Anxiety is the cause of the worse outcomes of allergic patients after total knee arthroplasty.

PURPOSE: The presence of allergies has been proposed as a risk factor for worse outcomes in total knee arthroplasty surgery. The aim of this study is to evaluate if the presence of some psychiatric disorders is more frequent in patients who report allergies and if they could be the main cause for the worse outcomes. METHODS: A prospective study, including patients undergoing a primary total knee arthroplasty, was designed. In the preoperative visit, all the patients completed a questionnaire about the presence of allergies and also psychiatric tests for anxiety (State-Trait Anxiety Inventory-STAI-), depression (Remission from Depression Questionnaire-RDQ-), somatization disorder (Patient Health Questionnaire-15-PHQ-15-), pain catastrophizing syndrome (Pain Catastrophizing Scale-PCS), and personality disorder (Reduced NEO-Inventory of Five Factors-NEO-FFI-). In the preoperative and at 6 months of follow up, the functional results of the surgery were assessed by the WOMAC, the SF-12, and the KSS scores. RESULTS: A total of 209 patients was included: 136 (65%) did not have reported allergies and 73 (35%) did report some allergies. The psychiatric questionnaires showed that the presence of anxiety was more prevalent in the group of patients with reported allergies (STAI-T: no allergies 24.08 points vs. allergies 19.18 points, p = 0.039). When comparing the functional outcomes at 6 months of follow up, most of the analyzed scores improved less in the group of patients with reported allergies than in the no allergy-referred group: WOMAC-total score (34.37 vs. 40.10 points, p = 0.023), WOMAC-pain score (6.03 vs. 7.50 points, p = 0.018), WOMAC-function score (22.97 vs. 27.24 points, p = 0.023), KSS-knee score (25.37 vs. 33.79 points, p = 0.002), and SF-12 physical score (7.89 vs. 11.15 points, p = 0.046). The significance of the difference in the outcomes scores in this group was lost after adjusting for anxiety (p > 0.05). CONCLUSION: Allergies reported by patients are confirmed as a risk factor for worse results after TKA surgery. The relationship with anxiety disorder seems to explain the association between self-reported allergies and sub-optimal outcomes. LEVEL OF EVIDENCE: II.

Risk factors for infection of tibial plateau fractures. / Factores de riesgo de infección de fracturas de meseta tibial.

INTRODUCTION: Tibial plateau fractures are injuries prone to postoperative infection, with its reported incidence being higher than that of other fractures, between 5% and 12%. The primary objectives of this study were to quantify the postoperative infection rate of internal fixation of tibial plateau fractures (TPF) and to identify the risk factors for this. MATERIAL AND METHODS: Retrospective cohort study including patients who underwent TPF osteosynthesis between 2015 and 2020, in the same center. The study population was divided into two groups, according to the presence or absence of postoperative infection. Demographic variables related to the fracture, surgical parameters, as well as the need for reoperation were collected. Finally, in the case of debridement, the number of positive cultures and the pathogen responsible for the infection were collected, as well as the treatment applied. RESULTS: One hundred and twenty-four patients were included, with a total of 14 infections (global infection rate of 11.3%). Risk factors for developing infection were open fractures (P=.002), Schatzker V and VI type fractures (P=.002) and the use of external fixation (P<.001). Regarding the surgical variables, only the longest ischemia time (P=.032) was identified as a risk factor. S. aureus was the most frequently identified microorganism (43%), followed by E. cloacae (35.7%). CONCLUSION: The overall infection rate after osteosynthesis of tibial plateau fractures was 11.3%. Different factors are associated with a higher risk of infection, including diabetes mellitus, open fractures, the use of external fixation, a higher grade in the Schatzker classification or a longer intraoperative ischemia time.

[Translated article] Risk factors for infection of tibial plateau fractures.

INTRODUCTION: Tibial plateau fractures are injuries prone to postoperative infection, with its reported incidence being higher than that of other fractures, between 5% and 12%. The primary objectives of this study were to quantify the postoperative infection rate of internal fixation of tibial plateau fractures (TPFs) and to identify the risk factors for this. MATERIAL AND METHODS: Retrospective cohort study including patients who underwent TPF osteosynthesis between 2015 and 2020, in the same center. The study population was divided into two groups, according to the presence or absence of postoperative infection. Demographic variables related to the fracture, surgical parameters, as well as the need for reoperation were collected. Finally, in the case of debridement, the number of positive cultures and the pathogen responsible for the infection were collected, as well as the treatment applied. RESULTS: One hundred and twenty-four patients were included, with a total of 14 infections (global infection rate of 11.3%). Risk factors for developing infection were open fractures (p=.002), Schatzker V and VI type fractures (p=.002) and the use of external fixation (p<.001). Regarding the surgical variables, only the longest ischemia time (p=.032) was identified as a risk factor. Staphylococcus aureus was the most frequently identified microorganism (43%), followed by Enterobacter cloacae (35.7%). CONCLUSION: The overall infection rate after osteosynthesis of tibial plateau fractures was 11.3%. Different factors are associated with a higher risk of infection, including diabetes mellitus, open fractures, the use of external fixation, a higher grade in the Schatzker classification or a longer intraoperative ischemia time.

[Functional and quality of life results after a total knee replacement per year and five years of follow-up]. / Resultados funcionales y de calidad de vida tras una artroplastía total de rodilla al año y cinco años de seguimiento.

INTRODUCTION: Classically the results of any joint replacement surgery are evaluated at a minimum of 5 years. This period could be considered excessive to evaluate the functional results of this procedure. The objective of this study is to compare functional and quality of life results to 1 and five years of follow-up following a total knee replacement (TKR). MATERIAL AND METHODS: Prospective observational study. All patients visited one year after the implantation of TKR were included. All of these filled out the SF-36 questionnaire and the KSS valuation scale. Both were administered again at age five after surgery. RESULTS: 689 patients were initially included in the study (163 men [23.7%] and 526 women [76.3%]) with an average age of 72.2 years. At age 5,585 (84.9%) of these patients were re-analyzed. While the knee section of the KSS scale remained similar in these two periods, the function section of the KSS titration scale showed a slight worsening over time (p = 0.008). With respect to SF-36, the physical summation worsened at five years (p = 0.00) and the mental summation remained stable (n.s.) between the year and five years after surgery. DISCUSSION: Five years after a TKR, the physical exam does not vary from the year of surgery. However, the subjective evaluation measured by the function-KSS section and the physical SF-36, worsen slightly during this period. This could be due to aging patients.

INTRODUCCIÓN: Clásicamente los resultados de cualquier cirugía de reemplazo articular se evalúan en un mínimo de cinco años. Este período podría considerarse excesivo para evaluar los resultados funcionales de este procedimiento. El objetivo de este estudio es comparar los resultados funcionales y de calidad de vida a uno y cinco años de seguimiento tras una artroplastía total de rodilla (ATR). MATERIAL Y MÉTODOS: Estudio prospectivo observacional. Se incluyeron todos aquellos pacientes visitados un año después de la implantación de una ATR. Todos ellos rellenaron el cuestionario SF-36 y la escala de valoración KSS. Ambos fueron administrados nuevamente al cabo de cinco años de la cirugía. RESULTADOS: 689 pacientes fueron incluidos inicialmente en el estudio (163 hombres [23.7%] y 526 mujeres [76.3%]) con una edad media de 72.2 años. A los cinco años, 585 (84.9%) de estos pacientes fueron analizados de nuevo. Mientras que la sección rodilla de la escala KSS se mantenía similar en estos dos períodos, la sección función de la escala de valoración KSS mostraba un leve empeoramiento con el tiempo (p = 0.008). Con respecto al SF-36, el sumatorio físico empeoraba a los cinco años (p = 0.00) y el sumatorio mental se mantenía estable (n.s.) entre un año y cinco años tras la cirugía. DISCUSIÓN: Después de cinco años de una ATR, el examen físico no varía con respecto al año de la cirugía. Sin embargo, la evaluación subjetiva medida mediante la sección función-KSS y el SF-36 físico empeoran ligeramente durante este período. Esto podría ser debido al envejecimiento de los pacientes.

Factores de riesgo de infección de fracturas de meseta tibial / Risk factors for infection of tibial plateau fractures

Introducción: Las fracturas de meseta tibial (FMT) son lesiones propensas a infecciones postoperatorias, siendo la incidencia descrita superior a la del resto de fracturas, entre un 5 y un 12%. Los objetivos primarios de este estudio fueron cuantificar la tasa de infección postoperatoria de osteosíntesis de FMT e identificar los factores de riesgo de esta. Material y métodos: Estudio de cohorte retrospectiva incluyendo a pacientes intervenidos de osteosíntesis de FMT entre 2015 y 2020, en un mismo centro. La población del estudio se dividió en 2 grupos, según la presencia o no de infección postoperatoria. Se recogieron variables demográficas relacionadas con la fractura, parámetros quirúrgicos, así como necesidad de reintervención. Finalmente, en caso de desbridamiento, se recogieron número de cultivos positivos y patógeno responsable de infección, así como el tratamiento aplicado. Resultados: Se incluyeron un total de 124 pacientes, con un total de 14 infecciones (tasa global de infección de 11,3%). Se identificaron como factores de riesgo para desarrollar infección el hecho de tratarse de fracturas abiertas (p=0,002), fracturas tipo Schatzker V y VI (p=0,002) y el uso de fijador externo (p<0,001). En lo que respecta a las variables quirúrgicas solo se identificó el mayor tiempo de isquemia (p=0,032) como factor de riesgo. S. aureus fue el microorganismo más frecuentemente identificado (43%), seguido de E. cloacae (35,7%). Conclusión: La tasa global de infección tras osteosíntesis de fractura de meseta tibial fue del 11,3%. Diferentes factores se asocian a más riesgo de infección, entre ellos la diabetes mellitus, las fracturas abiertas, el uso de fijador externo, un mayor grado en la clasificación de Schatzker o un mayor tiempo de isquemia intraoperatoria.(AU)

Introduction: Tibial plateau fractures are injuries prone to postoperative infection, with its reported incidence being higher than that of other fractures, between 5% and 12%. The primary objectives of this study were to quantify the postoperative infection rate of internal fixation of tibial plateau fractures (TPF) and to identify the risk factors for this. Material and methods: Retrospective cohort study including patients who underwent TPF osteosynthesis between 2015 and 2020, in the same center. The study population was divided into two groups, according to the presence or absence of postoperative infection. Demographic variables related to the fracture, surgical parameters, as well as the need for reoperation were collected. Finally, in the case of debridement, the number of positive cultures and the pathogen responsible for the infection were collected, as well as the treatment applied. Results: One hundred and twenty-four patients were included, with a total of 14 infections (global infection rate of 11.3%). Risk factors for developing infection were open fractures (P=.002), Schatzker V and VI type fractures (P=.002) and the use of external fixation (P<.001). Regarding the surgical variables, only the longest ischemia time (P=.032) was identified as a risk factor. S. aureus was the most frequently identified microorganism (43%), followed by E. cloacae (35.7%). Conclusion: The overall infection rate after osteosynthesis of tibial plateau fractures was 11.3%. Different factors are associated with a higher risk of infection, including diabetes mellitus, open fractures, the use of external fixation, a higher grade in the Schatzker classification or a longer intraoperative ischemia time.(AU)

[Translated article] Risk factors for infection of tibial plateau fractures / Factores de riesgo de infección de fracturas de meseta tibial

Introducción: Las fracturas de meseta tibial (FMT) son lesiones propensas a infecciones postoperatorias, siendo la incidencia descrita superior a la del resto de fracturas, entre un 5 y un 12%. Los objetivos primarios de este estudio fueron cuantificar la tasa de infección postoperatoria de osteosíntesis de FMT e identificar los factores de riesgo de esta. Material y métodos: Estudio de cohorte retrospectiva incluyendo a pacientes intervenidos de osteosíntesis de FMT entre 2015 y 2020, en un mismo centro. La población del estudio se dividió en 2 grupos, según la presencia o no de infección postoperatoria. Se recogieron variables demográficas relacionadas con la fractura, parámetros quirúrgicos, así como necesidad de reintervención. Finalmente, en caso de desbridamiento, se recogieron número de cultivos positivos y patógeno responsable de infección, así como el tratamiento aplicado. Resultados: Se incluyeron un total de 124 pacientes, con un total de 14 infecciones (tasa global de infección de 11,3%). Se identificaron como factores de riesgo para desarrollar infección el hecho de tratarse de fracturas abiertas (p=0,002), fracturas tipo Schatzker V y VI (p=0,002) y el uso de fijador externo (p<0,001). En lo que respecta a las variables quirúrgicas solo se identificó el mayor tiempo de isquemia (p=0,032) como factor de riesgo. S. aureus fue el microorganismo más frecuentemente identificado (43%), seguido de E. cloacae (35,7%). Conclusión: La tasa global de infección tras osteosíntesis de fractura de meseta tibial fue del 11,3%. Diferentes factores se asocian a más riesgo de infección, entre ellos la diabetes mellitus, las fracturas abiertas, el uso de fijador externo, un mayor grado en la clasificación de Schatzker o un mayor tiempo de isquemia intraoperatoria.(AU)

Introduction: Tibial plateau fractures are injuries prone to postoperative infection, with its reported incidence being higher than that of other fractures, between 5% and 12%. The primary objectives of this study were to quantify the postoperative infection rate of internal fixation of tibial plateau fractures (TPF) and to identify the risk factors for this. Material and methods: Retrospective cohort study including patients who underwent TPF osteosynthesis between 2015 and 2020, in the same center. The study population was divided into two groups, according to the presence or absence of postoperative infection. Demographic variables related to the fracture, surgical parameters, as well as the need for reoperation were collected. Finally, in the case of debridement, the number of positive cultures and the pathogen responsible for the infection were collected, as well as the treatment applied. Results: One hundred and twenty-four patients were included, with a total of 14 infections (global infection rate of 11.3%). Risk factors for developing infection were open fractures (P=.002), Schatzker V and VI type fractures (P=.002) and the use of external fixation (P<.001). Regarding the surgical variables, only the longest ischemia time (P=.032) was identified as a risk factor. S. aureus was the most frequently identified microorganism (43%), followed by E. cloacae (35.7%). Conclusion: The overall infection rate after osteosynthesis of tibial plateau fractures was 11.3%. Different factors are associated with a higher risk of infection, including diabetes mellitus, open fractures, the use of external fixation, a higher grade in the Schatzker classification or a longer intraoperative ischemia time.(AU)

Pressure algometry is an excellent tool to measure knee pain relief after a closing-wedge high tibial osteotomy.

PURPOSE: The aim of this study was to assess the utility of pressure algometry (PA) to measure pain relief in the medial part of the knee after a closing-wedge high tibial osteotomy (CWHTO). METHODS: Prospective study including 44 CWHTO. Pain relief was evaluated with the visual analogue scale (VAS) and PA, a radiological study was done and a functional assessment was carried out with the KSS preoperatively, at 6-months and at 1-year after the surgery. PA was applied to the medial and lateral part of the knee and to the infra-clavicular fossa as a control point. RESULTS: The mechanical femorotibial angle was changed from 172.2° (SD2.2) to 180.6° (SD2.6) (p=0.00). KSS Knee improved from 53.4 (SD11.2) to 92.8 (SD7.3) (p=0.00), KSS Function from 69.4 (SD9.3) to 93.1 (SD8) (p=0.00). The VAS went from 6.84 (SD1.5) to 2.5 (SD2.1) (p=0.00) at the 1-year follow-up. The pressure pain threshold (PPT), measured with PA in the medial part of the knee also improved from 348.8kPa (SD159.3) to 447.1kPa (SD218.8) (p=0.01). However, the PPT in the lateral part of the knee and in the sub-clavicular fossa remained the same from the preoperative period to 6-months and 1-year, postoperatively. Neither were there any differences between the 6-month and 1-year postoperative values in terms of the different functional, radiological and pain relief obtained. CONCLUSION: The pain relief obtained after a CWHTO in the medial part of the knee can be measured by using PA. Furthermore, the functional and pain improvement obtained at 1-year follow-up is no better than those obtained at 6-months postoperatively.

Pressure algometry is a useful tool to quantify pain in the medial part of the knee: an intra- and inter-reliability study in healthy subjects.

PURPOSE: Pain quantification is essential for diagnostic and pain monitoring purposes in disorders around the knee. Pressure algometry is a method described to determine pressure pain threshold (PPT) by applying controlled pressure to a given body point. The purpose of this study was to determine the reliability of this method when it was applied to the medial part of the proximal tibia metaphysis and to evaluate the PPT levels between genders. METHODS: Fifty healthy (mean age; 46.9) volunteers were recruited, 25 men and 25 women. Pressure algometry was applied to a 1 cm(2)-probe area on the medial part of the knee by 2 raters. Intra- and interclass correlation (ICC) was obtained and differences between genders were evaluated. Bland-Altman plots were performed to evaluate the variability of the measures. RESULTS: The mean values of PPT obtained by rater 1 and 2 were 497.5 Kpa and 489 Kpa respectively. The intrarater reliability values (95% IC) for rater 1 and 2 were 0.97 (0.95-0.98) and 0.84 (0.73-0.90) respectively. With regard to interrater reliability, the ICC (95% IC) for the first measurement was 0.92 (0.87-0.95) and 0.86 (0.78-0.92) for the second one. Women showed significant lower values of PPT than men. The Bland-Altmand plots showed excellent agreement. CONCLUSIONS: Pressure algometry has excellent reliability when it is applied to the medial part of the proximal metaphysis of the tibia. Women have lower values of PTT than men. The high reliability of the PA in an individual volunteer makes it a more valuable tool for longitudinal assessment of a given patient than for comparison between them. LEVEL OF EVIDENCE: Level III. Prospective study.