objective of this consensus is to define minimum performance standards for the selection of conventional primary hip replacement prosthesis. Material and methods: The consensus was carried out using the methodology of 'nominal group'. This included: 1. A review of the available evidence and the issues to be evaluated, 2. Meeting for the vote and discussion, 3. Quantitative statistical analysis with median (M) and interquartile range (IQR) and qualitative one with proportions of the results to generate recommendations. Results: The primary source of information for prosthesis selection (M: 8; IQR: 7-9), choice in the event of conflicting evidence (M: 8; IQR: 7-9), or limited evidence in the literature (M: 7; IQR: 4.75-825) should be national registries. The minimum acceptable follow-up is 10 years (M: 9; IQR: 8-9) and the minimum acceptable survival is 90% at 10 years (M: 8; IQR: 5-8.5). Discussion: According to these results, the consensus of experts proposed that the selection of the implant for conventional primary hip replacement must be based on the information published in the national registries and that the prosthesis must have a minimum follow-up of 10 years and show a minimum survival of 90%.

[How to select a prosthesis for a primary hip replacement? Minimum acceptable survival: results of a consensus of experts]. / ¿Cómo seleccionar una prótesis para un reemplazo primario de cadera? Mínima supervivencia aceptable: resultados de un consenso de expertos.

BACKGROUND: One of the most critical points in the planning of hip replacement surgeries is the selection of the implant, since its survival significantly impacts the patients health. However, the ideal survival time that an implant must prove to be selected has not been defined. The objective of this consensus is to define minimum performance standards for the selection of conventional primary hip replacement prosthesis. MATERIAL AND METHODS: The consensus was carried out using the methodology of nominal group. This included: 1. A review of the available evidence and the issues to be evaluated, 2. Meeting for the vote and discussion, 3. Quantitative statistical analysis with median (M) and interquartile range (IQR) and qualitative one with proportions of the results to generate recommendations. RESULTS: The primary source of information for prosthesis selection (M: 8; IQR: 7-9), choice in the event of conflicting evidence (M: 8; IQR: 7-9), or limited evidence in the literature (M: 7; IQR: 4.75-825) should be national registries. The minimum acceptable follow-up is 10 years (M: 9; IQR: 8-9) and the minimum acceptable survival is 90% at 10 years (M: 8; IQR: 5-8.5). DISCUSSION: According to these results, the consensus of experts proposed that the selection of the implant for conventional primary hip replacement must be based on the information published in the national registries and that the prosthesis must have a minimum follow-up of 10 years and show a minimum survival of 90%.

INTRODUCCIÓN: Uno de los puntos más críticos en la planeación de las artroplastías de cadera es la selección del implante, puesto que su supervivencia impacta significativamente la salud de los pacientes. Sin embargo, hasta el momento no se ha definido cuál es la supervivencia ideal que debe demostrar un implante para ser seleccionado. El objetivo de este consenso es definir los estándares mínimos de desempeño para la selección de prótesis en reemplazo primario convencional de cadera. MATERIAL Y MÉTODOS: El consenso se realizó mediante la metodología de «grupo nominal¼. Esto incluyó: 1. Revisión de la evidencia disponible y definición de los temas a evaluar, 2. Reunión para la votación y discusión y 3. Análisis estadístico cuantitativo con medianas (M) y rangos intercuartílicos (RIC) y cualitativo con proporciones de los resultados obtenidos para generar recomendaciones. RESULTADOS: La fuente primaria de información para la selección de prótesis (M: 8; RIC: 7-9) y de elección en caso de evidencia contradictoria (M: 8; RIC: 7-9) o limitada en la literatura (M: 7; RIC: 4.75-825) son los registros nacionales. El mínimo seguimiento aceptable es 10 años (M: 9; RIC: 8-9) y el mínimo de supervivencia aceptable es 90% a 10 años (M: 8; RIC: 5-8.5). DISCUSIÓN: De acuerdo con estos resultados, el consenso de expertos propone que la selección del implante en el reemplazo articular primario convencional de cadera se realice con base en la información publicada en los registros nacionales y que dicha prótesis tenga un seguimiento mínimo de 10 años y demuestre una supervivencia mínima de 90%.

Tratamiento del pie plano valgo espástico mediante triple artrodesis por doble abordaje: presentación de una técnica modificada / Treatment of flatfood by triple arthrodesis

Se presenta una modificación a la técnica de triple artrodesis para el tratamiento del pie plano valgo inestable en pacientes con paralisis cerebral. Se compara una serie de casos de pacientes sometidos a la técnica modificada con otra que incluye pacientes manejados con la técnica original. La evaluación postoperatoria, realizada desde el punto de vista clinico y radiografico, sugiere que la técnica modificada ofrece mejores resultados que la técnica clasica en pies pianos valgos inestables en pacientes con paralisis cerebral. El diseño empleado impide afirmar que estos datos sean conclusivos

Efectividad del calzado ortopédico pronador en el tratamiento postoperatorio de niños con pie equino varo congénito idiopático rígido / Effectiveness of the corrective shoes in the posoperative treatment of equinovarus deformities in children

El uso de calzado ortopedico en el tratamiento postoperatorio del pie equino varo congenito idiopatico (PEVCI) es motivo de controversia. Con el fin de conocer la efectividad del uso del calzado con modificaciones especiales (botas pronadoras) en el manejo postoperatorio del paciente con PEVCI, a quienes se les efectuó una liberación posterointerna ampliada (LIPA), se realizó un estudio experimental clinico controlado ciego, que comparó dos intervenciones: al primer grupo se le formuló zapato ortopedico (botas pronadoras), al segundo se le asigno zapato normal. Para la evaluación se utilizaron los enterizos de Turco modificados. Los resultados se clasificaron como buenos regulares y malos. Se presenta un analisis interno con el objeto de detectar diferencias entre los grupos. Hasta el momento no se han encontrado diferencias por lo que se autoriza la continuación del estudio para definir con mayor precisión la efectividad de la intervención

[Pharmacokinetic findings following the oral application of granulated Mebacid in cattle, calves and sheep]. / Pharmakokinetische Untersuchungsergebnisse nach oraler Applikation von Mebacidgranulat beim Rind, Kalb und schaf.

The pharmacokinetic properties of sulphamerazine, following oral application of granulated Mebacid to cattle, calf, and sheep, were compared with results obtained from the use of Mebacid tablets. Elimination half-life was higher in cattle, calf, and sheep, following oral application of Mebacid tablets. Different pharmacokinetic properties of sulphamerazine were found to exist between the two modes of preparation. Sulphonamide was eliminated more rapidly by cattle, calf, and sheep, when granulated Mebacid was used. When granulate is used, higher sulphamerazine doses have to be applied to calf and sheep to obtain the sulphonamide levels required for effective therapy. No intolerance was recorded from the above species, following oral application of granulated Mebacid.

[Modification of blood serum mineral levels and aspartate aminotransferase, leucine aminopeptidase and alkaline phosphatase activity and plasma in glucose levels in healthy cattle by Ca-Mg-containing solutions]. / Untersuchungen über die Beeinflussung des Gehalts an Mineralstoffen und der Aktivität der Aspartataminotransferase, der Leuzinaminopeptidase und der Alkalischen Phosphatase im Blutserum sowie des Gehaltes an Glukose im Blutplasma von gesunden Rindern durch die Infusion von Ca-Mg-haltigen Lösungen.

Three high-performance cows in lactation were tested each for the effects of two kinds of infusion each, 500 ml of Tetamag-2 solution (60 g of calcium gluconate and 60 g of magnesium adipate) and 500 ml of Calcimag (100 g of calcium gluconate and 20 g of magnesium adipate), upon the levels of calcium, magnesium, Pa, potassium, and sodium as well as upon the activities of aspartate-aminotransferase, leucine-aminopeptidase, and alkaline phosphatase in blood serum and upon glucose levels in blood plasma. Migration of calcium out of blood plasma was found to take place at much higher rate than that of magnesium. Infusion of Pa and glucose was followed soon by some temporary drop of values. No directional effects were recordable from potassium and sodium. Aspartate-aminotransferase activity did not change in response to transfusion. Intravenous infusion of Tetamag-2 solution caused strong temporary rise in magnesium concentration and, consequently, activation of leucine-aminopeptidase.

[Blood mineral (Ca, Mg, Na K, Pa) levels and aspartate aminotransferase, leucine aminopeptidase, creatine phosphokinase and alkaline phosphatase activity and blood glucose levels in cattle with hypomagnesemia prior to and following infusion of a 500 ml solution containing 60 g of Mg adipate and 60 g of Ca gluconate]. / Untrsuchungen über den Gehalt an Mineralstoffen (Ca, Mg, Na, K, Pa) und über die Aktivität der Aspartataminotransferase, der Leuzinaminopeptidase, der Kreatinphosphokinase und der Alkalischen Phosphatase im Blutserum sowie über den Gehalt an Glukose im Blutplasma von Rindern mit Hypomagnesämie vor und nach Infusion einer Lösung mit je 60 g Mg-Adipat und Ca-Glu-konat in 500 ml.

The levels of various compounds in blood serum and blood plasma were tested in 14 heads of cattle with hypomagnesiaemia (x = 0.76 +/- 0.29 mg/100 ml), prior to and following infusion of 500 ml of a calcium-magnesium solution (containing 60 g of magnesium adipate and 60 g of calcium gluconate). Concomitant hypocalcaemia (6.1 mg/100 ml) was recordable only from one animal. Most of the potassium as well as all Pa and protein values in blood serum were physiologically normal, while sodium ws somewhat reduced. The glucose level in blood plasma was increased in the animal with concomitant hypocalcaemia and in one animal with poor recovery potential. The drops in magnesium and calcium levels in blood serum, following infusion, in cattle with hypomagnesiaemia was very similar to that in clinically intact cattle. Aspartate-aminotransferase and creatinine-phosphokinase activities of the serum were increased in all cattle, but leucine-aminopeptidase activity in only some of them. The activity of alkaline phosphatase of the blood serum was physiologically normal.

[Pharmacokinetic model studies of sulfamerazine in domestic mammals. 4. Mebacid tablet and Mebacid 200 dosage calculation problems]. / Pharmakokinetische Modelluntersuchungen an Sulfamerazin bei Haussäugetieren. 4. Mitteilung: Zur Problematik von Dosisberechnungen an Mebacid-Tabletten und Mebacid 200.

The highly variegated complex of aspects relating to dosage calculation for veterinary drugs is explained and discussed by examples of Mebacid 200 and Mebacid tablets. For domestic mammals, a dosage interval of 24 hours is desirable for reasons of economy. Therefore, due allowance must be made, by means of unilateral confidence, of the most unfavourable case of high protein fixation, low half-life for elimination, and high coefficient of distribution. The following equation, proposed by DETTLI and SPRING (1966) was used for dosage calculation: AD = c . delta' . ek2 . t or ED = c . delta' . (ek2 . t -1) The dosage will now be in a twelve-hour rhythm, because of the low half-life for elimination of sulphamerazine-Na. A pharmacokinetically founded dosage interval of 24 hours will be feasible only by oral application of Mebacid tablets. The difference between the calculated initial and maintenance doses was found to be negligible.

[Pharmacokinetic model studies of sulfamerazine in domestic mammals. 6. Absence of drug residues]. / Pharmakokinetische Modelluntersuchungen an Sulfamerazin bei Haussäugetieren. 6. Mitteilung: Zur Problematik der Rückstandsfreiheit.

The problem of no residues is elucidated and discussed under pharmacokinetic aspects. An equation with due consideration confidence by which to calculate the absence of residues in drugs is given under the assumption that elimination of such residues should follow the concepts of the monocompartment model. The time is calculated by which all residues of sulphamerazine have disappeared, following application of Mebacid 200 and Mebacid tablets to farm animals.

[Pharmacokinetic model studies of sulfamerazine in domestic mammals. 2. Elimination of Mebacid 200 and Mebacid tablets following oral, subcutaneous and intramuscular administration]. / Pharmakokinetische Modelluntersuchungen an Sulfamerazin bei Haussäugetieren. 2. Mitteilung: Die Elimination von Mebacid 200 und Mebacid-Tabletten nach oraler, subkutaner und intramuskulärer Applikation.

The mathematical foundations underlying pharmacokinetic testing and acceptance of medicaments for domestic mammals are expounded and discussed, with reference being made to examples of intramuscular, subcutaneous, and oral application of Mebacid 200 and Mebacid tablets. Elimination of sulphamerazine may be mathematically described by means of the following bi-exponential function: c = B x e-k2 x t -- A x e-k1 x t The concepts of the mono-compartmental model "Extravasal Application" can be claimed as being of basic validity. Blood levels established after intramuscular and subcutaneous application of sulphamerazine-sodium (Mebacid 200) were lower than those recorded after oral application of Mebacid tablets. The half-lives of elimination, following oral application to big animals of Mebacid tablets, were longer than those following intravenous application of comparable injection solution.

[Pharmacokinetic model studies of sulfamerazine in domestic mammals. 5. Resorption of Mebacid tablets in large animals]. / Pharmakokinetische Modelluntersuchungen and Sulfamerazin bei Haussäugetieren. 5. Mitteilung: Zur Problematik der Resorption von Mebacid-Tabletten beim Grosstier.

The formula proposed by RITSCHEL (1973) for calculation of rates of resorption is explained and modified for use of the monocompartment model. Resorption rates were calculated for cattle, calf, horse, and sheep, with reference being made to the example of Mebacid tablets. The most favourable rate of resorption was established for calf.

[Pharmacokinetic model studies of sulfamerazine in domestic mammals. 3. Acetylation, protein binding, and minimal inhibitory concentration of sulfamerazine]. / Pharmakokinetische Modelluntersuchungen an Sulfamerazin bei Haussäugetieren. 3. Mitteilung: Azetylierung, Eiweissbindung und minimale Hemmkonzentration von Sulfamerazin.

Acetylation and protein fixation were established for the purpose of elucidating the chemotherapeutically effective part of sulphamerazine when applied to cattle, swine, horse, sheep, dog, and cat. The highest degree of acetylation and lowest protein fixation in all species tested, were recorded from swine. A reciprocal correlation was found to exist between the two above parameters, and it was statistically secured, except for horse. A mathematical description of the functional relationship between sulphamerazine fixed to serum protein and free sulphamerazine was possible by means of the Freundlich isothermia which had been recommended by SCHOLTAN (1962) in the following form: cgeb = K+ . cfreim The problem of minimum inhibitory concentration is discussed and explained in greater detail by computational examples with Escherichia coli.

[Pharmacokinetic model studies of sulfamerazine in domestic mammals. 1. Elimination of Mebacid 200 following intravenous administration to large animals]. / Pharmakokinetische Modelluntersuchungen an Sulfamerazin bei Haussäugetieren. 1. Mitteilung: Die Elimination von Mebacid 200 nach intravenöser Applikation beim Grosstier.

Pharmacokinetic data of sulphamerazine were recorded from eight heads each of calf, adult cattle, horse, and sheep, following intravenous application of Mebacid 200, and mathematical implications were discussed. Exponential excretion was recorded from all species, according to the following equation: c = B x e-k2 x t The most favourable pharmacokinetic parameters were recorded from calf.

[Grass tetany in cattle]. / Untersuchungen über die Weidetetaniebehandlung des Rindes

An optimal magnesium supply of dairy cows during pasture period is still a pressing problem in our farms and husbandry. Experiences are described concerning the application of different magnesium concentrated preparations in cases of grass tetany in 1970 to 1975 in the district of Potsdam. In 224 cows with magnesium concentrations values in the serum below 1.8 mg/100 ml a 25% MgSO4-solution, Parevert and Vers. A, a test solution of VEB Tierarzneimittelwerk Leipzig are used as a metaphylactic treatment. Losses by grass tetany could be reduced after application of the named preparations. Also in cases of low dosage a further, at least temporary drop of magnesium values in the serum could be prevented. Metaphylactic measures are recommended for andangered herds.

[Studies on serum Mg and Ca levels in cattle with grass tetany on hypocalcemia before and following infusion with high Mg and medium or high Ca concentrations]. / Untersuchungen über den Gehalt des Blutserums an Mg und Ca bei an Weidetetanie bzw. Hypokalzämie erkrankten Rindern vor und nach Infusion von Lösungen mit einem hohen Mg-Gehalt und mit einem mittleren bzw. hohen Ca-Gehalt

Behaviour of Mg and Ca content in the blood serum of 28 cattle with grass tetany and hypocalcaemia was evaluated at short time intervals after infusion of 500 ml of a solution A (containing 12 g Mg-adipat and 5 g Ca-gluconate/100 ml aqua dest.) and a solution B (containing 12 g Mg-adipate and 12 g Ca-gluconate/100 ml) respectively. After treatment with the last-named solutions there was evident a considerable increase of Mg-values in the blood serum for a longer period (up to 6 h), also in the case of distinct hypomagnesaemia while Ca-values of the circulating blood declined more quickly. Efficacy of treatment was the better the earlier infusion was performed after occurence of clinical signs. Application of solution B for treatment of grass tetany and paresis with tetany like symptoms is recommended for several reasons. Necessity of assurance the Mg and Ca supply after infusion is emphasized.

[Use of the latex test in the serodiagnosis of enzootic leukosis of cattle]. / Untersuchungen zur Verwendbarkeit des Latextestes als serologisches Diagnostikum bei der enzootischen Rinderleukose

Two antigenic extracts, prepared by different methods, were tried on 317 serum samples in the microscope-slide agglutination, sedimentation and tube agglutination tests. In comparison with the haematological findings, both antigens and all the tests gave a proportion of non-specific positive results, which made it impossible to obtain specific results. Various ways of reducing the proportion of non-specific reactions were tried, without success.

[Phosphoric acid ester preparations used in cattle, swine and sheep with special reference to cholinesterase activity. 3. Use of phosphoric acid ester preparations and their effect on acetylcholinesterase activity in swine]. / Untersuchungen mit Phosphorsäureesterpräparaten beim Rind, Schwein und Schaf unter besonderer Berücksichtigung der Cholinesteraseaktivität. 3. (Mitteilung:) Der Einsatz von Phosphorsäureesterpräparaten und deren Einfluss auf die Acetylcholinesteraseaktivität beim Schwein

The use of organophosphorus preparations in the treatment of ectoparasites and endoparasites of pigs is discussed. Treatment of 43 store pigs with preparations produced in the German Democratic Republic by washing and by the pour-on method resulted in considerable inactivation of acetylcholinesterase, which implies good systemic action. Overdosage increased this effect, but without producing signs of toxicity. The oral dosages for pigs cited in the literature were confirmed. Repeated treatment was recommended for the best results, as pigs rapidly break down the preparations. It is necessary to take into account adverse effects of oral administration on palatability of the ration and on weight gain. Addition of a preparation to a batch of food for a group of pigs is likely to be less successful than individual dosing, which is the best method for sows.