Two-year outcomes of Elektra prosthesis for trapeziometacarpal osteoarthritis: a longitudinal cohort study.

The aim of this study was to evaluate clinical and radiographic outcomes of Elektra® trapeziometacarpal prostheses after 2 years. We present a longitudinal cohort study of 19 prostheses for the treatment of Eaton stage II and III osteoarthritis (mean follow-up of 29 months). QuickDASH score, pinch strength and mobility were determined, and radiographs were analysed. Isotope scans were taken in patients with persistent pain or suspected loosening. Although the QuickDASH score was 69 before and 38 after surgery, nine patients had pain at the trapeziometacarpal joint with radiographic osteolysis around the trapezium component and a positive bone scan uptake at subsequent follow-up. The implant was revised in three of these nine patients and another patient underwent surgery for periprosthetic fracture. Only ten of the 19 implants showed no sign of failure. Most problems derived from the trapezium cup. Because of these poor outcomes after only 2 years, we cannot recommend this implant.

Aplicación de periostio en un modelo experimental de cicatrización tendinosa en conejo / Use of periosteum in tendon healing; an experimental model in rabbits

Objetivo. Evaluar la formación de adherencias, labiomecánica y la calidad de la cicatriz tendinosa en un modelo experimental de lesión tendinosa en conejo tras la aplicación de periostio en comparación con ácido hialurónico y politetrafluoroetileno (PTFE). Material y método. Sección y sutura del tendón de Aquiles del conejo de Nueva Zelanda con interposición de ácido hialurónico, PTFE y periostio. Períodos de sacrificio: 1, 3 y 6 semanas. Intervención de 72 conejos. Se realizó análisis macroscópico de la adherencia, análisis biomecánico (fuerza de ruptura), análisis histológico (colágeno) y análisis digital de imagen (calidad de cicatrización). Resultados. Los tendones tratados con periostio mostraron menos adherencias que los tratados con ácido hialurónico o PTFE (p < 0,05). En la primera semana aumentó la fuerza de ruptura con respecto al control, excepto en el grupo del PTFE. Los tendones tratados con periostio presentaron una mayor fuerza de ruptura (p < 0,001). También mostraron una mayor superficie de colágeno en la cicatriz (p < 0,05). El perímetro de colágeno en la cicatriz fue menor en los tratados con PTFE. La menor dispersión del colágeno se observó en los tratados con periostio (p < 0,01). Conclusiones. El periostio disminuyó la formación de adherencias con respecto a los otros grupos de tratamiento. Las sustancias empleadas aumentaron la fuerza de ruptura, y el periostio aún más con respecto a los otros grupos de tratamiento. El análisis digital de imagen puso de manifiesto diferencias en la calidad de la cicatrización de las heridas, de forma que los tendones tratados con periostio mostraron una mayor colagenización que los tratados con ácido hialurónico o PTFE

Purpose. To assess the formation of adhesions, the biomechanics and the quality of tendon healing, at the repair site of a tendon lesion, in an experimental rabbit model, comparing the use of periosteum, Hyaluronic Acid (HA) and Polytetrafluoroethylene (PTFE). Materials and methods. Transection and suture of the Achilles tendon in New Zealand white rabbits through the application of Hyaluronic Acid, Polytetrafluoroethylene and periosteum. The rabbits were put down at: 1, 3 and 6 weeks. We studied the adhesions macroscopically, carried out a biomechanical analysis (rupture strength), studied the histology (collagen), and analysed digital images (quality of healing). Results. The tendons treated with periosteum had fewer adhesions than those treated with HA or PTFE (p < 0.05). During the first week rupture strength increased in all groups when compared to the control group-with the exception of the PTFE group. The tendons treated with periosteum showed a higher rupture strength (p < 0.001), they also had a larger area of collagen at the repair site (p < 0.05). The perimeter of the collagen area at the healing site was smaller in cases treated with PTFE. The smallest dispersion of collagen was seen in cases treated with periosteum (p < 0.01).Conclusions. The use of periosteum decreased the formation of adhesions when compared to other treatment groups. All three substances increased rupture strength, but periosteum did so most of all, compared to the other treatment groups. The analysis of digital images clearly showed differences in the quality of wound healing, tendons treated with periosteum showed a greater deposit of collagen than those treated with HA or PTFE

Autoinjerto y aloinjerto en la reconstrucción del ligamento cruzado anterior / Autografts and allografts in reconstruction of the anterior cruciate ligament

Objetivo. Comparar los resultados con las plastias autólogas y homólogas en la reconstrucción del ligamento cruzado anterior (LCA) en dos grupos de pacientes con un seguimiento mínimo de dos años. Material y método. Estudio retrospectivo no aleatorizado. Se realizaron 96 reconstrucciones de forma artroscópica por dos cirujanos entre agosto de 1997 y abril de 2000. Se instauró un protocolo precoz de rehabilitación. Se llamaron telefónicamente para revisión, acudiendo 66 (30 autoinjertos y 36 aloinjertos). Se valoró la sintomatología subjetiva mediante la escala de Lysholm y se objetivaron los signos clínicos y radiológicos mediante las pruebas de Lachman, pívot shift y Lachman activo radiológico, comparando con la rodilla sana. Resultados. No hubo diferencias estadísticamente significativas en los resultados de las pruebas de Lachman, pívot shift, Lachman activo radiológico y escala de Lysholm. Hubo dos casos de artrofibrosis entre los autoinjertos; en el grupo de los aloinjertos se produjeron dos casos de osteólisis tibial. Conclusiones. Observamos una mayor tendencia al deslizamiento en las pruebas de Lachman y pívot shift en los aloinjertos, si bien los pacientes presentan subjetivamente rodillas estables. Creemos que ambas opciones de tratamiento son igualmente adecuadas, ya que los resultados son estadísticamente similares en ambos grupos (AU)

Hydroxyapatite-coated stems with metaphyseal and diaphyseal press-fit. Eleven-year follow-up results.

We report the 11-year follow-up results of 52 unilateral primary hip arthroplasties performed with hydroxyapatite-coated stems. The femoral prosthesis used was a collarless titanium alloy implant, with proximal circumferential hydroxyapatite coating and increased distal thickness to fit the proximal diaphyseal region of the femur. Clinical evaluation was performed using the Merle d'Aubigné Hip Score. Anteroposterior and lateral radiographs were obtained and compared with previous postoperative films. Radiographic evaluation was carried out following Engh's criteria for uncemented implant fixation and using Livermore's method for measurement of polyethylene wear. At the end of the follow-up period, excellent and good clinical results were recorded in 40 arthroplasties (77%). The incidence of thigh pain at one year was 32.7%, but it decreased to 4.2% after the first post-operative year. The 11-year survival rate was 92.3%. Seven arthroplasties were revised because of aseptic loosening of the cup in one case, aseptic loosening of the stem, in one case, septic loosening of the stem in one case, periprosthetic fracture in two cases and polyethylene wear in three cases. Forty-two (87.5%) of the nonrevised stems met the criteria for radiographic osseointegration. Cortical hypertrophy was observed around the mid-part and tip of the stem in 22 patients of the series. This sign tends to be related to thigh pain (p < 0.1). Calcar osteolysis was present in 8 cases. There was only one case of distal femoral osteolysis. We found a strong and significant relationship between long-term wear rates and the occurrence of osteolysis (p < 0.001). We concluded that thigh pain is in relation to the distal diameter of the stems and significantly decreases after the first postoperative year. There was a low incidence of osteolysis in our series in comparison with other series of noncemented implants with 32-mm femoral heads and with similar follow-up.