[TOTAL KNEE REPLACEMENT WITH PATIENT SPECIFIC INSTRUMENT IN PATIENTS WITH SECONDARY OSTEOARTHRITIS].

INTRODUCTION: Total knee arthroplasty is the most prevalent operation with a high success rate in the treatment of primary osteoarthritis. However, patients with complex secondary osteoarthritis remained marginalized to the surgical response or otherwise exposed to high risk conventional surgery. Early decades of life, surgical history, technical complexity, high surgical morbidity, variability of pathology and anatomy and poor clinical outcome are a few of the reasons. The assimilation of modern technology shifted the concept and practice in the field of arthroplasty, opening a window of treatment opportunities for patients with secondary osteoarthritis with patient specific implants (PSI). AIMS: Evaluate safety, efficacy and applicability limitations of PSI as an alternative to conventional total knee arthroplasty in complex clinical settings. Furthermore, the study aimed to conduct assessments of clinical outcome and technical aspects. METHODS: This was a prospective cohort clinical study, based on Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire pre and post-operative. The study was conducted through a structured analysis of parameters characterizing patients who are candidates for treatment with PSI, highlighting technical points. RESULTS: A curve of 31point improvement (p=0.021) in the WOMAC score at minimum 12 month follow up was observed. There was demonstration of the specific elements required for balancing lower limb axis deformity and previous metal retaining situations. CONCLUSIONS: PSI technology offers a reduction of surgical complexity, morbidity and complication potential with significant improvement in clinical outcome, in patients with secondary osteoarthritis associated with extra articular deformities, presence of hardware, and in musculoskeletal rare diseases. DISCUSSION: A first time presentation of focused, isolated and specified characteristics of a patient population with secondary osteoarthritis where PSI establishes a step forward in the treatment and outcome of patients with complex clinical presentation.

Rehabilitation of elderly patients in the community following surgery for hip fracture - utilization of personal and health care services.

PURPOSE: To assess the change in utilization of personal and health care services following surgery for hip fracture in elderly patients rehabilitated in the community. METHODS: A descriptive study of patients hospitalized in the orthopedic surgery ward for traumatic hip fracture. The first interview took place after surgery and included functional and medical data, and details on utilization of personal and health care services in the month prior to surgery. The second interview took place at home three months after discharge from the hospital and documented corresponding data for the last month. RESULTS: The study included 91 elderly patients. The mean number of contacts with health care providers increased from 4.6/month before HF to 6.4/month during rehabilitation; in particular an increase in home visits by primary care nurses and physicians from 0.4 to 1.0 visit/month (p < 0.001). Personal care showed a greater increase from 32.5 to 95.0 weekly hours (p < 0.001). Multivariate analyses showed that the increase in primary care visits was associated with chronic co-morbidity and being single, while the increase in personal care was associated with medium dependence level and an ambulatory rehabilitation setting. CONCLUSIONS: During the rehabilitation period in the community there was an increase in non-rehabilitative services-medical and personal. Morbidity and functional data could predict the increase in use at time of discharge from hospital.

Vibrio vulnificus infection of the lower limb after fish spine injuries.

Five patients with soft tissue infection of the lower extremity caused by Vibrio vulnificus after penetrating injuries by fish spines are described. Despite previously reported dismal rates of morbidity and mortality associated with Vibrio septicemia, early measures including wide-spectrum intravenous antibiotics and surgical excision of devitalized tissues resulted in complete resolution in all cases. Although penetrating injury is the common route of infection, indirect seeding may occur by the contamination of open wounds or injury to a limb previously submerged in contaminated water.

[Congenital cervical spondylolisthesis].

Cervical spondylolysis with spondylolisthesis is a complex abnormality involving the posterior elements of the cervical vertebra, and anterolisthesis of the same vertebra. Cervical spondylolysis is defined as a corticated cleft between the superior and inferior articular facets of the articular "pillar", the cervical equivalent of the pars intraarticularis in the lumbar spine. The typical radiological features of this condition are as follows: 1. Spondylolysis (a break in the "pillar" on one or both sides) 2. Spina bifida of dysplastic vertebra 3. Affection of posterior intervertebral joints (abnormal inclination of the superior and inferior articular facets of the affected bones may present) Recognition of this congenital disorder and its differentiation from traumatic injury is extremely important in patients who have a history of recent cervical trauma.