Acupuncture in the Treatment of a Series of Patients with Chronic Pain Associated with Hip Osteoarthritis / Acupuntura no tratamento de uma série de pacientes com dor crônica associado à osteoartrite de quadril

Abstract Objective Hip osteoarthritis (HO) causes pain and deranges functioning. Surgical treatment is the preferred approach in severe cases, but clinical comorbidities, age and the long waiting list may compromise quality of life. This study aimed to describe the results of acupuncture for the control pain and improvement of functioning in subjects with HO. Method Twelve severe HO patients were treated with ten weekly sessions of a standardized acupuncture point protocol. Pain intensity was assessed with the Visual Analog Pain Scale (VAS) and quality of life with WOMAC Index. Results Pain intensity (VAS) reduced from 75.8 ± 18.8 mm to 20.0 ± 22.6 mm after 10 acupuncture sessions and 48.3 ± 26.6mm in the follow-up (ANOVA F = 7.99; p < 0.001). WOMAC Index values reduced from 74.7 ± 12.7 to 45.7 ± 22.1 and 54.6 ± 22.9 at the same timepoints. Conclusion Acupuncture is an effective conservative rehabilitation strategy to reduce pain and improve quality of life in subjects with severe HO.

Resumo Objetivo A osteoartrite (OA) de quadril causa dor e perda da funcionalidade. O tratamento cirúrgico é a procedimento de escolha nos casos graves, mas as comorbidades clínicas, a idade e a longa lista de espera podem comprometer a qualidade de vida. Este estudo teve como objetivo descrever os resultados da acupuntura no controle da dor e melhora da funcionalidade em indivíduos com OA de quadril. Método Doze pacientes com OA de quadril grave foram tratados com dez sessões semanais de um protocolo padronizado de pontos de acupuntura. A intensidade da dor foi avaliada pela Escala Visual Analógica de Dor (EVA) e a qualidade de vida pelo Índice WOMAC. Resultados A intensidade da dor (EVA) reduziu de 75,8 ± 18,8mm para 20,0 ± 22,6mm após 10 sessões de acupuntura e 48,3 ± 26,6mm no período de seguimento (ANOVA F = 7,99; p < 0,001). Os valores do Índice WOMAC reduziram de 74,7 ± 12,7 para 45,7 ± 22,1 e 54,6 ± 22,9 nos mesmos momentos. Conclusão A acupuntura é uma estratégia de reabilitação conservadora eficaz para reduzir a dor e melhorar a qualidade de vida em indivíduos com OA de quadril grave.

Artroplastia total de cadera con tallo de revisión en un paciente con exostosis múltiple hereditaria y osteoartritis secundaria / Total hip arthroplasty with revision stem in hereditary multiple exostoses with secondary osteoarthritis

Presentamos a una mujer de 42 años con antecedente de exostosis múltiple hereditaria, y dolor y limitación de la movilidad de la cadera izquierda. Los estudios radiográficos mostraron osteoartrosis y exostosis femoral con displasia bilateral de cadera y subluxación de la cabeza femoral. Se realizó una artroplastia total de cadera izquierda con un implante no cementado modular. El resultado a los 7 años fue excelente. El objetivo de este artículo es mostrar una opción alternativa de reconstrucción para las deformidades complejas. Nivel de Evidencia: IV

We present a 42-year-old woman with a history of hereditary multiple exostoses (HME), with pain and limited range of motion of the left hip. Radiographic studies showed osteoarthritis added to femoral exostosis with bilateral hip dysplasia and femoral head subluxation. Total left hip replacement was performed using a modular uncemented implant with excellent postoperative results at 7 years of follow-up. Level of Evidence: IV

Vástagos femorales cortos para el reemplazo total de cadera primario en pacientes jóvenes. Resultados clínicos y biomecánicos / Short femoral stems for primary total hip arthroplasty in young patients. Clinical and biomechanical outcomes

La artroplastia total de cadera es una cirugía eficaz para tratar la artrosis. Con el aumento de la necesidad de una mejor calidad de vida, este procedimiento se está realizando en pacientes más jóvenes. Pero, con la mayor expectativa de vida, también crece la demanda de múltiples cirugías de revisión para el mismo paciente. Esto plantea desafíos técnicos debido a la pérdida de hueso. Existe una necesidad creciente de identificar implantes duraderos y altamente funcionales que sean adecuados para la revisión futura. Aunque los vástagos femorales cementados eran la opción principal en el pasado, los vástagos femorales no cementados han logrado una fijación a largo plazo y excelentes resultados. Sin embargo, aún se pueden mejorar algunos problemas relacionados con la fijación. Los vástagos femorales cortos han sido desarrollados para abordar algunos de estos desafíos, mientras se mantienen los buenos resultados obtenidos con los vástagos convencionales. En este artículo, se analiza la experiencia tras 10 años de uso de vástagos femorales cortos en cirugías de cadera en pacientes jóvenes. Se comparan los resultados biomecánicos y la preservación ósea femoral, se reportan los resultados posoperatorios en relación con el regreso al deporte, y se evalúan las complicaciones relacionadas con su uso. El empleo de vástagos cortos en cirugía primaria de cadera brinda múltiples ventajas. La indicación de este tipo de implante está justificada en pacientes jóvenes y activos, con el objetivo de reproducir los resultados de los implantes convencionales con un menor consumo de hueso y la posibilidad de una revisión futura. Nivel de Evidencia: IV

Total hip arthroplasty is an effective surgery to treat osteoarthritis. Given the rising demand for a higher quality of life, this procedure is being performed on increasingly younger patients. However, a longer life expectancy is also tied to a higher demand for multiple revision surgeries for the same patient. This poses technical challenges due to bone loss. There is a growing need to identify durable and highly functional implants that are suitable for future revision. Although cemented femoral stems were the main option in the past, uncemented femoral stems have demonstrated long-term fixation and excellent results. However, some issues related to fixation can still be improved. Short femoral stems have been developed to address some of these challenges while maintaining the good results obtained with conventional stems. This study analyzes the experience after 10 years of using short femoral stems in hip surgeries on young patients. Biomechanical outcomes and femoral bone preservation are compared, postoperative outcomes regarding return to sports are reported, and complications related to their use are evaluated. Short stems have multiple advantages when used in primary hip surgery. The indication for this type of implant is justified in young and active patients, to reproduce the results of conventional implants with less bone consumption and the possibility of future revision. Level of Evidence: IV

Cirugía de prótesis de cadera en el adulto con enfermedad de Legg-Calvé-Perthes / Total hip arthroplasty in adults with Legg-Calvé-Perthes disease

Objetivos: Revisar las cirugías de prótesis totales de cadera realizadas en nuestro hospital, determinar el origen de la artrosis e identificar cuántas se colocaron por coxartrosis secundarias a enfermedad de Legg-Calvé-Perthes. Materiales y Métodos: Se realizó un estudio retrospectivo en el que se revisaron todas las cirugías de prótesis totales de cadera desde 2008 hasta diciembre de 2021. Se evaluaron las radiografías prequirúrgicas para determinar la etiología de la artrosis, y se consideraron variables, como lateralidad, sexo y edad en el momento de la intervención. Resultados: Se revisaron 1103 caderas en 935 pacientes. El 81% correspondía a coxartrosis primaria. En 11 caderas de 10 pacientes (1%), se detectó coxartrosis secundaria a la enfermedad de Legg-Calvé-Perthes. La media de la edad de estos pacientes era de 61 años. Conclusiones: Hay evidencia de que las alteraciones del crecimiento de la fisis femoral proximal o el sobrecrecimiento del trocánter mayor, propias de la enfermedad de Legg-Calvé-Perthes, pueden contribuir a la aparición de un choque femoroacetabular, con su consiguiente coxartrosis precoz. Es posible que algunas "mal clasificadas" coxartrosis primarias fueran identificadas así porque no existía otro dato sugerente de coxartrosis secundarias, y escondieran otra etiología evolucionada. Asimismo, proponemos el seguimiento del paciente joven con enfermedad de Legg-Calvé-Perthes, más allá del final del crecimiento, para identificar el choque femoroacetabular en sus inicios y poder ofrecer opciones terapéuticas artroscópicas. Nivel de Evidencia: III

Objectives: To review the number of total hip replacements (THA) performed in our hospital, determine their aetiology and identify how many of them were performed for hip osteoarthritis secondary to Legg-Calvé-Perthes disease (LCPD). Materials and Methods: We conducted a retrospective study reviewing all THA surgeries from 2008 to December 2021. We studied the pre-operative radiographs, determining the aetiology of the osteoarthritis, laterality, sex and age of the patient at the time of surgery. Results: We reviewed a total of 1103 hips in 935 patients. Primary hip osteoarthritis accounted for 81% of the cases. We gathered a total of 11 hips from 10 individuals (1%), with a mean age of 61 years, for hip osteoarthritis secondary to LCPD. Conclusions:There is evidence that femoro-acetabular impingement (FAI), which results in early secondary hip osteoarthritis, may be influenced by changes in the growth of the proximal femoral physis or overgrowth of the greater trochanter, which are characteristics of LCPD. We believe that certain cases of "misclassified" primary hip osteoarthritis may have been incorrectly identified since no additional information was found to support the diagnosis of secondary hip osteoarthritis, hiding the potential of an alternate, evolved aetiology. Furthermore, we suggest monitoring young patients with LCPD after their growth is complete in order to detect early FAI and provide arthroscopic therapeutic options. Level of Evidence: III

Patients Who Present with Functional Limitations, Limited Range of Motion and Reduced Muscle Strength 6 Months after Total Hip Arthroplasty: A Cross-Sectional Study / Pacientes que apresentam limitações funcionais, amplitude de movimento limitada e força muscular reduzida, 6 meses após a artroplastia total do quadril: Um estudo de corte transversal

Abstract Objective To evaluate levels of pain, range of motion, hip isometric peak torque, and functional task performance in patients 6 months after total hip arthroplasty (THA) and to compare them to asymptomatic control participants (CG). Methods We recruited participants with unilateral THA due to hip osteoarthritis (OA) within a median of 6 months who had not developed postoperative complications. We assessed the pain levels, hip range of motion, peak isometric torque, self-reported assessment (Harris Hip Score) and objectively measured function (Timed Up & Go Test [TUG]) of the patients. The THA group was compared with a group of asymptomatic participants ≥50 years old recruited in the community. Comparisons are presented as mean differences (MDs) and 95% confidence intervals (CIs). Results A total of 23 participants were included in each group. Pain levels were low in the THA group (1.48 [1.60]), and 91.3% of the patients reported to be satisfied with the surgical procedure. Participants in the THA group reported significantly lower objectively measured (THA 12.2 [10.0-21.6]; CG 9.0 [6.7-12.2]) and self-reported function (THA 78.5 [43.8-93.9]; CG 100.0 [95.8-100.0]) compared with CG. The THA group also had significantly reduced range of motion for flexion (p< 0.001), internal (p< 0.001) and external rotation (p= 0.003) movements and reduced peak torque for flexion (p< 0.001), extension (p< 0.001), abduction (p< 0.001) and adduction (p= 0.024) movements compared with participants of the CG. Conclusions Despite reporting overall low pain scores and satisfaction with the surgery, the patients present with functional limitations, limited range of motion, and reduced muscle strength 6 months after THA. Evidence Level 3b

Resumo Objetivo Avaliar os níveis de intensidade da dor, amplitude de movimento, pico de torque isométrico do quadril e desempenho da tarefa funcional em pacientes 6 meses após a artroplastia total do quadril (ATQ), e comparar estes valores com os de participantes assintomáticos do grupo controle (GC). Métodos Recrutamos participantes com ATQ unilateral devida a osteoartrite (OA) do quadril, dentro de uma mediana de tempo de 6 meses, que não tinham desenvolvido complicações pós-operatórias. Os participantes foram avaliados quanto à intensidade da dor, à amplitude de movimento do quadril, ao pico de torque isométrico, à autoavaliação (questionário de avaliação do quadril Harris Hip Score [HHS, na sigla em inglês) e à função medida objetivamente por meio do teste Timed Up and Go (TUG, na sigla em inglês). O grupo ATQ foi comparado com um grupo de participantes assintomáticos com idade ≥ 50 anos recrutados na comunidade. As comparações são apresentadas como diferenças médias (DMs) e intervalos de confiança (ICs) de 95%. Resultados Cada grupo contou com 23 participantes. A intensidade da dor foi baixa no grupo ATQ (1,48 [1,60]), sendo que 91,3% dos pacientes relataram estar satisfeitos com o procedimento cirúrgico. Os participantes do grupo ATQ relataram uma função medida objetivamente significativamente menor (ATQ 12,2 [10,0-21,6]; GC 9,0 [6,7-12,2]) e a função autoavaliação (ATQ 78,5 [43,8-93,9]; GC 100,0 [95,8-100,0]), em comparação com o GC. O grupo ATQ também teve reduzida de forma significativa a amplitude de movimento para flexão (p< 0,001), os movimentos internos (p< 0,001) e de rotação externa (p= 0,003). O grupo ATQ também apresentou pico de torque reduzido para flexão (p< 0,001), extensão (p <0,001), movimentos de abdução (p< 0,001) e adução (p = 0,024) em comparação com os participantes do GC. Conclusões Apesar de informarem escores gerais de dor de baixa intensidade e satisfação com a cirurgia, os pacientes apresentaram limitações funcionais, amplitude de movimento limitada e redução da força muscular após 6 meses do procedimento cirúrgico de ATQ. Nível de Evidência3B.

Artroplastia total de cadera bilateral en un tiempo: una opción quirúrgica para pacientes con coxartrosis severa bilateral / Simultaneous bilateral total hip arthroplasty: a surgical option for patients with several bilateral hip osteoarthritis

Total hip arthroplasty is a successful procedure with high rates of functional satisfaction and pain relief. A large number of patients with bilateral hip pathology will require both hip joint replacement, from there born the inquietude to knowing benefits and disadvantage of bilateral simultaneous hip arthroplasty. We present a female patient case who developed bilateral hip osteoarthritis secondary to development dysplasia of the hip which was surgically managed with bilateral arthroplasty at one time. We show a follow-up report of the case and a review of the literature to know the main advantages of this new current of hip arthroplasty in patients with bilateral hip pathology

Factores de riesgo de artrosis de rodilla, cadera o ambas en mujeres chilenas de mediana edad: un estudio de cohorte de tres décadas / Risk factors for the development of osteoarthritis in middle-aged women

BACKGROUND: Osteoarthritis (OA) is a health problem affecting millions of individuals worldwide. Aim: To evaluate risk factors for hip and knee osteoarthritis (OA) in women aged 40 to 59 years. MATERIAL AND METHODS: Analysis of a prospective cohort of 1159 women attending preventive health care programs and followed during 28 years. They underwent a clinical and laboratory evaluation from 1990 to 1993. The diagnosis of OA was retrieved from registries of a special program for osteoarthritis in 2020. RESULTS: Twenty four percent of participants developed osteoarthritis during the follow-up. At the beginning of the study and compared with women without OA, they were older (median [interquartile range or IQR]: 49.6 [8.5] and 47.2 [8.2] years respectively), had a higher body mass index (26.3 [5.3] and 25.1 [5.3] respectively), and a higher frequency of jobs with low qualification (76 and 62% respectively). The presence of type 2 diabetes mellitus, chronic hypertension, a previous history of alcohol or cigarette consumption, postmenopausal status and lipid and glucose blood levels did not differ between women with or without OA. Cox regression showed a final model that incorporates body mass index (hazard ratio (HR): 1.04; 95% confidence intervals (CI): 1.01-1.07), age (HR: 1.05; 95% CI: 1.03-1.08) and having an unqualified job (HR: 1.88; 95% CI: 1.43-2.47) as risk factors for OA. CONCLUSIONS: Obesity and the type of job are the most relevant risk factors found for OD: both may be modified with proper care.

¿Conoce la semiología de la Cadera? / ¿Do you know the semiology of the hip?

La prevalencia de artrosis de cadera en personas mayores de 45 años es de 9.2% y 27% de ellos evidencian signos radiológicos de la enfermedad, siendo el dolor uno de los motivos de consulta más comunes de quienes acuden al médico general y al ortopedista. La historia clínica precisa y el examen físico adecuado pueden llevar al clínico a determinar el origen del dolor. Sin embargo, nuestra experiencia en la consulta es que la mayoría de los médicos generales no conocen cuáles son los síntomas de la patología de la cadera. El objetivo de este artículo es presentar una guía práctica de su evaluación clínica y la patología más común, que sea útil para el estudiante de medicina, el médico general y el especialista. El artículo se desarrollará en el orden en que se realiza la evaluación de la cadera para al final poder tener un diagnóstico claro.

The prevalence of osteoarthritis of the hip among people over 45 years of age is 9.2% and 27% of them show radiological signs of this joint disorder, with pain being one of the most common reasons for consultation of patients seen by general practitioners and orthopedic surgeons. An accurate clinical history and a proper physical examination can lead the clinician to determine the origin of the pain. However, our experience in office visits shows that most general practitioners are unaware of the symptoms of hip disorders. The purpose of this article is to present a practice guideline for clinical examination of the hip and the most common disorders, which is useful for the medical student, general practitioner and specialist. The article will outline the steps in which hip evaluation is performed to obtain a clear diagnosis in the end

Association of osteoporosis with radiologic grading of the hip among older Filipino patients with suspected hip osteoarthritis

Introduction@#Among older populations, osteoarthritis (OA) is one of the most common chronic joint disorders and is a leading cause of disability, while osteoporosis is the most common metabolic bone disease, conferring fragility and significant risk of fracture. The relationship between OA and osteoporosis remains controversial. Although earlier studies reported an inverse association between the two diseases, more recent literature found a complex relationship mediated by various factors. @*Objective@#The investigators sought to determine the association of osteoporosis with radiologic grading of the hip among older Filipino patients with suspected hip osteoarthritis.@*Methodology@#A cross-sectional analytical study was conducted involving 256 patients with suspected hip OA who underwent radiography of the hips and central dual energy x-ray absorptiometry (DXA). Radiographs of the hips were evaluated by a radiologist using the Kellgren-Lawrence (KL) grading scale, while central DXA images were processed and evaluated by a nuclear medicine physician using the World Health Organization criteria for the diagnosis of osteoporosis and the 2019 International Society for Clinical Densitometry guidelines. The primary outcome measures were the prevalence of osteoporosis in patients with suspected hip OA, and the association of osteoporosis with radiologic KL grading of the hips. The secondary outcome measure was the association of osteoporosis with sex and BMI. @*Results@#The study found that osteoporosis was present in 136 (53.1%) of the 256 patients who all presented with radiologic evidence of hip OA. There was a positive association between the presence of osteoporosis and the radiologic grade of hip OA (p-value: 0.006 on the right hip and 0.036 on the left). Osteoporosis was more prevalent in women compared to men (p-value: 0.031). Likewise, osteoporosis had a direct relationship with BMI (p-value: <0.001). @*Conclusion@#Osteoporosis was prevalent in a significant proportion of older Filipino patients with clinical and radiologic evidence of hip OA, particularly among women, and was positively associated with increasing severity of OA. The study suggests that obesity may not necessarily protect against osteoporosis in this population, possibly relating to increased adiposity and decreased lean muscle mass.

Artroplastia total bilateral de cadera / Bilateral Total Hip Arthroplasty

Introducción: La artroplastia total de cadera es uno de los procedimientos más exitosos del siglo veinte. Cuando se realizan de manera simultánea, presentan varios beneficios como son: menor costo, menor estadía hospitalaria, uso de una sola dosis de anestésico y retorno precoz a las actividades diarias. Objetivo: Presentar el primer caso de artroplastia total bilateral simultánea, realizado satisfactoriamente en el Hospital Universitario Manuel Ascunce Domenech en la provincia de Camagüey. Presentación del caso: Paciente femenina de 78 años de edad, color de piel blanca, con antecedentes de coxartrosis bilateral de cinco años de evolución con dolor moderado y crisis de dolor intenso a predominio de la cadera izquierda. Presentó además escoliosis antálgica. A la exploración física se constató limitación a la abducción de ambas caderas con predominio de la izquierda, con las maniobras de Patrick, Thomas y Trendelemburg positivas bilaterales. En la radiografía simple de pelvis ósea anteroposterior se observaron: disminución marcada del espacio articular, osteofitos marginales bilaterales y esclerosis subcondral marcada. Se decidió realizar una artrolplastia total bilateral en un tiempo quirúrgico, una vez evaluadas las condiciones clínicas de la paciente y su consentimiento. Se utilizó el sistema Surgival no cementado. Conclusiones: La artoplastia total de cadera se presenta como un procedimiento factible, que proporciona numerosas ventajas, y aunque no está exento de complicaciones, estas no representan un riesgo sobreañadido, siempre y cuando se seleccionen los pacientes de manera adecuada. El caso presentado, evolucionó de manera satisfactoria tras dos años de realizada la cirugía(AU)

Introduction: Total hip replacement is one of the most successful procedures of the twentieth century. When performed simultaneously, it poses several benefits such as lower cost, shorter hospital stay, use of a single dose of anesthetic and early return to daily activities. Objective: To report the first case of simultaneous bilateral total arthroplasty, successfully performed at Manuel Ascunce Domenech University Hospital in Camagüey province. Case report: This is a case of a 78-year-old female patient, white skin color, with a five-year history of bilateral coxarthrosis, moderate pain and crisis of intense pain mainly in the left hip. She also had antalgic scoliosis. The physical examination revealed abduction limitation of both hips mainly on the left, with positive bilateral Patrick, Thomas and Trendelenburg maneuvers. In the plain anteroposterior bone pelvis radiograph marked decrease in joint space, bilateral marginal osteophytes, and marked subchondral sclerosis were observed. It was decided to perform a bilateral total arthroplasty in a surgical time, once the clinical conditions of the patient and her consent had been evaluated. The uncemented Surgival system was used. Conclusions: Total hip replacement represents a feasible procedure, which provides numerous advantages, and although it is not exempt from complications, these do not signify added risks, as long as the patients are properly selected. The case reported here evolved satisfactorily after two years of surgery(AU)

Implementación de rehabilitación remota en artrosis bilateral de cadera / Implementation of Remote Rehabilitation in Bilateral Hip Osteoarthritis

Introducción: La pandemia causada por el COVID-19 obligó a cambiar la modalidad en la cual se llevan cabo los procesos de rehabilitación -de presencial a remoto- incluso la de aquellos tratamientos ya planificados. Objetivos: Implementar la telerehabilitación y documentar si el cambio de modalidad basada en el ejercicio terapéutico tiene efectos en los resultados de la intervención. Presentación del caso: Se presenta el caso de una paciente con osteoartritis bilateral de cadera cuya intervención de terapia física tuvo que ser modificada a una modalidad remota, debido a la pandemia por COVID-19. Conclusiones: La modalidad remota adoptada no afectó la recuperación funcional establecida en las primeras etapas. Se recomienda utilizar evaluaciones funcionales, así como considerar las condiciones en el hogar requeridas para la continuidad de las intervenciones(AU)

Introduction: The pandemic caused by COVID-19 forced to change the modality in the rehabilitation processes -from face-to-face to remote- including that of those already planned treatments. Objectives: To implement remote rehabilitation and to set down whether the change of modality based on therapeutic exercise impacts on the results of the intervention. Case report: The case of a patient with bilateral hip osteoarthritis is reported here. Her physical therapy intervention had to be modified to a remote modality, due to the COVID-19 pandemic. Conclusions: The remote modality adopted did not affect the functional recovery established in the early stages. It is recommended to use functional evaluations, as well as to consider the required conditions at home to continue the interventions(AU)

Evolución epidemiológica de la artroplastia de cadera y rodilla durante 17 años en pacientes con artrosis severa en un hospital Chileno / Evolution of hip and knee arthroplasty epidemiology in a single hospital of Chile: a 17 years overview

INTRODUCCIÓN: La artroplastia total de cadera (ATC), es la cirugía del siglo XX por el impacto en la calidad de vida. Por su parte, la artroplastia de rodilla (AR), ha demostrado ser un procedimiento costo-efectivo en gonartrosis. OBJETIVO: Describir la evolución de ATC y AR, en cuanto a número de procedimientos, edad y género en pacientes operados en un hospital general. MÉTODO: Estudio transversal analítico. Fueron incluidos todos los procedimientos realizados en un único centro, entre enero de 2002 y diciembre 2018, que estuvieran registrados por los códigos de prestación Fonasa 2104129 y 2104153. Fueron excluidos todos los procedimientos de revisión de artroplastia, tumores y fracturas. Se realizó un análisis de correlación de Spearman, se estableció una significancia de 0,05. RESULTADOS: Fueron incluidos 3270 procedimientos, 1975 corresponden a ATC (60,4%) y 1295 AR (39,6%). El número de ATC ha ido aumentando, en 2002 fueron realizados 122, mientras que en 2018, fueron 164. Por su parte, las AR también aumentaron, en 2002 fueron realizadas 40, mientras que en 2018 fueron 155. La proporción ATC/AR ha disminuido significativamente. La edad promedio ha disminuido en AR y aumentado en ATC, sin significación estadística. En ATC, se observa un incremento en la proporción de hombres operados. CONCLUSIONES: El perfil epidemiológico de los pacientes operados de artroplastia ha cambiado significativamente. La epidemiología mundial y la de este estudio muestran un significativo incremento de pacientes que requieren AR, por lo cual, parece importante incluir ese procedimiento en las necesidades sanitarias a satisfacer, en el diseño de nuevas políticas públicas.

OBJECTIVE: To describe the evolution of hip and knee arthroplasty in a general hospital, in terms of number of procedures, average age and gender. METHOD: Analytical cross-sectional study. All procedures performed between January 2002 and December 2018 in a single center were included. All procedures performed for revision surgery, tumors or fracture were excluded. The following data were obtained from the registry: age at the time of surgery, gender of the patient and year of the procedure. A Spearman correlation analysis was performed, a significance of 0.05 was established. RESULTS: 3270 procedures were included, 1975 correspond to hip arthroplasty (60.4%) and 1295 to knee arthroplasty (39.6%). The number of hip arthroplasty has increased over time, in 2002 a total of 122 procedures were performed and in 2018 there were 164. On the other hand, knee arthroplasty procedures have also increased, from 40 in 2002 to 155 in 2018. The ratio between hip and knee arthroplasty has been decreasing, this finding being significant. The average age has been decreasing in knee arthroplasty, meanwhile, decreasing in hip arthroplasty during the studied period. On the other hand, the proportion of men that underwent hip arthroplasty has been increasing over time. CONCLUSIONS: The number of knee arthroplasty has increased significantly, decreasing its difference with respect to the number of hip arthroplasty. An explosive increase in knee arthroplasty has been described in the literature, consistent with the outcomes of this study, so it seems important to include this procedure the new health public policies.

Tendencia temporal y evaluación demográfica de hospitalizaciones por osteoartritis / Temporal trends and demographic evaluation of hospitalizations due to osteoarthritis

OBJETIVO: Describir la tendencia temporal de osteoartritis (OA) según egresos hospitalarios considerando ubicación anatómica, distribución por sexo, edad, condiciones más frecuentes, y ubicación geográfica en Chile entre los años 2012 y 2018. METODOLOGÍA: Estudio descriptivo, retrospectivo, poblacional, que analizó las bases de datos públicas del Departamento de Estadísticas e Información en Salud (DEIS) del Ministerio de Salud de Chile, en particular los registros con codificación de M15 a M19. Se calcularon las tasas por 100 mil egresos hospitalarios, así como también el porcentaje de OA según las categorías analizadas. RESULTADOS: Se encontraron 11.622.605 egresos hospitalarios entre 2012 y 2018. El número total de egresos hospitalarios por OA fue de 78.700. Se observó que la distribución por sexo fue similar a lo largo de los años ( 40% y 60% en hombres y mujeres, respectivamente). El rango de edad más afectado fue el de 65 a 79 años, cuya tasa promedio fue de 2.046 por 100 mil egresos; además, fue el grupo que presentó el mayor aumento (60%) en su tasa de 2012 a 2018. La Región Metropolitana (291,7 egresos) y de Valparaíso (89,6 egresos) presentaron las tasas más altas. La cadera (56,6%) y la rodilla (31%) fueron las ubicaciones más frecuentes de casos de OA, con distribución similar por sexo, edad y geografía en comparación a los egresos totales por OA. CONCLUSIONES: Los egresos hospitalarios por OA en Chile aumentaron entre 2012 y 2018, preferencialmente en casos de OA en las articulaciones de cadera y rodilla en el grupo de mujeres de edad avanzada de la zona centro del país. NIVEL DE EVIDENCIA: Estudio descriptivo.

OBJECTIVE: To describe the temporal trends of osteoathritis (OA) according to hospital discharges considering anatomical location, distribution by gender, age, more frequent conditions, and geographic location in Chile between 2012 and 2018. METHODOLOGY: A retrospective, descriptive and population study which analyzed the public databases of the Department of Health Statistics and Information (Departamento de Estadísticas e Información en Salud, DEIS, in Spanish) of the Ministry of Health of Chile, in particular the records with codes M15 through M19. Rates per 100 thousand hospital discharges were calculated, as well as the percentage of OA according to the categories analyzed. RESULTS: A total of 11,622,605 hospital discharges were found between 2012 and 2018. The total number of hospital discharges due to OA was of 78,700. The distribution by gender was similar over the years ( 40% and 60% among men and women respectively). Adults aged between 65 and 79 years were the most affected, and their average rate was of 2,046 per 100 thousand discharges. It was also the group that presented the highest increase (60%) in rate from 2012 to 2018. The Metropolitan Region (291.7 discharges) and Valparaíso (89.6 discharges) presented the highest rates in Chile. The hip (56.6%) and knee (31%) were the most frequent locations of OA, which presented similar distribution by gender, age and geography when compared with the total discharges due to OA. CONCLUSIONS: Hospital discharges due to OA in Chile increased between 2012 and 2018, preferentially in cases of hip and knee-joint OA in the group of elderly women in the central area of the country. LEVEL OF EVIDENCE: Descriptive study.

Tratamiento de las fracturas trocántero-subtrocantéricas asociadas a coxartrosis ipsilateral en pacientes mayores de 65 años / Treatment of trochanteric and subtrochanteric fractures associated to ipsilateral coxarthrosis in patients older than 65 years old / Tratamento de fraturas trocantéricas-subtrocantéricas associadas a coxartrose ipsilateral em pacientes com mais de 65 anos

Resumen: Introducción: las fracturas de cadera y la coxartrosis son patologías con alta incidencia en la población anciana. A pesar de esto es una observación clínica frecuente que no se presenten asociadas. No existe consenso de cuál es la mejor opción terapéutica para esta asociación. El objetivo del estudio es actualizar el conocimiento acerca del tratamiento de fracturas trocántero-subtrocantéricas asociadas a coxartrosis ipsilateral en pacientes mayores de 65 años. Materiales y métodos: se realizó una búsqueda sistematizada a través de los buscadores electrónicos PubMed y Ovid. La búsqueda alcanzó un total de 2,499 artículos, de acuerdo a los criterios de inclusión y exclusión se seleccionaron 12 trabajos para realizar nuestra revisión bibliográfica. Resultado: la mayoría de los trabajos analizados son estudios tipo serie de casos retrospectivos. Se realizaron tres subgrupos según tipo de tratamiento para analizar los resultados. Discusión: la asociación entre fracturas de fémur proximal y coxartrosis ipsilateral es poco frecuente. Dentro de este grupo de fracturas las de tipo trocantérico son las que muestran con mayor frecuencia esta asociación. Se plantean dos opciones terapéuticas para resolver esta asociación: tratar la fractura y la patología articular en un mismo acto quirúrgico mediante una artroplastia, o tratar primero la fractura mediante osteosíntesis y en una segunda cirugía la patología articular. El tratamiento mediante artroplastia disminuye el tiempo para la deambulación postoperatoria evitando así complicaciones médicas relacionadas a la enfermedad fracturaria, obteniendo mejores resultados funcionales a corto plazo. La osteosíntesis requiere un menor tiempo quirúrgico y una perdida sanguínea menor, siendo un procedimiento menos demandante técnicamente. La tasa de mortalidad no depende de la opción terapéutica, pero sí de la presencia de 3 o más comorbilidades y edad mayor a 80 años. Resulta importante conocer el tratamiento más adecuado para esta asociación de patologías, ello contribuiría a disminuir los efectos de la enfermedad fracturaria sobre este grupo de pacientes vulnerables. Conclusión: no existe la suficiente evidencia científica para afirmar que una opción terapéutica sea superior a la otra en estos pacientes.

Summary: Introduction: hip fractures and hip joint arthrosis are highly prevalent conditions among older adults. However, according to clinical examination, they are seldom seen together and today there is no general consensus on the best therapy for these associated conditions. The study aims to update existing knowledge on the treatment of trochanteric and subtrochanteric fractures that are associated to ipsilateral coxarthrosis in patients older than 65 years old. Method: we conducted a systematized search on Pubmed and Ovid including 2,499 articles and selected 12 studies to perform our bibliographic review based on inclusion and exclusion criteria. Result: most studies analysed are series of retrospective cases. Cases were classified them into three subgroups to analyse results. Discussion: the association between proximal femur fractures and ipsilateral coxarthrosis is rather unusual. When seen, trochanteric fractures are the most frequent ones. There are two therapeutic options to treat this condition: treating the fracture and the articulation in the same surgery, by means of an arthroplasty, or treating the fracture first with osteosynthesis and operating afterwards to treat the articulation condition. Arthroplasty reduces the time of postoperative ambulation and thus avoids medical complications in connection with the fracture disease, what results in better functional outcome in the short term. Osteosynthesis requires a shorter surgery and implies smaller blood loss, what makes it less technically demanding as a procedure. The mortality rate does not depend on the therapy chosen, but on the presence of three or more comorbilities, or the patient being older than 80 years old. It is important to define what the most appropriate treatment is for these associated conditions, what would contribute to reducing the effects of the fracture on this group of vulnerable patients. Conclusion: there is no sufficient scientific evidence to state whether one therapy is better than the other one in these patients.

Resumo: Introdução: as fraturas de quadril e coxartrose são patologias com alta incidência na população idosa. Apesar disso, é frequente a observação clínica de que não estão associados. Não há consenso sobre qual a melhor opção terapêutica para essa associação. O objetivo deste estudo é atualizar o conhecimento sobre o tratamento das fraturas trocantéricas-subtrocantéricas associadas à coxartrose ipsilateral em pacientes com mais de 65 anos. Materiais e métodos: foi realizada uma busca sistemática nas bases PubMed e Ovid. Foram encontrados 2.499 artigos; após aplicação dos critérios de inclusão e exclusão, foram selecionados 12 artigos para realização de nossa revisão bibliográfica. Resultado: a maioria dos estudos analisados são séries de casos retrospectivos. Para análise dos resultados, foram divididos em três subgrupos de acordo com o tipo de tratamento. Discussão: a associação entre fratura de fêmur proximal e coxartrose ipsilateral é rara. Dentro desse grupo de fraturas, as do tipo trocantérica são as que mais frequentemente apresentam essa associação. Duas opções terapêuticas são propostas para resolver essa associação: tratar a fratura e a patologia articular no mesmo ato cirúrgico por meio de uma artroplastia, ou tratar a fratura primeiro por osteossíntese e em uma segunda cirurgia a patologia articular. O tratamento por artroplastia reduz o tempo de deambulação pós-operatória, evitando complicações médicas relacionadas à doença da fratura, obtendo melhores resultados funcionais em curto prazo. A osteossíntese requer menos tempo cirúrgico e menos perda sanguínea, sendo um procedimento menos exigente tecnicamente. A taxa de mortalidade não depende da opção terapêutica, mas sim da presença de 3 ou mais comorbidades e idade superior a 80 anos. É importante identificar o tratamento mais adequado para esta associação de patologias, o que ajudaria a reduzir os efeitos da patologia da fratura neste grupo de pacientes vulneráveis. Conclusão: não há evidências científicas suficientes para afirmar que uma opção terapêutica seja superior a outra nestes pacientes.

Osteotomía periacetabular de Ganz para el tratamiento de la displasia del desarrollo de la cadera: experiencia inicial y resultados de los primeros 44 casos / Ganz periacetabular osteotomy for the treatment of developmental dysplasia of the hip. Initial experience and results from the first 44 cases

Objetivo: Describir la técnica quirúrgica, las indicaciones y los resultados iniciales de la osteotomía periacetabular bernesa para tratar la displasia del desarrollo de la cadera. Materiales y métodos: Entre mayo de 2011 y mayo de 2020, se realizaron 44 osteotomías periacetabulares bernesas en 44 pacientes (35 mujeres, edad promedio 30 años [rango 23-38]). Todos tenían diagnóstico de displasia de cadera sintomática. El ángulo centro-borde promedio fue de 17° (rango 9°-20°) y el índice acetabular promedio, de 18° (rango 15°-20°). En 22 casos, se evaluaron y repararon los hallazgos intrarticulares por artroscopia en el mismo acto quirúrgico. Se evaluaron la corrección obtenida, la consolidación de la osteotomía y los resultados funcionales al final del seguimiento. Resultados: En 22 pacientes, se detectó hipertrofia y rotura del labrum acetabular asociadas a displasia de cadera. Diez pacientes tenían quistes paralabrales. El ángulo centro-borde promedio posoperatorio fue de 32° (rango 27°-35°) y el índice acetabular, de 6° (rango 4°-9°). El tiempo quirúrgico para la osteotomía periacetabular bernesa fue de 130 min, cuando se sumó un procedimiento artroscópico, el tiempo fue de 148 minutos. Conclusiones: La osteotomía periacetabular bernesa es técnicamente demandante, pero logra resultados predecibles en pacientes con integridad del cartílago articular y deformidades corregibles. La artroscopia antes de la osteotomía permite evaluar las condiciones del cartílago, diagnosticar y tratar lesiones intrarticulares asociadas con esta enfermedad y decidir si es necesaria la corrección del déficit de cobertura. Nivel de Evidencia: IV

Objective: To describe the surgical technique, indications, and initial results of the Bernese periacetabular osteotomy (PAO) for the treatment of developmental dysplasia of the hip. Materials and methods: Between May 2011 and May 2020, 44 PAOs were performed in 44 patients (35 women) with an average age of 30 years (23-38). All patients had a diagnosis of symptomatic hip dysplasia. The average center-edge angle was 17° (9° to 20°) and the average acetabular index was 18° (15° to 20°). In 22 cases, the intra-articular findings were evaluated and repaired by arthroscopy in the same surgical stage. The correction obtained, the consolidation of the osteotomy, and the functional outcomes at the end of the follow-up were evaluated. Results: Hypertrophy and rupture of the acetabular labrum associated with hip dysplasia were evidenced in 22 patients. Paralabral cysts were found in 10 patients in the series. The average postoperative center-edge angle was 32° (27° to 35°) and the acetabular index was 6° (4° to 9°). The surgical time for PAO was 130 minutes; in patients where an arthroscopic procedure was added, the time was 148 minutes. Conclusions: PAO is technically demanding, but has predictable outcomes in patients with articular cartilage integrity and correctable deformities. Arthroscopy before osteotomy allows assessing cartilage conditions, diagnosing and treating intra-articular lesions associated with this pathology, and deciding on the need to correct the soft tissue deficit. Level of Evidence: IV

Artrosis rápidamente progresiva de cadera secundaria a una fractura por insuficiencia subcondral del acetábulo. Reporte de un caso / Rapidly progressive osteoarthritis of the hip secondary to a subchondral insufficiency fracture of the acetabulum: A case report

Las fracturas por insuficiencia subcondral son una causa poco frecuente de cadera dolorosa. A diferencia de las fracturas traumáticas agudas, las fracturas por insuficiencia del acetábulo son menos frecuentes que las femorales. Ocurren habitualmente en mujeres posmenopáusicas con comorbilidades. Su diagnóstico inicial suele ser dificultoso y la sospecha clínica es de gran importancia. La resonancia magnética es una herramienta fundamental para detectar este cuadro. Subestimar estas lesiones puede llevar al desarrollo de una artrosis rápidamente progresiva y al reemplazo articular como desenlace. Se presenta el caso de una paciente de 68 años con una fractura por insuficiencia subcondral del acetábulo a quien se le indicó una artroplastia total de cadera no cementada. Nivel de Evidencia: IV

Subchondral insufficiency fractures are a rare cause of hip pain. Unlike acute traumatic fractures, acetabulum insufficiency fractures are less common than femoral fractures. They commonly occur in postmenopausal women with comorbidities. Its initial diagnosis is usually difficult and clinical suspicion is of great importance. Magnetic resonance imaging (MRI) is a fundamental tool for the detection of this pathology. Underestimating these injuries can lead to the development of rapidly progressive osteoarthritis and joint replacement as an outcome. We present the case of a 68-year-old patient with a subchondral insufficiency fracture of the acetabulum who underwent uncemented total hip arthroplasty. Level of Evidence: IV

Tratamiento conservador de la artrosis de cadera / Conservative treatment of hip osteoarthritis

Ante un escenario clínico de coxalgia por artrosis de cadera se planteó la necesidad de conocer los tratamientos con-servadores más seguros y efectivos para el manejo del dolor. El tratamiento de la artrosis requiere un enfoque integral e individualizado en función de las preferencias del paciente para lograr el máximo beneficio clínico. Existen numerosas estrategias útiles para el manejo del dolor en pacientes con artrosis de cadera siendo fuertemente recomendados de inicio la actividad física, los antiinflamatorios no esteroideos (AINE) orales y en ciertos casos los corticoides intraarticulares, tramadol o duloxetina, siempre asociado con la actividad física. Los ejercicios más recomendados son los aeróbicos y el Tai Chi o yoga. (AU)

Faced with a clinical scenario of coxalgia due to hip osteoarthritis, the need to know the safest and most effective conservative treatments for pain management arose. The treatment of osteoarthritis requires a comprehensive and individualised approach based on the patient's preferences to achieve maximum clinical benefit. There are numerous useful strategies for pain management in patients with hip osteoarthritis being strongly recommended from the beginning such as physical activity, oral non-steroidal anti-inflammatory drugs (NSAID) and in certain cases intra-articular corticosteroids, tramadol or duloxetine, always associated with physical activity. The most recommended exercises are aerobics and Tai Chi or yoga. (AU)

Mortalidad de los pacientes intervenidos de artroplastia de rodilla y cadera en Chile: análisis de sobrevida / Mortality after hip or knee arthroplasty for osteoarthritis in Chile: a survival analysis

Introducción El propósito de este estudio es determinar si los pacientes con artrosis severa intervenidos con artroplastia de rodilla o cadera ponen en riesgo su expectativa de vida. Método Se diseñó un estudio de sobrevida el cual fue aprobado por el comité de ética de nuestra institución. Los pacientes fueron incluidos si fueron intervenidos de artroplastia de rodilla y cadera por artrosis severa y tenían más de 50 años. Los pacientes fueron excluidos si la artroplastia se realizó por fractura, hemofilia o un tumor. Una regresión multiparamétrica de Weibull fue estimada, siendo reportado el hazard ratio. Un bootstrap de 200 repeticiones fue realizada para validación interna. Resultados Un total de 4094 artroplastias fueron incluidos. La curva de Kaplan-Meier estima una mayor sobrevida que la población general hasta los 12 años, luego de lo cual la mediana de sobrevida es menor que la de la población general. La regresión multiparamétrica de Weibull estimó hazard ratios de 1,53 (intervalo de confianza 95%: 1,27 a 1,84) en mujeres, de 1,09 (1,08 a 1,10) por cada año de edad y de 1,29 (1,07 a 1,53) en artroplastia de cadera. Conclusión La mortalidad después de una intervención de artroplastia de rodilla o cadera sigue un comportamiento bimodal respecto a la población general similar a series reportadas en Estados Unidos y Suecia. Inicialmente la sobrevida es mayor que la población general, pero es menor luego de 12 a 15 años.

Background The purpose of this study is to determine if patients with osteoarthritis that undergo hip or knee arthroplasty jeopardize their life expectancy in Chile. Methods A survival analysis study was designed and approved by our institutional ethics review board. Patients were included if they underwent surgery for hip or knee osteoarthritis and were 50 years or older at the time of surgery. Patients were excluded if arthroplasty was performed for fracture, hemophilia arthropathy, or tumor. A multiparametric Weibull regression was estimated, and the hazard ratio was reported. For internal validity, a bootstrap of 200 repetitions was performed. Results A total of 4 094 arthroplasties were included. The Kaplan-Meier curve estimates a higher survival than the general population up to 12 years, after which the median survival is less than the general population. The bootstrap multiparametric Weibull regression estimated a hazard ratio of 1.53 (95% confidence interval: 1.27 to 1.84) for women, 1.09 (1.08 to 1.10) for every year older, and 1.29 (1.07 to 1.53) for hip arthroplasty patients. Conclusion Mortality after hip and knee arthroplasty in Chile follows a bimodal behavior similar to reports from the United States and Europe. At first, mortality is lower than the general population but worsens after 12 to 15 years of surgery.

Femoroacetabular Impingement and Acetabular Labral Tears - Part 1: Pathophysiology and Biomechanics / Impacto femoroacetabular e lesão do lábio acetabular - Parte 1: Fisiopatologia e biomecânica

Abstract Femoroacetabular impingement (FAI) is an important cause of hip pain, and the main etiology of hip osteoarthritis in the young population. Femoroacetabular impingement is characterized by subtle alterations in the anatomy of the acetabulum and proximal femur, which can lead to labrum tearing. The acetabular labrum is essential to the stability of the hip joint. Three types of FAI were described: cam (anespherical femoral head), pincer (acetabular overcoverage) and mixed (characteristics of both cam and pincer). The etiology of FAI is related to genetic and environmental characteristics. Knowledge of this condition is essential to adequately treat patients presenting with hip pain.

Resumo O impacto femoroacetabular (IFA) é uma importante causa de dor no quadril, e a principal etiologia da osteoartrose do quadril no jovem. O IFA é caracterizado por alterações sutis da anatomia do acetábulo e do fêmur proximal que podem causar lesões do complexo condrolabial. O lábio é uma estrutura fibrocartilaginosa essencial na estabilidade articular. Três tipos de IFA são descritos: came (onde há uma anesfericidade da cabeça femoral), pincer (onde há uma sobrecobertura acetabular) e misto (que apresenta características de ambos). A etiologia do IFA está relacionada com características genéticas e ambientais. O conhecimento desta doença e sua fisiopatologia é essencial para o tratamento de pacientes que apresentam dor no quadril.