Revision total knee arthroplasty: hybrid vs standard cemented fixation.

INTRODUCTION: Modular systems with stems are necessary for the stability of revision total knee arthroplasty (rTKA), but controversy remains as to the best fixation method: cemented or hybrid (noncemented stem). The aim of this study was to assess the clinical, X-ray, life-quality and survival results obtained with each fixation method. MATERIALS AND METHODS: During the period 2000-2013, rTKA was performed on 67 patients (29 cemented arthroplasty and 38 hybrid fixation). The average follow-up was 7 years (range 2-15). All patients were evaluated clinically and radiographically using the American Knee Society Score (AKSS), the Western Ontario and McMaster Universities Arthritis Index (WOMAC), and the Short Form Health Survey (SF-36). A survival study was performed via Kaplan-Meier analysis. RESULTS: There were no differences between the cemented and hybrid fixation groups in the preoperative and postoperative AKSS clinical evaluation indices and the SF-36 health index. However, the WOMAC assessment scale did reveal statistically significant differences between the groups, with a global classification of 64.9 points weighted at 100 (SD 16.8) for cemented fixation versus 78.9 (SD 9.0) for hybrid fixation (p = 0.001). The corresponding values for stiffness were 61.6 (SD 12.9) and 80.5 (SD 14.7) (p = 0.001), and those for function were 61.3 (SD 19.4) and 78.1 (SD 10.5) (p = 0.001). No significant differences between the groups were recorded with respect to the pain score (p = 0.4) or the results of the Kaplan-Meier survival analysis. CONCLUSION: Although the results were similar for the two groups, hybrid fixation tended to produce better results than cemented fixation. In view of the risk of further loosening, we prefer the more conservative approach, i.e. hybrid fixation. LEVEL EVIDENCE: Level III.

Rotura distal del tendón de la porción larga del bíceps braquial. ¿Por qué está aumentado su incidencia? ¿Cuándo se debe reparar? / Rupture of the distal biceps tendon. Why is increasing its incidence? When it should be repaired?

Introducción y objetivos: La rotura del tendón distal del bíceps braquial es poco frecuente y representa sólo el 3% de todas las roturas de este tendón, aunque en la última década ha aumentado hasta un 10%. Son características en varones de edad media con predominio del brazo dominante. Se asocian factores de riesgo locales (alta demanda funcional) y sistémicos (tabaco, dislipemia, corticoides, anabolizantes, obesidad). Nuestro objetivo es analizar los factores de riesgos asociados a esta patología y evaluar los resultados tras la reparación quirúrgica de dicho tendón. Material y métodos: Estudio retrospectivo de 13 pacientes diagnosticados de rotura de bíceps distal en nuestro servicio desde mayo de 2012 hasta enero de 2014. Todos fueron tratados quirúrgicamente con reinserción anatómica con vía única (69,23% con técnica Endobutton y 30,77% con reanclaje mediante arpones. Se ha valorado los posibles factores de riego, movilidad articular, complicaciones precoces y tardías y satisfacción del paciente (escala de Karunakar). Su seguimiento clínico ha sido de al menos 6 meses. Resultados: Todos fueron varones con edad media de 42,69 años en brazo dominante en el 92,3%. El 76,92% realizaban deportes para ejercitar el bíceps y el 53,84% tomaba medicación por dislipemia. El resultado obtenido tras el tratamiento fue excelente estando satisfechos la totalidad de los pacientes Conclusiones y discusión: Los factores de riesgo conocidos hasta la fecha son el tabaco, dislipemia, corticoides, anabolizantes y obesidad que no justifican el aumento de la incidencia actual. La práctica deportiva habitual que implique tonificar y muscular el músculo braquial en pacientes con factores de riesgo aumenta la probabilidad de rotura del tendón distal de bíceps y su reinserción anatómica por vía anterior es una correcta opción terapéutica

Introduction and objectives: The breaking of the distal biceps tendon is rare and represents only 3% of all breakings of this tendon. However, for the last decade this percentage has increased up to 10%. They are characteristic of middle-aged men with a predominance of the dominant arm. Local risk factor (high functional demand) and systemic ones (smoking, dyslipidemia, steroids, analogies, obesity) are associated with this pathology. Our goal is to analyze the risk factors which are associated with this condition and evaluate the results after surgical repair of the tendon. Materials and methods: Retrospective study of 13 patients diagnosed with distal biceps tendon breaking in our hospital from May 2012 to January 2014. All patients were treated surgically with anatomic reattachment single trak (69,23 % with Endobutton’s technique and 30,77 % remembering using harpoons). There have been assessed factors such us potential risk factors, joint mobility, early and late complications and the patient’s degree of satisfaction (scale Karunakar). Their clinical follow-up was carried out for at least 6 months after the surgery. Result: All patients were male, with an average age of 42,69 years, the 92,3 % were in the dominant arm, 76,92 % of the patients usually exercised the biceps while training and 53,84 % were taking medication for dyslipidemia. The results obtained after the treatment were excellent, shawing that all patients were satisfied with it. Conclusion: The risk factors that are known so far such us smoking, dyslipidemia, steroids, anabolics and obesity do not justify the increase in the currents incidence rate. Regular exercise involving the biceps brachial muscle in patients with risk factors increases the probability of breaking the distal biceps tendon and anatomic reattachment anterior approach is a correct treatment option

Hierro intravenoso preoperatorio como estrategia de ahorro de sangre en cirugía de fractura de cadera / Preoperative intravenous iron as a strategy for blood saving in surgery for hip fracture

Fundamento y objetivo: El propósito del estudio ha sido comprobar si la administración de hierro intravenoso en un paciente diagnosticado de fractura de cadera disminuye la necesidad de transfundir sangre. Pacientes y método: Se ha realizado un estudio observacional de casos y controles comparando un grupo control de 63 pacientes intervenidos de fractura de cadera y sin la administración de hierro intravenoso, frente a otro grupo de 57 pacientes en el que se administraron dosis de hierro sacarosa. Se describieron las diferencias demográficas, clínicas y hematométricas entre los casos y controles. Se valoraron la aparición de complicaciones de carácter infeccioso y la mortalidad. Se utilizó el programa SPSS® para el estudio estadístico. Resultados: Existe una correlación estadísticamente significativa entre una menor necesidad de transfusión y la administración de hierro sacarosa intravenoso, siendo necesario un menor número de concentrados en el grupo de casos (1,37 frente a 0,6). En dicho grupo se observa una tendencia decreciente estadísticamente significativa en la tasa de mortalidad hospitalaria (grupo caso: 0,8%/grupo control: 8,3%). No se ha demostrado una disminución de la infección intrahospitalaria con la administración del hierro intravenoso. Se observa una mayor necesidad de transfusión (80%) cuando los valores de hemoglobina son iguales o inferiores a 11 g/dl (p < 0,05). Conclusiones: La administración de hierro sacarosa intravenoso en pacientes diagnosticados de fractura de cadera antes de ser operados podría ser una medida efectiva de ahorro de sangre en esta cirugía traumática. Además, su utilización ha sido segura, sin presentar ningún efecto secundario (AU)

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[Preoperative intravenous iron as a strategy for blood saving in surgery for hip fracture]. / Hierro intravenoso preoperatorio como estrategia de ahorro de sangre en cirugía de fractura de cadera.

BACKGROUND AND OBJECTIVE: To determine whether administration of intravenous iron in a patient diagnosed with hip fracture reduces the need for blood transfusion. PATIENTS AND METHODS: A retrospective observational case-control study was performed comparing a control group of 63 patients diagnosed with hip fracture with another group of 57 patients treated with parenteral iron. Demographic, clinical condition/clinical record and hematometric differences of the case-control patients were described. We analyzed the morbidity (post-surgical infection) and mortality rate. SPSS(®) was used for statistical studies. RESULTS: Being statistically significant, after the administration of intravenous iron sucrose, the need of blood transfusion was reduced in the case group, as well as the quantity of concentrates required (1.37 vs 0.6). In the case group, there was a statistically significant decreasing trend in hospital mortality rate (case group: 0.8%/control group: 8.3%). It was not been proven the relation between the decrease in nosocomial infection and the administration of intravenous iron CONCLUSIONS: The administration of intravenous iron sucrose in patients diagnosed with hip fracture before surgery could be effective blood saving measure in this type of trauma surgery. Furthermore, its use has been reliable without causing any side effects.

Infección de prótesis de rodilla tratada mediante desbridamiento e irrigación artroscópica / Infected knee arthrplasty treated by arthroscopic debridement and irrigation

Varios métodos han sido descritos para el tratamiento de la prótesis de rodilla infectada. Entre estos destacan la antibioterapia prolongada, el desbridamiento de la prótesis de forma abierta mediante artrotomía, el recambio protésico en uno o dos tiempos, la artrodesis e incluso la amputación de la extremidad. Un método no frecuentemente utilizado es el desbridamiento y la irrigación artroscópica de la prótesis. Presentamos un caso tratado mediante este procedimiento con buenos resultados por lo que creemos que el tratamiento artroscópido de la prótesis de rodilla infectada es totalmente válido en pacientes debidamente seleccionados

Various methods have been described for the treatment of the infected total knee arthroplasty. These include prolonged antibiotic suppression, open debridement and irrigation, exchange arthroplastry is one or two stages, the arthrodesis and even the amputation of the extremity. A method done not frequently utilize is the arthroscopic irrigation and debridement of the arthroplasty. We present a case treated by this procedure with good results for which we believe that this method of treatment is totally valid in patients properly selected