ABSTRACT
Resumen: Antecedentes: La luxación tras la artroplastía de rodilla es una complicación poco frecuente y de difícil manejo. Una brecha en flexión demasiado grande asociada a una laxitud de los ligamentos colaterales puede llevar a la inestabilidad y a la luxación en flexión. Material y métodos: Informamos del caso de un paciente que tuvo una luxación posterior de su prótesis de rodilla posteroestabilizada sin antecedente traumático. La inestabilidad franca al forzar el varo en flexión y un cajón anterior positivo que aumentaba en rotación interna condujeron a la revisión quirúrgica sin plantear un tratamiento conservador. Resultados: Se implantó una prótesis condilar constreñida tras lo cual sufrió un nuevo episodio de las mismas características un mes después, que puso de manifiesto que el nivel de constricción no fue suficiente para la inestabilidad severa en flexión asimétrica por insuficiencia de las estructuras externas. Luego de implantarle una prótesis tipo bisagra rotatoria, no ha tenido nuevos episodios de inestabilidad. Conclusiones: A través de un repaso exhaustivo de la bibliografía, se describen los posibles factores que pueden conducir a la inestabilidad tibiofemoral tras la artroplastía total de rodilla, así como las consideraciones técnicas para su manejo.
Abstract: Background: Dislocation after total knee arthroplasty is a rare complication and a difficult problem to address. When the flexion gap is larger than the extension gap and the collateral ligaments are injured, instability and knee arthroplasty dislocation can occur. Material and methods: We report the case of a patient presenting with a posterior dislocation of a posterior-stabilized prosthesis without trauma. Frank instability in varus stress test and a positive anterior drawer test with tibial internal rotation dismissed the conservative treatment. Results: A constrained condylar prosthesis was used for the revision. He suffered a similar episode after a month, which demonstrated that the increase in the level of constraint was not enough to correct the severe asymmetric instability in flexion due to the damaged external structures. A rotating-hinge prosthesis was then implanted and the patient reported no additional episodes of instability. Conclusions: We made an exhaustive review of the literature, analyzed the possible causes that can lead to the tibiofemoral instability after a total knee arthroplasty and described some technical considerations.
Subject(s)
Humans , Male , Prosthesis Design , Arthroplasty, Replacement, Knee , Joint Instability , Knee Prosthesis , Reoperation , Knee JointABSTRACT
La sífilis es una enfermedad infecciosa humana causada por una bacteria: el Treponema pallidum. La enfermedad es transmitida por contacto directo a través de lesiones durante el estadio primario y secundario, por vía transplacentaria intrauterina o a través del canal uterino; puede afectar cualquier órgano de la economía causando un número infinito de presentaciones clínicas. La sífilis secundaria cursa con manifestaciones mucocutáneas características y eventual sintomatología general. La presentación clínica de nuestros dos pacientes es singular ya que solo poseían lesiones en la cavidad oral. La respuesta al tratamiento instaurado fue buena.
Syphilis is a human infectious disease caused by the bacterium Treponema pallidum. The disease is transmitted by direct contact with a lesion during the primary or secondary stages, in utero by the transplacental route, or during delivery as the baby passes through an infected canal. The bacterium may infect any organ, causing an infinite number of clinical presentations. Secondary syphilis is characterized by mucocutaneous lesions, a flulike syndrome, and generalized adenopathy. Hepatosplenomegaly may be present. The oral mucosa is the second most frequent site of luetic lesions; the genital areas are the most frequent. In the oral cavity, the most characteristic lesion is a whitish mucosal patch, normally located on the lips, tongue, or palate, which is extremely contagious. The differential diagnosis of this lesion may include oral squamous carcinoma, leukoplakia, candidosis, lichen planus, and hairy oral leukoplakia. Definitive diagnosis is based on clinical information and completed by laboratory examinations even the biopsy can help us. With the diagnosis of secondary syphilis treatment with penicillin G benzathine must be started. We present two cases of secondary syphilis with oral lesions only; the first one, a man with macule covered with a whitish membrane on palate mucosa and a lateral neck adenopathy. The lesion had been present for three months. The second one, a woman with painful whitish mucosal patch since two weeks ago. No fever or flulike syndrome. Luetic serologic tests were positive in both cases and in the first one the biopsy showed a chronic inflammatory infiltrate. The drug of choice in the treatment of our patients was benzathine penicillin G.