[Translated article] In vitro elution of local anaesthetics from PMMA bone cement.

BACKGROUND AND AIM: Currently, we do not have a gold standard for pain management after total knee arthroplasty. We may use one of more drug delivery systems, none of which are ideal. An ideal depot delivery system would provide therapeutic, nontoxic, doses of drug at the surgical side, especially during 72h postoperatively. The bone cement used in arthroplasties has been used as a drug delivery system, especially antibiotics, since 1970. Based on this principle, we developed this study with the aim to characterize the elution profile of two local anaesthetics (lidocaine hydrochloride and bupivacaine hydrochloride) from PMMA (polymethilmethacrylate) bone cement. MATERIAL AND METHODS: Palacos® R+G bone cement and lidocaine hydrochloride or bupivacaine hydrochloride specimens were obtained depending on the study group. These specimens were immersed in PBS (phosphate buffered saline) and removed from the solution at different set times. Subsequently, the concentration of local anaesthetic in the liquid was analyzed by liquid chromatography. RESULTS: The percentage of lidocaine eluted from PMMA bone cement in this study was 9.74% of the total lidocaine content per specimen at 72h and 18.73% at 336h (14 days). In case of bupivacaine, the elution percentage was 2.71% of the total bupivacaine content per specimen at 72h and 2.70% at 336h (14 days). CONCLUSIONS: Local anaesthetics elute in vitro from PMMA bone cement, reaching doses at 72h close to the doses used in anaesthetic blocks.

[Translated article] Study of femoral component malrotation as a cause of pain after total knee arthroplasty.

INTRODUCTION: The total knee arthroplasty (TKA) has been shown to be a successful and cost-benefit procedure in terms of pain improvement in patient with symptomatic knee osteoarthritis. However, almost a 20% of the patients are not satisfied with the result of the surgery. MATERIAL AND METHOD: We have carried out a transversal unicentric cases controls study with clinical cases of the own hospital, obtained by a clinical records revision. A total of 160 patients with a TKA with at least 1 year of follow-up were selected. Demographic variables, functional scales (WOMAC and VAS) and rotation of the femoral component through the analysis of the images obtained by CT scan were collected. RESULTS: The total was 133 patients that was divided in two groups. A control group and pain group. The Control group was made up of 70 patients with a mean age of 69.59 years (23 men and 47 women) and the pain group was made up of 63 patients with a mean age of 69.48 years (13 men and 50 women). We didn't find difference regarding the analysis of the rotation of the femoral component. In addition, we were not found significant differences when applying a stratification by sex. And, the analysis of the malrotation of the femoral component, previously defining limits of value rotation considered as extreme, in any of the case did not show significant differences. CONCLUSION: The results of the study confirm that malrotation of the femoral component had no influence on the presence of pain at a minimum of one year of follow-up after TKA implantation.

Estudio in vitro de elución de anestésicos locales en cemento óseo de PMMA / In vitro elution of local anesthetics from PMMA bone cement

Antecedentes y objetivo:Actualmente, no disponemos de un gold standard para el manejo del dolor postoperatorio tras una artroplastia total de rodilla, dado que se pueden administrar analgésicos a través de diferentes vías y ninguna de estas está exenta de riesgos. El sistema ideal de administración de analgésicos debería proporcionar dosis terapéuticas, no tóxicas, en el sitio quirúrgico, especialmente durante las primeras 72h. El cemento óseo utilizado en las artroplastias se ha usado como un medio de liberación de fármacos, especialmente antibióticos, desde 1970. Basado en este principio, se desarrolló este estudio con el objetivo de conocer el perfil de elución de dos anestésicos locales (hidrocloruro de lidocaína e hidrocloruro de bupivacaína) desde el cemento óseo de polimetilmetacrilato (PMMA). Material y métodos: Se obtuvieron especímenes de cemento óseo Palacos® R+G e hidrocloruro de lidocaína o hidrocloruro de bupivacaína según el grupo de estudio. Estos especímenes se sumergieron en PBS (por sus siglas en inglés de phosphate buffered saline) y se retiraron de la solución en diferentes cortes temporales establecidos. Posteriormente, se analizó la concentración de anestésico local en el líquido mediante cromatografía líquida. Resultados: El porcentaje de lidocaína eludida del cemento óseo PMMA de este estudio ha sido del 9,74% del contenido total de lidocaína por espécimen a las 72h y del 18,73% a las 336h (14 días). En el caso de la bupivacaína, el porcentaje de elución ha sido del 2,71% del contenido total de bupivacaína por espécimen a las 72h y del 2,70% a las 336h (14 días). Conclusiones: Los anestésicos locales eluyen in vitro desde el cemento óseo, alcanzando a las 72h dosis cercanas a las dosis utilizadas en bloqueos anestésicos.(AU)

Background and aim: Currently, we do not have a gold standard for pain management after total knee arthroplasty. We may use one of more drug delivery systems, none of which are ideal. An ideal depot delivery system would provide therapeutic, nontoxic, doses of drug at the surgical side, especially during 72h postoperatively. The bone cement used in arthroplasties has been used as a drug delivery system, especially antibiotics, since 1970. Based on this principle, we developed this study with the aim to characterize the elution profile of two local anesthetics (lidocaine hydrochloride and bupivacaine hydrochloride) from PMMA (polymethilmethacrylate) bone cement. Material and methods: Palacos® R+G bone cement and lidocaine hydrochloride or bupivacaine hydrochloride specimens were obtained depending on the study group. These specimens were immersed in PBS (phosphate buffered saline) and removed from the solution at different set times. Subsequently, the concentration of local anesthetic in the liquid was analyzed by liquid chromatography. Results: The percentage of lidocaine eluted from PMMA bone cement in this study was 9.74% of the total lidocaine content per specimen at 72h and 18.73% at 336h (14 days). In case of bupivacaine, the elution percentage was 2.71% of the total bupivacaine content per specimen at 72h and 2.70% at 336h (14 days). Conclusions: Local anesthetics elute in vitro from PMMA bone cement, reaching doses at 72h close to the doses used in anesthetic blocks.(AU)

[Translated article] In vitro elution of local anaesthetics from PMMA bone cement / Estudio in vitro de elución de anestésicos locales en cemento óseo de PMMA

Antecedentes y objetivo:Actualmente, no disponemos de un gold standard para el manejo del dolor postoperatorio tras una artroplastia total de rodilla, dado que se pueden administrar analgésicos a través de diferentes vías y ninguna de estas está exenta de riesgos. El sistema ideal de administración de analgésicos debería proporcionar dosis terapéuticas, no tóxicas, en el sitio quirúrgico, especialmente durante las primeras 72h. El cemento óseo utilizado en las artroplastias se ha usado como un medio de liberación de fármacos, especialmente antibióticos, desde 1970. Basado en este principio, se desarrolló este estudio con el objetivo de conocer el perfil de elución de dos anestésicos locales (hidrocloruro de lidocaína e hidrocloruro de bupivacaína) desde el cemento óseo de polimetilmetacrilato (PMMA). Material y métodos: Se obtuvieron especímenes de cemento óseo Palacos® R+G e hidrocloruro de lidocaína o hidrocloruro de bupivacaína según el grupo de estudio. Estos especímenes se sumergieron en PBS (por sus siglas en inglés de phosphate buffered saline) y se retiraron de la solución en diferentes cortes temporales establecidos. Posteriormente, se analizó la concentración de anestésico local en el líquido mediante cromatografía líquida. Resultados: El porcentaje de lidocaína eludida del cemento óseo PMMA de este estudio ha sido del 9,74% del contenido total de lidocaína por espécimen a las 72h y del 18,73% a las 336h (14 días). En el caso de la bupivacaína, el porcentaje de elución ha sido del 2,71% del contenido total de bupivacaína por espécimen a las 72h y del 2,70% a las 336h (14 días). Conclusiones: Los anestésicos locales eluyen in vitro desde el cemento óseo, alcanzando a las 72h dosis cercanas a las dosis utilizadas en bloqueos anestésicos.(AU)

Background and aim: Currently, we do not have a gold standard for pain management after total knee arthroplasty. We may use one of more drug delivery systems, none of which are ideal. An ideal depot delivery system would provide therapeutic, nontoxic, doses of drug at the surgical side, especially during 72h postoperatively. The bone cement used in arthroplasties has been used as a drug delivery system, especially antibiotics, since 1970. Based on this principle, we developed this study with the aim to characterize the elution profile of two local anesthetics (lidocaine hydrochloride and bupivacaine hydrochloride) from PMMA (polymethilmethacrylate) bone cement. Material and methods: Palacos® R+G bone cement and lidocaine hydrochloride or bupivacaine hydrochloride specimens were obtained depending on the study group. These specimens were immersed in PBS (phosphate buffered saline) and removed from the solution at different set times. Subsequently, the concentration of local anesthetic in the liquid was analyzed by liquid chromatography. Results: The percentage of lidocaine eluted from PMMA bone cement in this study was 9.74% of the total lidocaine content per specimen at 72h and 18.73% at 336h (14 days). In case of bupivacaine, the elution percentage was 2.71% of the total bupivacaine content per specimen at 72h and 2.70% at 336h (14 days). Conclusions: Local anesthetics elute in vitro from PMMA bone cement, reaching doses at 72h close to the doses used in anesthetic blocks.(AU)

Situación actual de la robótica en cirugía protésica de rodilla, ¿una tecnología que ha venido para quedarse? / Current situation of robotics in knee prosthetic surgery, a technology that has come to stay?

La cirugía robótica es una técnica quirúrgica que va en aumento. El objetivo de la artroplastia total de rodilla asistida por robot (ATRar) es el de proveer al cirujano de una herramienta para ejecutar de forma precisa los cortes óseos de acuerdo con una planificación quirúrgica previa para restablecer la cinemática de una rodilla primitiva y el balance de partes blandas, pudiendo aplicar de forma precisa el tipo de alineación que escojamos. Además, la ATRar es una herramienta muy útil para la formación.Dentro de las limitaciones, encontramos la curva de aprendizaje, la necesidad de equipos específicos, los costes elevados de adquisición de los dispositivos, en algunos sistemas el aumento de radiación y que cada robot está ligado a un tipo específico de implante.Los estudios actuales muestran que con la ATRar disminuyen las variaciones de alineación del eje mecánico, mejora el dolor posoperatorio y se facilita un alta más precoz. Por otro lado, no muestran diferencias a nivel de rango de movimiento, alineación, balance de gaps, complicaciones, tiempo quirúrgico o resultados funcionales.(AU)

Robotic surgery is a surgical technique that is on the rise. The goal of robotic-assisted total knee arthroplasty (RA-TKA) is to provide the surgeon with a tool to accurately execute bone cuts according to previous surgical planning to restore knee kinematics and balance of soft tissue, being able to precisely apply the type of alignment that we choose. In addition, RA-TKA is a very useful tool for training.Within the limitations, there is the learning curve, the need for specific equipment, the high cost of the devices, the increase in radiation in some systems and that each robot is linked to a specific type of implant.Current studies show, with RA-TKA, variations in the alignment of the mechanical axis are reduced, postoperative pain is improved and earlier discharge is facilitated. On the other hand, there are no differences in terms of range of motion, alignment, gap balance, complications, surgical time or functional results.(AU)

[Translated article] Current situation of robotics in knee prosthetic surgery: A technology that has come to stay? / Situación actual de la robótica en cirugía protésica de rodilla, ¿una tecnología que ha venido para quedarse?

La cirugía robótica es una técnica quirúrgica que va en aumento. El objetivo de la artroplastia total de rodilla asistida por robot (ATRar) es el de proveer al cirujano de una herramienta para ejecutar de forma precisa los cortes óseos de acuerdo con una planificación quirúrgica previa para restablecer la cinemática de una rodilla primitiva y el balance de partes blandas, pudiendo aplicar de forma precisa el tipo de alineación que escojamos. Además, la ATRar es una herramienta muy útil para la formación.Dentro de las limitaciones, encontramos la curva de aprendizaje, la necesidad de equipos específicos, los costes elevados de adquisición de los dispositivos, en algunos sistemas el aumento de radiación y que cada robot está ligado a un tipo específico de implante.Los estudios actuales muestran que con la ATRar disminuyen las variaciones de alineación del eje mecánico, mejora el dolor posoperatorio y se facilita un alta más precoz. Por otro lado, no muestran diferencias a nivel de rango de movimiento, alineación, balance de gaps, complicaciones, tiempo quirúrgico o resultados funcionales.(AU)

Robotic surgery is a surgical technique that is on the rise. The goal of robotic-assisted total knee arthroplasty (RA-TKA) is to provide the surgeon with a tool to accurately execute bone cuts according to previous surgical planning to restore knee kinematics and balance of soft tissue, being able to precisely apply the type of alignment that we choose. In addition, RA-TKA is a very useful tool for training.Within the limitations, there is the learning curve, the need for specific equipment, the high cost of the devices, the increase in radiation in some systems and that each robot is linked to a specific type of implant.Current studies show, with RA-TKA, variations in the alignment of the mechanical axis are reduced, postoperative pain is improved and earlier discharge is facilitated. On the other hand, there are no differences in terms of range of motion, alignment, gap balance, complications, surgical time or functional results.(AU)

[Translated article] In vitro elution of local anaesthetics from PMMA bone cement.

BACKGROUND AND AIM: Currently, we do not have a gold standard for pain management after total knee arthroplasty. We may use one of more drug delivery systems, none of which are ideal. An ideal depot delivery system would provide therapeutic, nontoxic, doses of drug at the surgical side, especially during 72h postoperatively. The bone cement used in arthroplasties has been used as a drug delivery system, especially antibiotics, since 1970. Based on this principle, we developed this study with the aim to characterise the elution profile of two local anaesthetics (lidocaine hydrochloride and bupivacaine hydrochloride) from PMMA (polymethilmethacrylate) bone cement. MATERIAL AND METHODS: Palacos® R+G bone cement and lidocaine hydrochloride or bupivacaine hydrochloride specimens were obtained depending on the study group. These specimens were immersed in PBS (phosphate buffered saline) and removed from the solution at different set times. Subsequently, the concentration of local anaesthetic in the liquid was analysed by liquid chromatography. RESULTS: The percentage of lidocaine eluted from PMMA bone cement in this study was 9.74% of the total lidocaine content per specimen at 72h and 18.73% at 336h (14 days). In case of bupivacaine, the elution percentage was 2.71% of the total bupivacaine content per specimen at 72h and 2.70% at 336h (14 days). CONCLUSIONS: Local anaesthetics elute in vitro from PMMA bone cement, reaching doses at 72h close to the doses used in anaesthetic blocks.

In vitro elution of local anesthetics from PMMA bone cement. / Estudio in vitro de elución de anestésicos locales en cemento óseo de PMMA.

BACKGROUND AND AIM: Currently, we do not have a gold standard for pain management after total knee arthroplasty. We may use one of more drug delivery systems, none of which are ideal. An ideal depot delivery system would provide therapeutic, nontoxic, doses of drug at the surgical side, especially during 72h postoperatively. The bone cement used in arthroplasties has been used as a drug delivery system, especially antibiotics, since 1970. Based on this principle, we developed this study with the aim to characterize the elution profile of two local anesthetics (lidocaine hydrochloride and bupivacaine hydrochloride) from PMMA (polymethilmethacrylate) bone cement. MATERIAL AND METHODS: Palacos® R+G bone cement and lidocaine hydrochloride or bupivacaine hydrochloride specimens were obtained depending on the study group. These specimens were immersed in PBS (phosphate buffered saline) and removed from the solution at different set times. Subsequently, the concentration of local anesthetic in the liquid was analyzed by liquid chromatography. RESULTS: The percentage of lidocaine eluted from PMMA bone cement in this study was 9.74% of the total lidocaine content per specimen at 72h and 18.73% at 336h (14 days). In case of bupivacaine, the elution percentage was 2.71% of the total bupivacaine content per specimen at 72h and 2.70% at 336h (14 days). CONCLUSIONS: Local anesthetics elute in vitro from PMMA bone cement, reaching doses at 72h close to the doses used in anesthetic blocks.

Study of femoral component malrotation as a cause of pain after total knee arthroplasty. / Estudio de la malrotación del componente femoral como causa de dolor tras la implantación de una artroplastia total de rodilla.

INTRODUCTION: The total knee arthroplasty (TKA) has been shown to be a successful and cost-benefit procedure in terms of pain improvement in patient with symptomatic knee osteoarthritis. However, almost a 20% of the patients are not satisfied with the result of the surgery. MATERIAL AND METHOD: We have carried out a transversal unicentric cases controls study with clinical cases of the own hospital, obtained by a clinical records revision. A total of 160 patients with a TKA with at least 1year of follow-up were selected. Demographic variables, functional scales (WOMAC and VAS) and rotation of the femoral component through the analysis of the images obtained by CT scan were collected. RESULTS: The total was 133 patients that was divided in two groups. A control group and pain group. The control group was made up of 70 patients with a mean age of 69.59years (23 men and 47 women) and the pain group was made up of 63 patients with a mean age of 69.48years (13 men and 50 women). We did not found difference regarding the analysis of the rotation of the femoral component. In addition, we were not found significant differences when applying a stratification by sex. The analysis of the malrotation of the femoral component, previously defining limits of value rotation considered as extreme, in any of the case did not show significant differences. CONCLUSION: The results of the study confirm that malrotation of the femoral component had no influence on the presence of pain at a minimum of one year of follow-up after TKA implantation.

[Translated article] Current situation of robotics in knee prosthetic surgery: A technology that has come to stay?

Robotic surgery is a surgical technique that is on the rise. The goal of robotic-assisted total knee arthroplasty (RA-TKA) is to provide the surgeon with a tool to accurately execute bone cuts according to previous surgical planning to restore knee kinematics and balance of soft tissue, being able to precisely apply the type of alignment that we choose. In addition, RA-TKA is a very useful tool for training. Within the limitations, there is the learning curve, the need for specific equipment, the high cost of the devices, the increase in radiation in some systems and that each robot is linked to a specific type of implant. Current studies show, with RA-TKA, variations in the alignment of the mechanical axis are reduced, postoperative pain is improved and earlier discharge is facilitated. On the other hand, there are no differences in terms of range of motion, alignment, gap balance, complications, surgical time or functional results.

Current situation of robotics in knee prosthetic surgery, a technology that has come to stay? / Situación actual de la robótica en cirugía protésica de rodilla, ¿una tecnología que ha venido para quedarse?

Robotic surgery is a surgical technique that is on the rise. The goal of robotic-assisted total knee arthroplasty (RA-TKA) is to provide the surgeon with a tool to accurately execute bone cuts according to previous surgical planning to restore knee kinematics and balance of soft tissue, being able to precisely apply the type of alignment that we choose. In addition, RA-TKA is a very useful tool for training. Within the limitations, there is the learning curve, the need for specific equipment, the high cost of the devices, the increase in radiation in some systems and that each robot is linked to a specific type of implant. Current studies show, with RA-TKA, variations in the alignment of the mechanical axis are reduced, postoperative pain is improved and earlier discharge is facilitated. On the other hand, there are no differences in terms of range of motion, alignment, gap balance, complications, surgical time or functional results.

[Interlocking femoral nail and total knee Arthroplasty in one stage for a patient with a femoral diaphyseal stress fracture]. / Enclavado femoral y artroplastía total de rodilla en un tiempo en una paciente con fractura diafisaria femoral por estrés.

We present the case of an 81-year-old woman who was followed up by the Rheumatology Service for osteoporosis and treated with bisphosphonates for more than five years. She reported a fracture of the distal third of the contralateral femur by a low energy mechanism, treated with retrograde intramedullary nailing the previous year. She presented a clinic of cruralgia and left gonalgia, without previous trauma. A scintigraphy and radiographs were performed to support the diagnosis of stress fracture of the distal third of the left femur and osteonecrosis of the left internal femoral condyle. Thinking about the possible complications of performing two interventions in an elderly patient, we decided to complete the treatment in a single time and by the same surgical approach, trying to resolve the osteonecrosis and the fracture at the same time, with the objective of an early rehabilitation and lower morbidity. A femoral retrograde prophylactic nailing was performed to stabilize the stress fracture and a retentive primary knee prosthesis was implanted for the posterior cruciate ligament by the same surgical approach. There were no incidents in the immediate postoperative period, with ambulation beginning with help 48 hours after the intervention. The fracture consolidated and the patient presented a good functional result of the knee, both in the immediate postoperative period and at three years of follow-up.

Presentamos el caso de una mujer de 81 años de edad, en seguimiento por el Servicio de Reumatología por osteoporosis y tratada con bifosfonatos durante más de cinco años. Refirió una fractura del tercio distal del fémur contralateral por mecanismo de baja energía, tratada con enclavado intramedular retrógrado el año anterior. Presentó una clínica de cruralgia y gonalgia izquierda, sin traumatismo previo. Se le realizó una gammagrafía y radiografías que apoyaron el diagnóstico de fractura de estrés del tercio distal del fémur izquierdo y osteonecrosis del cóndilo femoral interno izquierdo. Pensando en las posibles complicaciones de llevar a cabo dos intervenciones en una paciente de avanzada edad, se decidió efectuar el tratamiento en un tiempo y por el mismo abordaje quirúrgico, tratando de resolver la osteonecrosis y la fractura a la vez, con el objetivo de una rehabilitación precoz y menor morbilidad. Se realizó un enclavado profiláctico retrógrado femoral para estabilizar la fractura de estrés y se implantó una prótesis de rodilla primaria retentiva para el ligamento cruzado posterior por el mismo abordaje quirúrgico. No hubo incidencias en el postoperatorio inmediato; se inició deambulación con ayuda a las 48 horas de la intervención. La fractura consolidó y la paciente presentó un buen resultado funcional de la rodilla, tanto en el postoperatorio inmediato como a los tres años de seguimiento.

Enclavado femoral y artroplastía total de rodilla en un tiempo en una paciente con fractura diafisaria femoral por estrés / Interlocking femoral nail and total knee Arthroplasty in one stage for a patient with a femoral diaphyseal stress fracture

Resumen: Presentamos el caso de una mujer de 81 años de edad, en seguimiento por el Servicio de Reumatología por osteoporosis y tratada con bifosfonatos durante más de cinco años. Refirió una fractura del tercio distal del fémur contralateral por mecanismo de baja energía, tratada con enclavado intramedular retrógrado el año anterior. Presentó una clínica de cruralgia y gonalgia izquierda, sin traumatismo previo. Se le realizó una gammagrafía y radiografías que apoyaron el diagnóstico de fractura de estrés del tercio distal del fémur izquierdo y osteonecrosis del cóndilo femoral interno izquierdo. Pensando en las posibles complicaciones de llevar a cabo dos intervenciones en una paciente de avanzada edad, se decidió efectuar el tratamiento en un tiempo y por el mismo abordaje quirúrgico, tratando de resolver la osteonecrosis y la fractura a la vez, con el objetivo de una rehabilitación precoz y menor morbilidad. Se realizó un enclavado profiláctico retrógrado femoral para estabilizar la fractura de estrés y se implantó una prótesis de rodilla primaria retentiva para el ligamento cruzado posterior por el mismo abordaje quirúrgico. No hubo incidencias en el postoperatorio inmediato; se inició deambulación con ayuda a las 48 horas de la intervención. La fractura consolidó y la paciente presentó un buen resultado funcional de la rodilla, tanto en el postoperatorio inmediato como a los tres años de seguimiento.

Abstract: We present the case of an 81-year-old woman who was followed up by the Rheumatology Service for osteoporosis and treated with bisphosphonates for more than five years. She reported a fracture of the distal third of the contralateral femur by a low energy mechanism, treated with retrograde intramedullary nailing the previous year. She presented a clinic of cruralgia and left gonalgia, without previous trauma. A scintigraphy and radiographs were performed to support the diagnosis of stress fracture of the distal third of the left femur and osteonecrosis of the left internal femoral condyle. Thinking about the possible complications of performing two interventions in an elderly patient, we decided to complete the treatment in a single time and by the same surgical approach, trying to resolve the osteonecrosis and the fracture at the same time, with the objective of an early rehabilitation and lower morbidity. A femoral retrograde prophylactic nailing was performed to stabilize the stress fracture and a retentive primary knee prosthesis was implanted for the posterior cruciate ligament by the same surgical approach. There were no incidents in the immediate postoperative period, with ambulation beginning with help 48 hours after the intervention. The fracture consolidated and the patient presented a good functional result of the knee, both in the immediate postoperative period and at three years of follow-up.

Artroplastia de rodilla en el contexto de una fractura de rótula en gonartrosis severa / Arthroplasty of the knee in patella fracture in a knee with severe osteoarthritis

Es objeto de debate el uso de la artroplastia total de rodilla como tratamiento agudo de las fracturas del fémur distal o de la tibia proximal. Sin embargo, en la población de edad avanzada, las comorbilidades asociadas representan un reto en el tratamiento de estos pacientes que va a favor del tratamiento combinado en un solo tiempo. Presentamos el caso clínico de una paciente de 79 años que sufrió una fractura de la rótula en una rodilla con artrosis sintomática severa. La paciente fue sometida a una artroplastia total de la rodilla y a la síntesis de la fractura de rótula en un solo tiempo quirúrgico. Este hecho nos permite realizar un único proceso de rehabilitación para las 2 enfermedades, consiguiendo una recuperación funcional más temprana que si se hubiera intervenido en 2 tiempos (AU)

The use of total knee arthroplasty for the acute treatment of fractures of the distal femur or proximal tibia is debated. However, in the elderly population, associated comorbidities represent a challenge to their treatment, supporting the use of combination therapy in a single intervention. We report the case of a 79-year- old woman with a patella fracture in a knee with severe symptomatic osteoarthritis. The patient underwent total knee arthroplasty and synthesis of the patellar fracture in one surgery. This allowed to carry out a single rehabilitation process for both conditions, which allowed to achieve an earlier functional recovery compared to the one following a two surgical stages approach (AU)