La artroplastía total bilateral de rodilla en un acto anestésico. Un procedimiento seguro, comparable a la artroplastía de rodilla unilateral / Bilateral total knee arthroplasty is a safe procedure compared to unilateral total knee arthroplasty

Introducción: El objetivo de este trabajo es comparar los resultados clínicos y complicaciones de la artroplastia total de rodilla bilateral (ATRB) con los de la artroplastia total de rodilla unilateral (ATRU).Materiales y métodos: estudio caso control. Se analizaron quince pacientes (treinta rodillas) con ATRB y ciento dos con ATRU, operados entre marzo del 2016 a agosto del 2018 por un mismo equipo quirúrgico, centro y modelo de prótesis. Se excluyeron artroplastias con componentes constreñidos. Se analizaron los datos demográficos, estadía hospitalaria (EH), caída del hematocrito, necesidad de transfusión sanguínea, días con drenaje, complicaciones postoperatorias, mortalidad, tiempo de isquemia y rango de movilidad (ROM). Se utilizó la encuesta KOOS Jr. para medir resultados funcionales y otra para valorar satisfacción. El análisis estadístico se realizó con t de Student, prueba exacta de Fisher y modelos mixtos (p <0.05).Resultados: ambos grupos fueron comparables en edad, IMC, tabaquismo, riesgo anestésico según la Sociedad Americana de Anestesiología (ASA), depresión y hematocrito. El grupo ATRB presentó una EH, días de drenaje, descenso del hematocrito postoperatorio y necesidad de transfusiones significativamente mayor. No hubo diferencias significativas en cuanto a tiempo de isquemia, complicaciones postoperatorias, mortalidad y en el ROM logrado a corto y mediano plazo. Se observó una tendencia a lograr antes el ROM objetivo (0-120°) en las ATRB. No hubo diferencias significativas en los resultados funcionales ni en satisfacción. Conclusión: en nuestro centro y en pacientes seleccionados, la ATRB es un procedimiento seguro sin una mayor tasa de complicaciones ni mortalidad asociada, con resultados clínicos similares a la ATRU. Nivel de Evidencia: III

Introduction: The aim of this study is to compares the clinical results and complications of bilateral total knee arthroplasty (BTKA) with unilateral total knee arthroplasty (UTKA).Materials and methods: case control study. Fifteen patients (thirty knees) with BTKA and hundred two patients with UTKA were analyzed, operated from March 2016 to August 2018 by the same surgical team, center and prosthetic model. Arthroplasties with constrained components were excluded. Demographic data, length of hospital stay (LOS), hematocrit drop, need for blood transfusion, days with drainage, post-operative complications, mortality, tourniquet time and range of motion (ROM) were analyzed. KOOS Jr. survey was answered, and satisfaction was reported. Statistical analysis was performed with t-Student, Fisher's test and mixed models (p <0.05).Results: the groups were comparable (age, BMI, smoking, anesthetic risk according to the classification system of the American Society of Anesthesiology (ASA), depression, hematocrit). The BTKA group presented LOS, drainage days, decrease in post operative hematocrit and need for transfusions significantly higher. There were no significant differences in terms of tourniquet time, post-operative complications, mortality and ROM achieved at short term. There is a tendency to achieve the target ROM (0-120 °) earlier on the BTKA group. There were no significant differences in functional results or satisfaction.Conclusion: In our center and in selected patients, the BTKA is a safe procedure without a higher rate of complications or associated mortality, with clinical results similar to the UTKA. Level of Evidence: III

[Isokinetic assessment post-ACL reconstruction: comparison of the semitendinous/gracilis and bone-tendon-bone techniques]. / Evaluación isocinética postreconstruccióón de ligamento cruzado anterior: comparación de dos técnicas.

UNLABELLED: The purpose of this study is to detect the differences in the isokinetic assessment after anterior cruciate ligament (ACL) reconstruction with the bone-patellar tendon-bone (BTB) and semitendinous/gracilis (STG) techniques. METHODS: Ninety-five patients with a minimum follow-up of six months were assessed with a Cybex 6000 dynamometer during concentric contraction at 60 degrees/s. The BTB technique was used in 27 patients and the STG technique in 68. The ANOVA and Pearson tables were used to analyze the flexion and extension strength deficit, peak torque (PT) strength in flexion and extension (Nm) and the muscle balance. RESULTS: Mean loss of strength in flexion was 18.82% with BTB and 11.05% with STG (p = 0.04). Mean loss of strength in extension was 24.04% with BTB and 17.1% with STG (p = 0.75). The mean PT strength in flexion was 113.2 Nm (38-203) for BTB and 128.4 Nm (73-219) for STG (p = 0.603). The mean PT strength in extension was 187.2 Nm (68-363) for BTB and 194 Nm (107-339) for STG (p = 0.102). The mean muscle balance was 73.4% for STG and 68.6% for BTB (p = 0.961). CONCLUSION: The flexion strength was more compromised after BTB reconstruction compared to the STG procedure. We documented a trend towards loss of PT strength in flexion and extension and muscle balance with flexor predominance post-BTB reconstruction.