Validación de la versión española de la escala de Harris modificada / Validation of the Spanish version of the modified Harris score

Antecedentes y objetivos: La escala de Harris modificada (EHM) es una de las herramientas más utilizadas para valorar pacientes con patología de cadera. A pesar de contar con una adaptación transcultural al español realizada por Lara et al., no cuenta con estudios que sustenten su validez. Se pretende obtener una validación de la versión adaptada de la EHM (ES-EHM), comparándola con la escala WOMAC. Materiales y métodos: La ES-EHM se aplicó a 100 pacientes operados de prótesis total de cadera: (1) previamente a la cirugía (ES-EHM prequirúrgica), (2) 2 años tras la cirugía (ES-EHM posquirúrgica) y (3) 6 meses después de la aplicación de la ES-EHM posquirúrgica (ES-EHM final). Se aplicó también, en una ocasión, el cuestionario WOMAC. Se compararon las medias de la ES-EHM prequirúrgica, posquirúrgica y final, así como la totalidad y los parámetros de dolor y función de la ES-EHM con la escala WOMAC. Se obtuvieron parámetros de fiabilidad, validez y sensibilidad al cambio. Resultados: Al comparar la ES-EHM prequirúrgica y la posquirúrgica, se observó una mejoría clínicamente relevante (46,54 puntos). Al comparar la ES-EHM posquirúrgica y la final, no se detectaron diferencias. Se obtuvo una correlación fuerte entre: (1) la ES-EHM posquirúrgica y la ES-EHM final, (2) ES-EHM y WOMAC y (3) parámetros de dolor y función de la ES-EHM y la WOMAC. El índice de respuesta media estandarizada fue de 2,99, la fiabilidad test-retest representada por el coeficiente de correlación intraclase de 0,90 y el índice de consistencia interna alfa de Cronbach de 0,95. Conclusiones: La adaptación transcultural de la ES-EHM muestra ser fiable, válida y sensible al cambio. Por lo tanto, el personal médico de la población española podrá aplicar la ES-EHM con el respaldo científico y la certeza de estar midiendo los parámetros deseados.(AU)

Background and objectives: Modified Harris Hip Score (HHS) is one of the most used scales in the assessment of patients with hip pathology. Although a Spanish cross-cultural adaptation has been recently published, there are many studies supporting its validity yet. Therefore, the aim of this study is to validate the newly adapted Spanish version of the HHS (ES-EHM), comparing it with the WOMAC scale. Materials and methods: The ES-EHM scale was applied to 100 patients who underwent a total hip replacement, in three different situations: (1) prior to surgery (pre-surgical ES-EHM), (2) after surgery, with at least 2 years of follow up (after surgery ES-EHM), and (3) 6 months after the postsurgical registration (final ES-EHM). WOMAC questionnaire was also applied once. We analyzed data of scale main score, pain score, function-related score as well as the mean of pre-surgical, postsurgical and final postsurgical ES-EHM scale, in both the ES-EHM and the WOMAC scales. Parameters of reliability, validity and sensitivity to change were obtained. Results: Clinically relevant improvement was observed (46.55 points) when comparing pre-surgical and post-surgical ES-EHM scores. However, no differences between postsurgical and final ES-EHM were detected. Even so, strong correlation was obtained between the following: (1) postsurgical ES-EHM and final ES-EHM scores, (2) ES-EHM and WOMAC scores, and (3) pain and function-related parameters of ES-EHM and WOMAC scores. Standardized response mean (SRM) was 2.99, test–retest reliability expressed by the intraclass correlation coefficient was 0.90 and Cronbach index 0.95. ConclusionsThe Spanish cross-cultural adaptation of the EHM scale shows to be reliable, valid and sensitive to change. Thus, the Spanish medical staff will be able to apply the ES-EHM scale with good scientific support.(AU)

Validation of the Spanish version of the modified Harris score. / Validación de la versión española de la escala de Harris modificada.

BACKGROUND AND OBJECTIVES: Modified Harris Hip Score (HHS) is one of the most used scales in the assessment of patients with hip pathology. Although a Spanish cross-cultural adaptation has been recently published, there are many studies supporting its validity yet. Therefore, the aim of this study is to validate the newly adapted Spanish version of the HHS (ES-EHM), comparing it with the WOMAC scale. MATERIALS AND METHODS: The ES-EHM scale was applied to 100 patients who underwent a total hip replacement, in three different situations: (1) prior to surgery (pre-surgical ES-EHM), (2) after surgery, with at least 2 years of follow up (after surgery ES-EHM), and (3) 6 months after the postsurgical registration (final ES-EHM). WOMAC questionnaire was also applied once. We analyzed data of scale main score, pain score, function-related score as well as the mean of pre-surgical, postsurgical and final postsurgical ES-EHM scale, in both the ES-EHM and the WOMAC scales. Parameters of reliability, validity and sensitivity to change were obtained. RESULTS: Clinically relevant improvement was observed (46.55 points) when comparing pre-surgical and post-surgical ES-EHM scores. However, no differences between postsurgical and final ES-EHM were detected. Even so, strong correlation was obtained between the following: (1) postsurgical ES-EHM and final ES-EHM scores, (2) ES-EHM and WOMAC scores, and (3) pain and function-related parameters of ES-EHM and WOMAC scores. Standardized response mean (SRM) was 2.99, test-retest reliability expressed by the intraclass correlation coefficient was 0.90 and Cronbach index 0.95. CONCLUSIONS: The Spanish cross-cultural adaptation of the EHM scale shows to be reliable, valid and sensitive to change. Thus, the Spanish medical staff will be able to apply the ES-EHM scale with good scientific support.

[Translated article] Validation of the Spanish version of the modified Harris score.

BACKGROUND AND OBJECTIVES: Modified Harris Hip Score (HHS) is one of the most used scales in the assessment of patients with hip pathology. Although a Spanish cross-cultural adaptation has been recently published, there are many studies supporting its validity yet. Therefore, the aim of this study is to validate the newly adapted Spanish version of the HHS (ES-EHM), comparing it with the WOMAC scale. MATERIALS AND METHODS: The ES-EHM scale was applied to 100 patients who underwent a total hip replacement, in three different situations: (1) prior to surgery (pre-surgical ES-EHM), (2) after surgery, with at least 2 years of follow up (after surgery ES-EHM), and (3) 6 months after the postsurgical registration (final ES-EHM). WOMAC questionnaire was also applied once. We analysed data of scale main score, pain score, function-related score as well as the mean of pre-surgical, postsurgical and final postsurgical ES-EHM scale, in both the ES-EHM and the WOMAC scales. Parameters of reliability, validity and sensitivity to change were obtained. RESULTS: Clinically relevant improvement was observed (46.55 points) when comparing pre-surgical and post-surgical ES-EHM scores. However, no differences between postsurgical and final ES-EHM were detected. Even so, strong correlation was obtained between the following: (1) postsurgical ES-EHM and final ES-EHM scores, (2) ES-EHM and WOMAC scores, and (3) pain and function-related parameters of ES-EHM and WOMAC scores. Standardised response mean (SRM) was 2.99, test-retest reliability expressed by the intraclass correlation coefficient was 0.90 and Cronbach index 0.95. CONCLUSIONS: The Spanish cross-cultural adaptation of the EHM scale shows to be reliable, valid and sensitive to change. Thus, the Spanish medical staff will be able to apply the ES-EHM scale with good scientific support.

Total hip arthroplasty associated with transverse subtrochanteric shortening osteotomy and conical stem fixation in Crowe type IV hip dysplasia.

PURPOSE: Total hip arthroplasty (THA) in high-dislocated hip dysplasia is a surgical challenge, presenting difficulties in the biomechanical reconstruction of the hip. The purpose of the present study is to analyze clinical and radiological outcomes of a series of patients with Crowe type IV hip dysplasia who underwent a THA with transverse subtrochanteric shortening osteotomy and conical stem fixation in our Hip surgery unit. METHODS: This non-interventional retrospective study included all patients diagnosed with Crowe type IV hip dysplasia who underwent a THA using a subtrochanteric shortening osteotomy and uncemented conical stem fixation between January 1, 2008, and December 31, 2015. Demographic, clinical and radiologic data were analyzed, including Harris Hip Score and Oxford Hip Score. RESULTS: Seventeen hips in 13 patients were included in the final analysis. All patients were women and mean age was 39 years (range 35-45). Mean follow-up was 5.6 years (range 1-8). Average length of the osteotomy was 3.4 cm (range 3-4.5) and mean lowering of the center of rotation was 5.67 cm (range 3.8-9.1). Mean time for bone union was 5.5 months. No nerve palsy or non-union was detected at the end of follow-up period. CONCLUSION: The use of cementless conical stem fixation associated with a transverse subtrochanteric shortening osteotomy for treating Crowe type IV hip dysplasia permits to correct the rotational alterations of the femur and provides good stability of the osteotomy, with very low risk of nerve palsy and non-union rates.

Cross-cultural adaptation for the Spanish population of the modified Harris score for functional and symptomatic hip joint assessment. / Adaptación transcultural para la población española de la escala de Harris modificada para la valoración funcional y sintomática de la articulación de la cadera.

BACKGROUND AND OBJECTIVES: The modified Harris hip score, is one of the most widely used scales for the functional assessment of hip pathology of the patients. However, there is no cross-cultural adaptation for the Spanish society. Therefore, this study aims to obtain a cross-cultural adaptation of the modified Harris hip score for the Spanish population. MATERIALS AND METHODS: For the cross-cultural adaptation the Beaton method was used, which includes: 2 translations into Spanish; expert review of the 2 provisional versions and obtaining a single Spanish version; reverse translation (into English) of the Spanish version; and application of the adapted version. The adapted version was applied twice to 100 patients, 6 months apart. RESULTS: Between the initial and final application of the adapted version, no clinically relevant differences were found. CONCLUSIONS: A cross-cultural translation and adaptation of the modified Harris hip score for the Spanish population was obtained, which should be applied to the Spanish population and to all Spanish-speaking countries, as long as they do not have an adapted version for the population to which they belong.

Adaptación transcultural para la población española de la escala de Harris modificada para la valoración funcional y sintomática de la articulación de la cadera / Cross-cultural adaptation for the Spanish population of the modified Harris score for functional and symptomatic hip joint assessment

Antecedente y objetivos: La Escala de Harris modificada es una de las escalas más utilizadas para la valoración funcional de los pacientes en la patología de cadera. Sin embargo, no existe una adaptación transcultural para la sociedad española. Por tanto, este estudio se plantea obtener una adaptación transcultural para la población española de la escala de cadera de Harris modificada. Materiales y métodos: Para la adaptación transcultural se utilizó el método de Beaton que incluye: 2 traducciones al idioma español; revisión por expertos de las 2 versiones provisionales y obtención de una única versión en español; traducción reversa (a inglés) de la versión en español; y aplicación de la versión adaptada. La versión adaptada fue aplicada en 2 ocasiones a 100 pacientes, con un periodo de separación de 6 meses. Resultados: Entre la aplicación inicial y final de la versión adaptada no se encontró diferencias clínicamente relevantes. Conclusiones: Se obtuvo una traducción y adaptación transcultural para la población española de la escala de cadera de Harris modificada, la misma que debería ser aplicada a la población española y a todos los países hispanohablantes, mientras no cuenten con una versión adaptada para la población a la que pertenecen.(AU)

Background and objectives: The modified Harris hip score, is one of the most widely used scales for the functional assessment of hip pathology of the patients. However, there is no cross-cultural adaptation for the Spanish society. Therefore, this study aims to obtain a cross-cultural adaptation of the modified Harris hip score for the Spanish population. Materials and methods: For the cross-cultural adaptation the Beaton method was used, which includes: 2 translations into Spanish; expert review of the 2 provisional versions and obtaining a single Spanish version; reverse translation (into English) of the Spanish version; and application of the adapted version. The adapted version was applied twice to 100 patients, 6 months apart. Results: Between the initial and final application of the adapted version, no clinically relevant differences were found. Conclusions: A cross-cultural translation and adaptation of the modified Harris hip score for the Spanish population was obtained, which should be applied to the Spanish population and to all Spanish-speaking countries, as long as they do not have an adapted version for the population to which they belong.(AU)

Cross-cultural adaptation for the Spanish population of the modified Harris score for functional and symptomatic hip joint assessment / Adaptación transcultural para la población española de la escala de Harris modificada para la valoración funcional y sintomática de la articulación de la cadera

Background and objectives: The modified Harris hip score, is one of the most widely used scales for the functional assessment of hip pathology of the patients. However, there is no cross-cultural adaptation for the Spanish society. Therefore, this study aims to obtain a cross-cultural adaptation of the modified Harris hip score for the Spanish population. Materials and methods: For the cross-cultural adaptation the Beaton method was used, which includes: 2 translations into Spanish; expert review of the 2 provisional versions and obtaining a single Spanish version; reverse translation (into English) of the Spanish version; and application of the adapted version. The adapted version was applied twice to 100 patients, 6 months apart. Results: Between the initial and final application of the adapted version, no clinically relevant differences were found. Conclusions: A cross-cultural translation and adaptation of the modified Harris hip score for the Spanish population was obtained, which should be applied to the Spanish population and to all Spanish-speaking countries, as long as they do not have an adapted version for the population to which they belong.(AU)

Antecedente y objetivos: La Escala de Harris modificada es una de las escalas más utilizadas para la valoración funcional de los pacientes en la patología de cadera. Sin embargo, no existe una adaptación transcultural para la sociedad española. Por tanto, este estudio se plantea obtener una adaptación transcultural para la población española de la escala de cadera de Harris modificada. Materiales y métodos: Para la adaptación transcultural se utilizó el método de Beaton que incluye: 2 traducciones al idioma español; revisión por expertos de las 2 versiones provisionales y obtención de una única versión en español; traducción reversa (a inglés) de la versión en español; y aplicación de la versión adaptada. La versión adaptada fue aplicada en 2 ocasiones a 100 pacientes, con un periodo de separación de 6 meses. Resultados: Entre la aplicación inicial y final de la versión adaptada no se encontró diferencias clínicamente relevantes. Conclusiones: Se obtuvo una traducción y adaptación transcultural para la población española de la escala de cadera de Harris modificada, la misma que debería ser aplicada a la población española y a todos los países hispanohablantes, mientras no cuenten con una versión adaptada para la población a la que pertenecen.(AU)

Luxación temprana en artroplastias total de cadera primarias realizadas mediante vía posterior con reparación capsular y de rotadores externos / Early dislocation in primary total hip arthroplasty using a posterior approach with repair of capsule and external rotators

Objetivo: Determinar la incidencia de luxación después de una artroplastia total de cadera primaria utilizando un abordaje posterior con reparación capsular y reinserción transósea de rotadores externos. Material y método: Estudio de una cohorte histórica entre enero del 2009 y diciembre del 2015 de todos los casos de luxación de artroplastia total de cadera primaria intervenidos mediante un abordaje posterior con reparación capsular y reinserción transósea de rotadores externos. Se recogieron y analizaron los datos demográficos y los datos clínicos referentes al paciente, a la cirugía y a la luxación. Se realizaron un análisis descriptivo y un estudio de supervivencia y función de riesgo por el método de Kaplan-Meier considerando como evento final la aparición de una luxación de cadera. Resultados: La incidencia de luxación en nuestro estudio fue del 1,2% (23 casos). En nuestro estudio, la mayor probabilidad de luxación ocurrió en los primeros 120 días. El 43,5% de pacientes luxados necesitaron cirugía de revisión. Conclusiones: La reparación capsular y la reinserción transósea de los rotadores externos pueden contribuir a reducir la incidencia de luxación en los pacientes operados de una artroplastia total de cadera mediante una vía posterior

Objective: To determine the incidence of dislocation after primary total hip arthroplasty using a posterior approach with repair of capsule and transosseous external rotators. Material and method: Historical cohort study between January 2009 and December 2015 of all the cases of dislocation of primary total hip arthroplasty operated using a posterior approach with repair of capsule and transosseous external rotators. Demographic and clinical data concerning the patient, surgery and dislocation were collected and analyzed. A descriptive analysis and a study of survival and risk function were performed by Kaplan Meier's method considering the appearance of a hip dislocation as the final event. Results: The incidence of dislocation in our study was 1.2% (23 patients). In our study, the highest probability of dislocation occurred in the first 120 days. Forty-three point 5percent of the dislocated patients needed revision surgery. Conclusions: Capsular repair and transosseous reattachment of the external rotators can help to reduce the incidence of dislocation in patients undergoing primary total hip arthroplasty through a posterior approach

Early dislocation in primary total hip arthroplasty using a posterior approach with repair of capsule and external rotators. / Luxación temprana en artroplastias total de cadera primarias realizadas mediante vía posterior con reparación capsular y de rotadores externos.

OBJECTIVE: To determine the incidence of dislocation after primary total hip arthroplasty using a posterior approach with repair of capsule and transosseous external rotators. MATERIAL AND METHOD: Historical cohort study between January 2009 and December 2015 of all the cases of dislocation of primary total hip arthroplasty operated using a posterior approach with repair of capsule and transosseous external rotators. Demographic and clinical data concerning the patient, surgery and dislocation were collected and analyzed. A descriptive analysis and a study of survival and risk function were performed by Kaplan Meier's method considering the appearance of a hip dislocation as the final event. RESULTS: The incidence of dislocation in our study was 1.2% (23 patients). In our study, the highest probability of dislocation occurred in the first 120 days. Forty-three point 5percent of the dislocated patients needed revision surgery. CONCLUSIONS: Capsular repair and transosseous reattachment of the external rotators can help to reduce the incidence of dislocation in patients undergoing primary total hip arthroplasty through a posterior approach.

Bilateral insufficiency hip fractures after bariatric surgery.

Bariatric surgery is one of the most common surgeries within developed countries due to the increase in morbid obesity that has been observed in the past decades. The short-term alterations in the metabolism of calcium and vitamin D are well known after these procedures; however, the clinical and biochemical consequences may not be detected for years or even remain undiagnosed. We present the first case of bilateral insufficiency hip fracture after years of bariatric surgery. Although this is a long-term and rare complication, with the high number of gastric bypass performed in the past years, the number of these cases could increase with time. Moreover, it is important as an undiagnosed hip fracture can cause a displacement that could need an arthroplasty, with all the complications that entails. For that reason, this long-term complication highlights the need to reevaluate the optimal follow-up of these patients and the importance to continue monitoring metabolic bone diseases in the prevention of insufficiency fractures.

Fracture of the Modular Neck in Total Hip Arthroplasty.

Modularity of the components in total hip arthroplasty has had an increase in popularity in the last decades. We present the case of a 53-year-old man with a history of avascular necrosis of the femoral head due to a hypophyseal adenoma. A total hip modular arthroplasty was implanted. Three and a half years after the surgery the patient attended the emergency room due to acute left hip pain with no prior traumatism. Radiological examination confirmed a fracture of the modular neck. A revision surgery was performed finding an important pseudotumoral well-organized periprosthetic tissue reaction. Through an extended trochanteric osteotomy the femoral component was removed, and a straight-stem revision prosthesis implanted. There are several potential advantages when using modularity in total hip arthroplasty that surgeons may benefit from, but complications have arisen and must be addressed. Various circumstances such as large femoral head with a long varus neck, corrosion, patient's BMI, and activity level may participate in creating the necessary environment for fatigue failure of the implant.