Influencia de la causa de revisión en el resultado tras revisión protésica de rodilla con implante varo-valgo constreñido / Influence of the cause of the revision on the outcome after revision knee arthroplasty with condylar constrained implant

Introducción. La artroplastia de revisión de rodilla es un procedimiento frecuente con resultados variables en función de la causa. Nuestro objetivo fue comparar los resultados clínicos y radiológicos en pacientes sometidos a revisión protésica tras infección frente aquellos con revisión por causa aséptica. Material y métodos. Se incluyeron 41 casos de revisión con el mismo implante constreñido varo-valgo. En todos los casos se realizó una valoración clínica (dolor, rango de movilidad, función mediante la escala KSS) y de complicaciones, así como un estudio radiológico. Se realizó un análisis comparativo de los resultados pre y postoperatorios y entre los grupos de causa séptica y aséptica. El seguimiento final medio fue de 6 años. Resultados. La movilidad al final del seguimiento mejoró una media de 17° de balance articular (p < 0,01). El KSS y el KSS funcional mejoraron significativamente respecto al preoperatorio. Radiológicamente, se restauró la interlínea articular y se corrigió el eje del miembro en todos los casos. Se encontraron radiolucencias en el 36,5% de los casos sin relación con la aparición de aflojamiento del implante. Se produjeron complicaciones en el 29,2% de los casos, siendo la mayoría relacionadas con la herida quirúrgica. La movilidad, el KSS, el KSS funcional y satisfacción al final del seguimiento fueron mejores en el grupo de pacientes de causa séptica. La supervivencia del implante fue del 95% al final del seguimiento. Conclusión. La artroplastia de revisión con implante constreñido varo-valgo es un procedimiento seguro y con buenos resultados a medio plazo independientemente de la causa del recambio (AU)

Introduction. Revision total knee arthroplasty (TKA) is a common procedure with varying results depending on the cause. Our objective was to compare the clinical and radiological outcomes in patients undergoing aseptic revision versus revision due to prosthetic infection. Material and methods. The study included 41 patients who underwent TKA revision with the same varus-valgus constrained implant. In all cases a clinical evaluation was performed including pain, range of motion (ROM), Knee Society Score (KSS), complications, as well as radiological study. A comparative analysis was performed on the pre- and postoperative results between septic and aseptic groups. The mean follow-up was 6 years. Results. ROM had a mean increase of 17 degrees (p<.01). KSS and functional KSS improved significantly postoperatively. In the radiological study, joint interline and limb alignment were restored in all cases. Radiolucencies were found in 36.5% of cases; however they were unrelated to the appearance of loosening of the implant. There were complications in 29.2% of cases, mostly related to the surgical wound. Mobility, KSS, KSS functional and satisfaction at follow-up were better in the septic group. Implant survival was 95% at follow-up. Conclusion. Revision arthroplasty with constrained varus-valgus implant is safe, and has successful mid-term results despite the cause of the replacement procedure (AU)

Tratamiento quirúrgico de la tendinopatía aquílea crónica no insercional en corredores mediante el uso de radiofrecuencia bipolar / Surgical treatment of chronic non-insertional Achilles tendinopathy in runners using bipolar radiofrequency

Objetivo. Presentar la técnica quirúrgica con liberación del peritendón y radiofrecuencia como un tratamiento eficaz para los pacientes con tendinopatía crónica del cuerpo del tendón de Aquiles en deportistas. Material y método. Se trata de un estudio descriptivo tipo serie de casos retrospectivo. La serie se compone de 17 tendones de Aquiles operados en 13 pacientes, todos ellos practicantes habituales de carrera a pie. Fueron incluidos aquellos pacientes con tendinopatía no insercional del tendón de Aquiles refractaria al tratamiento conservador. Se realizó un seguimiento mínimo de 12 meses, evaluándose la mejoría clínica con ayuda de la escala de Nirschl-Pain, así como el rendimiento deportivo de los atletas. Resultados. Se obtuvo un 94% de desaparición de los síntomas y una vuelta al rendimiento previo del 70% de los casos en los 12 meses de seguimiento. Discusión. La liberación del peritendón combinada con radiofrecuencia bipolar se presenta como una solución eficaz en esta enfermedad sobre la cual no existe en la actualidad un consenso acerca del mejor tratamiento. En los pacientes que tras un tratamiento conservador adecuado durante un periodo suficiente (al menos 6 meses) persiste la tendinopatía no insercional del tendón de Aquiles, la adhesiólisis abierta asociada a radiofrecuencia bipolar constituye una intervención segura y con una alta tasa de éxito, tanto clínica como funcional. En el deportista de alto rendimiento esta técnica permite la vuelta a la actividad previa en un alto porcentaje (AU)

Objective. To present the surgical technique with release of peritendon and radiofrequency as an effective treatment for athletes with chronic tendinopathy of the Achilles tendon body. Materials and methods. This is a retrospective case series descriptive type study. The series consists of 17 Achilles tendon surgeries in 13 patients, who habitually run. The study included patients with non-insertional Achilles tendinopathy refractory to conservative treatments. After a minimum follow-up of 12 months, clinical improvement of the athletes was assessed using the Nirschl pain scale, as well as athletic performance. Results. An improvement was obtained in 94% of symptoms and a return to the previous performance in of 70% of cases in the 12 months follow-up. Discussion. Peritendon release combined with bipolar radiofrequency is presented as an effective solution in this condition, for which there is currently no consensus on the best treatment. In patients in whom, after an appropriate conservative treatment for a sufficient period (at least 6 months) the non-insertional Achilles tendinopathy persists, open adhesiolysis combined with bipolar radiofrequency is a safe and with a high success rate clinical and functional intervention. In high performance athletes this technique allows a return to previous activity in a high percentage of cases (AU)

Influence of the cause of the revision on the outcome after revision knee arthroplasty with condylar constrained implant. / Influencia de la causa de revisión en el resultado tras revisión protésica de rodilla con implante varo-valgo constreñido.

INTRODUCTION: Revision total knee arthroplasty (TKA) is a common procedure with varying results depending on the cause. Our objective was to compare the clinical and radiological outcomes in patients undergoing aseptic revision versus revision due to prosthetic infection. MATERIAL AND METHODS: The study included 41 patients who underwent TKA revision with the same varus-valgus constrained implant. In all cases a clinical evaluation was performed including pain, range of motion (ROM), Knee Society Score (KSS), complications, as well as radiological study. A comparative analysis was performed on the pre- and postoperative results between septic and aseptic groups. The mean follow-up was 6 years. RESULTS: ROM had a mean increase of 17 degrees (p<.01). KSS and functional KSS improved significantly postoperatively. In the radiological study, joint interline and limb alignment were restored in all cases. Radiolucencies were found in 36.5% of cases; however they were unrelated to the appearance of loosening of the implant. There were complications in 29.2% of cases, mostly related to the surgical wound. Mobility, KSS, KSS functional and satisfaction at follow-up were better in the septic group. Implant survival was 95% at follow-up. CONCLUSION: Revision arthroplasty with constrained varus-valgus implant is safe, and has successful mid-term results despite the cause of the replacement procedure.

Hemipelvectomías tras sarcomas de localización pélvica de alto grado: pronóstico en condrosarcomas frente a otros tipos histológicos / Hemipelvectomy for the treatment of high-grade sarcomas: Pronostic of chondrosarcomas compared to other histological types

Introducción. La baja incidencia y la heterogeneidad histológica de los sarcomas pélvicos primarios dificulta el análisis y publicación de cohortes homogéneas. Objetivo. Describir el pronóstico vital y funcional dependiendo del tipo histológico en una serie de sarcomas primarios de localización pélvica de alto grado localmente avanzados tratados mediante hemipelvectomía. Material y métodos. Estudio descriptivo, epidemiológico y funcional de 15 casos tratados entre 2006-2012. Se realizó análisis de supervivencia, valoración funcional y estudio comparativo en función del tipo histológico, comparando los condrosarcomas frente al resto de diagnósticos histológicos. Resultados. El tipo histológico más frecuente en la serie fue el condrosarcoma (46%), y la localización más frecuente la zona P2 (periacetabular) (73%). Se realizó una hemipelvectomía interna en el 66% de los casos, siendo mayor (83%) en el caso de los condrosarcomas. La supervivencia global a los 2 años fue del 54%, siendo más elevada en el grupo condrosarcoma (67%) que en el resto (43%). La situación funcional dependió del tipo de intervención, sin encontrar diferencias en función del tipo histológico ni de la realización de reconstrucción. Discusión y conclusiones. La hemipelvectomía como procedimiento quirúrgico está indicada para el tratamiento de los sarcomas primarios de localización pélvica de alto grado localmente avanzados independientemente del tipo histológico. La incidencia de conservación del miembro y la supervivencia global es mayor en los condrosarcomas frente al resto de tipos histológicos (AU)

Introduction. The low incidence and histological heterogeneity of primary sarcomas located in the pelvis makes it difficult to find homogeneous cohorts. Objective. To describe the life and functional prognosis depending on the histological type of sarcoma in a series of locally advanced high-grade pelvis located sarcomas treated by hemipelvectomy. Methods. A descriptive epidemiological and functional study was conducted on 15 cases treated between 2006 and 2012. Survival analysis, functional assessment, and a comparative study by histological type were performed, comparing chondrosarcomas to other histological diagnoses. Results. The most frequent histological type was chondrosarcoma (46%), and the most frequent location was P2 (periacetabular) (73%). An internal hemipelvectomy was performed in 66% of cases, with a higher incidence (83%) in chondrosarcomas. Overall two-year survival was 54%, with higher survival in the chondrosarcoma group (67%) than in the other sarcomas (43%). Functional status depended on the type of intervention, with no differences in histological type or the performance of the reconstruction. Discussion and conclusions. Hemipelvectomy is a surgical procedure that is indicated for the treatment of locally advanced high grade pelvis located sarcomas, regardless of histological type. The incidence of limb preservation and overall survival is higher in chondrosarcomas compared to other sarcomas (AU)

[Hemipelvectomy for the treatment of high-grade sarcomas: Pronostic of chondrosarcomas compared to other histological types]. / Hemipelvectomías tras sarcomas de localización pélvica de alto grado: pronóstico en condrosarcomas frente a otros tipos histológicos.

INTRODUCTION: The low incidence and histological heterogeneity of primary sarcomas located in the pelvis makes it difficult to find homogeneous cohorts. OBJECTIVE: To describe the life and functional prognosis depending on the histological type of sarcoma in a series of locally advanced high-grade pelvis located sarcomas treated by hemipelvectomy. METHODS: A descriptive epidemiological and functional study was conducted on 15 cases treated between 2006 and 2012. Survival analysis, functional assessment, and a comparative study by histological type were performed, comparing chondrosarcomas to other histological diagnoses. RESULTS: The most frequent histological type was chondrosarcoma (46%), and the most frequent location was P2 (periacetabular) (73%). An internal hemipelvectomy was performed in 66% of cases, with a higher incidence (83%) in chondrosarcomas. Overall two-year survival was 54%, with higher survival in the chondrosarcoma group (67%) than in the other sarcomas (43%). Functional status depended on the type of intervention, with no differences in histological type or the performance of the reconstruction. DISCUSSION AND CONCLUSIONS: Hemipelvectomy is a surgical procedure that is indicated for the treatment of locally advanced high grade pelvis located sarcomas, regardless of histological type. The incidence of limb preservation and overall survival is higher in chondrosarcomas compared to other sarcomas.

[Surgical treatment of chronic non-insertional Achilles tendinopathy in runners using bipolar radiofrequency]. / Tratamiento quirúrgico de la tendinopatía aquílea crónica no insercional en corredores mediante el uso de radiofrecuencia bipolar.

OBJECTIVE: To present the surgical technique with release of peritendon and radiofrequency as an effective treatment for athletes with chronic tendinopathy of the Achilles tendon body. MATERIALS AND METHODS: This is a retrospective case series descriptive type study. The series consists of 17 Achilles tendon surgeries in 13 patients, who habitually run. The study included patients with non-insertional Achilles tendinopathy refractory to conservative treatments. After a minimum follow-up of 12 months, clinical improvement of the athletes was assessed using the Nirschl pain scale, as well as athletic performance. RESULTS: An improvement was obtained in 94% of symptoms and a return to the previous performance in of 70% of cases in the 12 months follow-up. DISCUSSION: Peritendon release combined with bipolar radiofrequency is presented as an effective solution in this condition, for which there is currently no consensus on the best treatment. In patients in whom, after an appropriate conservative treatment for a sufficient period (at least 6 months) the non-insertional Achilles tendinopathy persists, open adhesiolysis combined with bipolar radiofrequency is a safe and with a high success rate clinical and functional intervention. In high performance athletes this technique allows a return to previous activity in a high percentage of cases.