An update on the study of synovial fluid in the geriatric patient.

BACKGROUND: The characteristics of synovial fluid (SF) in geriatric patients differ from those in younger patients. In Mexico, epidemiologic data on the incidence of different rheumatic diseases in geriatric patients are scarce. OBJECTIVE: To describe the physical characteristics of geriatric SF and the prevalence of crystals in knee and other joint aspirates from patients with previously diagnosed joint disease. MATERIALS AND METHODS: A retrospective study was performed with a baseline of 517 SF samples between 2011 and 2023. White blood cell count was performed by Neubauer chamber and crystals were identified by polarized light microscopy. Descriptive statistical analysis was performed and prevalence was reported as a percentage. RESULTS: The mean age of the adults was 73.5±5.0 years, 54.4% were women and 45.6% were men. The mean SF volume was 6.3±9.5mL in older adults and 15.3±24.9mL in those younger than 65 years. The mean viscosity in older adults was 9.5±4.5mm and the mean leukocyte count was 7352±16,402leukocytes/mm3. Seventy percent of the older adults' SFs were referred to the laboratory for osteoarthritis (OA), with lower proportions for rheumatoid arthritis (RA) (14.6%) and gout (5.1%). Of the crystals observed in the geriatric population, 14.6% corresponded to monosodium urate crystals (CUM) and 18.9% to calcium pyrophosphate crystals (CPP). CONCLUSIONS: The characteristics of LS in older adults were smaller volume, increased viscosity, and non-inflammatory. The main diagnoses were OA, RA, and gout. The crystal content of the SF of the geriatric population corresponded mainly to CPP.

An update on the study of synovial fluid in the geriatric patient / Panorama actual del estudio de líquido sinovial en el paciente geriátrico

Background: The characteristics of synovial fluid (SF) in geriatric patients differ from those in younger patients. In Mexico, epidemiologic data on the incidence of different rheumatic diseases in geriatric patients are scarce. Objective: To describe the physical characteristics of geriatric SF and the prevalence of crystals in knee and other joint aspirates from patients with previously diagnosed joint disease. Materials and methods: A retrospective study was performed with a baseline of 517 SF samples between 2011 and 2023. White blood cell count was performed by Neubauer chamber and crystals were identified by polarized light microscopy. Descriptive statistical analysis was performed and prevalence was reported as a percentage. Results: The mean age of the adults was 73.5±5.0 years, 54.4% were women and 45.6% were men. The mean SF volume was 6.3±9.5mL in older adults and 15.3±24.9mL in those younger than 65 years. The mean viscosity in older adults was 9.5±4.5mm and the mean leukocyte count was 7352±16,402leukocytes/mm3. Seventy percent of the older adults’ SFs were referred to the laboratory for osteoarthritis (OA), with lower proportions for rheumatoid arthritis (RA) (14.6%) and gout (5.1%). Of the crystals observed in the geriatric population, 14.6% corresponded to monosodium urate crystals (CUM) and 18.9% to calcium pyrophosphate crystals (CPP). Conclusions: The characteristics of LS in older adults were smaller volume, increased viscosity, and non-inflammatory. The main diagnoses were OA, RA, and gout. The crystal content of the SF of the geriatric population corresponded mainly to CPP.(AU)

Antecedentes: Las características del líquido sinovial (LS) en pacientes geriátricos varían en comparación con pacientes más jóvenes. En México, los datos epidemiológicos sobre la incidencia de diversas enfermedades reumáticas en el paciente geriátrico son escasos. Objetivo: Describir las características físicas del LS geriátrico y la prevalencia de cristales en aspirados de rodilla y otras articulaciones de pacientes con enfermedades articulares previamente diagnosticadas.Materiales y métodos: Se realizó un estudio retrospectivo con una base de 517 muestras de LS entre 2011 y 2023. El recuento de glóbulos blancos se realizó con cámara de Neubauer, y los cristales se identificaron por microscopia de luz polarizada. Se realizó un análisis estadístico descriptivo y la prevalencia se reportó como porcentaje. Resultados: La edad promedio en los adultos fue de 73,5±5,0 años; el 54,4% fueron mujeres y el 45,6%, hombres. El volumen promedio del LS en adultos mayores fue de 6,3±9,5ml, mientras que en menores de 65 años fue de 15,3±24,9ml. La viscosidad promedio fue de 9,5±4,5mm en los adultos mayores, y una cuenta de 7.352±16.402 leucocitos/mm3. El 70% de los LS de los adultos mayores fueron remitidos a laboratorio por osteoartritis (OA), u una proporción más baja, por artritis reumatoide (AR) (14,6%) y gota (5,1%). En cuanto a los cristales observados en los LS de la población geriátrica, el 14,6% correspondieron a cristales de urato monosódico (CUM) y el 18,9%, a cristales de pirofosfato de calcio (CPP). Conclusiones: Las características del LS en los adultos mayores fueron menor volumen, viscosidad incrementada y no inflamatorios. Los principales diagnósticos fueron OA, AR y gota. El contenido de los cristales en los LS de la población geriátrica correspondió principalmente a CPP.(AU)

Effect of smoking on the redox status of knee osteoarthritis: A preliminary study.

Even though smoking has been scarcely studied in osteoarthritis (OA) etiology, it is considered a controversial risk factor for the disease. Exposure to tobacco smoke has been reported to promote oxidative stress (OS) as part of the damage mechanism. The aim of this study was to assess whether smoking increases cartilage damage through the generation of OS. Peripheral blood (PB) and synovial fluid (SF) samples from patients with OA were analyzed. The samples were stratified according to smoking habit, Kellgren-Lawrence score, pain, and cotinine concentrations in PB. Malondialdehyde (MDA), methylglyoxal (MGO), advanced protein oxidation products (APOPs), and myeloperoxidase (MPO) were assessed; the activity of antioxidant enzymes such as gamma-glutamyl transferase (GGT), glutathione S-transferase (GST) and catalase (CAT), as well as the activity of arginase, which favors the destruction of cartilage, was determined. When stratified by age, for individuals <60 years, the levels of MDA and APOPs and the activity of MPO and GST were higher, as well as antioxidant system activity in the smoking group (OA-S). A greater degree of pain in the OA-S group increased the concentrations of APOPs and arginase activity (P < 0.01 and P < 0.05, respectively). Arginase activity increased significantly with a higher degree of pain (P < 0.01). Active smoking can be an important risk factor for the development of OA by inducing systemic OS in young adults, in addition to reducing antioxidant enzymes in older adults and enhancing the degree of pain and loss of cartilage.

[Incidence of hip and knee prosthetic infections in a specialized center of Mexico City]. / Incidencia de infecciones protésicas primarias de cadera y rodilla en un centro de la Ciudad de México.

BACKGROUND: Hip and knee prosthetic replacements have proven to be the most appropriate treatment in the joints that do not benefit from medical or arthroscopic interventions; however, infections are the most feared complication. It is recommended that the incidence of infection should not exceed 2%. MATERIAL AND METHODS: This was an observational, prospective, longitudinal and observational study conducted in patients fitted with a prosthetic joint from August 2011 to July 2012. Patients were followed up pre and post-surgery for one year to identify a prosthetic infection, diagnosed using international parameters. We calculated the incidence of prosthetic infection, as well as the incidence density. RESULTS: A total of 339 patients (179 hip and 160 knee) were included. Variations in the time of pre-operative antibiotics' administration were observed. Six prosthetic infections were identified with an incidence rate of 1.79/339 arthroplasties, 2.2/179 hip procedures, and 1.25/160 knee arthroplasties. An incidence density of 0.02/year for hip arthroplasties and 0.11/year for knee procedures was identified. There were 4 infections of hip and 2 of knee. Five infections were acute and one chronic. The isolated microorganisms were E. faecalis, S. epidermidis (2), S. mitis, S. aureus and P. stomatis. CONCLUSIONS: The incidence of prosthetic joint infection in the first year of follow-up at our centre is within the recommended parameters. Surgical techniques and organizational practices influence the results.

[Total hip arthroplasty in patients with cerebral vascular event. Case report]. / Artroplastia total de cadera primaria en paciente con evento vascular cerebral. Reporte de un caso.

INTRODUCTION: Associated neurological disorders pose a challenge hip joint reconstruction. The imbalance and poor muscle tone predispose to dislocation and loosening of the prosthesis. CLINICAL CASE: The following is the case of a 67 years old patient with a hemorrhagic cerebral vascular event with a secondary left hemiparesis. Ten years later had a femoral neck fracture on the affected side. Initially she was treated with conservative management resulting in pain and discapacity, valued with WOMAC scale as 12 points. Two years later was treated with total hip arthroplasty with large diameter femoral head. We present the follow up of 41 months, asymptomatic, walking using a cane and a WOMAC score of 41, with no signs of radiological loosening or dislocation. CONCLUSIONS: There is no experience documented in neurological disorders associated with hip diseases that requires a total hip arthroplasty. Loosening of the implants, dislocation and heterotopic ossification has been described as complications of the procedure. Large heads in total hip arthroplasty and a correct surgical technique associated with a multidisciplinary management in patients with neurological disorders offers an opportunity as a treatment in patient with hip disorders.

[Functional outcomes in patients subjected to acetabular revision with reinforcement rings]. / Resultados funcionales de los pacientes sometidos a revisión acetabular con anillos de reforzamiento.

BACKGROUND: Total hip arthroplasty is the most successful orthopedic procedure and the frequency of use of revision components has grown exponentially. The increased number of revisions results from the longer life expectancy of the population and the greater frequency of the hip arthroplasty indication among young patients. The purpose of this study is to evaluate the functional results of patients subjected to revision of the acetabular component using reinforcement rings. MATERIAL AND METHODS: The study included patients with a diagnosis of septic or aseptic prosthetic loosening and sequelae of acetabular fractures between January 2007 and November 2009 in whom a reinforcement ring was used. The WOMAC scale was used for the functional evaluation. RESULTS: According to the WOMAC scale, the patient functionality results showed a mean preoperative score of 41.89 and a mean postoperative score of 74.26, which represented an improvement of 33.11 points in the median of patients subjected to the surgical intervention, with a statistically significant difference (p = 0.036). DISCUSSION: This study shows an improvement in the functionality of the patients subjected to surgery with a reinforcement ring, as, first and foremost, a statistically significant difference was seen between the preoperative and postoperative values and, secondly, there are papers published in the literature showing that a difference of more than 12 points between the preoperative and postoperative scores in the WOMAC scale indicates a significant clinical improvement of patients. CONCLUSION: Patients subjected to acetabular revision with a reinforcement ring together with cemented polyethylene have an improved quality of life after the surgical intervention.

Tratamiento quirúrgico de la osteoartritis en la cadera: actualidades en artroscopia de cadera / Surgical treatment of hip osteoarthritis: hpdete on hip arthroscopy

La cirugía artroscópica de cadera es un procedimiento habitual en cada vez más instituciones en el mundo. Las indicaciones de este procedimiento aumentan a medida que se adquiere más experiencia. Gracias a la artroscopia de cadera se ha identificado lesiones, como roturas de labrum y lesiones condrales y de ligamento redondo, que pueden contribuir a la génesis de la osteoartritis en la cadera. También se han transformado técnicas de cirugía abierta de cadera a técnicas artroscópicas, como en el caso del pinzamiento femoroacetabular. Se sabe que el pinzamiento femoroacetabular puede contribuir al desarrollo de osteoartritis en la cadera. La cirugía artroscópica de cadera tiene escasa utilidad en el tratamiento de la osteoartritis formalmente establecida y sólo se debe utilizarla en casos con cambios degenerativos mínimos en pacientes jóvenes (AU)

Arthroscopic surgery of the hip is a routine procedure in an increasing number of institutions around the world. Indications for this procedure increase as more experience is developed. Thanks to hip arthroscopy some intraarticular lesions like labral or ligamentum teres tears and cartilage lesions have been recognized. All of these have the potential to develop hip osteoarthritis. Open techniques for the treatment of femoroacetabular impingement have been transformed to arthroscopic techniques. Femoroacetabular impingement has the potential to cause hip osteoarthritis. The role of hip arthroscopy in the treatment of formally established hip osteoarthritis is limited and has better results in young patients with early degenerative changes (AU)

Tratamiento quirúrgico de la osteoartritis en la cadera: actualidades en artroplastia total de cadera / Surgical treatment of hip osteoarthritis: update in total hip arthroplasty

La artroplastia total de cadera es uno de los procedimientos quirúrgicos más exitosos en cirugía ortopédica. Hay dos técnicas para la fijación de implantes protésicos en la cadera: la cementada y la no cementada. La combinación de ambas se denomina híbrida. De la estabilidad de los implantes al hueso depende la duración del implante. El desgaste de las superficies articulares es la principal limitación a la durabilidad de los implantes estables. El desgaste del polietileno del acetábulo genera partículas que acceden las interfaces implante-hueso o hueso-cemento-implante y generan inflamación, osteólisis y aflojamiento. Existen polietilenos mejorados con más resistencia al desgaste y articulaciones sin polietileno (duro en duro) para disminuir el desgaste. Los accesos quirúrgicos de mínima invasión limitan la lesión de los tejidos blandos y facilitan una mejor y más rápida recuperación (AU)

Total hip replacement is one of the most successful procedures in orthopaedic surgery. There are two different technologies for implant fixation in total hip replacement: cemented and cementless, both can be combined, which is called Hybrid arthroplasty. Long term implant stability results in long term function. The most important factor that limits longevity of well-fixed implants is the wear of the articular surfaces. Wear of the polyethylene from the acetabulum generates particles that access the implant bone or the implant-cement-bone interface. This produces an inflammatory reaction, osteolysis and implant loosening. Polyethylene of higher resistance to wear and prosthetic articulations without polyethylene (hard on hard bearings), have been introduced to improve wear particle generation. Minimally invasive surgical techniques minimize surgical trauma to sort tissue around the hip joint, facilitating a better and more rapid recovery (AU)

[Surgical treatment of hip osteoarthritis: hpdete on hip arthroscopy]. / Tratamiento quirúrgico de la osteoartritis en la cadera: actualidades en artroscopia de cadera.

Arthroscopic surgery of the hip is a routine procedure in an increasing number of institutions around the world. Indications for this procedure increase as more experience is developed. Thanks to hip arthroscopy some intraarticular lesions like labral or ligamentum teres tears and cartilage lesions have been recognized. All of these have the potential to develop hip osteoarthritis. Open techniques for the treatment of femoroacetabular impingement have been transformed to arthroscopic techniques. Femoroacetabular impingement has the potential to cause hip osteoarthritis. The role of hip arthroscopy in the treatment of formally established hip osteoarthritis is limited and has better results in young patients with early degenerative changes.

[Surgical treatment of hip osteoarthritis: update in total hip arthroplasty]. / Tratamiento quirúrgico de la osteoartritis en la cadera: actualidades en artroplastia total de cadera.

Total hip replacement is one of the most successful procedures in orthopaedic surgery. There are two different technologies for implant fixation in total hip replacement: cemented and cementless, both can be combined, which is called Hybrid arthroplasty. Long term implant stability results in long term function. The most important factor that limits longevity of well-fixed implants is the wear of the articular surfaces. Wear of the polyethylene from the acetabulum generates particles that access the implant bone or the implant-cement-bone interface. This produces an inflammatory reaction, osteolysis and implant loosening. Polyethylene of higher resistance to wear and prosthetic articulations without polyethylene (hard on hard bearings), have been introduced to improve wear particle generation. Minimally invasive surgical techniques minimize surgical trauma to sort tissue around the hip joint, facilitating a better and more rapid recovery.

Factores de riesgo y manejo de la infección en la artroplastía total de rodilla / Risk factors and treatment for infection in total knee replacement

Objetivo. Con el presente estudio se trata de establecer los factores de riesgo para la artroplastía total de la rodilla, su frecuencia de infección y la eficacia del tratamiento para las complicaciones. Material y métodos. Estudio retrospectivo extraído de un total de 447 casos de prótesis total de rodilla (PTR) operados en un periodo de 10 años. Se diseñaron dos grupos comparativos, uno con 19 casos infectados y otro con 237 no infectados, tomados al azar, para un total de 256, con edad promedio de 68 años. Resultados. La edad promedio en mujeres con infección fue de 71 años (no infectadas 60 años, p = 0.002). Para mujeres infectadas con AR fue de 78 años (no infectadas con AR 54 años, p = 0.0001). No hubo diferencia entre mujeres que tenían enfermedades coexistentes, independientemente de artrosis o AR. En hombres con infección, la edad promedio fue 56.9 años para AR y 72.6 para artrosis (p = 0.0001). En todos los casos se resolvió mediante diversos procedimientos, como recambio del componente rotuliano en uno, recambio total en dos, desbridamiento y colgajos en cinco y artrodesis en 10. Conclusión. Los principales riesgos de infección parecen ser, la existencia en la 8a década de la vida para mujeres, independientemente de sufrir o no AR así como la presencia de AR en hombres menos viejos. La sola edad en varones, y la artrosis o las enfermedades coexistentes indistintamente del sexo no parecen ser por sí solas, factores de riesgo significativo.

Eficacia comparativa entre los abordajes lateral y medial para corregir la deformidad en valgo mayor de 15 grados en la artroplastía total de la rodilla / Comparative trial betwenn medial and lateral approach for corrrecting valgus of the knee, greater than 15 degrees in total knee replacement

Objetivo. Valorar la conveniencia de utilizar el abordaje pararrotuliano lateral en la artoplastía total de la rodilla (ATR) en pacientes con valgo exagerado de la rodilla. Material y métodos. Se trata de un estudio retrospectivo de 13 mujeres (de un total de 14), operadas de ATR de 1995 a 2000, con un valgo preoperatorio mayor de 15 grados. Sin selección al azar, el abordaje lateral se usó en 6 (prom. 60.8 años y valgo 17.5º) y el medial en 7 (70.4 años, valgo 17.2º). La causa fue artrosis en los seis de abordaje medial y en cinco de los siete con abordaje lateral, y AR en los dos restantes. Resultados. Con base en los parámetros de dolor postoperatorio, estabilidad articular y arco de movimiento, los resultados fueron buenos en cuatro y malos en tres para el abordaje medial, mientras que fueron buenos en cinco y malos en uno para el abordaje lateral. El único resultado más notorio es la diferencia entre los resultados para el abordaje lateral, que parece orientarse a su favor, ya que en el caso del abordaje medial no hay diferencia alguna. Conclusión. El abordaje pararrotuliano lateral debe considerarse como una alternativa para la ATR en virtud de la tendencia aparente a cursar con menor proporción de complicaciones en pacientes con genu valgo exagerado.