[Clinical-radiological evaluation of the impaction allografting and cemented rod technique in revision knee surgery]. / Evaluación clínico-radiológica de la técnica de aloinjerto compactado y vástago cementado en cirugías de revisión de cadera.

OBJECTIVE: Long term clinical and radiological evaluation of results, survival, and peri- operative and post-operative complications of the patients who have been operated on for revision total hip arthroplasty using the impaction allografting and cemented rod technique. MATERIAL AND METHODS: An observational, analytical, prospective and non-random study was conducted on 26 patients who underwent revision total hip arthroplasty in our Hospital (1997-98). They were clinically and radiologically assessed, and a survival analysis of the implant was performed. RESULTS: Statistically significant differences were identified in the pre- and post-operative values, according to Harris and Merle D́Aubigne scores. The femoral components survival was considered as an endpoint of the revision replacement, which was 84% at a mean of 13 years. There were 9 intraoperative complications (6 were fractures) and they significantly affected the length of hospital stay. No post-operative complications were observed in 70% of the patients. None of the analysed variables had any influence on the radiological subsidence of the femoral component. DISCUSSION: Several techniques aim to solve the bone stock deficiency in revision total hip arthroplasty, but only impaction grafting attempts to recover it. CONCLUSIONS: The Ling's technique shows an improvement over the Merle D́Aubigne and Harris scores, in the medium-long term. The intraoperative complications are mainly an increase in the length of hospital stay and the number of days needed to be able to sit down. Ling's technique is a good option to consider in young patients where it is foreseeable that there is a new revision surgery in the future.

Minimally invasive hip surgery: the approach did not make the difference.

BACKGROUND: We hypothesized that minimally invasive surgery was superior to conventional surgery for total hip arthroplasty procedure. PURPOSE: To compare the results of total hip replacement (THR) made by minimally invasive lateral approach with the results of THR made by conventional lateral approach. MATERIALS AND METHODS: Prospective, randomized trial. Fifty patients were selected and then divided into two groups based on utilized approach. DATA COLLECTED: Perioperative bleeding, postoperative pain, time of recovery, components orientation, complications and functional results. Five-year follow-up. RESULTS: No differences were found in blood loss, postoperative pain, surgical time, components orientation, rate of complications or functional result. Minimally invasive lateral approach produced faster recovery with less hospital stay and earlier walking start. CONCLUSION: Our results suggested that minimally invasive lateral approach has not provided significant benefits over conventional lateral approach for the implantation of a total hip arthroplasty.

Minimally invasive osteosynthesis in stable trochanteric fractures: a comparative study between Gotfried percutaneous compression plate and Gamma 3 intramedullary nail.

AIM: Our objective was to compare the results of PCCP (Percutaneous Compression Plate) device and Gamma 3 nail for the treatment of stable trochanteric hip fractures and to demonstrate that PCCP device is a minimally invasive system. METHOD: Prospective, randomized trial. Eighty patients aged 60 and over with stable trochanteric fracture were selected and then randomized using a table of randomized numbers. Length of time of operative procedure, hemoglobin levels at 6 and 48 h after surgery, packed cells units administered, and hospital stay were recorded. In addition, the postoperative complications in the first year after the surgery was collected. RESULTS: No differences were found in hospital stay, surgical time, blood loss, functional outcome at 1-year follow-up, neck-shaft angle, fracture collapse, and mortality. CONCLUSIONS: PCCP and Gamma 3 have not presented significant differences in any measured parameter for treatment of stable trochanteric fractures. Therefore, the PCCP system is shown to be as minimally invasive as the Gamma 3.

Aflojamiento de las artroplastias de cadera / Wearing away of hip arthroplasties

La revisión de una prótesis puede sere debida a diferentes causas que requieren tratamientos específicos. El factor fundamental es el tipo de fijación del implante. El cemento y su forma de utilización influyen en los buenos resultados actuales. Es necesario adoptar una clasificación de los aflojamientos radiográficos femorales, siendo las más conocidas las propuestas por Harris y Johnston para los vástagos cementados y la de Engh para los no cementados. No hay una técnica general que pueda aplicarse a todos los casos con las mismas posibilidades de buenos resultados. La cirugía de reconstrucción acetabular y femoral, la debe indicar el cirujano según la osteolisis periprotésica y los síntomas del enfermo

Revision of a prosthesis may be due to different causes requiring specific treatments. The fundamental factor is the type of implant fixation involved. The cement and its method of use influence the good results presently obtained. A classification is required of femoral radiographic loosening - the best known being the classification proposed by Harris and Johnston for cemented stems, and the Engh classification for non-cemented stems. There is no general technique for application to all cases with the same possibilities of good results. Acetabular and femoral reconstruction surgery should be indicated by the surgeon according to the observed periprosthetic osteolysis and patient symptoms

A simple method for bone-graft handling during spine surgery.

Morsellized bone-graft handling during spine surgery to get vertebral fusion can be a slow, laborious and time-consuming procedure. It is not absolutely exempt from complication risk. An easy, quick and inexpensive alternative technique is described.

Filling of segmental bone defects in revision knee arthroplasty using morsellized bone grafts contained within a metal mesh.

For revision knee surgery with uncontained tibial bone defects, the authors report the containment of compacted morsellized allograft using metal-wire mesh, followed by implantation of a cemented total knee prosthesis. This method is comparable to the "impaction grafting technique" described for revision hip surgery and could be an alternative to metal wedges, augmented components, custom-made implants, polymethyl-methacrylate or structural bone grafts to solve some problems of cavitary and segmental bone defects in revision total knee arthroplasty.

A simple technique for handling morcellized bone-graft during impaction grafting.

Handling morcellized bone-graft during impaction grafting can be a slow and laborious procedure. An alternative quick technique is described.