Acute Haematogenous Revision Total Knee Arthroplasty Infection by Streptococcus canis Treated by Debridement, Antibiotics, and Implant Retention: A Case Report.

Prosthetic joint infections (PJIs) are one of the most feared complications by orthopaedic surgeons. Haematogenous PJI represents an important part of PJI cases. Streptococcus canis is an extremely rare cause of haematogenous PJI and its medical and surgical treatment and prognosis are not well established. We present a 79-year-old female patient who had a revision total knee arthroplasty (rTKA) surgery three years before. She was admitted to the hospital referring to three days of knee pain, restricted range of motion, and fever. Blood tests demonstrated leukocyte and C-reactive protein elevation. Joint fluid aspiration showed elevated white blood cell count with a high neutrophil differential and its conventional culture was positive for Streptococcus canis. She did not have pets but she took care of her daughter's dog. An acute haematogenous infection of the rTKA was diagnosed and treated with debridement, antibiotics (eight weeks of IV ceftriaxone), and implant retention (DAIR). After one year, the patient remains clinically asymptomatic without changes on X-rays and with normal serum levels of inflammatory blood markers. Streptococcus canis has to be kept in mind as a possible cause of haematogenous TKA infection in patients who have contact with domestic pets and patients should be asked for this contact. We recommend DAIR as a viable treatment option for this type of infection, which may show excellent results.

Localized hamstring bioimpedance in marathon runners is related to muscle high-energy enzyme serum levels and predicts race time.

Introduction: The aim was to analyze the response of serum levels of inflammatory, high-energy muscle biomarkers and hamstring localized bioimpedance (L-BIA) measurements to marathon running and to ascertain whether they correlate with each other or with race time. Methods: Blood samples and hamstrings tetra-polar L-BIA measurements from 14 Caucasian male recreational athletes at the Barcelona Marathon 2019 were collected at base line, immediately after and 48 h post-race. Serum C reactive protein (sCRP), creatinine kinase (sCK) and lactate dehydrogenase (sLDH) were determined using an AU-5800 chemistry analyzer. L-BIA was obtained at 50 kHz with a Quantum V Segmental phase-sensitive bioimpedance analyzer. Results: Median sCRP increased (4-fold) after 48 h post-race. Median sCK and sLDH levels increased immediately post-race (3-fold, 2-fold) and 48h post-race (5-fold, 1-fold). Left, right and combined hamstring reactance (Xc) and phase angle (PhA) increased immediately post-race. Xc combined hamstring pre- and immediately post-race correlated with race-time and with sCK and sLDH median levels pre-race. Xc combined hamstring pre- and immediately post-race > 15.6 Ω and 15.8 Ω, respectively, predicted the race time of 3:00:00 h. Conclusion: L-BIA reactance (Xc) is an objective direct, real time, easy, noninvasive bioelectrical parameter that may predict muscle and marathon athlete performance.

Perioperative experiences of patients with high pain catastrophizing and knee arthroplasty after receiving or not preoperative physiotherapy: Qualitative study.

BACKGROUND: Among the risk factors studied for persistent pain after total knee arthroplasty (TKA), pain catastrophizing stands out above the others. In this regard, preoperative interventions based on pain neuroscience education or multimodal physiotherapy have been shown to be effective in reducing pain catastrophizing. OBJECTIVES: The present qualitative study aims to explore the perioperative experiences of high pain catastrophizing participants undergoing total knee arthroplasty surgery. Comparisons will be made between those who received, and those who did not receive a preoperative physiotherapy intervention. METHODS: Based on the purposive sampling approach, participants from a randomized controlled trial were selected. In total, 14 persons participated in face-to-face semi-structured interviews. RESULTS: Following a thematic analysis, the results were divided into two themes: 1) The preoperative experiences of patients with symptomatic knee arthroplasty, covering aspects related to health, functioning, cognition, and behaviour; and 2) The perioperative TKA rehabilitation process, illustrating differing experiences between individuals who received the preoperative physiotherapy interventions and those who did not. CONCLUSIONS: While participants who received no preoperative physiotherapy intervention showed limited coping strategies during post-surgery rehabilitation and the same cognitions as before (hypervigilance, rumination, or avoidance of activities), those participants who received the preoperative physiotherapy showed abilities to cope with their pain, felt empowered and were involved in their rehabilitation.

Combined femoral and tibial component total knee arthroplasty device rotation measurement is reliable and predicts clinical outcome.

BACKGROUND: The optimal total knee arthroplasty (TKA) rotational alignment and how best to obtain and measure it are debatable. The aim was to analyse the reliability of the Berger femoral, three different tibial and four different combined two-dimensional computer tomography (2D-CT) TKA component rotation measurements, and to ascertain which rotational values best predict a successful clinical outcome. METHODS: The 2D-CT scans were obtained post-operatively on 60 patients who had TKA. We determined one femoral [Berger's femoral angle (BFA)], three tibial [Berger's tibial angle (BTA), anatomical tibial angle (ATA) and bimalleolar posterior tibial component angle (BM_PTCA)] and four combined [transepicondylar posterior tibial component angle (TE_PTCA), bicondylar posterior tibial component angle (BC_PTCA, transepicondylar bimalleolar angle (TE_BM) and bicondylar bimalleolar angle (BC_BM)] TKA rotation angles. We made all measures in 23 patients twice by three observers and determined inter- and intra-observer agreement using the Bland-Altman plot method. We analysed measures of 55 patients using the area under the ROC curve (AUC) analysis to ascertain the discriminative capacity of BFA, ATA, TE_PTCA and BC_PTCA for predicting a successful clinical outcome according to the Knee Society Score (KSS) threshold. RESULTS: ATA showed the smaller inter- and intra-observer average of differences (-0.1° and 1.6°, respectively) of the studied methods followed by BFA (-0.9° and 1.4°), TE_PTCA (-2.1° and 2.7°) and BC_PTCA (-0.5° and 1.8°). BFA (-4° to 2.1° and -6.1° to 8.8°) and BC_PTCA (-4.4° to 3.4° and -7.9° to 4.4°) showed the narrower inter- and intra-observer limits of agreement. A TKA device rotation (BC_PTCA) < 0.8° of external rotation (ER) predicted a KSS and KSS knee successful outcome, and < 3.8° ER for KSS functional (AUC = 0.889; 0.907 and 0.764, respectively). BFA and ATA < 0.9° ER and < 3.9° internal rotation (IR) predicted a successful KSS knee outcome (AUC = 0.796 and 0.889, respectively). CONCLUSION: The ATA tibial component rotation measurement was the most reliable of those studied. BFA, TE_PTCA and BC_PTCA were reliable measures for TKA femoral and combined rotation. The presence of a minimal rotation between the TKA components (BC_PTCA) and a small femoral ER or tibial IR predicted a successful KSS outcome.

A feasibility study of home-based preoperative multimodal physiotherapy for patients scheduled for a total knee arthroplasty who catastrophize about their pain.

BACKGROUND: Preoperative pain catastrophizing (PC) and pain are both risk factors for poor outcomes after a total knee arthroplasty (TKA). Despite that, there is limited evidence about physiotherapy interventions' effectiveness on addressing such factors. PURPOSE: To evaluate the feasibility and clinical impact of a home-based multimodal physiotherapy intervention in reducing pain and PC, in patients scheduled for a TKA who present preoperative moderate-to-severe pain and PC. METHODS: Three-armed parallel-group randomized controlled feasibility study. Subjects with symptomatic osteoarthritis and a score of ≥ 20 on the Pain Catastrophizing Scale (PCS) were recruited. The control group received usual care. Both experimental groups received pain neuroscience education, coping skills training and therapeutic exercise, but differ in the number of sessions, dosage, hands-on approach, and grade of supervision. All outcomes were measured before and after the intervention. RESULTS: A total of 33,7% were eligible for inclusion, and 97,1% agreed to participate. Every participant completed the treatment. Treatment compliance was higher in the group with additional supervision. Both groups showed significant effects in PC and pain reduction. A total of 33 patients would be required for a full trial. CONCLUSION: Preoperative physiotherapy is a feasible and effective treatment in reducing pain intensity and PC in high PCS osteoarthritis subjects scheduled for a TKA.

Location, Clinical Presentation, Diagnostic Algorithm and Open vs. Arthroscopic Surgery of Knee Synovial Haemangioma: A Report of Four Cases and a Literature Review.

Objective: The aim was to report 4 patients with intra-articular knee synovial haemangioma (KSH) and to perform a systematic review to describe the patient characteristics, patterns of tumor location, clinical presentation, usefulness of imaging examinations, pros and cons of arthroscopic vs. open resection, and follow-up in the literature. Design: From 1996 to 2016, four patients with KSH were retrospectively reviewed. A literature search was conducted in PubMed from 2000/01 to 2020/06 using the search terms "synovial haemangioma" and "knee." Fifty full-text articles that included a total of 92 patients were included for further discussion. Results: Four adults (20-40 years) were diagnosed with KSH. Three lesions located in the suprapatellar pouch, two eroding the patella and one the supratrochlear bone, and one in the posterior compartment. Persistent anterior knee pain was the main complain. MRI revealed a benign tumor mass in all cases except one. Open excisional biopsy and regional synovectomy were performed in three patients, and by arthroscopy of the posterior compartment in the fourth. Histological type was arteriovenous in three cases and capillary in one. A pain-free knee without recurrence was achieve in all cases except one, which was successfully reoperated. Average follow-up time was 3.5 years. A literature review showed that KSH appears most frequently in children and teenagers (64.6%) and does not differ by gender. The suprapatellar and patella-femoral joint compartment was the most frequent location (47.9%). The bony tissue of the knee was rarely affected (13.5%). Pain, swelling and haemarthrosis were frequently reported (88.2, 66.7, and 47.1%). MRI was the most commonly used imaging test (98%). Treatment consisted of regional synovectomy by open surgery or arthroscopy in 66.7 and 15.6% of cases, respectively. Conclusions: KSH should be considered in the differential diagnosis of adult patients with chronic low-intensity knee pain. MRI is the most useful exam because it establishes the location, extent and benign characteristics of the tumor. Definitive diagnosis requires histological examination. We believe excisional biopsy and regional synovectomy by arthroscopy should be the treatments of choice for intra-articular tumors, but we recommend open surgery when the lesion extends to the tendons, muscle or bone.

Marathon Running Increases Synthesis and Decreases Catabolism of Joint Cartilage Type II Collagen Accompanied by High-Energy Demands and an Inflamatory Reaction.

Objective: To determine the effect of marathon running on serum levels of inflammatory, high energy, and cartilage matrix biomarkers and to ascertain whether these biomarkers levels correlate. Design: Blood samples from 17 Caucasian male recreational athletes at the Barcelona Marathon 2017 were collected at the baseline, immediately and 48 h post-race. Serum C reactive protein (CRP), creatin kinase (CK), and lactate dehydrogenase (LDH) were determined using an AU-5800 chemistry analyser. Serum levels of hyaluronan (HA), cartilage oligomeric matrix protein (COMP), aggrecan chondroitin sulphate 846 (CS846), glycoprotein YKL-40, human procollagen II N-terminal propeptide (PIINP), human type IIA collagen N-propeptide (PIIANP), and collagen type II cleavage (C2C) were measured by sandwich enzyme-linked immune-sorbent assay (ELISA). Results: Medians CK and sLDH levels increased (three-fold, two-fold) post-race [429 (332) U/L, 323 (69) U/L] (p < 0.0001; p < 0.0001) and (six-fold, 1.2-fold) 48 h post-race [658 (1,073) U/L, 218 (45) U/L] (p < 0.0001; p < 0.0001). Medians CRP increased (ten-fold) after 48 h post-race [6.8 (4.1) mg/L] (p < 0.0001). Mean sHA levels increased (four-fold) post-race (89.54 ± 53.14 ng/ml) (p < 0.0001). Means PIINP (9.05 ± 2.15 ng/ml) levels increased post-race (10.82 ± 3.44 ng/ml) (p = 0.053) and 48 h post-race (11.00 ± 2.96 ng/ml) (p = 0.001). Mean sC2C levels (220.83 ± 39.50 ng/ml) decreased post-race (188.67 ± 38.52 ng/ml) (p = 0.002). In contrast, means COMP, sCS846, sPIIANP, and median sYKL-40 were relatively stable. We found a positive association between sCK levels with sLDH pre-race (r = 0.758, p < 0.0001), post-race (r = 0.623, p = 0.008) and 48-h post-race (r = 0.842, p < 0.0001); sHA with sCRP post-race vs. 48 h post-race (r = 0.563, p = 0.019) and sPIINP with sCK pre-race vs. 48-h post-race (r = 0.499, p = 0.044) and with sLDH 48-h pre-race vs. post-race (r = 0.610, p = 0.009) and a negative correlation of sPIIANP with sCRP 48-h post-race (r = -0.570, p = 0.017). Conclusion: Marathon running is an exercise with high-energy demands (sCK and sLDH increase) that provokes a high and durable general inflammatory reaction (sCRP increase) and an immediately post-marathon mechanism to protect inflammation and cartilage (sHA increase). Accompanied by an increase in type II collagen cartilage fibrils synthesis (sPIINP increase) and a decrease in its catabolism (sC2C decrease), without changes in non-collagenous cartilage metabolism (sCOMP, sC846, and sYKL-40). Metabolic changes on sPIINP and sHA synthesis may be related to energy consumption (sCK, sLDH) and the inflammatory reaction (sCRP) produced.

Relationship Between Bioimpedance Vector Displacement and Renal Function After a Marathon in Non-elite Runners.

Purpose: This study investigates the relationship between whole-body bioimpedance vector displacement, using bioelectrical impedance vector analysis (BIVA), and renal function through serum biomarkers [creatinine, urea, sodium, C-reactive protein (CRP), and creatine kinase] and urine biomarkers after a marathon. Methods: Bioimpedance measurements were taken among 19 non-elite runners at 24 h pre-race, immediately post-race, and at 48 h post-race. The bioimpedance measurements were analyzed by BIVA using the Hotelling's T2 test. The runners were divided according to a cutoff of serum creatinine level immediately post-race in G1 (<1.2 mg/dl of serum creatinine level) and G2 (≥1.2 mg/dl of serum creatinine level). The increase of the serum creatinine levels in 83% of G2 runners was related to acute kidney injury (AKI) stage 1. Results: Neither G1 nor G2 showed a creatinine clearance rate (CCr) lower than 60 ml/min. G2 showed a significant increase in CRP values at 48 h post-race vs baseline compared to G1 (P < 0.05), with over 5 mg/L (6.8-15.2) in 92% of the runners, and in CK values with over 215 U/L (282-1,882) at 48 h post-race in 100% of the runners. By BIVA, the 95% confidence ellipses of G2 showed shorter bioimpedance vectors than G1, with a noticeable minor Xc/H (P < 0.01), indicating an expansion on extracellular water and inflammation. The runners with 48 h post-race Xc/H values ≤30.5 Ω, with a decrease from -3 to -12% with respect to the Xc/H value at 24 h pre-race, indicated AKI stage 1 with 85.7% sensitivity and 91.7% specificity, with a direct correlation between AKI stage 1 with greater CRP values at 48 h post-race and bioimpedance vector displacement, but not with CK values at 48 h post-race. Conclusion: Through this data collection, it was evidenced that a transient reduction in renal function is more related to inflammatory factors than muscle damage. The BIVA method along with serum biomarkers could be used to follow up the kidney function in runners.

Different femoral rotation with navigated flexion-gap balanced or measured resection in total knee arthroplasty does not lead to different clinical outcomes.

PURPOSE: Femoral rotation in total knee arthroplasty (TKA) is hypothesized to vary in the same knee depending on the method used to establish it. METHODS: Thirty-eight patients who underwent TKA surgery using a measured resection technique (RT) were compared with 40 patients who underwent a flexion-gap balancing technique with computer-assisted (for navigation) surgery (FB-CAS) to assess clinical and radiographic alignment differences at two years postoperatively. In 36 of the 40 patients in the FB-CAS group, both methods were used. Intraoperatively, the transepicondylar femoral rotation (TEFR) in reference to the transepicondylar axis was established as the rotation that balanced the flexion gap. Once the TEFR was obtained, an analogous rotation as measured by a posterior reference femoral rotation (PRFR) cutting guide was determined. RESULTS: Femoral component rotation determined by the TEFR and PRFR methods differed in each of the knees. The median TEFR was 0.08°±0.6° (range - 1.5°, 1.5°), and the median PRFR was 0.06°±2.8° (range - 6°, 5°). The mean difference in the rotational alignment between the TEFR and PRFR techniques was 0.01° ± 3.1°. The 95% limits of agreement between the mean differences in measurements were between 6.2° external rotation and - 6.1° internal rotation. At 2 years postoperatively, we found no differences in the radiographic or clinical American Knee Society score between the two groups. CONCLUSION: Rotation of the femoral component in TKA can vary in the same knee depending on the surgical method used to establish it. This variation in femoral rotation is sufficiently small enough to have no apparent effect on the 2-year clinical outcome score. LEVEL OF EVIDENCE: II.

Intervention to reduce the incidence of surgical site infection in spine surgery.

BACKGROUND: This study examines the incidence, characteristics, and risk factors of surgical site infections (SSIs) after spine surgery and evaluates the efficacy of a preventive intervention. METHODS: This was a quasi-experimental pretest/posttest study in patients undergoing spinal surgery in an orthopedic surgery department from December 2014 to November 2016. Based on the results of the study, we revised the preventive protocol with modification of wound dressing, staff training, and feedback. SSI rates were compared between the pre-intervention (December 2014 to November 2015) and post-intervention (December 2015 to November 2016) periods. The risk factors were analyzed using univariate and multivariate analyses. RESULTS: Of the 139 patients included, 14 cases of SSI were diagnosed, with a significant decrease in the incidence of SSIs from the pre-intervention period to the post-intervention period (19.4% vs 2.6%; P = .001). The etiology was known in 13 cases, with enteric flora being predominant in the pre-intervention group. Univariate analysis showed that age, body mass index, days until sitting and ambulation, and incontinence were statistically significant risk factors. After multivariate analysis, only body mass index and days until ambulation remained significant. When the effect of intervention was adjusted with other risk factors, this variable remained statistically significant. CONCLUSIONS: An intervention that includes modification of wound dressing and early mobilization, as well as staff awareness training, monitoring, and feedback, allowed a significant reduction in the incidence of SSI following spinal surgery, particularly infections caused by enteric flora.

Protesis total de cadera tras la falla de la osteotomia intertrocanterea de femur / Total hip arthroplasty after failed interthrochanteric osteotomy

Introduccion: Son bien conocidas las complicaciones y la incidencia de infecciones a corto plazo cuando se coloca una protesis total de cadera (PTC) despues de una osteotomia intertrocanterea de femur, pero no ocurre lo mismo con la experiencia a largo plazo. En el presente trabajo relatamos nuestra experiencia con 63 caderas intervenidas por presentar una falla de la osteotomia intertrocanterea con la colocacion de una PTC. Materiales y metodos: Se trataron en nuestro hospital 63 osteotomias intertrocantereas en 58 pacientes (35 mujeres y 23 varones) con una media de edad de 44,5 años (rango, 23 y 66 años) con la colocacion de una protesis de cadera tras la falla de una osteotomia intertrocanterea con avance de la coxartrosis. El seguimiento fue de 7,27 años (rango, 2-22 años). Los pacientes tenian osteotomia de varizacion en 31 casos, osteotomia de valguizacion en 17 casos y osteotomia de translacion en 15 casos. Resultados: En el seguimiento, 8 pacientes precisaron cirugia de revision de la PTC colocada, en 3 casos por infeccion de la protesis, en 4 casos por aflojamiento aseptico de la protesis y en un caso por sufrir una fractura periprotesica que requirio osteosintesis de la fractura. Los resultados al final del seguimiento fueron buenos en 42 pacientes (66,66 por ciento), con 16-18 puntos del baremo de Merle dãAubigne, regulares en 17 casos (26,98 por ciento) y malos en 4 casos (6,34 por ciento). Conclusiones: La osteotomia intertrocanterea es un buen tratamiento de la coxartrosis en los pacientes jovenes. (AU)

Protesis total de cadera tras la falla de la osteotomia intertrocanterea de femur / Total hip arthroplasty after failed interthrochanteric osteotomy

Introduccion: Son bien conocidas las complicaciones y la incidencia de infecciones a corto plazo cuando se coloca una protesis total de cadera (PTC) despues de una osteotomia intertrocanterea de femur, pero no ocurre lo mismo con la experiencia a largo plazo. En el presente trabajo relatamos nuestra experiencia con 63 caderas intervenidas por presentar una falla de la osteotomia intertrocanterea con la colocacion de una PTC. Materiales y metodos: Se trataron en nuestro hospital 63 osteotomias intertrocantereas en 58 pacientes (35 mujeres y 23 varones) con una media de edad de 44,5 años (rango, 23 y 66 años) con la colocacion de una protesis de cadera tras la falla de una osteotomia intertrocanterea con avance de la coxartrosis. El seguimiento fue de 7,27 años (rango, 2-22 años). Los pacientes tenian osteotomia de varizacion en 31 casos, osteotomia de valguizacion en 17 casos y osteotomia de translacion en 15 casos. Resultados: En el seguimiento, 8 pacientes precisaron cirugia de revision de la PTC colocada, en 3 casos por infeccion de la protesis, en 4 casos por aflojamiento aseptico de la protesis y en un caso por sufrir una fractura periprotesica que requirio osteosintesis de la fractura. Los resultados al final del seguimiento fueron buenos en 42 pacientes (66,66 por ciento), con 16-18 puntos del baremo de Merle dãAubigne, regulares en 17 casos (26,98 por ciento) y malos en 4 casos (6,34 por ciento). Conclusiones: La osteotomia intertrocanterea es un buen tratamiento de la coxartrosis en los pacientes jovenes. (AU)

Protesis total de cadera tras la falla de la osteotomia intertrocanterea de femur / Total hip arthroplasty after failed interthrochanteric osteotomy

Introduccion: Son bien conocidas las complicaciones y la incidencia de infecciones a corto plazo cuando se coloca una protesis total de cadera (PTC) despues de una osteotomia intertrocanterea de femur, pero no ocurre lo mismo con la experiencia a largo plazo. En el presente trabajo relatamos nuestra experiencia con 63 caderas intervenidas por presentar una falla de la osteotomia intertrocanterea con la colocacion de una PTC. Materiales y metodos: Se trataron en nuestro hospital 63 osteotomias intertrocantereas en 58 pacientes (35 mujeres y 23 varones) con una media de edad de 44,5 años (rango, 23 y 66 años) con la colocacion de una protesis de cadera tras la falla de una osteotomia intertrocanterea con avance de la coxartrosis. El seguimiento fue de 7,27 años (rango, 2-22 años). Los pacientes tenian osteotomia de varizacion en 31 casos, osteotomia de valguizacion en 17 casos y osteotomia de translacion en 15 casos. Resultados: En el seguimiento, 8 pacientes precisaron cirugia de revision de la PTC colocada, en 3 casos por infeccion de la protesis, en 4 casos por aflojamiento aseptico de la protesis y en un caso por sufrir una fractura periprotesica que requirio osteosintesis de la fractura. Los resultados al final del seguimiento fueron buenos en 42 pacientes (66,66 por ciento), con 16-18 puntos del baremo de Merle d’Aubigne, regulares en 17 casos (26,98 por ciento) y malos en 4 casos (6,34 por ciento). Conclusiones: La osteotomia intertrocanterea es un buen tratamiento de la coxartrosis en los pacientes jovenes.

Fracturas periprotesicas del femur / Periprosthetic femoral fractures

Introducción: Las fracturas de fémur asociadas con la prótesis total de cadera son un hecho infrecuente. La incidencia de estas fracturas informada en la literatura varía desde el 0,1 por ciento en la cirugía primaria al 4,2 por ciento en la cirugía de revisión. El tratamiento sin embargo es difícil y viene condicionado por diferentes factores: son pacientes de edad avanzada y con mala calidad del hueso. Materiales y métodos: Presentamos 59 pacientes operados en nuestro hospital por presentar una fractura periprotésica de fémur. La media de seguimiento fue de 7,3 años. Estos pacientes presentaban una fractura tipo A de la clasificación de Vancouver en 20 casos, tipo B en 24 casos y tipo C en 15 casos. Las fracturas fueron tratadas con recambio protésico en 24 casos, 33 casos con fijación interna, un caso con artroplastia resección de Girdlestone y un caso conservadoramente. En 21 casos se utilizaron injertos corticoesponjosos. Resultados: Al final del tratamiento hubo 7 complicaciones: 3 casos de seudoartrosis, 2 casos de infección y 2 casos de refractura. Al final del seguimiento 35 pacientes tenían un excelente o buen resultado, 17 un resultado regular y 12 un mal resultado (baremo de Merle DAubigne). El resultado fue mejor en los casos tratados con recambio protésico que en los tratados con fijación interna. Conclusiones: Se consiguió un buen resultado en los casos tratados con recambio protésico y un mal resultado en los tratados con osteosíntesis de la fractura. La clasificación de Vancouver es la mejor para escoger el tratamiento más adecuado. (AU)

Tratamiento quirúrgico de la luxación recidivante del hombro con la técnica de Bankart / Surgical treatment for recurrent dislocation of the shoulder with the Bankart procedure

El éxito del tratamiento de la inestabilidad anterior del hombro requiere un equilibrio entre el restaurar una estabilidad de la articulación y su normal movilidad. Escoger el tratamiento puede personalizarse en función de las caracteristicas del paciente como su trabajo habitual, actividad deportiva, así como el grado de inestabilidad del hombro. A pesar de las diferentes ideas, la existencia de la lesión de Bankart es sin lugar a duda la mas importante en estas inestabilidades. El tratamiento debe permitir reconocer y resolver la inestabilidad durante el acto operatorio. Gran cantidad de técnicas han sido propuestas para el tratamiento de la inestabilidad anterior del hombro, sin embargo, la estabilización abierta sigue siendo la que mejor opción especialmente en las inestabilidades severas y deportistas. Presentamos un estudio retrospectivo de 33 pacientes que presentaban una inestabilidad anterior escápalo- humeral producida por un traumatismo deportivo. El diagnóstico se realizó mediante la anamnesis y exploración física acompañada de radiología simple y resonancia magnética. Todos los pacientes ful:ron intervenidos mediante la técnica de Bankart a cielo abierto, utilizando los anc1ajes metálicos para la reparación del complejo cápsulo-labrum, y la cápsula fue suturada de manera que la parte infero-externa fue suturada en la porción medial superior, a modo de retensado capsular. Se trataban de 33 pacientes, 29 varones y 4 mujeres, con una edad media de 24 años. Seguimiento medio de los pacientes fue de 31 meses. El resultado final según la escala de Rowe fue excelente o bueno en 31 pacientes (93,9%) regular en 1 caso (3,03%) y malo en un caso. La movilidad fue completa en 28 pacientes pero hubo 5 casos que presentaron una disminución de la rotación externa, con una media de perdida de 8°Todos los pacientes volvieron a su actividad deportiva al finalizar el tratamiento. Hubo un caso de recidiva de la luxación y un caso en el que se comprobó una subluxación, en ambos casos dejaron la práctica deportiva

Successful treatment of anterior instability of the shoulder requires a balance between restoringjoint stability and minimizing loss of glenohumeral motion. The choice of treatment should be individualized on the basis ofthe patient's occupation and level of participation in sports, as well as on the degree of instability of the shoulder. Despite discussions to the contrary, there is no single "essential lesion," as proposed by Bankart, that is responsible for recurrent anterior shoulder instability, although the Bankart lesion is by far the most important. The choice of operative treatment must be tailored to correct the abnormality that is identified at the time of surgery. A variety of techniques have been developed for the treatment of anterior shoulder instability; however, open stabilization remains the standard, especially for severe instabilities, revision procedures, and for athletes who participate in contact sports. We present a retrospective study of 33 patients with traumatic anterior instability of the shoulder produced by sport injury. The diagnostic was made with the medical exploration and XR and MR. All patients underwent surgerywith the open Bankart technique using sutures supported on bone anchors with metal hooks. The series consisted 29 men and 4 women with a mean age of 24 years. The mean postoperative followup was 23.4 months evaluated on the Rowe scale. The results were excellent or good in 31 patients, fair in 1, and poor in 1. Complete mobility was recovered in 28 patients, but external rotation was limited in 5 patients, with a mean loss of 8°. AII patients carne back sport finished the treatment There were l case of recurrent dislocation and another case of subluxation, Both 2 cases leave de sport practical

Fracturas periprotesicas del femur / Periprosthetic femoral fractures

Introducción: Las fracturas de fémur asociadas con la prótesis total de cadera son un hecho infrecuente. La incidencia de estas fracturas informada en la literatura varía desde el 0,1 por ciento en la cirugía primaria al 4,2 por ciento en la cirugía de revisión. El tratamiento sin embargo es difícil y viene condicionado por diferentes factores: son pacientes de edad avanzada y con mala calidad del hueso. Materiales y métodos: Presentamos 59 pacientes operados en nuestro hospital por presentar una fractura periprotésica de fémur. La media de seguimiento fue de 7,3 años. Estos pacientes presentaban una fractura tipo A de la clasificación de Vancouver en 20 casos, tipo B en 24 casos y tipo C en 15 casos. Las fracturas fueron tratadas con recambio protésico en 24 casos, 33 casos con fijación interna, un caso con artroplastia resección de Girdlestone y un caso conservadoramente. En 21 casos se utilizaron injertos corticoesponjosos. Resultados: Al final del tratamiento hubo 7 complicaciones: 3 casos de seudoartrosis, 2 casos de infección y 2 casos de refractura. Al final del seguimiento 35 pacientes tenían un excelente o buen resultado, 17 un resultado regular y 12 un mal resultado (baremo de Merle D'Aubigne). El resultado fue mejor en los casos tratados con recambio protésico que en los tratados con fijación interna. Conclusiones: Se consiguió un buen resultado en los casos tratados con recambio protésico y un mal resultado en los tratados con osteosíntesis de la fractura. La clasificación de Vancouver es la mejor para escoger el tratamiento más adecuado.

La luxacion transescafoperilunar en el deporte: a proposito de tres casos / The transscaphoid perilunate dislocation in the sport: about three cases

Las fracturas luxaciones transescafoperilunares constituyen untipo de lesiones poco frecuentes en la traumatología y menos aún en el ámbito deportivo. Normalmente se producen en caídas con apoyo de la mano estando la muñeca en hiperextensión. Su baja incidencia hace que exista cierta controversia en cuanto al tipo de tratamiento que precisan. Para algunos autores es mejor la reducción a cielo cerrado y no realizar osteosintesis de la fractura, mientras que para otros autores es imprescindible la reducción a cielo abierto con osteosintesis interna. Nosotros presentamos tres casos tratados en nuestro servicio producidos por accidentes deportivos. En todos ellos realizamos una reducción a cielo abierto acompañada de osteosintesis interna, en dos casos mediante agujas de Kirschner y en un casos con la colocación de un tornillo de compresión de Herber (AU)

What is the role of bone scintigraphy in the diagnosis of infected joint prostheses?

AIM: To analyse the role played by bone scintigraphy in the diagnosis of infected joint prostheses. METHODS: The study included 77 patients, aged 32-77 years, in whom infection of a joint prosthesis (48 hip, 29 knee) was suspected. In all patients the following examinations were performed consecutively: a two-phase Tc methylene diphosphonate (Tc-MDP) bone scan, a Tc hexamethylproplyene amine oxime (Tc-HMPAO) labelled white blood cell (WBC) scan, and a Tc microcolloid bone marrow (BM) scan. The minimum interval between examinations was 48 h. The diagnoses were based on data obtained from bacteriological cultures. RESULTS: The bone scan was positive in all patients and 28 of them had an infection (sensitivity 100%, specificity 0%). The WBC scan was positive in 61 patients but only 27 had an infection. The WBC scan was negative in 16 patients, and the possibility of infection was discarded in 15 of these cases (sensitivity 96%, specificity 30%). The results of the bone marrow scan were not compatible with those of the WBC scan (suggestive of infection) in 27 patients: 26 of them had prosthesis infection. The results of both examinations were compatible in the other 34 patients and the possibility of infection was discarded in 33 of these patients (sensitivity 92.8%, specificity 98%). The addition of a BM scan to a WBC scan decreased the sensitivity from 96% to 92.8% but increased specificity from 30% to 98%. The addition of a bone scan to this dual combination did not alter the results. CONCLUSIONS: When infection of a prosthesis is suspected the diagnostic procedure should start with a WBC scan followed, if positive, by a BM scan. This procedure reduces the cost, the time required for a diagnosis, and the dose of radiation received by the patient.

La luxación esternoclavicular en accidente deportivo: a proposito de un caso / Posterior sternoclavicular dislocation in sport: one case

La luxación posterior esternoclavicular es una entidad poco frecuente en el ámbito deportivo, y que puede ocasionar lesiones importantes a nivel de los grandes vasos y de las estructuras del mediastino superior. Su diagnóstico es difícil debido a su baja frecuencia de incidencia así como la poca ayuda que nos da la radiografía antero-posterior. Por esta razón es de gran ayuda tanto la meticulosa exploración física como el uso de la tomografía axial computerizada. En el presente trabajo presentamos una luxación posterior esternoclavicular producida tras accidente deportivo de judo, y al mismo tiempo revisamos la bibliografía existente sobre estas lesiones (AU)

Localized pigmented villonodular synovitis in an unusual location in the knee.

PURPOSE: Localized pigmented villonodular synovitis (LPVNS) is a rare lesion that can affect any joint, although it is most frequently found in the knee. Clinically, it is difficult to diagnose. Radiographs are usually within normal limits. TYPE OF STUDY: Case series. METHODS: We present a series of 9 cases of LPVNS of the knee in 9 patients with an average age of 36 years. In 7 of the 9 cases, the lesions were in an an unusual location, 4 in the fat pad and 3 in the posterior compartment of the knee. The other 2 cases were located in the meniscocapsular junction and the intercondylar notch, respectively. The mean time from the onset of symptoms to diagnosis was 2.26 years. Magnetic resonance image (MRI) provided a characteristic image that helped with diagnosis and localizing the lesion in all cases. RESULTS: Complete resection of the lesion using arthrotomy was performed in 4 cases and resection assisted using arthroscopy was performed in 5. All cases had an excellent result. There were no signs of clinical or MRI recurrence after a mean follow-up of 36 months. CONCLUSIONS: LPVNS of the knee is a rare lesion. MRI provides the basis for diagnosis. Complete resection using arthrotomy or arthroscopy is the treatment.