[Total knee arthroplasty in a patient with meniscal transplantation]. / Artroplastía total de rodilla en paciente con trasplante meniscal.

BACKGROUND: The natural history of a knee subjected to total meniscectomy leads to poor outcomes, so we should be careful with these lesions. Meniscal transplantation may be a proper treatment for these patients as it involves a good medium-term survival. MATERIAL AND METHOD: We report the case of a 52 year-old male who underwent meniscal transplantation and developed left gonarthrosis. The surgical approach consisted of medial longitudinal arthrotomy and implantation of a posterior stabilized prosthesis after releasing the soft tissues, which were very retracted. RESULTS: At the one year follow-up the operated knee had an articular range of 0-110 degrees, with no gap and no pain; no external support was required for walking. CONCLUSIONS: Despite the fact that most case series report good short- and medium-term results, some patients do not have good results and need a total knee prosthesis.

[Trabecular metal box for acute acetabular fracture in an elderly patient]. / Caja de metal trabecular para fractura acetabular aguda en paciente anciano.

BACKGROUND: We are currently observing an increase in the incidence of acetabular fractures in elderly patients due to the increase in this population age group. These fractures represent a challenge to the traumatologist because in some cases there is the surgical alternative of combining fixation with total acute hip arthroplasty. In this paper we explore the use of trabecular metal combining the stability provided by a cage with potential bone incorporation, applying the principles of revision surgery to speed-up the healing process without the limitations resulting from the restrictions in the load of the operated limb. MATERIAL AND METHODS: We assessed the clinical and radiological results, with a 2-year follow-up, after total hip arthroplasty for the acute treatment of an acetabular fracture of the anterior column, with involvement of the quadrilateral lamina in an elderly 85 year-old patient. RESULTS: Important pain relief occurred, with functional improvement and an appropriate range of motion using the Merle d'Aubigné system. Radiologically, the graft areas in the particles surrounding the acetabular component were uniformly integrated. No loosening, screw rupture or implant migration occurred. CONCLUSIONS: This indication using a revision technique based on a trabecular metal reconstruction cage should be considered as an alternative to bear in mind in these patients.

[Bilateral avascular necrosis after resurfacing hip arthroplasty. A case report]. / Necrosis avascular bilateral tras artroplastía de cadera de recubrimiento. Reporte de un caso.

Resurfacing hip arthroplasty is an alternative to conventional arthroplasty and it is indicated in young and active patients. Good results and the prevention of complications stem from a meticulous surgical technique and proper patient selection. We present herein the case of a 43 year-old patient who, after undergoing bilateral hip replacement with resurfacing prostheses, sustained a non-simultaneous fracture of both femoral necks due to avascular necrosis. He was treated by placing a metaphyseal anchoring stem. Postoperative X-rays showed proper implant placement without femoral notching, with a discrete 7 degrees valgus alignment of the femoral component. Both passive and active mobility was painful. X-rays showed cervical fracture of the right femur. The femoral head was attached to the implant, with no metallosis nor loosening of the femoral or acetabular components, but the bone had a fragmented and friable appearance that histopathologically was defined as avascular necrosis. Femoral neck fracture is the main complication after resurfacing hip arthroplasty. The effect of other factors like bone necrosis due to cement is unknown.

[Monostotic patellar Paget's disease]. / Enfermedad de Paget monostótica rotuliana.

Paget's disease or osteitis deformans is a bone metabolic disease characterized by an increased bone resorption followed by an increased but irregular bone formation. This results in a weakened, deformed bone and an increase bone mass with collagen fibers forming an irregular and pathologic mosaic instead of the parallel symmetry that characterizes healthy bone. It is considered as a non-neoplastic disorder that mimics a bone tumor. Its origin is still uncertain; however, it has been postulated that genetic or environmental factors are involved in its etiology. It rarely occurs in young patients and its prevalence increases with age. It usually affects both genders with a slight predominance of males. It may be symptomatic or asymptomatic depending on the bones involved, with the most common clinical manifestation being pain of the affected bone. Lesion distribution varies from monostotic involvement (25%) to generalized disease (75%). The most frequent complication is a fracture in a pathological area, while the most serious one is sarcomatous degeneration (approximately 1%; higher in the generalized form). The diagnosis is usually radiologic, by means of plain X-rays and biochemical markers such as alkaline phosphatase, among others, which is elevated in 85% of patients. Treatment of this disease consists of bisphosphonates, which have a proven efficacy and high remission rates. They are indicated in patients with clinical manifestations and in asymptomatic patients with evidence of disease activity. We report the case of a patient with Paget's disease in an infrequent location as is the patella.