Cultivo condral in vitro bajo estímulos de compresión y cizallamiento. De las células troncales mesenquimales al cartílago hialino / In vitro chondral culture under compression and shear stimuli. From mesenchymal stem cells to hyaline cartilage

INTRODUCCIÓN: La creación in vitro de cartílago hialino articular supone un reto, ya que, a día de hoy, no se ha conseguido la síntesis ex vivo de un tejido estructurado con las mismas propiedades biomecánicas e histológicas del cartílago articular. Para simular las condiciones fisiológicas hemos diseñado un sistema de cultivo in vitro que reproduce el movimiento articular. MATERIAL Y MÉTODO: Hemos desarrollado un biorreactor de cultivo celular que imprime un estímulo mecánico sobre una matriz de elastina en la que están embebidas células troncales mesenquimales (MSC). La primera fase de estudio corresponde al desarrollo de un biorreactor para cultivo de cartílago hialino y la comprobación de la viabilidad celular en la matriz de elastina en ausencia de estímulo. La segunda fase del estudio engloba el cultivo de MSC bajo estímulo mecánico y el análisis del tejido resultante. RESULTADOS: Tras el cultivo bajo estímulo mecánico no obtuvimos tejido hialino por falta de celularidad y desestructuración de la matriz. CONCLUSIÓN: El patrón de estímulo utilizado no ha resultado efectivo para la generación de cartílago hialino, por lo que se deberán explorar otras combinaciones en futuras investigaciones

INTRODUCTION: The in vitro creation of hyaline joint cartilage is a challenge since, to date, the ex vivo synthesis of a structured tissue with the same biomechanical and histological properties of the joint cartilage has not been achieved. To simulate the physiological conditions we have designed an in vitro culture system that reproduces joint movement. MATERIAL AND METHOD: We have developed a cell culture bioreactor that prints a mechanical stimulus on an elastin matrix, in which mesenchymal stem cells (MSC) are embedded. The first phase of study corresponds to the development of a bioreactor for hyaline cartilage culture and the verification of cell viability in the elastin matrix in the absence of stimulus. The second phase of the study includes the MSC culture under mechanical stimulus and the analysis of the resulting tissue. RESULTS: After culture under mechanical stimulation we did not obtain hyaline tissue due to lack of cellularity and matrix destructuring. CONCLUSION: The stimulus pattern used has not been effective in generating hyaline cartilage, so other combinations should be explored in future research

In vitro chondral culture under compression and shear stimuli. From mesenchymal stem cells to hyaline cartilage. / Cultivo condral in vitro bajo estímulos de compresión y cizallamiento. De las células troncales mesenquimales al cartílago hialino.

INTRODUCTION: The in vitro creation of hyaline joint cartilage is a challenge since, to date, the ex vivo synthesis of a structured tissue with the same biomechanical and histological properties of the joint cartilage has not been achieved. To simulate the physiological conditions we have designed an in vitro culture system that reproduces joint movement. MATERIAL AND METHOD: We have developed a cell culture bioreactor that prints a mechanical stimulus on an elastin matrix, in which mesenchymal stem cells (MSC) are embedded. The first phase of study corresponds to the development of a bioreactor for hyaline cartilage culture and the verification of cell viability in the elastin matrix in the absence of stimulus. The second phase of the study includes the MSC culture under mechanical stimulus and the analysis of the resulting tissue. RESULTS: After culture under mechanical stimulation we did not obtain hyaline tissue due to lack of cellularity and matrix destructuring. CONCLUSION: The stimulus pattern used has not been effective in generating hyaline cartilage, so other combinations should be explored in future research.

3D printing utility for surgical treatment of acetabular fractures. / Utilidad de la impresión 3D para el tratamiento quirúrgico de las fracturas acetabulares. Beca proyecto de investigación SECOT 2014.

INTRODUCTION: Preoperative 3D modelling enables more effective diagnosis and simulates the surgical procedure. MATERIAL AND METHODS: We report twenty cases of acetabular fractures with preoperative planning performed by pre-contouring synthesis plates on a 3D printed mould obtained from a computarized tomography (CT) scan. The mould impression was made with the DaVinci 1.0 printer model (XYZ Printing). After obtaining the printed hemipelvis, we proceeded to select the implant size (pelvic Matta system, Stryker®) that matched the characteristics of the fracture and the approach to be used. RESULTS: Printing the moulds took a mean of 385minutes (322-539), and 238grams of plastic were used to print the model (180-410). In all cases, anatomic reduction was obtained and intra-operative changes were not required in the initial contouring of the plates. The time needed to perform the full osteosynthesis, once the fracture had been reduced was 16.9minutes (10-24). In one case fixed with two plates, a postoperative CT scan showed partial contact of the implant with the surface of the quadrilateral plate. In the remaining cases, the contact was complete. CONCLUSIONS: In conclusion, our results suggest that the use of preoperative planning, by printing 3D mirror imaging models of the opposite hemipelvis and pre-contouring plates over the mould, might effectively achieve a predefined surgical objective and reduce the inherent risks in these difficult procedures.

[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.

Artroplastia total tras fractura intracapsular de cadera en paciente con parálisis cerebral infantil / A case of intracapsular hip fracture in a patient with infantile cerebral palsy

Objetivo: Presentamos el caso de un paciente de 36 años con una fractura intracapsular de extremidad proximal de fémur de larga evolución que fue sometido a una artroplastia de sustitución total con un resultado funcional excelente. La tasa de aflojamiento del implante es baja a pesar de la juventud de estos pacientes, pues tienen un nivel de actividad bajo y precisan de ayuda de bastones. Hay que considerar la espasticidad, los movimientos involuntarios y la realización de tenotomías que merman la estabilidad del implante (AU)

Objective: We present the case of a 36 year-old patient with an intracapsular fracture of the proximal femur who underwent a total replacement arthroplasty with an excellent functional outcome. The loosening rate of the implant is low despite youth of these patients, as they have a low level of activity and require the aid of crutches. It should be considered that spasticity, involuntary movements and the performance of tenotomies decrease the stability of the implant (AU)

[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.

[Comparison of hemostatic markers under different techniques for anesthesia-analgesia in total hip or knee replacement]. / Comparación de los marcadores de la hemostasia dependiendo de la técnica anestésica/analgésica empleada en cirugía de prótesis de rodilla y cadera.

BACKGROUND AND OBJECTIVE: Surgery promotes a state of hypercoagulability, predisposing to the possibility of postoperative thromboembolic complications. Our aim was to determine whether certain combinations of techniques (neuraxial, intravenous or both) for anesthesia and analgesia might be associated with attenuation of the prethrombotic state following total hip or knee replacement. METHODS: Prospective longitudinal study of 45 patients undergoing elective hip or knee prosthetic surgery. The patients were randomized to 3 groups to receive different anesthesia-analgesia combinations: spinal-intravenous, spinal-epidural, or general-intravenous. From induction until 36 hours after surgery, we recorded the postoperative time course of the following markers of coagulation and fibrinolysis: platelet count; fibrinogen level; activated partial thromboplastin time; international normalized ratio; and levels of prothrombin activation fragments 1 and 2, thrombin-antithrombin III complex, and D-dimer. RESULTS: No statistically significant between-group differences were found in patient demographic, clinical, surgical or postoperative data. No symptomatic thromboembolic complications or deaths were recorded in the 30 days after surgery. Statistically significant differences were found in laboratory results for samples taken 36 hours after surgery. Patients who received spinal-epidural anesthesia and analgesia had lower levels of prothrombin activation fragments 1 and 2 and longer activated partial thromboplastin times than the group receiving the spinal-intravenous combination. CONCLUSIONS: The anesthetic technique used during surgery did not affect hemostasis. However, continuous epidural analgesia in the postoperative recovery period attenuated some markers of hypercoagulability.

Comparación de los marcadores de la hemostasia dependiendo de la técnica anestésica/analgésica empleada en cirugía de prótesis de rodilla y cadera / Comparison of hemostatic markers under different techniques for anesthesia-analgesia in total hip or knee replacement

INTRODUCCIÓN Y OBJETIVO: La cirugía provoca unestado de hipercoagulabilidad en el postoperatorio quepuede predisponer a complicaciones tromboembólicas.El objetivo de este estudio es determinar si una combinaciónde técnicas anestésicas/analgésicas (neuroaxialeso intravenosas o ambas) se asocia con una atenuacióndel estado pretrombótico en el postoperatorio de cirugíade prótesis total de rodilla y cadera.MÉTODOS: Estudio longitudinal y prospectivo con 45pacientes sometidos a cirugía electiva ortopédica de rodillao cadera. Los pacientes fueron distribuidos aleatoriamentea 3 grupos dependiendo de las técnicas anestésicas/analgésicas empleadas: subaracnoidea/intravenosa,subaracnoidea/epidural y general/intravenosa. Se siguióla evolución temporal de los siguientes marcadores deactivación de la coagulación y fibrinolisis, desde elmomento previo a la inducción hasta 36 horas después dela cirugía: número de plaquetas, fibrinógeno, tiempo detromboplastina parcial activada, relación normalizadainternacional, fragmento de activación de protrombinaF1+2, complejo trombina-antitrombina III y dímero-D.RESULTADOS: No encontramos ninguna diferenciaestadísticamente significativa entre los grupos en términosde características demográficas, datos intraoperatorioso postoperatorios. No hubo complicaciones tromboembólicasclínicamente sintomáticas, ni fallecimientos enlos primeros 30 días del postoperatorio. Encontramosdiferencias estadísticamente significativas entre los gruposen las muestras obtenidas 36 h después de la cirugía,donde el grupo de pacientes anestesiados con anestesiasubaracnoidea/epidural presentaba menores cifras defragmentos F1+2 y un tiempo de tromboplastina parcialactivada más prolongado, comparado con el grupo anestesiadocon anestesia subaracnoidea/intravenosa...(AU)

BACKGROUND AND OBJECTIVE: Surgery promotes a stateof hypercoagulability, predisposing to the possibility ofpostoperative thromboembolic complications. Our aimwas to determine whether certain combinations oftechniques (neuraxial, intravenous or both) foranesthesia and analgesia might be associated withattenuation of the prethrombotic state following total hipor knee replacement.METHODS: Prospective longitudinal study of 45 patientsundergoing elective hip or knee prosthetic surgery. Thepatients were randomized to 3 groups to receive differentanesthesia–analgesia combinations: spinal–intravenous,spinal–epidural, or general–intravenous. From inductionuntil 36 hours after surgery, we recorded thepostoperative time course of the following markers ofcoagulation and fibrinolysis: platelet count; fibrinogenlevel; activated partial thromboplastin time; internationalnormalized ratio; and levels of prothrombin activationfragments 1 and 2, thrombin-antithrombin III complex,and D-dimer.) RESULTS: No statistically significant between-groupdifferences were found in patient demographic, clinical,surgical or postoperative data. No symptomaticthromboembolic complications or deaths were recordedin the 30 days after surgery. Statistically significantdifferences were found in laboratory results for samplestaken 36 hours after surgery. Patients who receivedspinal–epidural anesthesia and analgesia had lowerlevels of prothrombin activation fragments 1 and 2 andlonger activated partial thromboplastin times than thegroup receiving the spinal–intravenous combination.CONCLUSIONS: The anesthetic technique used duringsurgery did not affect hemostasis. However, continuousepidural analgesia in the postoperative recovery periodattenuated some markers of hypercoagulability(AU)

Estudio de citoquinas y proteínas de choque térmico en pacientes polifracturados / Study of cytokines and heat shock proteins in multiple fracture patients

Objetivo: Valorar la repercusión y comportamiento de los niveles séricos de factores proinflamatorios con respecto a la aparición de complicaciones médico–quirúrgicas en pacientes politraumatizados. Material y métodos: se incluyeron 18 pacientes politraumatizados, 10 hombres y 8 mujeres, con 2 o más fracturas óseas y un ISS>16, con edad media de 42 años y cuyo mecanismo lesional más frecuente fue el accidente de tráfico (44%). El valor medio del ISS fue de 26,83 y de 33,72 para el NISS. Se recogieron datos demográficos, lesiones ocasionadas, intervenciones quirúrgicas realizadas, datos de evolución, complicaciones y secuelas. Se analizó en sangre, leucocitos, fibrinógeno, proteína C reactiva, TNFα, interleucina 1β, interleucina 6, proteína de choque térmico HSP70i y anticuerpos antiHSP70i. Resultados: Los valores de TNFα, tienen una curva ascendente, con un aumento de la pendiente a partir de las 48 horas del traumatismo. La IL-1‚ mostró el pico máximo en la primera medición inmediatamente después del traumatismo, para disminuir de manera progresiva. La IL-6 presentó cifras por encima de 500 pg/ml. Los niveles séricos elevados de HSP70i máximos en el momento inicial para disminuir en las siguientes 48 horas. Conclusiones: Las curvas de reacción de factores proinflamatorios establecidas servirán de base para futuros estudios que los afiancen como biomarcadores de politraumatismo (AU)

Objective: To evaluate the repercussion and behavior of the serum levels of proinflammatory factors in relation to the appearance of clinical-surgical complications in polytraumatized patients. Material and methods: The study comprised 18 polytraumatized patients, 10 males and 8 females, with two or more bone fractures and an injury severity score (ISS) >16, and with a mean age of 42 years, in which traffic accidents were the main cause of injury (44%). The mean ISS was 26.83, with a new injury severity score (NISS) of 33.72. Demographic data were collected, together with information on the injuries produced, the surgical interventions, outcome, complications and sequelae. Blood tests were performed to record leukocyte count, fibrinogen, C-reactive protein, TNF·, interleukin 1‚, interleukin 6, heat shock protein HSP70i and antiHSP70i antibodies. Results: The TNF· values showed an ascending tendency, with an increase in slope starting 48 hours after trauma. IL-1 in turn showed a maximum value on occasion of the first measurement immediately after injury, followed by a gradual decrease. IL-6 showed values above 500 pg/ml. Peak serum HSP70i elevation were recorded at first determination, followed by a decrease over the following 48 hours. Conclusions: The established proinflammatory factor response curves will serve as a basis for future studies to consolidate them as biomarkers applicable to polytraumatized patients (AU)

Estudio comparativo del tratamiento con enclavado elástico y fijador externo en las fracturas de fémur del niño: a propósito de 40 casos / Elastic nailing vs. external fixation as methods to address pediatric femoral fractures: a review of 40 cases

Objetivo: analizar los resultados de las fracturas de diáfi sis femoral del niño tratadas ennuestro centro mediante enclavado intramedular elástico y su comparación con los resultadosdel tratamiento con fi jador externo.Material y método: se estudió retrospectivamente a 40 pacientes con fracturas de fémurintervenidos en nuestro centro entre mayo de 1995 y enero de 2006. Veinte pacientes setrataron mediante enclavado elástico y 20 mediante fi jador externo. La media de tiempode seguimiento fue 20,6 (intervalo, 3-59) meses. Se analizaron los resultados radiográfi -cos iniciales y evolutivos, y su relación con el tiempo de ingreso, tiempo de consolidación,número de consultas de revisión e incidencia de complicaciones y reintervenciones.Resultados: la duración de la cirugía, la estancia media hospitalaria y las complicacionesde la herida quirúrgica son menores en el grupo de enclavado elástico. El tiempo de consolidaciónde la fractura, así como las complicaciones a largo plazo, y el número de reintervencionesfueron también menores en este grupo. Los hallazgos radiológicos demostrarontambién menores angulación, desplazamiento y discrepancia de longitud fi nal delas extremidades en los niños tratados con clavos elásticos.Conclusiones: en este trabajo se refuerza la idea de que el enclavado elástico, por lasencillez del proceso, menores agresión y necesidad de cuidados para el niño, los mejoresresultados clínico-radiológicos y la menor tasa de complicaciones y reintervenciones,es una mejor opción en el tratamiento de estas fracturas(AU)

Purpose: To analyze the outcomes of pediatric femoral shaft fractures in our hospital,comparing the results obtained with elastic intramedullary nailing with those of externalfi xation.Materials and methods: We retrospectively studied 40 patients with femoral fracturesoperated in our hospital between May 1995 and January 2006. 20 patients were treatedby means of elastic nailing and 20 with an external fi xator. Mean follow-up was 20.6months (range: 3-59). Initial and subsequent radiographic results were analyzed, as wellas their relationship with hospitalization time, time to healing, number of follow-upvisits and incidence of complications and reoperations.Results: OR time, mean hospital stay and complications related to the surgical woundwere lower in the elastic nailing group. Time to fracture union, the rate of long-termcomplications and the number of reoperations were also lower in this group. Radiologicalfi ndings also showed less angulation, displacement and fi nal leg length discrepancy inchildren treated with elastic nails.Conclusions: This study confi rms the notion that elastic nailing, given the simplicity ofthe procedure and its lower degree of invasiveness, the reduced need to protect thechild, its better clinical-radiological results and the lower rate of complications andreoperations, is a better option for treating these fractures(AU)

Artroplastia patelar secundaria en el tratamiento de la prótesis total de rodilla dolorosa / Secondary patellar resurfacing in painful total knee arthroplasty

Objetivo. Analizar los resultados de las artroplastias patelares secundarias (APS) realizadas en nuestro centro sobre pacientes con artroplastia total de rodilla (ATR) dolorosa.Material y método. Se estudiaron retrospectivamente 20 pacientes sobre los que se había realizado una APS por presentar una ATR con dolor de origen patelar. El intervalo medio de tiempo desde la ATR fue de 24,8 meses (8,5-67) y el seguimiento posoperatorio medio de los casos fue de 13,5 meses (2-44). Se realizó un análisis radiológico y una evaluación clínica mediante las variaciones del rango articular y el alivio del dolor.Resultados. El 60% de los pacientes tuvo un alivio del dolor, el 30% de forma permanente y el 30% de forma temporal con un tiempo medio libre de dolor de 8,2 meses (1,5- 18). Los parámetros radiológicos de alineación rotuliana mejoraron en todos los casos y se observó un acortamiento del tendón rotuliano. El grosor patelar medio posoperatorio fue mayor que el preoperatorio. Se observaron complicaciones en el 10% de los pacientes.Conclusiones. La reproducibilidad de la técnica con losnuevos implantes, la baja tasa de complicaciones y las aceptables cifras de resultados satisfactorios la convierten en una técnica valorable para determinados casos. El carácter multifactorial de la ATR dolorosa con rótula nativa y la complejidad diagnóstica que esto implica debe plantear cautela a la hora de indicar una APS de forma rutinaria

Purpose. To analyze the results of the secondary patellar resurfacing (SPR) procedures carried out in our department for the treatment of patients with painful total knee arthroplasty (TKA).Materials and methods. We retrospectively reviewed 20 patients who had undergone SPR due to persistent anteriorknee pain following TKA. The mean time interval to secondary resurfacing was 24.8 months (8.5-67) and the mean follow- up was 13.5 months (2-44). Patients were evaluated radiologically and clinically through an analysis of variations in ROM and pain relief.Results. Pain relief was reported for 60% of patients, 30% permanently and 30% temporaly with a pain-free time interval of 8.2 months (1.5-18). The radiological parameters for patellofemoral congruency improved in all patients and there was a shortening of the mean length of the patellar tendon. The mean patellar thickness increased after the secondary procedure. There were complications in 10% of patients.Conclusions. The reproducibility of the technique with new implants, the low rate of complications and the percentage of satisfactory results make this technique suitable for selected cases. The diverse origin of painful TKA and the complexities of diagnosis should make the surgeon weigh the situation carefully before embarking on an SPRc

Artropatía neuropática de hombro asociada a siringomielia / Artrophatic neuropathy of the shoulder associated to syringomyelia

Se presenta un caso del conocido como hombro de Chopart, una artropatía neuropática como consecuencia de siringomielia en una paciente de 62 años con antecedentes durante 5 años en su hombro. La clínica y la RMN de la columna cervical permitieron el diagnóstico. El tratamiento fue conservador con una buena evolución (AU)

A case of Chopart shoulder, a neuropathic shoulder arthropathy associated with syringomyelia, was detected in a 62 years old woman with five years shoulder clinic. The clinical examination and a cervical MRI detected the ethiology. The treatment was functional with a good outcome (AU)

Lumbalgia en varón diagnosticado de luxación congénita de cadera / No disponible

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Estudio prospectivo de los reactantes fase aguda tras una artroplastia total de rodilla / Prospective study of acute phase response factors after total knee artrhoplasty

Introducción: La artroplastia total de rodilla actualmentees el tratamiento de elección para las artrosis evolucionadasde dicha articulación. Al igual que otras lesiones mayores, lasintervenciones quirúrgicas o los traumatismos, originan respuestasmetabólicas, hormonales y hemodinámicas. Nos proponemosvalorar los reactantes de fase aguda tanto en prótesistotales de rodilla normales como en infectadas.Material y método: De forma consecutiva, a partir de marzodel 2003, se reclutaron 36 pacientes a los que se les implantóuna prótesis total de rodilla (grupo I). Además se estudiaron10 pacientes (grupo II) a los que se les habíaimplantado una prótesis de rodilla y presentaban criterios deinfección.Resultado: En el grupo I, los leucocitos y la PCR presentanun pico máximo a las 24 horas de la intervención, observándoseniveles preoperatorios en la extracción obtenida al mes;El fibrinógeno y la VSG muestran un ascenso hasta la extraccióntomada al mes de la cirugía, y continúan con niveles superioresa los basales incluso después de tres meses.Lo pacientes del grupo II mostraron niveles, estadísticamentesignificativos, más altos de fibrinógeno, VSG y PCR.Conclusiones: Los reactantes de fase aguda ofrecen unamoderada eficacia diagnóstica por lo que deben apoyar aldiagnóstico basado en los criterios clínicos de infección

Introduction: Nowadays total knee arthroplasty (TKA) isthe choice treatment in evolved knee artrosis. Operations ortraumas cause metabolism and hormone responses.Patients and Methods: Consecutively, from 2003, we includedprospectively in this research, 36 patients undergoingelective TKA (group I). Also we studied 10 patients (group II)that were diagnosed as infected TKA.Results: Acute phase response evolution in group I showsmaximum leukocytes and C-reactive protein (CRP) levels duringthe first 24 hours after the surgery, returning to presurgicallevels after one month. Erythrocyte sedimentation (ESR)rate and fibrinogen are increased even 3 months after the surgery.The patients of the goup II showed hihger levels, statisticallysignificant, of fibrinogen, CRP and ESR.Discussion: Acute phase response factors offer modest diagnosticefficacy, so we always have to use the clinical criterionto achive a god diagnosis

Lumbalgia inespecífica tras artroplastia lumbar / No disponible

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