¿Se puede predecir el pronóstico de la cadera contralateral tras una artroplastia total de cadera? / Prognosis of the contralateral hip after primary total hip replacement: Can it be predicted?

Introducción: La coxartrosis es una de las patologías más frecuentes e incapacitantes. El 20% de los mayores de 60 años desarrollará coxartrosis sintomática y el 10% requerirá una prótesis total de cadera. La artroplastia total de cadera es uno de los procedimientos quirúrgicos que más aumenta la calidad de vida de estos pacientes. Cuando recomendamos la artroplastia en la práctica clínica, los pacientes a menudo preguntan sobre el pronóstico de su otra cadera: ¿Se deteriorará de la misma forma? ¿Será necesario operarla? ¿Cuándo? El objetivo es determinar si existe alguna variable o signo radiológico que prediga el pronóstico a medio plazo de la cadera contralateral tras una artroplastia total de cadera. Material y métodos: Se realizó un estudio retrospectivo de pacientes intervenidos de artroplastia total de cadera en nuestro hospital durante los años 2011 y 2012, con un total de 543 pacientes. Se determinó el grado de coxartrosis, según las clasificaciones JOA y Tönnis, en la radiografía de ambas caderas en el momento de la primera artroplastia y a intervalos regulares durante el seguimiento, analizando cada uno de los ítems incluidos en estas clasificaciones. Se estableció la relación de estos hallazgos radiográficos con la progresión de la artrosis y la necesidad de artroplastia contralateral. Resultados y conclusiones: Podría esperarse una progresión de la artrosis de la cadera contralateral en los próximos 3 años en el 10% de los pacientes. Esta progresión será mayor y más rápida en aquellos con grado JOA III-IV/Tönnis II-III y, especialmente, en aquellos con mayor estrechamiento articular y mayor alteración de la cabeza femoral, pudiendo alcanzar entre el 25 y el 30% de los pacientes. El grado de JOA/Tönnis inicial es un factor predictor de necesitar una prótesis de cadera contralateral.

Introduction: Coxarthrosis is one of the most frequent and disabling pathologies. 20% of individuals over 60 years of age will develop symptomatic coxarthrosis and 10% of them will need a hip replacement; it is probably one of the orthopaedic procedures that most increases quality of life. When we recommend arthroplasty in clinical practice, patients often ask about the prognosis of their other hip. Will it deteriorate in the same way? Will it be necessary to replace it? When? The aim of the study is to determine if there is any variable or radiological sign that predicts the medium-term prognosis of the contralateral hip after total hip arthroplasty. Material and methods: A retrospective review of patients who underwent total hip arthroplasty in our hospital during 2011 and 2012 was carried out, with a total of 543 patients. The coxarthrosis degree at X-ray was determined at the time of the first arthroplasty and at regular intervals during follow-up, according to the JOA and Tönnis classifications, analyzing each of the items included in these classifications. Its relation with the progression of osteoarthritis and the need of contralateral hip replacement was established. Results and conclusions: A progression of osteoarthritis of the contralateral hip could be expected in the next 3 years in 10% of patients. This progression will be greater and faster in those with JOA grade III–IV/Tönnis grade II–III, especially, in those with greater joint narrowing and femoral head shape score, and can reach between 25 and 30% of patients. The initial JOA/Tönnis degree is a predictive factor for requiring a hip replacement on the contralateral side.(AU)

[Translated article] Prognosis of the contralateral hip after primary total hip replacement: Can it be predicted? / ¿Se puede predecir el pronóstico de la cadera contralateral tras una artroplastia total de cadera?

Introduction: Coxarthrosis is one of the most frequent and disabling pathologies. 20% of individuals over 60 years of age will develop symptomatic coxarthrosis and 10% of them will need a hip replacement; it is probably one of the orthopaedic procedures that most increases quality of life. When we recommend arthroplasty in clinical practice, patients often ask about the prognosis of their other hip. Will it deteriorate in the same way? Will it be necessary to replace it? When? The aim of the study is to determine if there is any variable or radiological sign that predicts the medium-term prognosis of the contralateral hip after total hip arthroplasty. Material and methods: A retrospective review of patients who underwent total hip arthroplasty in our hospital during 2011 and 2012 was carried out, with a total of 543 patients. The coxarthrosis degree at X-ray was determined at the time of the first arthroplasty and at regular intervals during follow-up, according to the JOA and Tönnis classifications, analyzing each of the items included in these classifications. Its relation with the progression of osteoarthritis and the need of contralateral hip replacement was established. Results and conclusions: A progression of osteoarthritis of the contralateral hip could be expected in the next 3 years in 10% of patients. This progression will be greater and faster in those with JOA grade III–IV/Tönnis grade II–III, especially, in those with greater joint narrowing and femoral head shape score, and can reach between 25 and 30% of patients. The initial JOA/Tönnis degree is a predictive factor for requiring a hip replacement on the contralateral side.(AU)

Introducción: La coxartrosis es una de las patologías más frecuentes e incapacitantes. El 20% de los mayores de 60 años desarrollará coxartrosis sintomática y el 10% requerirá una prótesis total de cadera. La artroplastia total de cadera es uno de los procedimientos quirúrgicos que más aumenta la calidad de vida de estos pacientes. Cuando recomendamos la artroplastia en la práctica clínica, los pacientes a menudo preguntan sobre el pronóstico de su otra cadera: ¿Se deteriorará de la misma forma? ¿Será necesario operarla? ¿Cuándo? El objetivo es determinar si existe alguna variable o signo radiológico que prediga el pronóstico a medio plazo de la cadera contralateral tras una artroplastia total de cadera. Material y métodos: Se realizó un estudio retrospectivo de pacientes intervenidos de artroplastia total de cadera en nuestro hospital durante los años 2011 y 2012, con un total de 543 pacientes. Se determinó el grado de coxartrosis, según las clasificaciones JOA y Tönnis, en la radiografía de ambas caderas en el momento de la primera artroplastia y a intervalos regulares durante el seguimiento, analizando cada uno de los ítems incluidos en estas clasificaciones. Se estableció la relación de estos hallazgos radiográficos con la progresión de la artrosis y la necesidad de artroplastia contralateral. Resultados y conclusiones: Podría esperarse una progresión de la artrosis de la cadera contralateral en los próximos 3 años en el 10% de los pacientes. Esta progresión será mayor y más rápida en aquellos con grado JOA III-IV/Tönnis II-III y, especialmente, en aquellos con mayor estrechamiento articular y mayor alteración de la cabeza femoral, pudiendo alcanzar entre el 25 y el 30% de los pacientes. El grado de JOA/Tönnis inicial es un factor predictor de necesitar una prótesis de cadera contralateral.

Prognosis of the contralateral hip after primary total hip replacement: Can it be predicted? / ¿Se puede predecir el pronóstico de la cadera contralateral tras una artroplastia total de cadera?

INTRODUCTION: Coxarthrosis is one of the most frequent and disabling pathologies. 20% of individuals over 60 years of age will develop symptomatic coxarthrosis and 10% of them will need a hip replacement; it is probably one of the orthopaedic procedures that most increases quality of life. When we recommend arthroplasty in clinical practice, patients often ask about the prognosis of their other hip. Will it deteriorate in the same way? Will it be necessary to replace it? When? The aim of the study is to determine if there is any variable or radiological sign that predicts the medium-term prognosis of the contralateral hip after total hip arthroplasty. MATERIAL AND METHODS: A retrospective review of patients who underwent total hip arthroplasty in our hospital during 2011 and 2012 was carried out, with a total of 543 patients. The coxarthrosis degree at X-ray was determined at the time of the first arthroplasty and at regular intervals during follow-up, according to the JOA and Tönnis classifications, analyzing each of the items included in these classifications. Its relation with the progression of osteoarthritis and the need of contralateral hip replacement was established. RESULTS AND CONCLUSIONS: A progression of osteoarthritis of the contralateral hip could be expected in the next 3 years in 10% of patients. This progression will be greater and faster in those with JOA grade III-IV/Tönnis grade II-III, especially, in those with greater joint narrowing and femoral head shape score, and can reach between 25 and 30% of patients. The initial JOA/Tönnis degree is a predictive factor for requiring a hip replacement on the contralateral side.

[Translated article] Prognosis of the contralateral hip after primary total hip replacement: Can it be predicted?

INTRODUCTION: Coxarthrosis is one of the most frequent and disabling pathologies. 20% of individuals over 60 years of age will develop symptomatic coxarthrosis and 10% of them will need a hip replacement; it is probably one of the orthopaedic procedures that most increases quality of life. When we recommend arthroplasty in clinical practice, patients often ask about the prognosis of their other hip. Will it deteriorate in the same way? Will it be necessary to replace it? When? The aim of the study is to determine if there is any variable or radiological sign that predicts the medium-term prognosis of the contralateral hip after total hip arthroplasty. MATERIAL AND METHODS: A retrospective review of patients who underwent total hip arthroplasty in our hospital during 2011 and 2012 was carried out, with a total of 543 patients. The coxarthrosis degree at X-ray was determined at the time of the first arthroplasty and at regular intervals during follow-up, according to the JOA and Tönnis classifications, analyzing each of the items included in these classifications. Its relation with the progression of osteoarthritis and the need of contralateral hip replacement was established. RESULTS AND CONCLUSIONS: A progression of osteoarthritis of the contralateral hip could be expected in the next 3 years in 10% of patients. This progression will be greater and faster in those with JOA grade III-IV/Tönnis grade II-III, especially, in those with greater joint narrowing and femoral head shape score, and can reach between 25 and 30% of patients. The initial JOA/Tönnis degree is a predictive factor for requiring a hip replacement on the contralateral side.

Alineación frontal en la artroplastia total de rodilla. Estudio comparativo entre medición radiográfica y con navegación quirúrgica / Frontal alignment in total knee arthroplasty. Comparative study between radiographic measurement and surgical navigation

Objetivo. Conocer la concordancia entre el ángulo del eje mecánico femorotibial medido en radiografías y en navegación quirúrgica, tanto en el pre como en el postoperatorio al implantar una artroplastia total de rodilla. Material y método. Se analizaron las mediciones pre y postoperatorias en 88 artroplastias totales del mismo modelo y realizadas todas con el mismo sistema de navegación quirúrgica. Se valoró el ángulo frontal mecánico (AMFFT) y anatómico femorotibial pre y posquirúrgico. Para ello se utilizó una telerradiografía en bipedestación, donde se midió el ángulo mediante técnicas digitalizadas. En la navegación se recogió el ángulo femorotibial en reposo y en varo-valgo forzado, hallándose la media de estos 3 valores. Resultados. La media del AMFFT preoperatorio medido en la radiografía fue 4,55°. La media del mismo ángulo medido en la radiografía postoperatoria fue de 1,72°, con diferencias estadísticamente significativas. La media del AMFFT medido con la navegación antes de iniciar la técnica quirúrgica fue de 3,12° y tras el implante con navegación fue de 0,53°, también con diferencias estadísticamente significativas (p=0,013). El coeficiente de concordancia entre el AMFFT preoperatorio en telerradiografía y en navegación fue de 0,869 (p<0,001) y en el postoperatorio de 0,709 (p=0,017). Conclusiones. Hemos encontrado una fuerte concordancia en el AMFFT entre la medición con radiografías y con navegación quirúrgica. Ello puede suponer que no es necesaria la realización de una telerradiografía cuando se utiliza navegación en el implante de una artroplastia total de rodilla (AU)

Objective. To establish the concordance between angulation of the femoro-tibial mechanical axis measured with x-rays and surgical navigation in both the pre and postoperative period after a total knee arthroplasty (TKA) was implanted. Material and method. Pre and postoperative measurements were analyzed in 88 TKA of the same model and all performed with the same surgical navigation system. The mechanical frontal angle (MFA) and femoro-tibial anatomic angle were measured before and after the TKA. The angulation was digitally measured with a teleradiography. In the navigation, the femoro-tibial angle at rest, forced varus and valgus were registered and the average of these three measurements was calculated. Results. The mean preoperative MFA measured on the radiograph was 4.55°. The mean of the same angle measured on the postoperative radiograph was 1.72°, (p=0.05). The mean of the MFA measured with navigation before TKA was 3.12° and after the implant with navigation was 0.53 (P=.013). The concordance coefficient between the MFA in teleradiography and in navigation was 0.869 (P<.001) preoperatively and 0.709 postoperatively (P=.017). Conclusions. We found a strong concordance between radiographic and surgical navigation measurements of the MFA. This may imply that teleradiography is not necessary when using surgical navigation in TKA (AU)

Frontal alignment in total knee arthroplasty. Comparative study between radiographic measurement and surgical navigation. / Alineación frontal en la artroplastia total de rodilla. Estudio comparativo entre medición radiográfica y con navegación quirúrgica.

OBJECTIVE: To establish the concordance between angulation of the femoro-tibial mechanical axis measured with x-rays and surgical navigation in both the pre and postoperative period after a total knee arthroplasty (TKA) was implanted. MATERIAL AND METHOD: Pre and postoperative measurements were analyzed in 88 TKA of the same model and all performed with the same surgical navigation system. The mechanical frontal angle (MFA) and femoro-tibial anatomic angle were measured before and after the TKA. The angulation was digitally measured with a teleradiography. In the navigation, the femoro-tibial angle at rest, forced varus and valgus were registered and the average of these three measurements was calculated. RESULTS: The mean preoperative MFA measured on the radiograph was 4.55°. The mean of the same angle measured on the postoperative radiograph was 1.72°, (p=0.05). The mean of the MFA measured with navigation before TKA was 3.12° and after the implant with navigation was 0.53 (P=.013). The concordance coefficient between the MFA in teleradiography and in navigation was 0.869 (P<.001) preoperatively and 0.709 postoperatively (P=.017). CONCLUSIONS: We found a strong concordance between radiographic and surgical navigation measurements of the MFA. This may imply that teleradiography is not necessary when using surgical navigation in TKA.

Computer-assisted navigation in total knee arthroplasty without femoral hardware removal.

PURPOSE OF THE STUDY: The use of navigation applied to total knee arthroplasty in knees with femoral hardware retained has not been studied. MATERIAL AND METHODS: We use navigation in six patients to implant a total knee arthroplasty while retaining the femoral hardware. The retained materials were screws in two cases, diaphyseal plates in another two, intramedullary nails in one and supracondylar tube/plate in another one. Preoperative knee scores were within the 46-66 range, whereas the functional scores were within 40-68. The coronal deformity varied between 30° varus and 5° valgus. RESULTS: The final femoral mechanical axis was between 2° valgus and 3° varus; the axis of the limb was between 4° valgus and 3° varus. Knee scores improved in all cases, with scores between 75 and 90 points (p = 0.028); functional scores were between 64 and 90 points (p = 0.043).The final range of mobility was within the 70°-110° range, with a slight improvement over the preoperative status (p = 0.042). No complications have arisen throughout the follow-up (mean 16 months). CONCLUSIONS: The use of navigation constitutes a good option in the treatment with total arthroplasties for patients with femoral hardware retained.

Distribución de la osteólisis periprotésica en la cadera. Estudio con resonancia magnética / Distribution of periprosthetic osteolysis in the hip: A study using magnetic resonance

Introducción. Con resonancia magnética es posible evaluar las lesiones óseas y de partes blandas secundarias a la producción de partículas de desgaste. Nuestro objetivo ha sido estudiar con este método la distribución de las lesiones en pacientes con un mismo tipo de componente acetabular no cementado. Material y método. Se incluyeron 40 artroplastias de cadera no cementadas con un cotilo poroso revestido de hidroxiapatita y multiperforado para anclaje opcional de tornillos con una evolución media de 13 años. Mediante estudios de imagen con resonancia magnética utilizando secuencias especiales de pulsos para disminuir los artefactos metálicos, se estudió la presencia, extensión y continuidad de la lesión granulomatosa y de las zonas de osteólisis. Resultados. Una cadera no fue susceptible de análisis. Se detectó lesión granulomatosa aislada en tres caderas y asociada a osteólisis en 32, sólo en pelvis en 10, sólo en el fémur en tres y en ambos segmentos en 19. En la pelvis la afectación fue, por zonas: ilion supra-acetabular en 15 caderas, rama isquio-pubiana en 24, isquion en 12 e isquion retro-acetabular en 21. Solo dos caderas y dos tornillos presentaban lesiones centrales aisladas del resto del granuloma. Comentarios y conclusiones. Con resonancia magnética ha sido posible estudiar las lesiones óseas y de partes blandas secundarias a desgaste. La distribución de las zonas de osteólisis ha seguido un patrón periférico propio de cotilos no perforados, destacando la existencia de escasas lesiones aisladas sobre los orificios o alrededor de los tornillos implantados coexistiendo con frecuencia afectación femoral proximal (AU)

Introduction. Magnetic resonance imaging (MRI) is useful in assessing bone and soft tissue lesions due to the production of wear particles. Our objective was to study the distribution of lesions in patients with one type of cementless acetabular component with this technique. Material and methods. We included 40 total hip arthroplasty with press-fitted hydroxyapatite porous-coated cup and multiple optional screw holes performed over a mean of 13years. We studied the presence, extent and continuity of the granulomatous lesion and osteolysis with MRI using special pulse sequences to reduce metal artefacts. Results. One hip was not amenable to analysis. An isolated granulomatous lesion was found in 3 hips, associated osteolysis in 32, in the pelvis only in 10, in the femur only in 3 and in both segments in 19. By zones, the pelvis involvement was supra-acetabular ilium in 15, ischium-pubic branch in 24, ischium in 12 and retro-acetabular ischium in 21. Only two hips and two screws central lesions were isolated from the granulomatous mass. Comments and conclusions. MRI osteolysis and soft tissue lesions secondary to wear to be studied. The distribution of osteolytic areas show a peripheral pattern typical of non-perforated acetabular cups frequently coexisting with proximal femoral involvement, highlighting few isolated lesions in the holes or around the implanted screws (AU)

Rotación del componente femoral en las artroplastias de rodilla. Utilidad de la cirugía asistida con ordenador / Rotation of the femoral component in the knee arthroplasties. Usefulness of computer assisted surgery

Objetivo: Conocer si las referencias anatómicas adquiridas con los sistemas de navegación quirúrgica en las artroplastias de rodilla facilitan una mejor colocación del componente femoral en la rotación adecuada y comprobar si la toma de referencias por parte de los cirujanos es coincidente con el verdadero eje transversal de la metáfisis distal femoral hallado mediante tomografía computada. Material y método: Estudio observacional descriptivo de corte transversal. Se han estudiado 19 artroplastias de rodilla. En 7 casos se utilizó la instrumentación estándar y en 12 un sistema inalámbrico de navegación quirúrgica. A los pacientes se les realizó una tomografía computada en el pre y postoperatorio para hallar la posición rotacional del implante en relación con el eje transepicondileo. Resultados: No se encontraron diferencias estadísticamente significativas en la rotación final atendiendo a la utilización del navegador. Tampoco se encontraron diferencias entre los grupos al estudiar las diferencias en el cambio de rotación entre tomografías pre y postoperatorias. Conclusiones: La localización de los epicóndilos, gesto que forma parte de la técnica de navegación, parece reproduccible y permiten implantar la artroplastia femoral en buena posición. No obstante este sistema no mejora la colocación del componente femoral en el plano transversal en relación con la técnica convencional (AU)

Objetive: To know if the anatomic references acquired with the technique of surgical navigation in knee arthroplasty get a better placement of the femoral component in the adequate rotation and checking if the location of references by the surgeons is coincident with the distal femoral metaphysis transversal axis in computer tomography. Material and method: Observational study cross-section descriptive. We studied 19 knee arthroplasties. In 7 cases was used the mechanical standard instrumentation and in 12 a wireless system of surgical navigation. A tomography computed was accomplished during the preop and postoperative time to find the rotational position of the implant in relation to the transepicondylar axis. Results: No statistically differences were found in the final rotation depending on the navigation use. When differences n the change of angulations were analyzed between pre and postoperative tomography neither differences were found. Conclusions: In navigation the location of femoral epicondyles is necessary and probably easy to reproduce and makes easier the implantation of the prosthesis in a good position. However the navigation does not improve the placement of the femoral component in the transversal axis when is compared with the conventional technique (AU)

Anillos de reconstrucción en la cirugía de revisión de las artroplastias de cadera / Acetabular rings in revision total hip replacement

Objetivo. Evaluar los resultados radiográficos de los anillos de reconstrucción utilizados en la cirugía de revisión de grandes defectos acetabulares. Material y método. Se ha estudiado la evolución radiológica de 13 anillos de reconstrucción utilizados en grados 3 y 4, con un seguimiento mínimo de 25 meses y máximo de 60 (media de seguimiento: 37 meses). En todos los casos se utilizaron aloinjertos debajo del anillo y cúpula cementada. Las mediciones radiológicas usadas tomaban como referencia la posición, altura y profundidad del anillo, así como la evolución del centro de la cabeza protésica. También se registró la presencia de complicaciones y la recuperación de la dismetría de extremidades. Resultados. Se presentaron tres complicaciones, una lesión vascular intraoperatoria, una luxación posterior y una infección superficial. El descenso medio del centro de rotación fue de 4 cm. En ningún caso fue necesario reintervenir a los pacientes. La dismetría de extremidades disminuyó de 6,3 cm en el preoperatorio a 3,1 cm en el postoperatorio inmediato. Después no se encontraron modificaciones en las mediciones radiográficas. Conclusiones. La utilización de un anillo de reconstrucción en la cirugía de revisión acetabular permite descender el centro de rotación de la cadera y recuperar precozmente la estructura y depósito óseo sin complicaciones graves (AU)

Purpose. To assess the radiographic results of reconstruction rings used in surgical procedures conducted to revise large acetabular defects. Materials and methods. A study was carried out to analyze the radiological evolution of 13 acetabular rings used in grade 3 and 4 patients, with a follow-up between 25 and 60 months (mean: 37 months). In all cases, allografts were placed underneath the ring and the cemented cup. The radiological measurements taken used as their landmarks the position, height and depth of the ring as well as the evolution of the center of the prosthetic head. The appearance of complications was also recorded, as was the restoration of limb dysmetry. Results. There were three complications, an intraoperative vascular lesion, a posterior dislocation as well as a superficial infection. The average downward migration of the center of rotation was 4 cm. In no case was it necessary to reoperate. Limb dysmetry went down from a preop value of 6.3 cm to 3.1 at the immediate postop. Alter this, no changes were found in the radiographical measurements. Conclusions. The use of an acetabular ring in revision THR enables the bringing down of the hip's center of rotation as well as an early restoration of both the structure of the area an the bone stock without any serious complications (AU)

Osteointegración de los vástagos no cementados en las artroplastias de cadera. ¿Son necesarias las revisiones clínicas anuales? / Osteointegration of uncemented stems in hip arthroplasty. Is annual clinical follow-up necessary?

Objetivo. Conocer los resultados de un vástago no cementado de cadera con exclusivo apoyo metafisario y un seguimiento mínimo de 5 años. Material y método. Estudio prospectivo de 338 vástagos del modelo Bihapro® implantados entre los años 1993 y 1998 para evaluar los cambios radiográficos durante este período. El vástago utilizado es anatómico con dos zonas, una metafisaria de superficie porosa e hidroxiapatita y otra distal lisa y afilada para evitar el contacto con el hueso cortical. Se estudiaron los criterios radiográficos de osteointegración a los 6 y 60 meses de la cirugía. Resultados. La serie final está formada por 316 vástagos. Los puentes óseos o puntos de soldadura fueron visibles en el 77,2% a los 6 meses y en el 83,9% a los 5 años. Las líneas radiotransparentes se detectaron en el 5,1% a los 6 meses y en el 4,7% a los 60 meses de seguimiento. La atrofia del calcar era evidente en el 18% a los 6 meses y en el 25% a los 60 meses. Las diferencias fueron estadísticamente significativas. Conclusiones. Los vástagos femorales no cementados de las artroplastias de cadera con apoyo metafisario y recubrimiento poroso e hidroxiapatita muestran signos radiográficos de integración ósea a los 6 meses que aumentan a los 60 meses, por lo que en los pacientes asintomáticos no es necesario realizar controles radiográficos anuales

Aim. To examine the outcome of uncemented hip stems with metaphyseal support alone and a minimum follow-up of 5 years. Materials and methods. Prospective study of 338 BiHAPro™ stems implanted between 1993 and 1998 to evaluate radiographic changes in this period. The stem is anatomically shaped with two sections: a metaphyseal section with a porous surface and hydroxyapatite coating and a tapered polished distal section designed to prevent cortical contact. Radiographic criteria were assessed at 6 and 60 months of surgery. Results. The final series consisted of 316 stems. Bone bridges or fusion points were visible in 77.2% at 6 months and in 83.9% at 5 years. Radiolucent lines were seen in 5.1% at 6 months and in 47% at 60 months of follow-up. Calcar atrophy was evident in 18% at 6 months and in 25% at 60 months. Differences were statistically significant. Conclusions: Uncemented femoral stems with metaphyseal support and a porous surface and hydroxyapatite coating show radiographic signs of osteointegration at 6 months that increase at 60 months, so it is not necessary to make annual radiographic revisions in asymptomatic patients

Reverse oblique intertrochanteric femoral fractures treated with the gamma nail.

We studied 47 reverse oblique intertrochanteric femoral fractures that were treated with gamma nails between 1992 and 2000. Fracture reduction was satisfactory in 38 patients (81%), the hip screw position was correct in 42 (89%) and there were no peri-operative complications. However, in three patients the nail displaced, resulting in non-union in one and protrusion into the acetabulum in another. A logistical regression analysis of our series showed that an incorrect position of the hip screw in the femoral head was the only predictor for complications. Thus, we consider that the gamma nail is a good option for the treatment of these complex fractures.

Extensively hydroxyapatite-coated stems in revision hip arthroplasty: A radiological mid-term follow-up study.

Femoral revision surgery involves the placement of a stable stem and the regeneration of the damaged bone structure. We retrospectively reviewed 36 cases of femoral revision surgery in which an extensively hydroxyapatite-coated porous stem was implanted with a five-year minimum follow-up. Nine of the cases had type I defects, 12 had type II defects, six had III-A defects and nine had III-B defects. The mean follow-up was 7.7 years (range 5-11). No cases of revision surgery, subsidence or displacement were detected. In 35 cases the integration of the stem had been achieved, the bone structure had been restored and there was no fibrous interface visible between the implant and the bone. The fully hydroxyapatite-coated stems thus proved a valuable alternative for femoral revision surgery in mild and moderate bone defects. (Hip International 2005; 15: 38-45).

Drenaje linfático manual en el linfedema facial / Manual lymph drainage in facial lymphedema

Presentamos la evolución de una paciente de 19 años de edad con un adenoma pleomorfo de parótida que tras varios tratamientos, incluyendo vaciamiento ganglionar cervical y radioterapia, desarrolló linfedema facial. Debido a la repercusión de tipo emocional que originó en la paciente, se planificó tratamiento físico rehabilitador con drenaje linfático manual con el que mejoró tanto subjetiva como objetivamente (AU)

La estimulación electromagnética en los fracasos de la consolidación. Factores pronósticos / Electromagnetic stimulation in consolidation failure. Prognostic factors

Objetivos: A pesar de que la estimulación con campos electromagnéticos pulsátiles es una técnica suficientemente acreditada en la bibliografía como tratamiento de los fracasos de la consolidación ósea, existen controversias en cuanto a sus indicaciones, tiempo necesario de estimulación y factores pronósticos.Pacientes: Se ha realizado un estudio retrospectivo de 137 casos de fracasos de la consolidación, tratados con un mismo tipo de corriente electromagnética. Los objetivos del estudio han sido conocer el porcentaje de consolidación obtenido, la influencia de determinados factores en los resultados y diseñar una tabla de puntuaciones pronóstica. La duración media de la estimulación fue de 3,6 meses.Resultados: En el 74,5 por ciento de los casos se consiguió la consolidación. No se encontraron diferencias estadísticas en los resultados atendiendo al sexo de los pacientes, al trazo de la fractura original ni a su localización, aunque la tibia ofreció el mayor porcentaje de consolidación que alcanzó el 85 por ciento. Por el contrario aparecieron diferencias estadísticamente significativas en los resultados atendiendo a la edad de los pacientes, siendo 43,6 años la edad media de los éxitos y 37,4 la de los fracasos (p = 0,048); la separación de los fragmentos, mayor o menor de 5 mm (p < 0,001), el tipo radiográfico de fracaso (atrófico o hipertrófico), el tratamiento previo ortopédico o quirúrgico (p = 0,02), la presencia de infección (p = 0,01) y la demora mayor o menor de 9 meses en el comienzo de la estimulación (p = 0,007) (AU)

Loosening of threaded acetabular cups in arthroplasty of the hip. The association with different types of coxarthrosis.

Seventy-nine patients underwent hip arthroplasty using a threaded acetabular cup during 1988 and 1989. Out of 71 cups implanted for coxarthrosis, radiographs of 62 have been reviewed at a mean follow up of 69 months. The survival rate at 5.5 years was 77.5%. The mean age at operation was 61 years. Loosening of the cup occurred in 7 cases with pain on walking; 5 had a revision operation. In another 28 patients, radiolucent lines greater than 1 mm were found around the cup and 7 of these were unstable. The previous coxarthrosis was classified as atrophic with 5 loose cups, normotrophic with 2 loose cups and hypertrophic with no loosening. This difference between loosening in the atrophic and hypertrophic types of preexisting coxarthrosis was statistically significant. Radiolucent lines were present in 61% of the atrophic cases, 53.4% of the normotrophic and 25% of the hypertrophic, which was also significant. If the cases of loosening are added to those with radiolucent lines, the types of coxarthrosis show highly significant differences. Threaded cups had a high percentage of failure which was greater in cases with atrophic coxarthrosis.