Cierre de herida en cirugía protésica de rodilla y cadera (PTR y PTC): Resultados de una encuesta sobre la práctica clínica en España / Wound closure after knee and hip replacement (TKA and THA): Survey results on the clinical practice in Spain

Introducción y objetivos: En cirugía protésica de rodilla y cadera está claro que aún no se ha desarrollado una técnica de cierre estandarizada óptima. A nivel local no existen datos que describan la práctica quirúrgica habitual en cierre de herida. El objetivo de este trabajo es analizar el cierre de herida en cirugía protésica a través de una encuesta sobre una muestra representativa a nivel nacional y así obtener información sobre el contexto del cierre en España. Material y método: Se conforma un grupo ad hoc de especialistas en cirugía protésica. El grupo de expertos, posterior al análisis de la literatura, elabora un cuestionario de 32 preguntas cerradas de opción múltiple, divididas en los siguientes bloques: hemostasia, cierre quirúrgico de la herida y apósitos. Resultados: Un total de 471 cirujanos respondieron la encuesta de forma completa y con información suficiente para efectuar el análisis descriptivo; 79% cree que el ácido tranexámico (ATX) puede influir en la disminución de tasa de infección de sitio quirúrgico; 96% cree que el tipo de cierre profundo a nivel de la artrotomía podría influir en los resultados y complicaciones tras prótesis de cadera y/o rodilla; 85% cree que el tipo de cierre superficial a nivel subcutáneo puede influir en los resultados y complicaciones tras prótesis de cadera y/o rodilla; 64% de los cirujanos utiliza la terapia de presión negativa incisional de simple uso para el tratamiento de las complicaciones de la herida quirúrgica (seromas, drenaje prolongado, dehiscencias). Conclusiones: Existe en nuestro entorno una alta variabilidad en el cierre de la herida y una baja inversión en formación sobre este tema. Los autores recomiendan a las diferentes sociedades científicas la inversión de recursos para mejorar la formación en dicho campo y reducir el porcentaje de cirujanos que se consideran inadecuadamente formados, así como adaptar las técnicas de cierre a aquellas consideradas patrón oro según la evidencia.(AU)

Background and objective: In orthopedic surgery, it is clear that an optimal standardized closure technique has not yet been developed. Locally, there are no objective data describing the standard surgical practice in wound closure. The aim of this study is to analyze the clinical practice of surgical wound closure in orthopedic surgery by means of a survey of a representative local sample and thus obtain information on the context of closure in Spain. Method: an ad hoc group of specialists in orthopedic surgery and traumatology was formed. The group of experts, after analyzing the literature, developed a questionnaire of 32 closed multiple-choice questions divided into the following blocks: hemostasis, surgical wound closure (deep, superficial, and cutaneous), and dressings. Results: A total of 471 surgeons responded to the survey completely and with sufficient information to perform the descriptive analysis. 79% believe that ATX can influence the decrease in surgical site infection rate. 96% believe that the type of deep closure at the level of the arthrotomy could influence outcomes and complications after hip and/or knee replacements. 85% believe that the type of shallow closure at the subcutaneous level may influence outcomes and complications after hip and/or knee replacement. 64% of surgeons use single-use incisional negative pressure therapy for the treatment of surgical wound complications (seroma, prolonged drainage, dehiscence). Conclusions: There is a high level of variability in wound closure in our setting and a low level of training on the subject. The authors recommend that the different scientific societies invest resources to improve training in this field and reduce the percentage of surgeons who are considered inadequately trained, as well as adapting closure techniques to those considered gold standard according to the evidence.(AU)

[Translated article] Wound closure after knee and hip replacement (TKA and THA): Survey results on the clinical practice in Spain / Cierre de herida en cirugía protésica de rodilla y cadera (PTR y PTC): resultados de una encuesta sobre la práctica clínica en España

Introducción y objetivos: En cirugía protésica de rodilla y cadera está claro que aún no se ha desarrollado una técnica de cierre estandarizada óptima. A nivel local no existen datos que describan la práctica quirúrgica habitual en cierre de herida. El objetivo de este trabajo es analizar el cierre de herida en cirugía protésica a través de una encuesta sobre una muestra representativa a nivel nacional y así obtener información sobre el contexto del cierre en España. Material y método: Se conforma un grupo ad hoc de especialistas en cirugía protésica. El grupo de expertos, posterior al análisis de la literatura, elabora un cuestionario de 32 preguntas cerradas de opción múltiple, divididas en los siguientes bloques: hemostasia, cierre quirúrgico de la herida y apósitos. Resultados: Un total de 471 cirujanos respondieron la encuesta de forma completa y con información suficiente para efectuar el análisis descriptivo; 79% cree que el ácido tranexámico (ATX) puede influir en la disminución de tasa de infección de sitio quirúrgico; 96% cree que el tipo de cierre profundo a nivel de la artrotomía podría influir en los resultados y complicaciones tras prótesis de cadera y/o rodilla; 85% cree que el tipo de cierre superficial a nivel subcutáneo puede influir en los resultados y complicaciones tras prótesis de cadera y/o rodilla; 64% de los cirujanos utiliza la terapia de presión negativa incisional de simple uso para el tratamiento de las complicaciones de la herida quirúrgica (seromas, drenaje prolongado, dehiscencias). Conclusiones: Existe en nuestro entorno una alta variabilidad en el cierre de la herida y una baja inversión en formación sobre este tema. Los autores recomiendan a las diferentes sociedades científicas la inversión de recursos para mejorar la formación en dicho campo y reducir el porcentaje de cirujanos que se consideran inadecuadamente formados, así como adaptar las técnicas de cierre a aquellas consideradas patrón oro según la evidencia.(AU)

Background and objective: In orthopedic surgery, it is clear that an optimal standardized closure technique has not yet been developed. Locally, there are no objective data describing the standard surgical practice in wound closure. The aim of this study is to analyze the clinical practice of surgical wound closure in orthopedic surgery by means of a survey of a representative local sample and thus obtain information on the context of closure in Spain. Method: an ad hoc group of specialists in orthopedic surgery and traumatology was formed. The group of experts, after analyzing the literature, developed a questionnaire of 32 closed multiple-choice questions divided into the following blocks: hemostasis, surgical wound closure (deep, superficial, and cutaneous), and dressings. Results: A total of 471 surgeons responded to the survey completely and with sufficient information to perform the descriptive analysis. 79% believe that ATX can influence the decrease in surgical site infection rate. 96% believe that the type of deep closure at the level of the arthrotomy could influence outcomes and complications after hip and/or knee replacements. 85% believe that the type of shallow closure at the subcutaneous level may influence outcomes and complications after hip and/or knee replacement. 64% of surgeons use single-use incisional negative pressure therapy for the treatment of surgical wound complications (seroma, prolonged drainage, dehiscence). Conclusions: There is a high level of variability in wound closure in our setting and a low level of training on the subject. The authors recommend that the different scientific societies invest resources to improve training in this field and reduce the percentage of surgeons who are considered inadequately trained, as well as adapting closure techniques to those considered gold standard according to the evidence.(AU)

Reporte de incidentes serios en productos sanitarios usados en cirugía intraocular. Proponiendo ideas / Reporting serious incidents in medical devices used in intraocular surgery: Proposing ideas

La entrada en vigor del reglamento sobre productos sanitarios obliga a los clínicos a identificar y reportar a las autoridades sanitarias los posibles incidentes serios derivados de su utilización. Dadas las dudas que pueden suscitarse sobre qué puede o no considerarse incidente serio, un grupo de trabajo, creado por miembros de la Sociedad Española de Retina y Vitreo (SERV) y el clúster de oftalmología y ciencias de la visión (Cluster4Eye), han elaborado un documento que pretende orientar a los oftalmólogos sobre algunos de los incidentes que, en la experiencia del equipo de trabajo, no son habituales o pueden causar un serio daño a la función del paciente. (AU)

The entry into force of the regulation on medical devices obliges clinicians to identify and report to the Health Authorities possible serious incidents arising from their use. In view of the doubts that may arise as to whether or not it may be considered a serious incident, a working group, set up by members of the Spanish Society of Retina and Vitreous (SERV) and the cluster of ophthalmology and vision sciences (Cluster4Eye) have prepared a document that aims to guide ophthalmologists about some of the incidents that, in the experience of the work team, are not common or can cause serious damage to the patient's function. (AU)

[Translated article] Wound closure after knee and hip replacement (TKA and THA): Survey results on the clinical practice in Spain.

BACKGROUND AND OBJECTIVE: In orthopaedic surgery, it is clear that an optimal standardised closure technique has not yet been developed. Locally, there are no objective data describing the standard surgical practice in wound closure. The aim of this study is to analyse the clinical practice of surgical wound closure in orthopaedic surgery by means of a survey of a representative local sample and thus obtain information on the context of closure in Spain. MATERIAL AND METHOD: An ad hoc group of specialists in orthopaedic surgery and traumatology was formed. The group of experts, after analyzing the literature, developed a questionnaire of 32 closed multiple-choice questions divided into the following blocks: hemostasis, surgical wound closure (deep, superficial, and cutaneous), and dressings. RESULTS: A total of 471 surgeons responded to the survey completely and with sufficient information to perform the descriptive analysis. 79% believe that ATX can influence the decrease in surgical site infection rate. 96% believe that the type of deep closure at the level of the arthrotomy could influence outcomes and complications after hip and/or knee replacements. 85% believe that the type of shallow closure at the subcutaneous level may influence outcomes and complications after hip and/or knee replacement. 64% of surgeons use single-use incisional negative pressure therapy for the treatment of surgical wound complications (seroma, prolonged drainage, dehiscence). CONCLUSIONS: There is a high level of variability in wound closure in our setting and a low level of training on the subject. The authors recommend that the different scientific societies invest resources to improve training in this field and reduce the percentage of surgeons who are considered inadequately trained, as well as adapting closure techniques to those considered gold standard according to the evidence.

Reporting serious incidents in medical devices used in intraocular surgery: Proposing ideas.

The entry into force of the regulation on medical devices obliges clinicians to identify and report to the Health Authorities possible serious incidents arising from their use. In view of the doubts that may arise as to whether or not it may be considered a serious incident, a working group, set up by members of the Spanish Society of Retina and Vitreo and the cluster of ophthalmology and vision sciences (Cluster4Eye) have prepared a document that aims to guide ophthalmologists about some of the incidents that, in the experience of the work team, are not common or can cause serious damage to the patient's function.

Revisión de revisiones sistemáticas de factores pronóstico para infección protésica / Overview of systematic reviews of risk factors for prosthetic joint infection

Introducción: La infección protésica es una de las complicaciones más graves en cirugía ortopédica, por lo que es importante detectar factores relacionados con su aparición. Las revisiones sistemáticas (RS) pronósticas detectan y evalúan factores relacionados con enfermedades, lo que permite una mejor predicción de los riesgos y la implementación de medidas preventivas. Aunque estas RS pronósticas son cada vez más frecuentes, su campo metodológico presenta algunas lagunas de conocimiento. Objetivo: Realizar una revisión de RS de factores pronósticos para infección protésica y describir la evidencia sintetizada. Secundariamente, evaluar el riesgo de sesgo y la calidad metodológica. Material y métodos: Búsqueda bibliográfica en 4bases de datos (en mayo de 2021) para identificar RS pronósticas que evaluaran factores pronósticos para infección protésica. Evaluamos el riesgo de sesgo mediante ROBIS y la calidad metodológica con la herramienta modificada AMSTAR-2. Se realizó un estudio de solapamiento entre RS. Resultados: Incluimos 23 RS que valoraban 15 factores asociados con la infección protésica; de ellos, 13 mostraron asociación significativa. Los más estudiados fueron obesidad, corticoides intraarticulares, tabaquismo y glucemia elevada. El solapamiento entre RS fue elevado para obesidad y muy alto para corticoides intraarticulares, tabaquismo y glucemia elevada. El riesgo de sesgo fue considerado bajo en 8 RS (34,7%), pero la herramienta de evaluación metodológica demostró una baja calidad en general. Conclusiones: La identificación de factores procedimentales modificables ofrecen mejores resultados a los pacientes. Sin embargo, muchas RS son redundantes. La evidencia en factores pronósticos en cirugía ortopédica es débil debido al alto riesgo de sesgo y a la calidad metodológica limitada.(AU)

Background: Prosthetic joint infection is one of the most serious complications in orthopedics. Prognostic systematic reviews (SR) detecting and assessing factors related to prosthetic joint infection, allow better prediction of risk and implementation of preventive measures. Although prognostic SR are increasingly frequent, their methodological field presents some knowledge gaps. Purpose: To carry out an overview of SR assessing risk factors for prosthetic joint infection, describing and synthesizing their evidence. Secondarily, to assess the risk of bias and methodological quality. Material and methods: We conducted a bibliographic search in 4databases (May 2021) to identify prognostic SR evaluating any risk factor for prosthetic joint infection. We evaluated risk of bias with the ROBIS tool, and methodological quality with a modified AMSTAR-2 tool. We computed the overlap degree study between included SR. Results: Twenty-three SR were included, studying 15 factors for prosthetic joint infection, of which, 13 had significant association. The most frequently studied risk factors were obesity, intra-articular corticosteroids, smoking and uncontrolled diabetes. Overlapping between SR was high for obesity and very high for intra-articular corticoid injection, smoking and uncontrolled diabetes. Risk of bias was considered low in 8SRs (34.7%). The modified AMSTAR-2 tool showed important methodological gaps. Conclusions: Identification of procedural-modifiable factors, such as intra-articular corticoids use, can give patients better results. Overlapping between SR was very high, meaning that some SR are redundant. The evidence on risk factors for prosthetic joint infection is weak due to high risk of bias and limited methodological quality.(AU)

[Translated article] Overview of systematic reviews of risk factors for prosthetic joint infection / Revisión de revisiones sistemáticas de factores pronóstico para infección protésica

Introducción: La infección protésica es una de las complicaciones más graves en cirugía ortopédica, por lo que es importante detectar factores relacionados con su aparición. Las revisiones sistemáticas (RS) pronósticas detectan y evalúan factores relacionados con enfermedades, lo que permite una mejor predicción de los riesgos y la implementación de medidas preventivas. Aunque estas RS pronósticas son cada vez más frecuentes, su campo metodológico presenta algunas lagunas de conocimiento. Objetivo: Realizar una revisión de RS de factores pronósticos para infección protésica y describir la evidencia sintetizada. Secundariamente, evaluar el riesgo de sesgo y la calidad metodológica. Material y métodos: Búsqueda bibliográfica en 4bases de datos (en mayo de 2021) para identificar RS pronósticas que evaluaran factores pronósticos para infección protésica. Evaluamos el riesgo de sesgo mediante ROBIS y la calidad metodológica con la herramienta modificada AMSTAR-2. Se realizó un estudio de solapamiento entre RS. Resultados: Incluimos 23 RS que valoraban 15 factores asociados con la infección protésica; de ellos, 13 mostraron asociación significativa. Los más estudiados fueron obesidad, corticoides intraarticulares, tabaquismo y glucemia elevada. El solapamiento entre RS fue elevado para obesidad y muy alto para corticoides intraarticulares, tabaquismo y glucemia elevada. El riesgo de sesgo fue considerado bajo en 8 RS (34,7%), pero la herramienta de evaluación metodológica demostró una baja calidad en general. Conclusiones: La identificación de factores procedimentales modificables ofrecen mejores resultados a los pacientes. Sin embargo, muchas RS son redundantes. La evidencia en factores pronósticos en cirugía ortopédica es débil debido al alto riesgo de sesgo y a la calidad metodológica limitada.(AU)

Background: Prosthetic joint infection is one of the most serious complications in orthopedics. Prognostic systematic reviews (SR) detecting and assessing factors related to prosthetic joint infection, allow better prediction of risk and implementation of preventive measures. Although prognostic SR are increasingly frequent, their methodological field presents some knowledge gaps. Purpose: To carry out an overview of SR assessing risk factors for prosthetic joint infection, describing and synthesizing their evidence. Secondarily, to assess the risk of bias and methodological quality. Material and methods: We conducted a bibliographic search in 4databases (May 2021) to identify prognostic SR evaluating any risk factor for prosthetic joint infection. We evaluated risk of bias with the ROBIS tool, and methodological quality with a modified AMSTAR-2 tool. We computed the overlap degree study between included SR. Results: Twenty-three SR were included, studying 15 factors for prosthetic joint infection, of which, 13 had significant association. The most frequently studied risk factors were obesity, intra-articular corticosteroids, smoking and uncontrolled diabetes. Overlapping between SR was high for obesity and very high for intra-articular corticoid injection, smoking and uncontrolled diabetes. Risk of bias was considered low in 8SRs (34.7%). The modified AMSTAR-2 tool showed important methodological gaps. Conclusions: Identification of procedural-modifiable factors, such as intra-articular corticoids use, can give patients better results. Overlapping between SR was very high, meaning that some SR are redundant. The evidence on risk factors for prosthetic joint infection is weak due to high risk of bias and limited methodological quality.(AU)

Situación actual de la robótica en cirugía protésica de rodilla, ¿una tecnología que ha venido para quedarse? / Current situation of robotics in knee prosthetic surgery, a technology that has come to stay?

La cirugía robótica es una técnica quirúrgica que va en aumento. El objetivo de la artroplastia total de rodilla asistida por robot (ATRar) es el de proveer al cirujano de una herramienta para ejecutar de forma precisa los cortes óseos de acuerdo con una planificación quirúrgica previa para restablecer la cinemática de una rodilla primitiva y el balance de partes blandas, pudiendo aplicar de forma precisa el tipo de alineación que escojamos. Además, la ATRar es una herramienta muy útil para la formación.Dentro de las limitaciones, encontramos la curva de aprendizaje, la necesidad de equipos específicos, los costes elevados de adquisición de los dispositivos, en algunos sistemas el aumento de radiación y que cada robot está ligado a un tipo específico de implante.Los estudios actuales muestran que con la ATRar disminuyen las variaciones de alineación del eje mecánico, mejora el dolor posoperatorio y se facilita un alta más precoz. Por otro lado, no muestran diferencias a nivel de rango de movimiento, alineación, balance de gaps, complicaciones, tiempo quirúrgico o resultados funcionales.(AU)

Robotic surgery is a surgical technique that is on the rise. The goal of robotic-assisted total knee arthroplasty (RA-TKA) is to provide the surgeon with a tool to accurately execute bone cuts according to previous surgical planning to restore knee kinematics and balance of soft tissue, being able to precisely apply the type of alignment that we choose. In addition, RA-TKA is a very useful tool for training.Within the limitations, there is the learning curve, the need for specific equipment, the high cost of the devices, the increase in radiation in some systems and that each robot is linked to a specific type of implant.Current studies show, with RA-TKA, variations in the alignment of the mechanical axis are reduced, postoperative pain is improved and earlier discharge is facilitated. On the other hand, there are no differences in terms of range of motion, alignment, gap balance, complications, surgical time or functional results.(AU)

[Translated article] Current situation of robotics in knee prosthetic surgery: A technology that has come to stay? / Situación actual de la robótica en cirugía protésica de rodilla, ¿una tecnología que ha venido para quedarse?

La cirugía robótica es una técnica quirúrgica que va en aumento. El objetivo de la artroplastia total de rodilla asistida por robot (ATRar) es el de proveer al cirujano de una herramienta para ejecutar de forma precisa los cortes óseos de acuerdo con una planificación quirúrgica previa para restablecer la cinemática de una rodilla primitiva y el balance de partes blandas, pudiendo aplicar de forma precisa el tipo de alineación que escojamos. Además, la ATRar es una herramienta muy útil para la formación.Dentro de las limitaciones, encontramos la curva de aprendizaje, la necesidad de equipos específicos, los costes elevados de adquisición de los dispositivos, en algunos sistemas el aumento de radiación y que cada robot está ligado a un tipo específico de implante.Los estudios actuales muestran que con la ATRar disminuyen las variaciones de alineación del eje mecánico, mejora el dolor posoperatorio y se facilita un alta más precoz. Por otro lado, no muestran diferencias a nivel de rango de movimiento, alineación, balance de gaps, complicaciones, tiempo quirúrgico o resultados funcionales.(AU)

Robotic surgery is a surgical technique that is on the rise. The goal of robotic-assisted total knee arthroplasty (RA-TKA) is to provide the surgeon with a tool to accurately execute bone cuts according to previous surgical planning to restore knee kinematics and balance of soft tissue, being able to precisely apply the type of alignment that we choose. In addition, RA-TKA is a very useful tool for training.Within the limitations, there is the learning curve, the need for specific equipment, the high cost of the devices, the increase in radiation in some systems and that each robot is linked to a specific type of implant.Current studies show, with RA-TKA, variations in the alignment of the mechanical axis are reduced, postoperative pain is improved and earlier discharge is facilitated. On the other hand, there are no differences in terms of range of motion, alignment, gap balance, complications, surgical time or functional results.(AU)

[Translated article] Overview of systematic reviews of risk factors for prosthetic joint infection.

BACKGROUND: Prosthetic joint infection is one of the most serious complications in orthopedics. Prognostic systematic reviews (SRs) detecting and assessing factors related to prosthetic joint infection, allow better prediction of risk and implementation of preventive measures. Although prognostic SRs are increasingly frequent, their methodological field presents some knowledge gaps. PURPOSE: To carry out an overview of SR assessing risk factors for prosthetic joint infection, describing and synthesizing their evidence. Secondarily, to assess the risk of bias and methodological quality. MATERIAL AND METHODS: We conducted a bibliographic search in 4 databases (May 2021) to identify prognostic SR evaluating any risk factor for prosthetic joint infection. We evaluated risk of bias with the ROBIS tool, and methodological quality with a modified AMSTAR-2 tool. We computed the overlap degree study between included SR. RESULTS: Twenty-three SRs were included, studying 15 factors for prosthetic joint infection, of which, 13 had significant association. The most frequently studied risk factors were obesity, intra-articular corticosteroids, smoking and uncontrolled diabetes. Overlapping between SR was high for obesity and very high for intra-articular corticoid injection, smoking and uncontrolled diabetes. Risk of bias was considered low in 8 SRs (34.7%). The modified AMSTAR-2 tool showed important methodological gaps. CONCLUSIONS: Identification of procedural-modifiable factors, such as intra-articular corticoids use, can give patients better results. Overlapping between SR was very high, meaning that some SRs are redundant. The evidence on risk factors for prosthetic joint infection is weak due to high risk of bias and limited methodological quality.

Overview of systematic reviews of risk factors for prosthetic joint infection. / Revisión de revisiones sistemáticas de factores pronóstico para infección protésica.

BACKGROUND: Prosthetic joint infection is one of the most serious complications in orthopedics. Prognostic systematic reviews (SR) detecting and assessing factors related to prosthetic joint infection, allow better prediction of risk and implementation of preventive measures. Although prognostic SR are increasingly frequent, their methodological field presents some knowledge gaps. PURPOSE: To carry out an overview of SR assessing risk factors for prosthetic joint infection, describing and synthesizing their evidence. Secondarily, to assess the risk of bias and methodological quality. MATERIAL AND METHODS: We conducted a bibliographic search in 4databases (May 2021) to identify prognostic SR evaluating any risk factor for prosthetic joint infection. We evaluated risk of bias with the ROBIS tool, and methodological quality with a modified AMSTAR-2 tool. We computed the overlap degree study between included SR. RESULTS: Twenty-three SR were included, studying 15 factors for prosthetic joint infection, of which, 13 had significant association. The most frequently studied risk factors were obesity, intra-articular corticosteroids, smoking and uncontrolled diabetes. Overlapping between SR was high for obesity and very high for intra-articular corticoid injection, smoking and uncontrolled diabetes. Risk of bias was considered low in 8SRs (34.7%). The modified AMSTAR-2 tool showed important methodological gaps. CONCLUSIONS: Identification of procedural-modifiable factors, such as intra-articular corticoids use, can give patients better results. Overlapping between SR was very high, meaning that some SR are redundant. The evidence on risk factors for prosthetic joint infection is weak due to high risk of bias and limited methodological quality.

Wound closure after knee and hip replacement (TKA and THA): Survey results on the clinical practice in Spain. / Cierre de herida en cirugía protésica de rodilla y cadera (PTR y PTC): Resultados de una encuesta sobre la práctica clínica en España.

BACKGROUND AND OBJECTIVE: In orthopedic surgery, it is clear that an optimal standardized closure technique has not yet been developed. Locally, there are no objective data describing the standard surgical practice in wound closure. The aim of this study is to analyze the clinical practice of surgical wound closure in orthopedic surgery by means of a survey of a representative local sample and thus obtain information on the context of closure in Spain. METHOD: an ad hoc group of specialists in orthopedic surgery and traumatology was formed. The group of experts, after analyzing the literature, developed a questionnaire of 32 closed multiple-choice questions divided into the following blocks: hemostasis, surgical wound closure (deep, superficial, and cutaneous), and dressings. RESULTS: A total of 471 surgeons responded to the survey completely and with sufficient information to perform the descriptive analysis. 79% believe that ATX can influence the decrease in surgical site infection rate. 96% believe that the type of deep closure at the level of the arthrotomy could influence outcomes and complications after hip and/or knee replacements. 85% believe that the type of shallow closure at the subcutaneous level may influence outcomes and complications after hip and/or knee replacement. 64% of surgeons use single-use incisional negative pressure therapy for the treatment of surgical wound complications (seroma, prolonged drainage, dehiscence). CONCLUSIONS: There is a high level of variability in wound closure in our setting and a low level of training on the subject. The authors recommend that the different scientific societies invest resources to improve training in this field and reduce the percentage of surgeons who are considered inadequately trained, as well as adapting closure techniques to those considered gold standard according to the evidence.

[Translated article] Current situation of robotics in knee prosthetic surgery: A technology that has come to stay?

Robotic surgery is a surgical technique that is on the rise. The goal of robotic-assisted total knee arthroplasty (RA-TKA) is to provide the surgeon with a tool to accurately execute bone cuts according to previous surgical planning to restore knee kinematics and balance of soft tissue, being able to precisely apply the type of alignment that we choose. In addition, RA-TKA is a very useful tool for training. Within the limitations, there is the learning curve, the need for specific equipment, the high cost of the devices, the increase in radiation in some systems and that each robot is linked to a specific type of implant. Current studies show, with RA-TKA, variations in the alignment of the mechanical axis are reduced, postoperative pain is improved and earlier discharge is facilitated. On the other hand, there are no differences in terms of range of motion, alignment, gap balance, complications, surgical time or functional results.

Oncological monitoring after transanal total mesorectal excision (TaTME) for rectal neoplasia.

BACKGROUND: The surgical treatment of choice for rectal neoplasia is total mesorectal excision (TME). The transanal approach enables a better approach in male and obese patients and/or those with a narrow pelvis and in patients with small tumors. Short-term results are comparable with those for laparoscopy or the open approach, but the medium- and long-term oncological data are sparse. The aim of the present study was to evaluate our early experience with transanal TME (TaTME). METHODS: This was a retrospective study conducted on patients who underwent TaTME at our center between August 2013 and April 2017 with a follow-up ≥ 3 years. Histopathology, complications, mortality, neoplastic recurrence and disease-free survival were analyzed. RESULTS: One hundred patients (68 men and 32 women,, median age 66.8 years [range 29.6-91.2 years]) were included. There were 67 T3 cases (67%) with 74 N0 cases (74%), the mesorectal quality was graded optimal for 87.6% and only 2 cases of radial margin involvement were detected (2%). The median follow-up period was 47.6 months (range 11.8-78.9 months). Eighteen cases of recurrence were diagnosed, of which 3 (3%) recurred locally with an average disease-free period of 43.1 months. Overall survival was 80% and mortality due to progression of disease was 13%. CONCLUSIONS: TaTME is a safe surgical procedure with surgical, anatomopathological and oncological results at 3 years (medium-term) comparable with those for the laparoscopic and open approaches. Better monitoring is required with studies of the long-term functional and quality of life outcomes, i.e., at 5 or 10 years.

Current situation of robotics in knee prosthetic surgery, a technology that has come to stay? / Situación actual de la robótica en cirugía protésica de rodilla, ¿una tecnología que ha venido para quedarse?

Robotic surgery is a surgical technique that is on the rise. The goal of robotic-assisted total knee arthroplasty (RA-TKA) is to provide the surgeon with a tool to accurately execute bone cuts according to previous surgical planning to restore knee kinematics and balance of soft tissue, being able to precisely apply the type of alignment that we choose. In addition, RA-TKA is a very useful tool for training. Within the limitations, there is the learning curve, the need for specific equipment, the high cost of the devices, the increase in radiation in some systems and that each robot is linked to a specific type of implant. Current studies show, with RA-TKA, variations in the alignment of the mechanical axis are reduced, postoperative pain is improved and earlier discharge is facilitated. On the other hand, there are no differences in terms of range of motion, alignment, gap balance, complications, surgical time or functional results.

Papel de la medicina perioperatoria en la prevención de la prótesis de rodilla dolorosa / Role of perioperative medicine in the prevention of painful knee replacement

La artroplastia total de rodilla es una de las cirugías realizadas con más frecuencia en ortopedia. No obstante, hasta un 20% de los pacientes mostrarán persistencia del dolor después del procedimiento. El dolor posquirúrgico persistente puede ser una continuación del dolor agudo tras la cirugía o aparecer después de un período asintomático durante más de 3 meses.En la actualidad, se han caracterizado los factores de riesgo que se asocian a dolor posquirúrgico persistente tras la artroplastia total de rodilla. Forman parte del contexto perioperatorio del paciente (preoperatorio, intraoperatorio y postoperatorio) y se pueden agrupar en diferentes dimensiones: genéticas, demográficas, clínicas, quirúrgicas, analgésicas, inflamatorias y psicológicas.Su identificación y prevención, mediante un abordaje multimodal y biopsicosocial, es esencial en el contexto de la medicina perioperatoria y ha demostrado que puede prevenir o mejorar el dolor tras la cirugía.(AU)

Perioperative medicine role in painful knee prosthesis prevention.

Total knee arthroplasty is one of the most frequently performed orthopaedic surgeries. However, up to 20% of patients develop persistent postoperative pain. Persistent postoperative pain may be an extension of acute postoperative pain, but can also occur after more than 3 months without symptoms. Risk factors associated with persistent postoperative pain after arthroplasty have now been characterised within the patient's perioperative context (preoperative, intraoperative and postoperative), and can be grouped under genetic, demographic, clinical, surgical, analgesic, inflammatory and psychological factors. Identification and prevention of persistent postoperative pain through a multimodal and biopsychosocial approach is essential in the context of perioperative medicine, and has been shown to prevent or ameliorate postoperative pain.

Proyecto PREVENCOT: ¿Seguimos las recomendaciones internacionales para la prevención de la infección del sitio quirúrgico en cirugía ortopédica programada? / PREVENCOT project: Do we follow international guidelines to prevent surgical site infection in orthopedic elective surgery?

Antecedentes y objetivo: La prevención de las infecciones postoperatorias en el sitio quirúrgico es realmente factible. El objetivo de este trabajo es analizar la adhesividad a las guías internacionales para la prevención de las infecciones en cirugía ortopédica protésica electiva a través de una encuesta sobre una muestra representativa de cirujanos ortopédicos españoles, con el fin de establecer unas recomendaciones generales. Material y método: Se realiza una encuesta poblacional en formato online compuesta por 78 preguntas para analizar la práctica clínica habitual de los cirujanos ortopédicos españoles ante las infecciones periprotésicas de cadera y rodilla, y la adhesividad de los mismos a las guías internacionales. Resultados: Los resultados de la encuesta (n=138) muestran que en práctica clínica existe una alta adhesividad de los cirujanos ortopédicos españoles a la mayoría de las recomendaciones internacionales. Conclusiones: La integración de la práctica clínica individual con la mejor evidencia científica disponible a partir de las recomendaciones de las guías internacionales es la mejor vía para el manejo adecuado de la prevención de infección periprotésica en cirugía electiva.(AU)

Background and objective: Prevention of postoperative surgical site infections is indeed feasible. The aim of this work is to analyses adherence to international guidelines for the prevention of infections in elective orthopedic prosthetic surgery by means of a survey of a representative sample of Spanish orthopedic surgeons, with the purpose to establish general recommendations. Material and method: A population survey was conducted in online format consisting of 78 questions to analyze the usual clinical practice of Spanish orthopedic surgeons in the face of periprosthetic infections of the hip and knee, and their adherence to international guidelines. Results: The results of the survey (n=138) show in clinical practice of Spanish orthopedic surgeons a high adherence to most of the international recommendations. Conclusions: The integration high adherence of individual clinical practice with the best available scientific evidence based on the recommendations of international guidelines is the best way to adequately manage the prevention of periprosthetic infection in elective surgery.(AU)

PREVENCOT project: Do we follow international guidelines to prevent surgical site infection in orthopaedic elective surgery? / Proyecto PREVENCOT: ¿Seguimos las recomendaciones internacionales para la prevención de la infección del sitio quirúrgico en cirugía ortopédica programada?

Background and objective: Prevention of postoperative surgical site infections is indeed feasible. The aim of this work is to analyses adherence to international guidelines for the prevention of infections in elective orthopedic prosthetic surgery by means of a survey of a representative sample of Spanish orthopedic surgeons, with the purpose to establish general recommendations. Material and method: A population survey was conducted in online format consisting of 78 questions to analyze the usual clinical practice of Spanish orthopedic surgeons in the face of periprosthetic infections of the hip and knee, and their adherence to international guidelines. Results: The results of the survey (n=138) show in clinical practice of Spanish orthopedic surgeons a high adherence to most of the international recommendations. Conclusions: The integration high adherence of individual clinical practice with the best available scientific evidence based on the recommendations of international guidelines is the best way to adequately manage the prevention of periprosthetic infection in elective surgery.(AU)

Antecedentes y objetivo: La prevención de las infecciones postoperatorias en el sitio quirúrgico es realmente factible. El objetivo de este trabajo es analizar la adhesividad a las guías internacionales para la prevención de las infecciones en cirugía ortopédica protésica electiva a través de una encuesta sobre una muestra representativa de cirujanos ortopédicos españoles, con el fin de establecer unas recomendaciones generales. Material y método: Se realiza una encuesta poblacional en formato online compuesta por 78 preguntas para analizar la práctica clínica habitual de los cirujanos ortopédicos españoles ante las infecciones periprotésicas de cadera y rodilla, y la adhesividad de los mismos a las guías internacionales. Resultados: Los resultados de la encuesta (n=138) muestran que en práctica clínica existe una alta adhesividad de los cirujanos ortopédicos españoles a la mayoría de las recomendaciones internacionales. Conclusiones: La integración de la práctica clínica individual con la mejor evidencia científica disponible a partir de las recomendaciones de las guías internacionales es la mejor vía para el manejo adecuado de la prevención de infección periprotésica en cirugía electiva.(AU)