Estudio descriptivo sobre el uso de aloinjerto óseo irradiado en cirugía de revisión de prótesis de cadera / Descriptive study on the use of irradiated bone allograft in revision hip replacement surgery

Introducción El uso de aloinjerto óseo irradiado en las revisiones de cadera es controvertido por las alteraciones que genera este tratamiento en el hueso. Se realizó una evaluación de una serie consecutiva de pacientes con revisión en que se utilizó este tipo de tejido. Materiales y métodos Se realizó una evaluación retrospectiva de una serie de casos consecutivos (2005-2013) de 54 pacientes (55 caderas) intervenidos por un solo cirujano. Resultados Dos pacientes requirieron una nueva revisión y tres pacientes terminaron sin prótesis por infección profunda. Se realizó el seguimiento de 39 caderas, en el cual se destaca una mejoría de la puntuación de Merle d'Aubigné-Postel, con un promedio de 9 a 14; se encontró que 11 de los 27 acetábulos (40,7%) presentaron una migración en algún plano mayor o igual a 5 mm y todos los restantes, menos uno, tuvieron alguna migración. La media de hundimiento del tallo femoral fue 4,9 mm. La incorporación del injerto se constató en el 14,8% (4/27) en el acetábulo y el 50% (8/16) en el fémur. Discusión Esta serie muestra excelentes resultados clínicos en general, pero, mientras el injerto irradiado en forma de chapas para el fémur y estructural para el acetábulo tiene buen resultado clínico y radiológico, y un buen índice de incorporación, el tejido que llega en chips para técnica de injerto compactado provoca fallas radiológicas muy frecuentes (con relación a lo publicado) y, a pesar de los buenos resultados clínicos y de la seguridad biológica ofrecida, debe indicarse con precaución y nunca debe ser la primera opción. Nivel de evidencia clínica Nivel IV.

Background The use of irradiated bone allograft in hip revision is controversial because of the alterations caused by this treatment in the allograft bone. A report is presented on a consecutive series of patients undergoing revision hip replacement using this type of tissue. Materials and methods A retrospective evaluation was performed on a series of consecutive cases (2005-2013) of 54 patients (55 hips) operated on by a single surgeon. Results Two patients required a new revision and three patients completed without prosthesis due to deep infection. Follow-up of 39 hips was performed, with an improvement in the Merle d'Aubigné-Postel score from 9 to 14. It was found that 11 (40.7%) of the 27 sockets had a migration in some plane greater or equal to 5 mm, and in the remainder all had some migration minus one. The mean subsidence of the femoral stem was 4.9 mm. The incorporation of the graft was in the acetabulum in 14.8% (4/27), and 50% (8/16) in the femur. Discussion This series shows excellent clinical results in general, but the irradiated graft in the form of plates for the femur, and structural for the acetabulum has good clinical and radiological results, and good incorporation index. Although the impaction bone grafting had good clinical outcomes and a biological safety, it should be indicated with caution and should never be the first option. Evidence level IV.

Metachronous multicentric giant cell tumor: a case report and literature review.

Metachronous multicentric giant cell tumors of bone are rare. The case of a 47-year-old woman who had a giant cell tumor of the ilium develop 24 years after resection of a giant cell tumor of the proximal tibia is reported. The initial and current surgical approaches for this patient are described. A literature review is presented to show that this patient had the longest disease-free interval documented for a patient with metachronous multicentric giant cell tumors.

Progress of National Multi-tissue Bank in Uruguay in the International Atomic Energy Agency (IAEA) Tissue Banking Programme.

The transplant law of 1971 based on informed consent, allows people to register their willingness to be a donor upon death. Since 1978 the governmental Institution, the National Bank of Organs and Tissues (BNOT), have been regulated the organ and tissue donation. Important progress was implemented in the BNOT and specially in the National Multi-tissue Bank (NMTB). Since 2001 with the participation in the IAEA Tissue Banking Programme, Quality System Management has been implemented in the NMTB. New bio-production for radiosterilized tissues for the first time and improved procedures were carried out. As a result an increased production of high-quality tissues was obtained and distributed for clinical use.