Análisis causal del dolor postartroplastia. Propuesta de un algoritmo diagnóstico-terapéutico / causal analysis of painful arthroplasty. Proposal of a diagnostic and therapeutic algorithm

Objetivo del trabajo: Determinar la incidencia de artroplastia dolorosa de rodilla, realizar un análisis causal exhaustivo del dolor postartroplastia y evaluar los resultados funcionales de los pacientes tratados en nuestro centro. Material y Métodos: Estudio observacional prospectivo en el que se evaluaron 540 pacientes sometidos a ATR primaria cementada durante dos años y se seleccionaron los que sufrían un dolor postartroplastia intenso. Todos los pacientes fueron sometidos a diferentes pruebas complementarias con el fin de determinar la causa más probable de dolor. De igual forma, para cada paciente se instauró un tratamiento quirúrgico específico que pretendía resolver la causa de dolor. Resultados: De las 541 artroplastias primarias practicadas, 63 pacientes presentaron un dolor postartroplastia intenso. La incidencia acumulada de dolor intenso ostartroplastia en nuestro centro durante los dos años de seguimiento fue de un 11,64 %. Las causas mecánicas intraarticulares fueron las más frecuentes, justificando el 52,4 % del dolor postartroplastia severo, seguidas por las causas biológicas intraarticulares que constituyeron el 34,9%. En el 11,1 % de los casos no se pudo determinar ninguna causa específica del dolor postartroplastia, considerando, por tanto el origen del dolor desconocido. Por último, las causas extraarticulares, que constituyeron sólo el 1,6% del dolor postartroplastia. Conclusiones: El dolor postartroplastia es una complicación frecuente de la artroplastia de rodilla que puede padecer uno de cada diez pacientes que se somete a una cirugía de sustitución articular. El dolor protésico tiene un origen multifactorial, por lo el diagnóstico causal es complicado y tedioso. Existen determinados factores, como padecer alteraciones psiquiátricas, la obesidad, y una demanda analgésica elevada antes de la intervención se asocian a una mayor probabilidad de dolor postartroplastia

Objective: The aim of this study was to determine the incidence of painful knee arthroplasty and performance a causal analysis of painful arthroplastyin our center. Material and Methods: A prospective observational study in which 540 patients undergoing primary cemented arthroplasty for two years. Were selected those suffering intense pain postarthroplasty. All patients were subjected to various tests in order to determine the most likely cause of pain. Similarly, for each patient a specific surgical treatment intended to address the cause of pain was realized. Results: Of the 541 primary arthroplasties performed, 63 patients suffered severe pain. The cumulative incidence of severe pain postartroplastia in our center during the two years of follow-up was 11.64 %. Mechanical causes were the most frequent justifying 52.4% of the cases, followed by intraarticular biological causes which constituted 34.9% In 11.1% of cases could not determine any specific cause of painful arthroplasty considering therefore an unknown pain. Finally, extra-articular causes, which constituted only 1.6% of painful arthroplasty. Conclusions: The painful arthroplasty is a common complication of knee arthroplasty can have one in ten patients undergoing joint replacement surgery. The prosthetic pain has a multifactorial etiology, so the causal diagnosis is difficult and tedious. Certain factors, such as having psychiatric disorders , obesity , high demand and analgesic before surgery are associated with a greater likelihood of painful arthroplasty

En 2010, la Consejería de Salud de Andalucía... [editorial] / No disponible

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Registro de artroplastias de Andalucía / Andalusia Arthroplasty register

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Recambios en un solo tiempo de prótesis de cadera y rodilla sobre terreno contaminado: nuestra experiencia / Combined replacement of hip and knee prostheses in a contaminated field: our experience

Objetivo del trabajo: Evaluar resultados obtenidos en recambios en un tiempo de artroplastia séptica o segundo tiempo de recambio séptico (implantación de prótesis sobre terreno contaminado). Material y métodos: Serie de 17 casos, con edad media de 66.8 años y seguimiento medio de 49 meses. Los criterios de exclusión fueron inmunodepresión grave y germen desconocido o no sensible al menos a tres antibióticos. Tras la intervención se administraron antibióticos correspondientes entre 6 semanas y 3 meses. Se estableció la curación como la normalización de las variables indicadoras de infección como mínimo a los 9 meses del recambio. Resultados:14 pacientes evolucionaron hacia la curación completa (seguimiento mínimo 9 meses y máximo 84 meses). 3 casos presentaron recidiva, los tres, portadores de Stafilococcus epidermidis ( a 1, 3 y 7 meses de seguimiento respectivamente). El porcentaje de éxito es de 82.41% (seguimiento medio de 49 meses). Conclusiones: El recambio en un tiempo es una opción atractiva sobre todo en pacientes pluripatológicos, por ofrecer una sola cirugía, menor morbilidad, retorno rápido a las actividades para restaurar una función normal, y un menor coste asociado (AU)

Objective: Evaluate the results obtained in the simultaneous replacement of a septic arthroplasty or a second septic replacement (implanting the prosthesis in a contaminated field). Material and method: Series of 17 cases, with a mean age of 66.8 years and average follow-up of 49 months. The exclusion criteria were serious immunological depression and unknown germ or not sensitive to at least three antibiotics. After the intervention, the corresponding antibiotics were administered between six weeks and three months. Recovery was established as the normality for infection indicator variables at least nine months after the replacement. Results: 14 patients developed towards total recovery (follow-up at least 9 months and maximum 84 months). 3 cases presented relapse, all three carriers of Staphylococcus epidermidis (at 1, 3 and 7 months of follow-up respectively). The success percentage is 82.41% (average follow-up of 49 months). Conclusions: Simultaneous replacements is an interesting option for patients with plural pathologies as it offers a single operation, less morbidity, quicker return to activities to restore normal function and less associated costs (AU)

Body mass index as predictor of health-related quality-of-life changes after total hip arthroplasty: a cross-over study.

The objective of this study was to examine the contribution of patient weight and other preoperative variables to improvements in the general physical health of patients undergoing total hip arthroplasty (THA). Data were prospectively collected on 63 THA patients (28 males and 35 females). The primary outcome measure was the improvement in general health (Short Form-12 Health Survey questionnaire) at three months post-THA. Patients with body mass index >28kg/m(2) showed greater improvements in function and in the physical component of general health after THA. Stepwise regression analyses revealed that the BMI and WOMAC general index were independent and significant predictors of physical function and together explained 34.2% of the variance in physical function scores. These findings suggest that the body mass index before surgery and improvements in hip function are relevant contributors to post-THA improvements in general health.

Percutaneous treatment of bone tumors by radiofrequency thermal ablation.

We present our experience of the treatment of bone tumors with radiofrequency thermal ablation (RFTA). Over the past 4 years, we have treated 26 cases (22 benign and 4 malignant) using CT-guided RFTA. RFTA was the sole treatment in 19 cases and was combined with percutaneous cementation during the same session in the remaining seven cases. Our approach to the tumors was simplified, using a single point of entrance for both RFTA and percutaneous osteoplasty. In the benign cases, clinical success was defined as resolution of pain within 1 month of the procedure and no recurrence during the follow-up period. It was achieved in 19 out of the 21 patients in which curative treatment was attempted. The two non-resolved cases were a patient with osteoid osteoma who developed a symptomatic bone infarct after a symptom-free period of 2 months and another with femoral diaphysis osteoblastoma who suffered a pathological fracture after 8 months without symptoms. The procedure was considered clinically successful in the five cases (4 malign and 1 benign) in which palliative treatment was attempted, because there was a mean (±SD) reduction in visual analogue scale (VAS) pain score from 9.0±0.4 before the procedure to <4 during the follow-up period.