¿Influye la ansiedad y depresión preoperatorias en los resultados de la artroplastia de rodilla? / Do preoperative anxiety and depression influence the outcome of knee arthroplasty?

ANTECEDENTES: La asociación de depresión y dolor crónico en la artrosis de rodilla es un fenómeno complejo y de difícil comprensión, en el que puede ser complicado establecer cuál de las dos entidades precedió a la otra. OBJETIVO: Además de analizar la relación entre ansiedad y depresión preoperatorias y los resultados de la artroplastia total de rodilla (ATR), se valoró la influencia de la ATR en la evolución de la sintomatología de ansiedad y depresión. MATERIAL Y MÉTODOS: Un total de 260 pacientes, con una edad promedio de 70,8 años, fueron evaluados preoperatoriamente y al año de la intervención, completando el Knee Society Score (KSS), la escala visual analógica (EVA), el Hospital Anxiety and Depression Scale (HADS) para valorar ansiedad y depresión, y el Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) para calidad de vida. RESULTADOS: Las puntuaciones medias de depresión/ansiedad preoperatorias descendieron de 6,55/7,63 a 4,96/5,96, respectivamente tras la cirugía, resultando estadísticamente significativas (p˂0,001). Las diferencias entre las puntuaciones preoperatorias y anuales, de los distintos grupos ordenados por el HADS, tanto para la ansiedad como para la depresión, resultaron estadísticamente significativas (p˂0,001). Las diferencias en las puntuaciones de la escala EVA fueron estadísticamente significativas (p = 0,02) en los pacientes con ansiedad preoperatoria pero no en los deprimidos. CONCLUSIONES: Aunque la ansiedad y depresión preoperatorias no influyeron en los resultados funcionales de la ATR, sí se objetivó que la ATR mejoró significativamente los niveles de ansiedad y depresión. En pacientes con ansiedad preoperatoria, el descenso en los niveles de dolor medidos por la EVA fue mayor tras la ATR

BACKGROUND: The association of depression and chronic pain in knee osteoarthritis is a complex and difficult phenomenon to understand. In fact, establishing the order of appearance of these entities might result in an arduous task. OBJECTIVE: In addition to analyzing the relationship between preoperative anxiety and depression according to the results of total knee arthroplasty (TKA), we will assess the evolution of anxiety and depression symptoms. MATERIAL AND METHODS: A study of 260 patients with a mean age of 70.8 years. Patients were evaluated preoperatively and one year post-surgery completing the Knee Society Score (KSS), the Visual Analogue Scale (VAS), the Hospital Anxiety and Depression Scale (HADS) for the assessment of anxiety and depression, and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) for quality of life. RESULTS: The mean scores of preoperative depression and anxiety decreased postoperatively from 6.55/7.63 to 4.96/5.96, respectively, a reduction that was statistically significant (P<.001). The differences between the preoperative scores and the 1-year scores of the different groups classified by HADS for both anxiety and depression were statistically significant (P˂.001). The differences in VAS scores (P=.02) showed a significant improvement in patients with preoperative anxiety, in contrast to depressed patients. CONCLUSIONS: TKA has proved to significantly decrease the preoperative levels of anxiety and depression. In patients with preoperative anxiety, the decrease in pain levels measured by the VAS was greater after TKA. Preoperative anxiety and depression did not influence the functional results of the TKA measured by the KSS

Do preoperative anxiety and depression influence the outcome of knee arthroplasty? / ¿Influye la ansiedad y depresión preoperatorias en los resultados de la artroplastia de rodilla?

BACKGROUND: The association of depression and chronic pain in knee osteoarthritis is a complex and difficult phenomenon to understand. In fact, establishing the order of appearance of these entities might result in an arduous task. OBJECTIVE: In addition to analyzing the relationship between preoperative anxiety and depression according to the results of total knee arthroplasty (TKA), we will assess the evolution of anxiety and depression symptoms. MATERIAL AND METHODS: A study of 260 patients with a mean age of 70.8 years. Patients were evaluated preoperatively and one year post-surgery completing the Knee Society Score (KSS), the Visual Analogue Scale (VAS), the Hospital Anxiety and Depression Scale (HADS) for the assessment of anxiety and depression, and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) for quality of life. RESULTS: The mean scores of preoperative depression and anxiety decreased postoperatively from 6.55/7.63 to 4.96/5.96, respectively, a reduction that was statistically significant (P<.001). The differences between the preoperative scores and the 1-year scores of the different groups classified by HADS for both anxiety and depression were statistically significant (P˂.001). The differences in VAS scores (P=.02) showed a significant improvement in patients with preoperative anxiety, in contrast to depressed patients. CONCLUSIONS: TKA has proved to significantly decrease the preoperative levels of anxiety and depression. In patients with preoperative anxiety, the decrease in pain levels measured by the VAS was greater after TKA. Preoperative anxiety and depression did not influence the functional results of the TKA measured by the KSS.

Total Knee Arthroplasty After Failed Unicompartmental Knee Arthroplasty. Clinical Results, Radiologic Findings, and Technical Tips.

BACKGROUND: The loss of anatomic references and bone stock turns unicompartmental knee arthroplasty (UKA) revision surgery difficult, and according to some authors, it is technically as challenging as a total knee arthroplasty (TKA) revision surgery. METHODS: A retrospective review of 559 Oxford medial UKA was performed between 2007 and 2013. Nineteen knees were revised to TKA for reasons other than infection, most commonly for osteoarthritis progression. RESULTS: The most frequent cause of failure in our series was osteoarthritis progression (10 cases, 52.63%). In 15 patients (78.95%), tibial stems were needed, and in 10 (55.5%), metallic blocks for augmentation of tibial plateau were used. Postoperative radiographic studies showed a correct implant alignment, preserving adequate joint line (24.8 mm), and patellar (1.1 mm) height (according to Insall-Salvati). After a mean follow-up of 21 months (range 6-51) mean values of 78.8 (standard deviation [SD] = 16.8) and 62.3 (SD = 19.6) were obtained for the physical and mental scores of the Knee Society Score test. In the SF-36 tests mean values of 45.2 (SD = 7.6) and 53 (SD = 5.2) were obtained for the physical and mental scores respectively. In one case, a varus/valgus instability occurred intraoperatively and it required revision with a prosthesis with higher constriction. No thromboembolic or infectious events were observed during postoperative follow-up. CONCLUSION: Following a standardized technique, UKA revision surgery can be achieved with TKA in almost every case despite bone stock loss and lack of anatomic landmarks.

Prótesis unicompartimental lateral de rodilla. Indicaciones, técnica y resultados a mediocorto plazo / Lateral unicompartimental knee replacement: indications, sugery procedures and shortmidterm outcomes

Objetivos: En los casos de gonartrosis del compartimento lateral, la prótesis unicompartimental es una de las alternativas quirúrgicas utilizadas, por el menor traumatismo que supone, corta estancia hospitalaria y rápida recuperación del paciente. Este estudio revisa nuestros casos. Material y método: Se describe la técnica utilizada y la prótesis implantada (polietileno móvil bicóncavo, OXFORD DOMED). Estudio observacional longitudinal retrospectivo de 15 casos intervenidos entre 2010 y 2013, 13 mujeres y 2 hombres, con una media de edad de 60’7 años, con diagnóstico de gonartrosis monocompartimental externa, sin afectación del compartimento medial ni fémororrotuliano y con ligamentos cruzados indemnes, con un seguimiento medio de 25 meses. Se les ha pasado escalas de funcionalidad y satisfacción. Resultados: Los resultados son favorables, con una mejoría de 6,60 puntos en la escala de EVA, de 3,73 sobre 1 en la función postoperatoria, muy satisfactorios en la OKS con una media de 38 puntos sobre 50, sin necesidad de ninguna revisión quirúrgica. Observamos tendinitis anserina en un 20% de los casos. Conclusiones: Se valoran los beneficios de esta cirugía frente a sus alternativas, así como de sus posibles inconvenientes. La artroplastia de rodilla unicompartimental externa es una alternativa efi caz en casos de gonartrosis confi nada al compartimento lateral sin otras lesiones asociadas

Objectives: In patients with lateral osteoarthritis of the knee, use of external unicompartmental knee arthroplasty it is a well known surgical alternative, used by the minor trauma involved, short hospital stay and rapid recovery. The purpose of this study is to show the clinical outcomes to short-medium term of patients undergoing this procedure. Methods: we describe the technique used and the peculiarities of the prosthesis (A Mobile-bearing lateral unicompartmental knee replacement, Oxford Domed(R)). This is an observational retrospective longitudinal study, of 15 arthroplasties performed in 13 women and 2 men, between 2010 and 2013, with a mean age of 60’7 years, with a diagnosis of lateral osteoarthritis of the knee, without involvement of the medial or patellofemoral compartment and cruciate ligaments functionally intact, with a mean follow up of 25 months. All patients complete the Oxford Knee Score and Visual Analog Scale (VAS) during the study. Results: The results are favorable, with an improvement of 6.60 points on the EVA, 3.73 for 1 in the postoperatory funcionality, the OKS very satisfactory with an average of 38 points over 50 and without any postoperative function surgical revision. Anserine tendinitis was observed in 20% of cases. Conclusions: The benefi ts of this surgery against their alternatives are assessed, and their potential drawbacks. External unicompartmental knee arthroplasty is an effective alternative in cases of knee osteoarthritis of the lateral compartment with no other associated injuries (AU)

Nuestra experiencia clínica en los rescates de ptr con el sistema Legión / Our clinical experience in ptr replacement with Legion system

Realizamos un estudio retrospectivo descriptivo con un tamaño muestral de 121 pacientes sometidos a recambio protésico mediante la prótesis Legión® en nuestra área hospitalaria Vírgen del Rocío, Sevilla, desde mayo de 2008 hasta marzo de 2011. En este estudio reflejamos los datos epidemiológicos y los detalles técnicos realizados, evaluando el dolor postoperatorio, la movilidad y los resultados funcionales mediante el uso de escalas de valoración funcional y estudios radiográficos seriados. El seguimiento medio fue de 19 meses, con una edad media de 71 años y un 87% mujeres. Obtuvimos un media de 20,41º de balance articular ganados, corrección de deformidades previas consiguiendo restaurar el eje tibiofemoral al valgo anatómico; solventamos las pérdidas óseas previas al rescate y conseguimos realizar un adecuado balance de la interlínea articular. Un 66% de los pacientes permanecían sin dolor postoperatorio, siendo en el 33% restante de características leves-moderadas. Con respecto al dolor en la punta del vástago, no hemos encontrado relación significativa con el ángulo de incidencia del vástago sobre la cortical ni con el tipo de cementación. Obtuvimos una tasa del 74% de intervenciones sin complicaciones, siendo éstas una rotura del tendón rotuliano en un paciente, un caso de fractura periprotésica, dos arrancamientos iatrogénicos de TTA y siete infecciones (4 de ellas diagnosticadas previamente)(AU)

We carried out a descriptive, retrospective study with a sample side of 121 patients with Legión® prosthesis replacement in our Vírgen del Rocío hospital area, in the city of Seville, from May of 2008 until March of 2011. This study included epidemiological data as well as technical information about the process performed, including post-operative pain, mobility and functional results using a functional assessment scale and series of radiological studies. Average follow-up was 19 months, with a mean age of 71 years and 87% women. We obtained an average of 20.41º for articular balance obtained, correction of prior deformities by restoring the tibia-femoral axis to the anatomic e balance articular angle; we resolved bone loss prior to replacement and carried out an adequate balance of the inter-lineal joint. 66% of the patients continued with no post-operative pain, with the other 33% reporting slight to moderate pain. With regards to pain at the point of the stem, we have found no significant relationship with the incidence angle of the stem on the cortical or with the type of cement. We observed a 74% rate of intervention without complications, with complications being rupture of the patellar tendon in one patient, one case of peri-prosthesis fracture, two iatrogenic avulsion fractures of the anterior tibial tuberosity and seven infections (4 were diagnosed previously)(AU)