Effectiveness and safety of a cement-on-cement removal system for hip and knee arthroplasty revision surgery.

Cement removal during hip or knee arthroplasty revision is challenging and not exempt of complications. Cement-on-cement procedure is among techniques developed to safe removal of cement from bone, and it could be a realistic solution. This cement-on-cement devices can provide advantages in removing bone cement during hip and knee arthroplasty septic and non-septic revision surgeries, and can be regarded as an effective and safe alternative. We present our experience using the cement-on-cement technique in 34 cases between 2010 and 2021, including revision surgeries for 20 knee and 14 hip arthroplasties. In 3 out of 34 cases the technique failed, with a success of 91%. Mean surgical time was 2.77 (SD 0.93) hours and blood transfusion was required in 23 cases. Success was achieved in every aseptic case. Of all patients, 60% were septic cases. Infection was considered to be eradicated in 70% (14/20) of patients with a septic revision. Cement-on-cement is a safe and effective alternative for cement removal during hip and knee arthroplasty revision. Level of evidence: III, retrospective case series.

Surgical Technique of a Cement-On-Cement Removal System for Hip and Knee Arthroplasty Revision Surgery.

Cement removal during hip or knee arthroplasty revision surgery is technically demanding and prone to severe complications such as periprosthetic fractures, incomplete cement removal, or perforations. Several alternative techniques have been developed to enable complete, accurate, and safe removal of cement from bone, including osteotomies and cortical windows, endoscopic instruments, ultrasound devices, lithotripsy, and laser-assisted removal. We describe a cement-on-cement technique with a sterile, single-use tool for cement removal. The cement is removed piece by piece using a specifically designed device, without osteotomies or cortical windows.

Aromatase expression in human chondrocytes: An induction due to culture.

OBJECTIVES: Despite the high prevalence of osteoarthritis (OA) in postmenopausal women, a relationship between circulating estrogen levels and the development of OA has not been found. Therefore, the purpose of this study was to evaluate the expression and activity of aromatase, a key enzyme in local production of estrogens, in human OA cultured articular chondrocytes, and to determine the physiological relevance of this enzyme in cartilage. METHODS: Human OA articular chondrocytes were isolated and cultured. Local production of estradiol was measured after incubation with 100 ng/ml testosterone for 8 and 24h. Furthermore, chondrocytes were culture for 2h, 48 h, 7 days or 15 days, or in alginate beads for 10 days. Aromatase, type II and X collagen, aggrecan, alkaline phosphatase, and Runx2 expression were evaluated in cartilage, freshly isolated chondrocytes and cultured chondrocytes. RESULTS: Aromatase was expressed and active in cultured human chondrocytes. Human cartilage, freshly isolated chondrocytes, and chondrocytes cultured for 2h expressed an insignificant amount of aromatase; however, expression arose after 48 h of culture and remained increased thereafter. Aromatase expression was not related to estrogen deprivation and was inversely correlated with differentiation. Re-differentiation did not reduce its expression. CONCLUSIONS: Aromatase presents an almost undetectable expression in human cartilage but is induced in cultured chondrocytes. Therefore, human cartilage might act as a mere target for estrogens rather than a producer, and researchers using cell expansion in culture for latter therapies should consider these changes in estrogen metabolism which may not be reverted after re-differentiation.

Clinical outcome and gait analysis of ankle arthrodesis.

BACKGROUND: The purpose of our study was to describe and analyze the functional outcomes of mid-term followup patients with ankle arthrodesis. METHODS: Twenty patients who had an isolated ankle arthrodesis were followed for a mean of 3 years after surgery. We performed physical and functional examination, radiographic examination and CT scan. Each completed standardized, self-reported outcome questionnaires SF-36, AOFAS and Mazur scores. All subjects were evaluated with a kinetic and kinematic gait analysis and a plantar pressure study. RESULTS: Only one patient used a cane and seven patients required an insole to walk. We observed no relation between the scores obtained. Most of the patients showed good functional results and poor life quality scores. The joints that were significantly more degenerated were the Chopart and the subtalar joints, which were affected in 16 patients in the fused limb. The kinematic parameters showed compensatory motion in the neighboring joints and the kinetic parameters studied were similar in the arthrodesis limb and the control limb. There was no significant difference between the arthrodesis limb and the contralateral limb for plantar pressures. CONCLUSION: Although ankle arthrodesis will help to relieve pain and to improve overall function, it is considered to be a salvage procedure that causes persistent alterations in gait, with the possible development of symptomatic osteoarthritis in the other joints of the foot. Patients and treating physicians should also expect overall pain and functional limitations to increase over time.

Primary fusion in worker's compensation intraarticular calcaneus fracture. Prospective study of 169 consecutive cases.

PURPOSE: To study the results of reconstruction and primary fusion in worker's compensation intraarticular calcaneus fractures. PATIENTS AND METHODS: We carried out a prospective study of 169 acute intraarticular calcaneus fractures treated by reconstruction and primary fusion with the minimally invasive Vira® system, in severe calcaneus fractures. The evaluation was performed by clinical, radiological and biomechanical analysis. RESULTS: AOFAS score averaged 77.26 points at the end of follow up. Forty-two cases (24.9%) obtained excellent results, 108 (63.9%) good, 12 (7.1%) mild and 7 (4.1%) poor. The improvement in Börder's angle after surgery was significant (p = 0.05) and this did not vary during the follow up. Subtalar arthrodesis was achieved in all cases and only three cases needed bone grafting. Five major post-surgical complications were observed, and one deep infection in a case of open Gustilo Grade III fracture. In the kinetic study, the support time of the operated foot was lower than that of the contralateral foot (p<0.21). The axial force of the heel contact and the single limb support of the operated foot reduced the toe-off axial forces. In the foot with arthrodesis the posterior forces increased (p <0.01). The pressures were lower in the region of the heel and the mid-foot and in the external part of the forefoot, and increased in the big toe. CONCLUSIONS: Calcaneal workplace injuries are challenging to treat. Primary subtalar fusion with a minimally invasive method allows rapid recovery for these patients with a satisfactory clinical, functional and radiological outcome.

Vira® system--a minimally invasive technique for severe fractures of the calcaneus treatment with primary subtalar fusion: a preliminary report.

OBJECTIVE: We presented the surgical technique and applicability of the Vira(®) system for severe calcaneus fractures treatment. MATERIAL AND METHODOLOGY: The Vira(®) system is a minimal invasive method for the reconstruction of severe calcaneal fractures with primary subtalar fusion. It comprises a fixation implant and a specific jig for the reduction of the fracture and placement of the holed nail and two screws for fixation to the talus. Additional advantages of this system are its high strength and stability allowing early weight bearing and the fact that additional bone grafting is not needed in most of the cases. The Vira(®) system is a new concept in calcaneal surgery to provide a definitive solution for patients, low aggression and complication rates combined with high clinical effectiveness and sooner recovery.

Treatment of severe fractures of the calcaneus by reconstruction arthrodesis using the Vira System: Prospective study of the first 37 cases with over 1 year follow-up.

PURPOSE: To study the surgical applicability and clinical results of the Vira System in treatment for severe fractures of the calcaneus. METHODS: A total of 37 acute intra-articular fractures of the calcaneus treated by reconstruction and primary fusion with the minimally invasive Vira System. Of them, 33 patients were analysed over a 2-year period. All fractures were classified, according to the Sanders criteria, as grade IV. The mean age was 42.08 years. Four were bilateral fractures and three were open fractures. All the patients were evaluated, in a prospective manner, using the American Orthopaedic Foot and Ankle Society (AOFAS) scale, plain radiographs and CT scan studies. RESULTS: The average AOFAS score 12 months after surgery was 75.43 points (SD: 13.9). In 31 cases, the result was considered good and very good, and in five and one case mild and poor. Most of the patients (81%) could wear normal shoes; the footprint and the alignment of the heel were considered normal in all cases but seven patients showed a mild valgus deviation. The Böhler angle improvement after surgery was significant (p=0.05) and it did not vary along the follow-up. Subtalar arthrodesis was achieved in all cases. Only one case needed bone grafting. Important post-surgical complications were not registered in this cohort. CONCLUSIONS: The Vira System is a useful option for the surgical treatment of severe fractures of the calcaneus, yielding good clinical and radiological results with a surgical procedure that is only minimally aggressive and has a low rate of complications.

Tratamiento de pseudoartrosis infectada de tibia mediante transporte óseo guiado por clavo endomedular de artrodesis de tobillo. A propósito de un caso / A case of infected pseudoarthrosis treated with bone transport guided by a tibiotalocalcaneal arthrodesis intramedullary nail

La eficacia del tratamiento de las pseudoartrosis infectadas mediante resección radical y transporte óseo está avalada por la literatura. Progresivamente estas técnicas se han ido desarrollando para evitar complicaciones y asegurar los resultados. Presentamos un caso clínico en el que la afectación de todo el extremo metafisodiafisario distal de la tibia se ha resuelto mediante la combinación del transporte óseo con el enclavado endomedular específico para artrodesis de tobillo (AU)

The effectiveness of the treatment of the infected nonunions by radical resección and bone transport is guaranteed by Literature. Progressively, these techniques have been developed to avoid complications and to assure the results. We presented a clinical case in which the affectation of all the distal end of the tibia has been solved by the combination of the bone transport with the endomedular specific nailing for fusion of the ankle (AU)

Closed degloving of the thumb.

We present a work-related injury where the drums of a printing machine caused a closed degloving of the distal phalanx of the thumb, which represents detachment of the soft tissue from the bone.