Manejo agudo de las fracturas acetabulares mediante artroplastia total de cadera con abordaje anterior / Acute management of acetabular fractures by total hip arthroscopy using an anterior approach

Introducción: Las fracturas acetabulares en pacientes de edad avanzada presentan un reto terapéutico, ya que su osteosíntesis puede estar dificultada por la conminución y la mala calidad ósea. En determinados casos, una buena solución es la artroplastia total de cadera (ATC) aguda por vía anterior directa, con o sin mínima osteosíntesis asociada. El objetivo de este estudio es establecer las indicaciones y valorar los resultados clínico-funcionales, radiológicos y complicaciones, a corto y medio plazo, de la ATC aguda mediante abordaje anterior tras fracturas acetabulares. Material y métodos: Analizamos a 15 pacientes, de los que recogimos: datos demográficos, clasificación de las fracturas, datos quirúrgicos, evaluación clínico-funcional y radiográfica evolutiva, junto con complicaciones perioperatorias. Resultados: El seguimiento medio de los pacientes ha sido de 40 meses con una valoración funcional final de 96,5 para Harris Hip Score y de excelente para Merle D'Aubigné (93%). Los controles radiológicos fueron satisfactorios, sin aflojamientos protésicos. Solo 2pacientes presentaron calcificaciones heterotópicas de bajo grado. El 94% de los pacientes presentó una óptima recuperación posquirúrgica, con carga inmediata. Solo se observó un fallecimiento por causas no relacionadas con la cirugía. Conclusiones: Ante determinadas fracturas acetabulares, la ATC aguda con abordaje anterior directo en decúbito supino y bajo control de escopia con un cotilo de revisión más osteosíntesis mínima asociada, si precisa, nos facilita una adecuada estabilización de la fractura, con recuperación funcional completa del paciente, con carga inmediata, excelentes resultados a corto y medio plazo y mínimas complicaciones

Introduction: Acetabular fractures in elderly patients present a therapeutic challenge, since their osteosynthesis may be hindered by comminution and poor bone quality. In certain cases, a good solution is acute total hip arthroplasty (THA) by direct anterior approach with or without minimal associated osteosynthesis. The objective of this study was to establish the indications and evaluate the clinical/functional, radiological results and complications, in the short and medium term, of acute THA using an anterior approach after acetabular fractures. Material and methods: We analyzed 15 patients collecting: demographic data, classification of fractures, surgical data, clinical/functional and evolutionary radiographic evaluation, together with perioperative complications. Results: The mean follow-up of the patients was 40 months with a final functional assessment of 96.5 for Harris Hip Score, and Merle D'Aubigné excellent in 93%. The radiological controls were satisfactory without prosthetic loosening. Only 2patients presented low-grade heterotopic calcifications. Ninety-four percent of the patients presented optimal postoperative recovery, with immediate loading. There was only one death for reasons unrelated to the surgery. Conclusions: Given certain acetabular fractures, acute THA using a direct anterior approach in the supine position and under scope control with a revision cup plus associated minimal osteosynthesis, if necessary, facilitates adequate fracture stabilization with full functional recovery of the patient with immediate loading and excellent results in the short and medium term with minimal complications

Acute management of acetabular fractures by total hip arthroscopy using an anterior approach. / Manejo agudo de las fracturas acetabulares mediante artroplastia total de cadera con abordaje anterior.

INTRODUCTION: Acetabular fractures in elderly patients present a therapeutic challenge, since their osteosynthesis may be hindered by comminution and poor bone quality. In certain cases, a good solution is acute total hip arthroplasty (THA) by direct anterior approach with or without minimal associated osteosynthesis. The objective of this study was to establish the indications and evaluate the clinical/functional, radiological results and complications, in the short and medium term, of acute THA using an anterior approach after acetabular fractures. MATERIAL AND METHODS: We analyzed 15 patients collecting: demographic data, classification of fractures, surgical data, clinical/functional and evolutionary radiographic evaluation, together with perioperative complications. RESULTS: The mean follow-up of the patients was 40 months with a final functional assessment of 96.5 for Harris Hip Score, and Merle D'Aubigné excellent in 93%. The radiological controls were satisfactory without prosthetic loosening. Only 2patients presented low-grade heterotopic calcifications. Ninety-four percent of the patients presented optimal postoperative recovery, with immediate loading. There was only one death for reasons unrelated to the surgery. CONCLUSIONS: Given certain acetabular fractures, acute THA using a direct anterior approach in the supine position and under scope control with a revision cup plus associated minimal osteosynthesis, if necessary, facilitates adequate fracture stabilization with full functional recovery of the patient with immediate loading and excellent results in the short and medium term with minimal complications.

Prótesis de rodilla LCS con plataforma rotatoria. Resultados a medio-largo plazo / LCS rotating platform knee prosthesis. Medium- to long-term results

Objetivorevisar los resultados clínicos y radiológicos de una serie de artroplastias de rodilla con plataforma rotatoria con un seguimiento de 6 a 12 años. Material y métodoestudio retrospectivo de 133 artroplastias intervenidas en nuestro centro, entre 1994 y 2001, mediante la técnica quirúrgica original. Aplicamos el Knee Score y Function Score de la American Knee Society para su valoración clínica y el estudio radiológico correspondiente. Resultadosen 6 (4,5%) prótesis se realizó recambio total o parcial, 2 por infección, otra por luxación de la plataforma rotatoria, una por aflojamiento del componente tibial, una por inestabilidad y otra por dolor de causa incierta. En otras 9 (6,7%) se intervino sin retirar los componentes: 4 por fricción de partes blandas, una infección extraarticular, una fractura de fémur, una resección de calcificación ósea, una protetización de rótula y una fractura de rótula. Todas las complicaciones tuvieron lugar antes del tercer año. No hubo desgaste de los componentes ni osteólisis importantes. La puntuación media para la rodilla y la función fue muy alta (90,6 y 86,5). Conclusioneslos resultados clínico-radiográficos a medio-largo plazo de este diseño protésico con plataforma rotatoria son muy satisfactorios, aunque a costa de un discreto incremento de complicaciones precoces

Purpose: To review the clinical and radiological results of a series of rotating platform knee arthroplasties with a follow-up of 6¿12 years. Materials and methodsRetrospective study of 133 arthroplasties implanted in our hospital between 1994 and 2001 using the original surgical technique. We applied the Knee Score and the Function Score of the American Knee Society in order to carry out the corresponding clinical assessment and radiological study. ResultsSix (4.5%) prostheses were totally or partially revised (2 cases of infection, 1 rotating platform spin out, one loosening of the tibial component, 1 instability and unidentifiable pain). Another 9 (6.7%) were operated without withdrawing any components (4 cases soft tissue friction, one extraarticular infection, one femoral fracture, one bone calcification resection, one patellar prosthetization and one patellar fracture). All complications occurred before the third year. There was no component wear or significant levels of osteolysis. Mean Knee and Function scores were very high: 90.6 and 86.5 respectively. ConclusionsClinical-radiographic medium- to long-term results for this rotating platform prosthetic design are highly satisfactory, albeit at the expense of a slight increase in the number of early complications (AU)