[Translated article] Results of cementless total knee arthroplasty in patients over 70 years of age.

OBJECTIVE: To analyse the clinical and radiologic results, the survival and complications obtained in 70 year or older patients who underwent cementless total knee arthroplasty (TKA). MATERIAL AND METHOD: An observational study of patients operated between January 2014 and December 2016 was carried out according to the Natural Knee model (Zimmer®, USA). The main variables were the Oxford Knee Score, the visual analogue scale, the presence of radiolucencies, complications, survival and reasons for revision. RESULTS: Of 104 TKA, 86 were available for revision. The median age was 76 years. The mean follow-up was 5.4 years (range 3.7-6.9). The Oxford Knee Score punctuation showed a median of 17 presurgical (range 0-40) and 37 post surgical (range 5-48), P<.001. The 87.2% of the patients obtained a clinically significant improvement. The median visual analogue scale punctuation was 8 for presurgical (range 4-10) and 2 for post surgical (range 1-9), P<.001. The 88.3% of the patients obtained a clinically significant decrease. Three months after the surgery, the 55.81% of the TKAs presented radiolucencies around the tibial plateau. At the end of the follow-up, radiolucencies were present in 30.23% of the TKAs. Survival from all causes was 91.86% at 77.2 months and 96.5% due to aseptic loosening. CONCLUSION: Cementless knee prostheses are a valid option in patients aged 70 or older, presenting good clinical, radiological and survival results.

Results of cementless total knee arthroplasty in patients over 70 years of age. / Resultados de la artroplastia total de rodilla no cementada en pacientes mayores de 70 años.

OBJECTIVE: To analyze the clinical and radiologic results, the survival and complications obtained in 70 year or older patients who underwent cementless total knee arthroplasty (TKA). MATERIAL AND METHOD: An observational study of patients operated between January 2014 and December 2016 was carried out according to the Natural Knee model (Zimmer®, USA). The main variables were the Oxford Knee Score, the visual analog scale, the presence of radiolucencies, complications, survival and reasons for revision. RESULTS: Of 104 TKA, 86 were available for revision. The median age was 76 years. The mean follow-up was 5.4 years (range 3.7-6.9). The Oxford Knee Score punctuation showed a median of 17 presurgical (range 0-40) and 37 post surgical (range 5-48), P<.001. The 87.2% of the patients obtained a clinically significant improvement. The median visual analog scale punctuation was 8 for presurgical (range 4-10) and 2 for post surgical (range 1-9), P<.001. The 88.3% of the patients obtained a clinically significant decrease. Three months after the surgery, the 55.81% of the TKAs presented radiolucencies around the tibial plateau. At the end of the follow-up, radiolucencies were present in 30.23% of the TKAs. Survival from all causes was 91.86% at 77.2 months and 96.5% due to aseptic loosening. CONCLUSION: Cementless knee prostheses are a valid option in patients aged 70 or older, presenting good clinical, radiological and survival results.

Mortality as a competition risk factor in the survival analysis of the results of the type of fixation of the total hip prosthesis in octogenarian patients. / Mortalidad como factor de riesgo de competencia en el análisis de supervivencia de los resultados del tipo de fijación de la prótesis total de cadera en pacientes octogenarios.

INTRODUCTION: Total hip replacement (THR) is challenging in octogenarians due to associated comorbidities and controversy regarding fixation type. We ask whether cemented THR is superior to uncemented THR in patients above the age of 80 years. MATERIAL AND METHODS: A total of 382 patients (441 hips) aged 80 years or older who underwent THR between 2004 and 2015 were analysed. A cemented THR was implanted in 196 hips (group 1), an uncemented THR with a grit-blasted stem in 121 (group 2), or with a porous-coated stem in 124 (group 3). Patients in group 1 had a higher mean age, more comorbidities and osteoporotic bone. Survival analysis was calculated using cumulative incidence function to account for the competing risk of death. RESULTS: Medical complications rate was similar. There were 3post-operative fractures: one in group 2 and 2in group 3. Competing risk analysis showed that the cumulative incidence of revision for any cause was 2.3 in group 1, 6.0 in group 2 and 4.1 in group 3 at 10years, and the cumulative incidence of revision for aseptic loosening was 1.2 in group 1, 3.7 in group 2 and 0 in group 3 at the same period. CONCLUSIONS: THR presents an acceptable number of adverse events for octogenarian patients. Despite uncemented fixation was satisfactory, the higher peri-prosthetic fracture rate worsens results in this group.

Resultados de la artroplastia total de rodilla no cementada en pacientes mayores de 70 años / Results of cementless total knee arthroplasty in patients over 70 years of age

Objetivo: Analizar los resultados clínicos, radiológicos, la supervivencia y las complicaciones obtenidos en pacientes de 70 años o más intervenidos mediante artroplastia total de rodilla (ATR) no cementada. Material y método: Se realizó un estudio observacional de pacientes intervenidos entre enero 2014-diciembre 2016 con el modelo Natural Knee (Zimmer®, Estados Unidos). Las variables principales fueron la puntuación de Oxford Knee Score y la de la escala visual analógica, la presencia de radiolucencias, complicaciones, supervivencia y motivo de revisión. Resultados: De 104 ATR, 86 estuvieron disponibles para su revisión. La mediana de edad fue de 76 años. El seguimiento medio fue de 5,4 años (rango 3,7-6,9). La puntuación del Oxford Knee Score presentó una mediana de 17 (rango 0-40) prequirúrgica y 37 (rango 5-48) posquirúrgica, p<0,001. El 87,2% de los pacientes obtuvo una mejoría clínicamente significativa. La mediana de la puntuación de la escala visual analógica fue 8 (rango 4-10) prequirúrgica y 2 (rango 1-9) posquirúrgica, p<0,001. El 88,3% de los pacientes obtuvo una disminución clínicamente significativa. Alrededor del platillo tibial, a los 3 meses de la cirugía, el 55,81% de las ATR presentaron radiolucencias, al final del seguimiento las radiolucencias estuvieron presentes en el 30,23% de las ATR. La supervivencia por todas las causas fue del 91,86% a los 77,2 meses y del 96,5% por aflojamiento aséptico. Conclusión: Las prótesis de rodilla no cementadas son una opción válida en pacientes de 70 o más años, presentando buenos resultados clínicos, radiológicos y de supervivencia.(AU)

Objective: To analyze the clinical and radiologic results, the survival and complications obtained in 70 year or older patients who underwent cementless total knee arthroplasty (TKA). Material and method: An observational study of patients operated between January 2014 and December 2016 was carried out according to the Natural Knee model (Zimmer®, USA). The main variables were the Oxford Knee Score, the visual analog scale, the presence of radiolucencies, complications, survival and reasons for revision. Results: Of 104 TKA, 86 were available for revision. The median age was 76 years. The mean follow-up was 5.4 years (range 3.7-6.9). The Oxford Knee Score punctuation showed a median of 17 presurgical (range 0-40) and 37 post surgical (range 5-48), P<.001. The 87.2% of the patients obtained a clinically significant improvement. The median visual analog scale punctuation was 8 for presurgical (range 4-10) and 2 for post surgical (range 1-9), P<.001. The 88.3% of the patients obtained a clinically significant decrease. Three months after the surgery, the 55.81% of the TKAs presented radiolucencies around the tibial plateau. At the end of the follow-up, radiolucencies were present in 30.23% of the TKAs. Survival from all causes was 91.86% at 77.2 months and 96.5% due to aseptic loosening. Conclusion: Cementless knee prostheses are a valid option in patients aged 70 or older, presenting good clinical, radiological and survival results.(AU)

[Translated article] Results of cementless total knee arthroplasty in patients over 70 years of age / Resultados de la artroplastia total de rodilla no cementada en pacientes mayores de 70 años

Objetivo: Analizar los resultados clínicos, radiológicos, la supervivencia y las complicaciones obtenidos en pacientes de 70 años o más intervenidos mediante artroplastia total de rodilla (ATR) no cementada. Material y método: Se realizó un estudio observacional de pacientes intervenidos entre enero 2014-diciembre 2016 con el modelo Natural Knee (Zimmer®, Estados Unidos). Las variables principales fueron la puntuación de Oxford Knee Score y la de la escala visual analógica, la presencia de radiolucencias, complicaciones, supervivencia y motivo de revisión. Resultados: De 104 ATR, 86 estuvieron disponibles para su revisión. La mediana de edad fue de 76 años. El seguimiento medio fue de 5,4 años (rango 3,7-6,9). La puntuación del Oxford Knee Score presentó una mediana de 17 (rango 0-40) prequirúrgica y 37 (rango 5-48) posquirúrgica, p<0,001. El 87,2% de los pacientes obtuvo una mejoría clínicamente significativa. La mediana de la puntuación de la escala visual analógica fue 8 (rango 4-10) prequirúrgica y 2 (rango 1-9) posquirúrgica, p<0,001. El 88,3% de los pacientes obtuvo una disminución clínicamente significativa. Alrededor del platillo tibial, a los 3 meses de la cirugía, el 55,81% de las ATR presentaron radiolucencias, al final del seguimiento las radiolucencias estuvieron presentes en el 30,23% de las ATR. La supervivencia por todas las causas fue del 91,86% a los 77,2 meses y del 96,5% por aflojamiento aséptico. Conclusión: Las prótesis de rodilla no cementadas son una opción válida en pacientes de 70 o más años, presentando buenos resultados clínicos, radiológicos y de supervivencia.(AU)

Objective: To analyze the clinical and radiologic results, the survival and complications obtained in 70 year or older patients who underwent cementless total knee arthroplasty (TKA). Material and method: An observational study of patients operated between January 2014 and December 2016 was carried out according to the Natural Knee model (Zimmer®, USA). The main variables were the Oxford Knee Score, the visual analog scale, the presence of radiolucencies, complications, survival and reasons for revision. Results: Of 104 TKA, 86 were available for revision. The median age was 76 years. The mean follow-up was 5.4 years (range 3.7-6.9). The Oxford Knee Score punctuation showed a median of 17 presurgical (range 0-40) and 37 post surgical (range 5-48), P<.001. The 87.2% of the patients obtained a clinically significant improvement. The median visual analog scale punctuation was 8 for presurgical (range 4-10) and 2 for post surgical (range 1-9), P<.001. The 88.3% of the patients obtained a clinically significant decrease. Three months after the surgery, the 55.81% of the TKAs presented radiolucencies around the tibial plateau. At the end of the follow-up, radiolucencies were present in 30.23% of the TKAs. Survival from all causes was 91.86% at 77.2 months and 96.5% due to aseptic loosening. Conclusion: Cementless knee prostheses are a valid option in patients aged 70 or older, presenting good clinical, radiological and survival results.(AU)

Revisión acetabular primaria: incidencia y mecanismos de utilización del injerto óseo / Primary Acetabular Revision: Incidence and Mechanisms of Bone Graft Use

Introducción: El recambio acetabular primario puede llegar a ser una intervención de gran complejidad en dependencia del defecto óseo existente. Las lesiones pueden ser segmentarias, cavitarias o combinadas. Este último patrón es el que se observa con mayor frecuencia en pérdidas óseas periprotésicas por aflojamiento aséptico. Objetivos: Mostrar la evolución de la cirugía de recambio en la artroplastia de cadera, y orientar al cirujano en la toma de decisiones de modo individualizado, para evitar las complicaciones. Método: Se realizó la investigación basada en el tema de estudio, mediante la revisión de libros de texto de la especialidad, artículos científicos publicados en diferentes bases de datos informáticas: Pubmed/MEDLINE, SciELO, BVS, Scopus, Ebsco, Google Scholar, Cochrane, así como otras consultas en bibliotecas médicas. Análisis de la información: Las prioridades en la planificación de la reconstrucción se establecen para proporcionar un implante estable, restaurar la masa ósea y optimizar la biomecánica de la cadera, aunque son los hallazgos intraoperatorios los que definitivamente indicarán el tipo de intervención a seguir. Las exigencias funcionales de los pacientes y las comorbilidades deben ser consideradas, así como el coste-efectividad de la reconstrucción planificada. Conclusiones: La artroplastia total de cadera ha demostrado mejorar significativamente la calidad de vida en pacientes, con una baja tasa de complicaciones. Para prevenir el aflojamiento aséptico es necesario ser cuidadosos en la técnica de colocación de los componentes protésicos y utilizar el tipo de material más adecuado a la edad, demanda funcional y reserva ósea de cada paciente(AU)

Introduction: Primary acetabular replacement can become a highly complex intervention depending on the existing bone defect. Lesions can be segmental, cavitary, or combined. This last pattern is the one most frequently observed in periprosthetic bone loss due to aseptic loosening. Objectives: To show the evolution of replacement surgery in hip arthroplasty, and to guide the surgeon in making individualized decisions, to avoid complications. Method: A research was carried out on the study topic, by reviewing specialty textbooks, scientific articles published in different databases such as Pubmed/ MEDLINE, SciELO, BVS, Scopus, Ebsco, Google Scholar, Cochrane, as well as other inquiries in medical libraries. Information analysis: Reconstruction planning priorities are established to provide a stable implant, restore bone mass, and optimize hip biomechanics, although it is the intraoperative findings that will definitely indicate the type of intervention to follow. The functional demands of the patients and the comorbidities must be considered, as well as the cost-effectiveness of the planned reconstruction. Conclusions: Total hip arthroplasty has been shown to significantly improve the quality of life in patients, with low rate of complications. To prevent aseptic loosening, it is necessary to be careful in the technique of placement of the prosthetic components and to use the type of material most appropriate to the age, functional demand and bone reserve of each patient(AU)

Historia y desarrollo de la artroplastía de cadera: una visión de sus aciertos, fallas y enseñanzas. (Segunda parte) / History and development of hip arthroplasty: a vision of its successes, failures and teachings. (Part two)

Resumen: Ésta es la segunda de dos partes de la Historia y Desarrollo de la Artroplastía de Cadera. En esta parte se hace una revisión histórica del desarrollo de la artroplastía contemporánea de la cadera, dando continuidad a la primera, donde se analizaron los cuatro primeros períodos. Esta quinta etapa corresponde a la revisión de su última etapa que comprende desde 1970 hasta el momento actual. También se hacen comentarios acerca de nuestras actitudes en el presente y la ruta que vislumbramos hacia el futuro.

Abstract: This is the second of two parts of the history and development of hip arthroplasty. In this part, a historical review of the development of contemporary hip alloarthroplasty is made. The purpose of this part is to give continuity to the first one where the first four periods were analyzed. This fifth part corresponds to the revision of its last stage that includes from 1970 to the present time. Comments are also made about our attitudes in the present and the route we envision towards the future.

[Cementless total hip arthroplasty after acute femoral neck fracture in active patients. Prospective matched study with a minimum follow-up of 5 years]. / Artroplastia total de cadera no cementada tras fractura cervical femoral aguda en pacientes activos. Estudio prospectivo emparejado con seguimiento mínimo de 5 años.

OBJECTIVES: To evaluate outcomes of cementless total hip replacement after acute femoral neck fracture in active patients. MATERIAL AND METHODS: A prospective matched study was conducted to compare the results between 76 patients with fractures and 76 patients with osteoarthritis. The Harris score, short-WOMAC and SF-12 were used for the clinical assessment. The mean follow-up was 7.3 years (range 5-11). RESULTS: There were no significant differences in medical or surgical complications between the 2 groups. Functional outcomes were similar, but more walking aids were used in fracture group. There were 6 revisions among the fractures group (one dislocation, 2 deep infections, 3 aseptic loosening), and 2 aseptic loosening among controls. There was no significant difference in arthroplasty survival at 10 years (88.7 vs. 96.1%, P=.15). The mortality rates at 2 and 10 years were similar. CONCLUSION: Cementless total hip replacement for treatment of acute femoral neck fracture showed similar results to those of elective surgery for osteoarthritis in these selected patients.