[Low back pain and referral to the spine specialist: situation and resources in Buenos Aires]. / Lumbalgia y derivación al especialista de columna: situación y recursos en hospitales públicos de la Ciudad Autónoma de Buenos Aires.

INTRODUCTION: 90% of cases of acute low back pain have no specific underlying cause. International guidelines are available to help identify those individuals who require specialized care. However, in our country, there is a limited emphasis on primary healthcare, with the primary focus on hospital-based care. The aim of this study is to provide an overview of the diagnostic and therapeutic resources utilized in the initial care of patients experiencing low back pain at their first consultation with a specialist physician. METHODS: Descriptive and cross-sectional study, with prospective data collection through a questionnaire administered to patients experiencing low back pain during their first visit to a specialist's office. RESULTS: A total of 44 patients were included, with an average age of 53 years; 50% sought medical attention for chronic pain. Informal referrals were associated with the referring physician's specialty (non-orthopedic), patients with a higher number of emergency department visits, and longer waiting times to obtain the consultation; 52% of patients arrived with at least one complementary study. CONCLUSION: Most of the referrals were appropriate; however, informal referrals were more common. Only 1/5 of the patients underwent an physical examination, and less than 30% of those with red flag symptoms presented with suitable complementary studies. The median waiting time for the consultation was 24 days.

Introducción: El 90% de las lumbalgias agudas son de causa inespecífica. Existen guías internacionales que permiten identificar a aquellos pacientes que requieren atención especializada. En nuestro país la orientación a la atención primaria de la salud es escasa, centrada principalmente en la atención en los hospitales. El objetivo del presente estudio fue describir los recursos de salud, diagnósticos y terapéuticos, utilizados en la atención inicial de pacientes con dolor lumbar que acuden a la consulta del médico especialista Métodos: Estudio descriptivo y transversal, con recolección prospectiva de los datos a través de un cuestionario destinado a pacientes con dolor lumbar que acuden por primera vez a la consulta especializada. Resultados: Se incluyeron 44 pacientes, edad media 53 años; 50% concurrió por dolor crónico. La derivación informal se asoció con: especialidad de derivación (no traumatólogo), pacientes con mayor número de consultas a guardia y mayor demora en obtener la consulta. El 52% concurrió con al menos un estudio complementario. Conclusión: La mayor parte de las derivaciones fueron correctas, sin embargo, predominó la derivación informal. Solo 1/5 de los pacientes fue examinado y menos del 30% de los pacientes con banderas rojas acudió con estudios complementarios adecuados. La mediana del tiempo de espera para la consulta fue 24 días.

Enhancing robotic precision in medial UKA: Image-based robot-assisted system had higher accuracy in implant positioning than imageless robot-assisted system across 292 knees.

PURPOSE: The objective of this study was to compare the degree of accuracy in implant positioning and limb alignment offered by two robot-assisted (RA) systems: an image-based robot-assisted (IBRA) versus an imageless robot-assisted (ILRA) system for the treatment of medial knee osteoarthritis with unicompartmental knee arthroplasty (UKA). METHODS: This retrospective radiographic study included medial UKAs performed between 2011 and 2023. Radiographic measurements taken preoperatively and at 1-year postoperative control visit focusing on hip-knee-ankle angle (HKA), posterior tibial slope (PTS), tibial component coronal alignment relative to Cartier's angle and restoration of proper joint line (JL) height were analyzed. Outliers for postoperative measurements were defined as follows: HKA <175° or >180°, PTS <2° or >8°, >3° or <-3° alterations in Cartier's angle and ±2 mm changes in the height of the joint line. RESULTS: The final sample consisted of 292 medial UKAs: 95 (32.5%) with an IBRA system and 197 (67.5%) with an ILRA system. Implant positioning and limb alignment were more accurate in the group of patients treated with IBRA, HKA (77.9% vs. 67.5%, p = 0.07), PTS (93.7% vs. 82.7%, p = 0.01), restoration of tibial varus relative to Cartier's angle (87.4% vs. 65%, p < 0.001) and restoration of JL height (81.1% vs. 69.5%, p = 0.04). CONCLUSION: Medial UKA surgery using an IBRA system was associated with a higher degree of accuracy in implant positioning and postoperative limb alignment as compared to an ILRA system. This is a valuable contribution to help communicate the advantages of using this surgical technique and improve its reproducibility. LEVEL OF EVIDENCE: Level III, Retrospective cohort study.

Associated patellofemoral osteoarthritis is not a contraindication for unicompartmental knee replacement. Report of one hundred ten prostheses with an average 6-year follow-up.

INTRODUCTION: Associated patellofemoral joint osteoarthritis (APFJ-OA) has typically been considered a contraindication for unicompartmental knee arthroplasty (UKA) in the treatment of femorotibial joint osteoarthritis. However, this contraindication is being challenged. The aim of this study was to assess clinical and functional outcomes, complications, and implant survival in medial or lateral UKA, regardless of clinical symptoms or radiographic signs of APFJ-OA. METHODS: This retrospective, comparative study included patients treated with medial or lateral UKA regardless of preoperative symptoms or signs of APFJ-OA, with a minimum 2-year follow-up. Intraoperatively, knees were subdivided based on APFJ-OA grade, according to the Outerbridge classification. Clinical and functional outcomes were analyzed using the 2011 Knee Society Score (KSS) at the last follow-up control. APFJ-OA was treated systematically, in a tailored, stepwise fashion according to its severity. Complications and implant survival rates were evaluated. Two-sided paired T-test, ANOVA, and Kruskal-Wallis tests were used with a significance level of 5%. RESULTS: Finally, 110 UKAs were assessed 81 (73.6%) medial and 29 (26.4%) laterals. The average follow-up was 6 years (2-19.5). According to Outerbridge, 22 knees (20%) were in grade 2, 59 (53.6%) were in grade 3, and 29 (26.4%) were in grade 4. All three groups showed a statistically significant increase in KSS scores and range of motion. There were no significant differences in clinical KSS improvement and flexion contracture between Outerbridge groups (average 35.7 and -4.9, respectively). Group 3 showed statistically significant improvement in functional KSS when compared to group 2 (68.8 vs 61.2). In maximum flexion, groups 3 and 4 did significantly better than group 2 (20° vs 15°). Three prostheses (2.7%) needed revision after 7, 8.6, and 12 years due to aseptic tibial loosening. Implant survival was 100% at 5 (64 of 64), 97% at 7 (30 of 31), 93% at 9 (14 of 15), and 89% at 12 years, respectively (8 of 9). CONCLUSION: Clinical and functional results, complications, and survival of medial or lateral UKA were not negatively affected by APFJ-OA assessed intraoperatively using the Outerbridge classification after an average follow-up of 6 years. We consider that APFJ-OA is not a contraindication for UKA when treated systematically according to its severity. LEVEL OF EVIDENCE: IV.

Reemplazo unicompartimental bilateral de rodilla en un tiempo quirúrgico. Resultados a mediano plazo de 86 prótesis con un seguimiento promedio de 6.2 años / Bilateral simultaneous unicompartmental knee arthroplasty. Medium-term outcomes in 86 arthroplasties with an average follow-up of 6.2 years

Objetivo: Evaluar los resultados funcionales, las complicaciones y la supervivencia a mediano plazo de la prótesis unicompartimental bilateral medial o lateral de rodilla en un tiempo quirúrgico. Materiales y Métodos: Estudio retrospectivo de pacientes con prótesis unicompartimental bilateral medial o lateral de rodilla colocada en un tiempo quirúrgico por gonartrosis entre abril de 2004 y abril de 2020, seguimiento mínimo 1 año. Se evaluaron los resultados clínico-funcionales con el KSS 2011. Se determinaron los tiempos quirúrgico total y de internación, y el requerimiento de transfusiones. Se analizaron las complicaciones a corto y mediano plazo, y las tasas de revisión y de supervivencia de la prótesis. Resultados: Se evaluaron 86 prótesis unicompartimentales en 43 pacientes (seguimiento promedio 6.1 años). El KSS clínico y funcional aumentó de 46,1 ± 10,2 a 80,9 ± 15,9 y de 22,8 ± 11,9 a 89,8 ± 18,9, respectivamente. La flexión máxima mejoró de 106,3° ± 5,2° a 125,1° ± 4,2° y la contractura en flexión, de 7,5° ± 2,2° a 2,3° ± 1,6°. La cirugía duró 178.6 min y la internación, 39.8 h. Dos pacientes requirieron transfusión. La tasa de complicaciones fue del 6,9%, todas menores. Tres rodillas tuvieron un aflojamiento mecánico aséptico y requirieron revisión a prótesis total de rodilla o nueva prótesis unicompartimental tras 12, 8.6 y 7 años. La supervivencia de la prótesis fue del 96,5%. Conclusión: La prótesis unicompartimental bilateral medial o lateral en un tiempo quirúrgico para la gonartrosis unicompartimental de rodilla proporciona excelentes resultados clínico-funcionales, con bajas tasas de complicaciones. Nivel de Evidencia: IV

Objective: The purpose of this article is to examine the functional outcomes, complications, and medium-term survivorship of medial or lateral bilateral simultaneous unicompartmental knee arthroplasty (bUKA) for the treatment of bilateral knee osteoarthritis. Materials and Methods: Retrospective report of patients who underwent a medial or lateral bUKA for treatment of bilateral knee osteoarthritis between April 2004 and April 2020, with a minimum follow-up of 1 year. The KSS 2011 was used for the clinical-functional evaluation of each patient. The duration of surgery, length of hospital stay, and transfusion requirements were determined. The short-term and medium-term complications were analyzed, as well as the revision rate and the prosthesis survivorship. Results: We evaluated 86 bUKAs in 43 patients with a mean follow-up of 6.1 years. The clinical and functional KSS improved from 46.1 ± 10.2 to 80.9 ± 15.9 and 22.8 ± 11.9 to 89.8 ± 18.9 respectively. Postoperative maximal flexion improved from 106.3º ± 5.2º to 125.1º ± 4.2º and flexion contracture improved from 7.5º ± 2.2º to 2.3º ± 1.6º. The mean surgical time was 178.6 minutes and the hospital stay was 39.8 hours. Two patients required transfusions. The complication rate was 6.9%. Three knees (3.5%) required revision surgery for aseptic loosening after 7, 8.6 and 12 years. The survivorship rate was 96.5%. Conclusion: Simultaneous medial or lateral bUKA provides excellent clinical-functional outcomes with a low rate of complications in patients with bilateral knee osteoarthritis. Level of Evidence: IV