Risk factors for complications in total hip arthroplasty. / Factores de riesgo para complicaciones en artroplastia total de cadera.

INTRODUCTION AND OBJECTIVE: Hip arthroplasty represents a significant advancement in the treatment of refractory chronic joint pain, improving quality of life and functionality. The objective of this study is to identify the risk factors associated with local and systemic complications in patients treated with total hip arthroplasty. METHODS: Observational, analytical, retrospective cohort study, which included 304 participants treated with total hip replacement. Comparison of variables between two groups was performed; 38 participants in the group with complications and 266 participants in the group without complications. RESULTS: The mean age in the complication group was 66 years (SD 18.7) and in the uncomplicated group it was 67,1 years (SD 15.1) (p 0,686). Female sex was observed in 73.3% of the group with complications and 65% in the group without complications. (p 0.292). Risk factors were: hip fracture as an indication for arthroplasty RR 1.33 [95% CI 1.004;1.775 p 0.047], coronary heart disease RR 1.31 [95% CI 1.067;1.616 p 0.010] and surgical bleeding equal to or greater than 400 cc RR 1.11 [95% CI 1.012;1.218 p 0.028]. CONCLUSIONS: The risk factors for complications in total hip arthroplasty were: hip fracture as the indication for arthroplasty, coronary artery disease, and surgical bleeding equal to or greater than 400 cc.

Resultados clínicos de artroplastia total de cadera asistida por brazo robótico en España: estudio preliminar / Clinical results of total hip arthroplasty assisted by robotic arm in Spain: Preliminary study

Objetivos: Resultados clínicos, radiológicos y funcionales de la primera serie española de pacientes intervenidos de artroplastia total de cadera (ATC) asistida mediante brazo robótico Mako® (Stryker) del Hospital Clínico San Carlos (HCSC) de Madrid. Material y métodos: Estudio descriptivo prospectivo que analiza los primeros 25 pacientes intervenidos de ATC asistida por robot (ATCaR) en el HCSC, con un seguimiento mínimo de 4meses. Se evaluaron la demografía, los estudios de imagen (procesamiento Mako®, Rx y TAC), los parámetros clínicos, la funcionalidad (Harris modificada) y las complicaciones asociadas. Resultados: La edad media fue 67,2años (min 47, max 88), siendo el 56% varones. El 88% corresponden a coxartrosis primaria, el 4% postraumática, el 4% secundaria a NAV y el 4% secundaria a choque femoroacetabular. El tiempo medio de cirugía fue de 116,9minutos (min 92, max 150). La media de las cinco primeras intervenciones fue 122,6minutos, y la de las cinco últimas, de 108,2minutos. Como complicaciones intraoperatorias se cuantificaron 4 pérdidas de marcadores intraoperatorios. El tiempo de ingreso medio fue 4,4días (min 3, max 7), con una disminución de hemoglobina posquirúrgica media de 3,08±1,08g/dl, requiriendo transfusión en el 12% de los casos. Se registran tres complicaciones médicas durante el ingreso, destacando un síndrome confusional con caída y fractura periprotésica AG1 no desplazada. El análisis del posicionamiento de los implantes registrados con sistema Mako® fueron 40,55±1,53 grados de inclinación y 12,2±3,6 grados de anteversión acetabular. El estudio de imagen posquirúrgico realizado a los pacientes, en concordancia con Mako®, muestra valores de inclinación acetabular de 41,2±1,7 en Rx y versión acetabular de 16±4,6 en TAC. La discrepancia de longitud de cadera varía de valores preoperatorios de −3,91mm (DE: 3,9; min −12, max 3) a 1,29mm (DE: 1,96) tras la cirugía registrados con Mako...(AU)

Objectives: Clinical, radiological and functional results of the first Spanish series of patients undergoing total hip arthroplasty assisted by Mako® (Stryker) robotic arm at the Hospital Clínico San Carlos (HCSC) in Madrid. Material and methods: Prospective and descriptive study analyzing the first 25 patients who underwent robotic-assisted THA at the HCSC, with a minimum follow-up of 4months. Demographics, imaging studies (Mako® processing, Rx and CT), clinical parameters, functionality (modified Harris) and associated complications were evaluated. Results: Average age was 67.2years (min 47, max 88), being 56% male population sample. 88% involves primary coxarthrosis, 4% post-traumatic coxarthrosis, 4% secondary avascular necrosis and 4% secondary femoroacetabular impingement. Average surgery time was 116.9min (min 92, max 150). The average time of the first five surgeries was 122.6min, and, regarding the last five interventions, it was 108.2min. Found medical intraoperative complications were four intraoperative markers loss. Average admission time was 4.4days (min 3, max 7), with an average postoperative hemoglobin decrease of 3.08±1.08g/dL, requiring a transfusion in 12% of the cases. Three medical complications have been registered in the meantime of the admission, with a relevant case of a confusional syndrome and a fall, which resulted in a non-displaced AG1 periprosthetic fracture. The analysis of the positioning of registered implants with Mako® system shows 40.55±1.53 acetabular inclination degrees and 12.2±3.6 acetabular anteversion degrees. The postoperative image study carried out on patients, are consistent with Mako® s results, as it shows an acetabular inclination of 41.2±1.7 in Rx, as well as acetabular anteversion of 16±4.6 in CT. Hip length variance ranges depending on preoperative values of 3.91mm (SD: 3.9; min −12, max 3) to 1.29mm (SD: 1.96) after surgery registered with...(AU)

[Translated article] Clinical results of total hip arthroplasty assisted by robotic arm in Spain: Preliminary study / Resultados clínicos de la artroplastia total de cadera asistida por brazo robótico en España: estudio preliminar

Objetivos: Resultados clínicos, radiológicos y funcionales de la primera serie española de pacientes intervenidos de artroplastia total de cadera (ATC) asistida mediante brazo robótico Mako® (Stryker) del Hospital Clínico San Carlos (HCSC) de Madrid. Material y métodos: Estudio descriptivo prospectivo que analiza los primeros 25 pacientes intervenidos de ATC asistida por robot (ATCaR) en el HCSC, con un seguimiento mínimo de 4meses. Se evaluaron la demografía, los estudios de imagen (procesamiento Mako®, Rx y TAC), los parámetros clínicos, la funcionalidad (Harris modificada) y las complicaciones asociadas. Resultados: La edad media fue 67,2años (min 47, max 88), siendo el 56% varones. El 88% corresponden a coxartrosis primaria, el 4% postraumática, el 4% secundaria a NAV y el 4% secundaria a choque femoroacetabular. El tiempo medio de cirugía fue de 116,9minutos (min 92, max 150). La media de las cinco primeras intervenciones fue 122,6minutos, y la de las cinco últimas, de 108,2minutos. Como complicaciones intraoperatorias se cuantificaron 4 pérdidas de marcadores intraoperatorios. El tiempo de ingreso medio fue 4,4días (min 3, max 7), con una disminución de hemoglobina posquirúrgica media de 3,08±1,08g/dl, requiriendo transfusión en el 12% de los casos. Se registran tres complicaciones médicas durante el ingreso, destacando un síndrome confusional con caída y fractura periprotésica AG1 no desplazada. El análisis del posicionamiento de los implantes registrados con sistema Mako® fueron 40,55±1,53 grados de inclinación y 12,2±3,6 grados de anteversión acetabular. El estudio de imagen posquirúrgico realizado a los pacientes, en concordancia con Mako®, muestra valores de inclinación acetabular de 41,2±1,7 en Rx y versión acetabular de 16±4,6 en TAC. La discrepancia de longitud de cadera varía de valores preoperatorios de −3,91mm (DE: 3,9; min −12, max 3) a 1,29mm (DE: 1,96) tras la cirugía registrados con Mako...(AU)

Objectives: Clinical, radiological and functional results of the first Spanish series of patients undergoing total hip arthroplasty assisted by Mako® (Stryker) robotic arm at the Hospital Clínico San Carlos (HCSC) in Madrid. Material and methods: Prospective and descriptive study analyzing the first 25 patients who underwent robotic-assisted THA at the HCSC, with a minimum follow-up of 4months. Demographics, imaging studies (Mako® processing, Rx and CT), clinical parameters, functionality (modified Harris) and associated complications were evaluated. Results: Average age was 67.2years (min 47, max 88), being 56% male population sample. 88% involves primary coxarthrosis, 4% post-traumatic coxarthrosis, 4% secondary avascular necrosis and 4% secondary femoroacetabular impingement. Average surgery time was 116.9min (min 92, max 150). The average time of the first five surgeries was 122.6min, and, regarding the last five interventions, it was 108.2min. Found medical intraoperative complications were four intraoperative markers loss. Average admission time was 4.4days (min 3, max 7), with an average postoperative hemoglobin decrease of 3.08±1.08g/dL, requiring a transfusion in 12% of the cases. Three medical complications have been registered in the meantime of the admission, with a relevant case of a confusional syndrome and a fall, which resulted in a non-displaced AG1 periprosthetic fracture. The analysis of the positioning of registered implants with Mako® system shows 40.55±1.53 acetabular inclination degrees and 12.2±3.6 acetabular anteversion degrees. The postoperative image study carried out on patients, are consistent with Mako® s results, as it shows an acetabular inclination of 41.2±1.7 in Rx, as well as acetabular anteversion of 16±4.6 in CT. Hip length variance ranges depending on preoperative values of 3.91mm (SD: 3.9; min −12, max 3) to 1.29mm (SD: 1.96) after surgery registered with...(AU)

[Translated article] Validation of the Spanish version of the modified Harris score / Validación de la versión española de la escala de Harris modificada

Objetivos: Resultados clínicos, radiológicos y funcionales de la primera serie española de pacientes intervenidos de artroplastia total de cadera (ATC) asistida mediante brazo robótico Mako® (Stryker) del Hospital Clínico San Carlos (HCSC) de Madrid. Material y métodos: Estudio descriptivo prospectivo que analiza los primeros 25 pacientes intervenidos de ATC asistida por robot (ATCaR) en el HCSC, con un seguimiento mínimo de 4meses. Se evaluaron la demografía, los estudios de imagen (procesamiento Mako®, Rx y TAC), los parámetros clínicos, la funcionalidad (Harris modificada) y las complicaciones asociadas. Resultados: La edad media fue 67,2años (min 47, max 88), siendo el 56% varones. El 88% corresponden a coxartrosis primaria, el 4% postraumática, el 4% secundaria a NAV y el 4% secundaria a choque femoroacetabular. El tiempo medio de cirugía fue de 116,9minutos (min 92, max 150). La media de las cinco primeras intervenciones fue 122,6minutos, y la de las cinco últimas, de 108,2minutos. Como complicaciones intraoperatorias se cuantificaron 4 pérdidas de marcadores intraoperatorios. El tiempo de ingreso medio fue 4,4días (min 3, max 7), con una disminución de hemoglobina posquirúrgica media de 3,08±1,08g/dl, requiriendo transfusión en el 12% de los casos. Se registran tres complicaciones médicas durante el ingreso, destacando un síndrome confusional con caída y fractura periprotésica AG1 no desplazada. El análisis del posicionamiento de los implantes registrados con sistema Mako® fueron 40,55±1,53 grados de inclinación y 12,2±3,6 grados de anteversión acetabular. El estudio de imagen posquirúrgico realizado a los pacientes, en concordancia con Mako®, muestra valores de inclinación acetabular de 41,2±1,7 en Rx y versión acetabular de 16±4,6 en TAC. La discrepancia de longitud de cadera varía de valores preoperatorios de −3,91mm (DE: 3,9; min −12, max 3) a 1,29mm (DE: 1,96) tras la cirugía registrados con Mako...(AU)

Objectives: Clinical, radiological and functional results of the first Spanish series of patients undergoing total hip arthroplasty assisted by Mako® (Stryker) robotic arm at the Hospital Clínico San Carlos (HCSC) in Madrid. Material and methods: Prospective and descriptive study analyzing the first 25 patients who underwent robotic-assisted THA at the HCSC, with a minimum follow-up of 4months. Demographics, imaging studies (Mako® processing, Rx and CT), clinical parameters, functionality (modified Harris) and associated complications were evaluated. Results: Average age was 67.2years (min 47, max 88), being 56% male population sample. 88% involves primary coxarthrosis, 4% post-traumatic coxarthrosis, 4% secondary avascular necrosis and 4% secondary femoroacetabular impingement. Average surgery time was 116.9min (min 92, max 150). The average time of the first five surgeries was 122.6min, and, regarding the last five interventions, it was 108.2min. Found medical intraoperative complications were four intraoperative markers loss. Average admission time was 4.4days (min 3, max 7), with an average postoperative hemoglobin decrease of 3.08±1.08g/dL, requiring a transfusion in 12% of the cases. Three medical complications have been registered in the meantime of the admission, with a relevant case of a confusional syndrome and a fall, which resulted in a non-displaced AG1 periprosthetic fracture. The analysis of the positioning of registered implants with Mako® system shows 40.55±1.53 acetabular inclination degrees and 12.2±3.6 acetabular anteversion degrees. The postoperative image study carried out on patients, are consistent with Mako® s results, as it shows an acetabular inclination of 41.2±1.7 in Rx, as well as acetabular anteversion of 16±4.6 in CT. Hip length variance ranges depending on preoperative values of 3.91mm (SD: 3.9; min −12, max 3) to 1.29mm (SD: 1.96) after surgery registered with...(AU)

[Translated article] Risk of venous thromboembolism in thromboprophylaxis between aspirin and low molecular weight heparins after total hip arthroplasty or total knee arthroplasty: Systematic review and meta-analysis.

INTRODUCTION: The aim of this study was to evaluate the efficacy of aspirin versus low molecular weight heparins (LMWH) for the prophylaxis of venous thromboembolism (VTE), deep vein thrombosis (DVT) and pulmonary embolism (PE) in patients undergoing total knee arthroplasty (TKA) and/or total hip arthroplasty (THA). MATERIALS AND METHODS: Systematic review and meta-analysis. Sixteen studies were selected. The risk of VTE, DVT and PE were analysed. Mortality, risk of bleeding and surgical wound complications was also analysed. RESULTS: 248,461 patients were included. 176,406 patients with thromboprophylaxis with LMWH and 72,055 patients with aspirin thromboprophylaxis. There were no significant differences in the risk of VTE (OR=0.93; 95% CI: 0.69-1.26; p=0.64), DVT (OR=0.72; 95% CI: 0.43-1.20; p=0.21) or PE (OR=1.13; 95% CI: 0.86-1.49; p=0.38) between both groups. No significant differences were found in mortality (p=0.30), bleeding (p=0.22), or complications in the surgical wound (p=0.85) between both groups. These same findings were found in the sub-analysis of only randomised clinical trials (p>0.05). CONCLUSIONS: No increased risk of PE, DVT, or VTE was found among patients with aspirin thromboprophylaxis versus patients with LMWH thromboprophylaxis. There was also no greater mortality, greater bleeding, or greater complications in the surgical wound found among patients with aspirin thromboprophylaxis versus patients with LMWH thromboprophylaxis.

Clinical results of total hip arthroplasty assisted by robotic arm in Spain: Preliminary study. / Resultados clínicos de artroplastia total de cadera asistida por brazo robótico en España: estudio preliminar.

OBJECTIVES: Clinical, radiological and functional results of the first Spanish series of patients undergoing total hip arthroplasty assisted by Mako® (Stryker) robotic arm at the Hospital Clínico San Carlos (HCSC) in Madrid. MATERIAL AND METHODS: Prospective and descriptive study analyzing the first 25 patients who underwent robotic-assisted THA at the HCSC, with a minimum follow-up of 4months. Demographics, imaging studies (Mako® processing, Rx and CT), clinical parameters, functionality (modified Harris) and associated complications were evaluated. RESULTS: Average age was 67.2years (min 47, max 88), being 56% male population sample. 88% involves primary coxarthrosis, 4% post-traumatic coxarthrosis, 4% secondary avascular necrosis and 4% secondary femoroacetabular impingement. Average surgery time was 116.9min (min 92, max 150). The average time of the first five surgeries was 122.6min, and, regarding the last five interventions, it was 108.2min. Found medical intraoperative complications were four intraoperative markers loss. Average admission time was 4.4days (min 3, max 7), with an average postoperative hemoglobin decrease of 3.08±1.08g/dL, requiring a transfusion in 12% of the cases. Three medical complications have been registered in the meantime of the admission, with a relevant case of a confusional syndrome and a fall, which resulted in a non-displaced AG1 periprosthetic fracture. The analysis of the positioning of registered implants with Mako® system shows 40.55±1.53 acetabular inclination degrees and 12.2±3.6 acetabular anteversion degrees. The postoperative image study carried out on patients, are consistent with Mako® s results, as it shows an acetabular inclination of 41.2±1.7 in Rx, as well as acetabular anteversion of 16±4.6 in CT. Hip length variance ranges depending on preoperative values of 3.91mm (SD: 3.9; min -12, max 3) to 1.29mm (SD: 1.96) after surgery registered with Mako®, with an increase of an average hip length of 5.64mm (SD: 3.35). Rx simple study results show a postoperative difference between both hips of 0.5±3.08mm, which is consistent with Mako® results. Native femoral offset was stable after surgery with a showing difference both pre and post operative of the intervened hip of 0.1mm (SD: 3.7), registered with Mako®. Preoperatory modified Harris punctuation was 41.6±13.3, improving to postoperative values of 74.6±9.7 after four months since the surgery. No complications were registered in immediate postoperative (4month). CONCLUSIONS: Total hip arthroplasty robot-assisted achieves an adequate precision and repeatability of the implant positioning and the postoperative hip dysmetry without showing an increase of associated complications to the technique applied. Surgery time, complications and functional results in a short-time period are similar to conventional techniques applied to great series previously published.

[Translated article] Clinical results of total hip arthroplasty assisted by robotic arm in Spain: Preliminary study.

OBJECTIVES: Clinical, radiological and functional results of the first Spanish series of patients undergoing total hip arthroplasty assisted by Mako® (Stryker) robotic arm at the Hospital Clínico San Carlos (HCSC) in Madrid. MATERIAL AND METHODS: Prospective and descriptive study analyzing the first 25 patients who underwent robotic-assisted THA at the HCSC, with a minimum follow-up of 4 months. Demographics, imaging studies (Mako® processing, Rx and CT), clinical parameters, functionality (modified Harris) and associated complications were evaluated. RESULTS: Average age was 67.2 years (min 47, max 88), being 56% male population sample. 88% involves primary coxarthrosis, 4% post-traumatic coxarthrosis, 4% secondary avascular necrosis and 4% secondary femoroacetabular impingement. Average surgery time was 116.9min (min 92, max 150). The average time of the first five surgeries was 122.6min, and, regarding the last five interventions, it was 108.2min. Found medical intraoperative complications were four intraoperative markers loss. Average admission time was 4.4days (min 3, max 7), with an average postoperative haemoglobin decrease of 3.08±1.08g/dl, requiring a transfusion in 12% of the cases. Three medical complications have been registered in the meantime of the admission, with a relevant case of a confusional syndrome and a fall, which resulted in a non-displaced AG1 periprosthetic fracture. The analysis of the positioning of registered implants with Mako® system shows 40.55±1.53 acetabular inclination degrees and 12.2±3.6 acetabular anteversion degrees. The postoperative image study carried out on patients, are consistent with Mako® results, as it shows an acetabular inclination of 41.2±1.7 in Rx, as well as acetabular anteversion of 16±4.6 in CT. Hip length variance ranges depending on preoperative values of 3.91mm (SD: 3.9; min -12, max 3) to 1.29mm (SD: 1.96) after surgery registered with Mako®, with an increase of an average hip length of 5.64mm (SD: 3.35). Rx simple study results show a postoperative difference between both hips of 0.5±3.08mm, which is consistent with Mako® results. Native femoral offset was stable after surgery with a showing difference both pre and post operative of the intervened hip of 0.1mm (SD: 3.7), registered with Mako®. Preoperatory modified Harris punctuation was 41.6±13.3, improving to postoperative values of 74.6±9.7 after four months since the surgery. No complications were registered in immediate postoperative (4 months). CONCLUSIONS: Total hip arthroplasty robot-assisted achieves an adequate precision and repeatability of the implant positioning and the postoperative hip dysmetry without showing an increase of associated complications to the technique applied. Surgery time, complications and functional results in a short-time period are similar to conventional techniques applied to great series previously published.

Comparison of early complications for primary total hip arthroplasty using modified direct anterior approach and lateral approach.

BACKGROUND: Total hip arthroplasty is a surgical procedure with reliable results, regardless of the approach used. The anterior approach has advantages by respecting muscle insertions, reflected in the lower number of complications and shorter recovery time compared to other approaches. OBJECTIVE: The goal of the study was to assess the progression of 150 total hip arthroplasty procedures in the first 90 postoperative days. 75 patients underwent a modified direct anterior approach (MDAA) using a minimally invasive technique with a special table, and 75 patients underwent a direct lateral approach (DLA). METHODS: An observational retrospective study was conducted, including 150 arthroplasties, performed by the same surgeon, using two surgical approaches. 75 cases with direct lateral approach (DLA) and 75 cases with modified direct anterior approach (MDAA), between January 2007 and December 2020. Baseline characteristics, surgical variables, and postoperative complications were compared between the two groups. RESULTS: At 90 days, both groups presented a similar percentage of minor complications (32% vs. 42%), however, there was a higher number of major complications due to DLA (40% vs. 12% p < 0.0001) overall, where motor neurological complications have a higher incidence (14 [18.6%]). No differences were found in terms of the Harris functional scale. CONCLUSION: MDAA is a safe and reliable technique with satisfactory results. It presents predictable early complications, such as other approaches. Although it allows a faster recovery, at 90 days, the evolution and satisfaction are similar between both approaches with excellent and good outcomes in > 90% of cases.

ANTECEDENTES: La artroplastia total de cadera es un procedimiento quirúrgico con buenos resultados, independientemente del abordaje empleado. El abordaje anterior presenta ventajas al respetar las inserciones musculares, lo que se refleja en un menor número de complicaciones y menos tiempo de recuperación en comparación con otros abordajes. OBJETIVO: El objetivo del estudio fue valorar la evolución de 150 reemplazos totales de cadera en los primeros 90 días comparando 75 pacientes operados por abordaje anterior directo y 75 pacientes operados por abordaje lateral. MÉTODO: Se realizó un estudio retrospectivo observacional, incluyendo 150 artroplastias realizadas entre enero de 2007 y diciembre de 2020 por el mismo cirujano empleando dos abordajes quirúrgicos: 75 casos con abordaje lateral directo y 75 casos con abordaje anterior directo modificado. Se compararon las características basales, las variables quirúrgicas y las complicaciones posoperatorias entre ambos grupos. RESULTADOS: A 90 días, ambos grupos presentaron un porcentaje similar de complicaciones menores (32 vs. 42%); sin embargo, hubo un mayor número de complicaciones mayores con el abordaje lateral directo (40 vs. 12%; p < 0.0001) de forma global, siendo las complicaciones neurológicas motoras las que presentaron mayor incidencia (14; 18.6%). No se encontraron diferencias en cuanto a la escala funcional de Harris. CONCLUSIONES: El abordaje anterior directo modificado es una técnica segura y confiable, con resultados satisfactorios. Presenta complicaciones tempranas predecibles y similares a las de otros abordajes. Aunque permite una más rápida recuperación, a 90 días la evolución y la satisfacción son similares para ambos abordajes, con desenlaces excelentes y buenos en más del 90% de los casos.

Artroplastia total de cadera primaria en pacientes con secuelas de poliomielitis / Primary total hip arthroplasty in patients with sequelae of poliomyelitis

Introducción: La prótesis total de cadera (PTC) en pacientes con secuelas de poliomielitis (SP) supone un reto quirúrgico. La morfología displásica, la osteoporosis y la debilidad glútea dificultan la orientación, incrementan el riesgo de fractura y reducen la estabilidad del implante. El objetivo de este estudio es describir una serie de pacientes con SP tratados mediante PTC. Material y métodos: Estudio descriptivo retrospectivo de pacientes con SP intervenidos mediante PTC entre 1999 y 2021 en un hospital de tercer nivel, con seguimiento clínico y radiológico y evaluación funcional y de las complicaciones hasta el presente o hasta el fallecimiento, con un mínimo de 12meses. Resultados: Se intervinieron 16 pacientes, implantándose 13PTC en el miembro parético, 6 por fractura y 7 por coxartrosis, mientras que las otras 3PTC se implantaron en el miembro contralateral. Se implantaron 4 cotilos de doble movilidad como medida antiluxante. Al año postoperatorio, 11 presentaban un balance articular completo sin aumentar los casos de Trendelenburg. El Harris Hip Score (HHS) mejoró 32,1puntos, la escala visual analógica (EVA), 5,25puntos, y la escala de Merlé-d’Augbiné-Poste, 6puntos. La corrección de la discrepancia de longitud fue de 13,77mm. La mediana del seguimiento fue de 3,5años (1-24). Dos casos se revisaron por usura del polietileno y 2 por inestabilidad, sin registrarse infecciones, fracturas periprotésicas o aflojamiento del cotilo o vástago. Conclusiones: La PTC en pacientes con SP permite mejorar la situación clínico-funcional con una tasa de complicaciones aceptable. El riesgo de luxación podría minimizarse con cotilos de doble movilidad.(AU)

Introduction: Total hip arthroplasty (THA) in patients with residual poliomyelitis (RP) is a surgical challenge. Dysplastic morphology, osteoporosis and gluteal weakness hinder orientation, increase fracture risk and reduce implant stability. The aim of this study is to describe a series of patients with RP treated by THA. Material and methods: Retrospective descriptive study of patients with RP treated with THA between 1999 and 2021 in a tertiary hospital, with clinical and radiological follow-up and functional and complication evaluation until present or death, with a minimum of 12months. Results: Sixteen patients underwent surgery, with 13THA implanted in the paretic limb, 6 for fracture and 7 for osteoarthritis, while the remaining 3 were implanted in the contralateral limb. Four dual mobility cups were implanted as an antiluxation measure. At 1year postoperatively, 11 had complete range of motion with no increase in Trendelenburg cases. The Harris hip score (HHS) improved 32.1points, the visual analog scale (VAS) 5.25 points, and the Merlé-d’Augbiné-Poste scale 6 points. The length discrepancy correction was 13.77mm. Median follow-up was 3.5years (1-24). Two cases were revised for polyethylene wear and two for instability, with no infections, periprosthetic fractures, or cup or stem loosening. Conclusions: THA in patients with RP allows improvement of the clinico-functional situation with an acceptable complication rate. The risk of dislocation could be minimized with dual mobility cups.(AU)

[Translated article] Primary total hip arthroplasty in patients with sequelae of poliomyelitis / Artroplastia total de cadera primaria en pacientes con secuelas de poliomielitis

Introducción: La prótesis total de cadera (PTC) en pacientes con secuelas de poliomielitis (SP) supone un reto quirúrgico. La morfología displásica, la osteoporosis y la debilidad glútea dificultan la orientación, incrementan el riesgo de fractura y reducen la estabilidad del implante. El objetivo de este estudio es describir una serie de pacientes con SP tratados mediante PTC. Material y métodos: Estudio descriptivo retrospectivo de pacientes con SP intervenidos mediante PTC entre 1999 y 2021 en un hospital de tercer nivel, con seguimiento clínico y radiológico y evaluación funcional y de las complicaciones hasta el presente o hasta el fallecimiento, con un mínimo de 12meses. Resultados: Se intervinieron 16 pacientes, implantándose 13PTC en el miembro parético, 6 por fractura y 7 por coxartrosis, mientras que las otras 3PTC se implantaron en el miembro contralateral. Se implantaron 4 cotilos de doble movilidad como medida antiluxante. Al año postoperatorio, 11 presentaban un balance articular completo sin aumentar los casos de Trendelenburg. El Harris Hip Score (HHS) mejoró 32,1puntos, la escala visual analógica (EVA), 5,25puntos, y la escala de Merlé-d’Augbiné-Poste, 6puntos. La corrección de la discrepancia de longitud fue de 13,77mm. La mediana del seguimiento fue de 3,5años (1-24). Dos casos se revisaron por usura del polietileno y 2 por inestabilidad, sin registrarse infecciones, fracturas periprotésicas o aflojamiento del cotilo o vástago. Conclusiones: La PTC en pacientes con SP permite mejorar la situación clínico-funcional con una tasa de complicaciones aceptable. El riesgo de luxación podría minimizarse con cotilos de doble movilidad.(AU)

Introduction: Total hip arthroplasty (THA) in patients with residual poliomyelitis (RP) is a surgical challenge. Dysplastic morphology, osteoporosis and gluteal weakness hinder orientation, increase fracture risk and reduce implant stability. The aim of this study is to describe a series of patients with RP treated by THA. Material and methods: Retrospective descriptive study of patients with RP treated with THA between 1999 and 2021 in a tertiary hospital, with clinical and radiological follow-up and functional and complication evaluation until present or death, with a minimum of 12months. Results: Sixteen patients underwent surgery, with 13THA implanted in the paretic limb, 6 for fracture and 7 for osteoarthritis, while the remaining 3 were implanted in the contralateral limb. Four dual mobility cups were implanted as an antiluxation measure. At 1year postoperatively, 11 had complete range of motion with no increase in Trendelenburg cases. The Harris hip score (HHS) improved 32.1points, the visual analog scale (VAS) 5.25 points, and the Merlé-d’Augbiné-Poste scale 6 points. The length discrepancy correction was 13.77mm. Median follow-up was 3.5years (1-24). Two cases were revised for polyethylene wear and two for instability, with no infections, periprosthetic fractures, or cup or stem loosening. Conclusions: THA in patients with RP allows improvement of the clinico-functional situation with an acceptable complication rate. The risk of dislocation could be minimized with dual mobility cups.(AU)

Artroplastia total de cadera por abordaje anterior directo (Hueter)

Introducción: La artroplastia de cadera se considera un tratamiento exitoso en ortopedia. El abordaje anterior directo, a través del intervalo de Hueter, evita la disección de inserciones musculares del hueso y disminuye la alteración de los tejidos blandos alrededor de la cadera. Objetivos: Presentar los resultados de artroplastias totales de cadera primarias, realizadas por abordaje anterior directo. Métodos: Se realizó un estudio descriptivo-prospectivo, tipo serie de casos, con pacientes intervenidos por artroplastia total de cadera primaria no cementada a través de abordaje anterior directo. Resultados: Predominaron el sexo femenino y los grupos etarios de 45 y 60 años. El índice de masa corporal resultó bajo y hubo escaso riesgo anestésico. El tiempo quirúrgico superó las dos horas, con escaso sangrado operatorio. La correcta colocación del componente acetabular y el femoral permitió que la deambulación iniciara en menos de tres días. Las complicaciones fueron escasas y se resolvieron con el tratamiento adecuado. Conclusiones: El empleo de abordaje anterior directo para artroplastias totales de cadera primarias ofrece resultados muy satisfactorios.

Introduction: Hip arthroplasty is considered a successful treatment in Orthopedics. The direct anterior approach, through Hueter interval, avoids the dissection of muscular attachments to the bone and decreases the alteration of the soft tissues around the hip. Objectives: To report the results of primary total hip arthroplasties, performed by direct anterior approach. Methods: A descriptive-prospective case series study was carried out with patients who underwent primary uncemented total hip arthroplasty through a direct anterior approach. Results: The female sex and the age groups of 45 and 60 years predominated. The body mass index was low and there was little anesthetic risk. Surgical time exceeded two hours, with little operative bleeding. The correct placement of the acetabular and femoral components allowed ambulation to begin in less than three days. Complications were rare and resolved with appropriate treatment. Conclusions: The use of the direct anterior approach for primary total hip arthroplasties offers very satisfactory results.

Artroplastia total de cadera en dos instituciones ortopédicas de Cuba

Introducción: La artroplastia total de cadera se considera un procedimiento seguro y eficaz que alivia el dolor, y mejora la salud física y la calidad de vida en los pacientes. Objetivos: Caracterizar la artroplastia total de cadera en pacientes intervenidos en el Hospital Ortopédico Docente "Fructuoso Rodríguez" y el Complejo Científico Ortopédico "Frank País". Métodos: Estudio descriptivo retrospectivo de pacientes intervenidos con artroplastia total de cadera en el Hospital Ortopédico Docente "Fructuoso Rodríguez" y el Complejo Científico Ortopédico "Frank País", entre septiembre de 2019 y marzo de 2021. Resultados: Predominaron el sexo femenino y las edades entre 60 y 62 años, con lateralidad izquierda. El principal diagnóstico preoperatorio resultó la coxartrosis. El tamaño de la copa acetabular y la cabeza del componente femoral fueron similares. La prótesis acetabular se fijó por presión. Conclusiones: Se encontraron grandes semejanzas en cuanto a la edad, el sexo, la lateralidad, el tamaño de los componentes acetabular y cabeza femoral, el tipo de fijación del componente acetabular y la cantidad de tornillos empleados. En el diagnóstico preoperatorio prevaleció la artrosis de cadera.

Introduction: Total hip arthroplasty is considered a safe and effective procedure that relieves pain and improves physical health and quality of life in patients. Objectives: To characterize the patients who underwent total hip arthroplasty at Fructuoso Rodríguez Teaching Orthopedic Hospital and Frank País Orthopedic Scientific Complex. Methods: A retrospective descriptive study was conducted with patients who underwent total hip arthroplasty at Fructuoso Rodríguez Teaching Orthopedic Hospital and Frank País Orthopedic Scientific Complex, from September 2019 to March 2021. Results: The female sex and the ages between 60 and 62 years predominated, with left laterality. The main preoperative diagnosis was coxarthrosis. The size of the acetabular cup and the head of the femoral component were similar. The acetabular prosthesis was fixed by pressure. Conclusions: Great similarities were found in terms of age, sex, laterality, the size of the acetabular components and femoral head, the type of fixation of the acetabular component and the number of screws used. Osteoarthritis of the hip prevailed In the preoperative diagnosis.

Malnutrition is associated with postoperative complications in elderly patients undergoing total hip arthroplasty.

INTRODUCTION: Malnutrition in elderly patients with hip fracture has been described as a factor associated with poor outcomes. This evidence for elderly patients undergoing elective total hip arthroplasty (THA) for osteoarthritis is not well-established. METHODS: We retrospectively studied a cohort of patients with an age ≥65 years admitted to the hospital for THA between January 2018 and December 2020. Demographic characteristics were collected. Albumin and total lymphocyte count were included in the pre-operative analysis and 24h postoperatively. Nutritional screening was carried out 24h postoperatively. GLIM criteria were applied for the diagnosis of malnutrition. RESULTS: 25 patients out of the total cohort of 65 (38.4%) were malnourished. Five out of six patients (83.3%) with postoperative complications presented malnutrition compared with 20 of 59 patients (33.8%) without postoperative complications (P=0.028). Mean length of stay (LOS) was 3.49±0.88 days. Five out of six (83.3%) patients with postoperative complications presented LOS >3 days compared with one out of six patients (16.6%) with LOS ≤3 days (P=0.009). 26 patients (40%) were referred to a community health centre, no differences in diagnosis of malnutrition were detected compared with patients who were discharged home. Patients with a diagnosis of malnutrition were significantly older, had a lower body mass index (BMI), a lower preoperative and postoperative albumin and worse anthropometric parameters. CONCLUSIONS: Malnutrition is associated with postoperative complications and longer LOS in elderly patients with elective THA. Risk factors for malnutrition are older age and low BMI.

Risk of venous thromboembolism in thromboprophylaxis between aspirin and low molecular weight heparins after total hip arthroplasty or total knee arthroplasty: Systematic review and meta-analysis. / Riesgo de tromboembolismo venoso en la tromboprofilaxis entre aspirina y heparinas de bajo peso molecular tras una artroplastia total de cadera o artroplastia total de rodilla. Revisión sistemática y metaanálisis.

INTRODUCTION: The aim of this study was to evaluate the efficacy of aspirin versus low molecular weight heparins (LMWH) for the prophylaxis of venous thromboembolism (VTE), deep vein thrombosis (DVT) and pulmonary embolism (PE) in patients undergoing total knee arthroplasty (TKA) and/or total hip arthroplasty (THA). MATERIALS AND METHODS: Systematic review and meta-analysis. Sixteen studies were selected. The risk of VTE, DVT and PE were analyzed. Mortality, risk of bleeding and surgical wound complications was also analyzed. RESULTS: 248,461 patients were included. 176,406 patients with thromboprophylaxis with LMWH and 72,055 patients with aspirin thromboprophylaxis. There were no significant differences in the risk of VTE (OR = 0.93; 95% CI: 0.69-1.26; P = .64), DVT (OR = 0.72; 95% CI: 0.43-1.20; P = .21) or PE (OR = 1.13; 95% CI: 0.86-1.49; P = .38) between both groups. No significant differences were found in mortality (P = .30), bleeding (P = .22), or complications in the surgical wound (P = .85) between both groups. These same findings were found in the sub-analysis of only randomized clinical trials (P>.05). CONCLUSIONS: No increased risk of PE, DVT, or VTE was found among patients with aspirin thromboprophylaxis versus patients with LMWH thromboprophylaxis. There was also no greater mortality, greater bleeding, or greater complications in the surgical wound found among patients with aspirin thromboprophylaxis versus patients with LMWH thromboprophylaxis.

Dynamic changes and clinic significance of serum high mobility group box 1 in patients with total hip arthroplasty.

BACKGROUND: Deeper understanding on the risk factors and seeking potential predicted biomarkers for prognosis of total hip arthroplasty (THA) patients are of great significance. Limited researches focused the correlation between high mobility group box protein-1 (HMGB1) and the prognosis of THA patients. OBJECTIVE: The objective of this study was to investigate the role of HMGB1 and inflammatory factors in patients underwent total hip arthroplasty (THA). METHODS: The present prospective study enrolled 208 THA patients who went to our hospital during January 2020 to January 2022. Serum levels of HMGB1, C-reactive protein (CRP), interleukin-1b (IL-1ß), and IL-6 were detected at the admission, 1 day, 3 days, 7 days, 30 days, and 90 days after surgery. The levels of Harris score, Fugl-Meyer, 36-item short-form health survey (SF-36), and Pittsburgh sleep quality index (PSQI) were detected on 90 days after surgery in two groups. Receiver operating characteristic curve (ROC) was performed for analyzing the diagnostic value of HMGB1 and logistic regression model was used for identifying the risk factor for poor prognosis of THA patients. RESULTS: Serum levels of HMGB1 and inflammatory factors increased after surgery compared with the baselines. A positive correlation was found between HMGB1 and CRP on 1 day after surgery, and positive correlations were found among HMGB1, IL-1ß, and IL-6 on 3 day after surgery. Besides, low HMGB1 reduced the incidence of post-operative complications and improved prognosis of THA patients. CONCLUSION: Serum HMGB1 was correlated with inflammatory factors and the prognosis of THA patients.

OBJETIVO: Profundizar la comprensión de los factores de riesgo y buscar predecir biomarcadores potenciales para el pronóstico de pacientes con reemplazo total de cadera es de gran importancia. Los estudios limitados se han centrado en la correlación entre la nhigh mobility group box 1 protein (HMGB1) y el pronóstico en pacientes con artroplastia total de cadera. Investigar el papel de la HMGB1 sérica y los factores inflamatorios en pacientes sometidos a artroplastia total de cadera. MÉTODO: Estudio prospectivo que incluyó 208 pacientes con artroplastia total de cadera que acudieron a nuestro hospital. Los niveles de puntuación de Harris, Fugl-Meyer, encuesta de salud de formato corto de 36 ítems (SF-36) e índice de calidad del sueño de Pittsburgh (PSQI) se determinaron 90 días después de la cirugía en dos grupos. Se realizó la curva característica operativa del receptor (ROC) para analizar el valor diagnóstico de HMGB1 y se utilizó un modelo de regresión logística para identificar el factor de riesgo para mal pronóstico de los pacientes con artroplastia total de cadera. RESULTADOS: Las concentraciones séricas de HMGB1 y los factores inflamatorios aumentaron después de la cirugía en comparación con los valores iniciales. Se encontró una correlación positiva entre la HMGB1 y la proteína C reactiva 1 día después de la cirugía, y correlaciones positivas entre la HMGB1 y las interleucinas 1b y 6 a los 3 días de la cirugía. CONCLUSIONES: La HMGB1 sérica se correlacionó con los factores inflamatorios y con el pronóstico de los pacientes con artroplastia total de cadera.

[Translated article] Primary total hip arthroplasty in patients with sequelae of poliomyelitis.

INTRODUCTION: Total hip arthroplasty (THA) in patients with residual poliomyelitis (RP) is a surgical challenge. Dysplastic morphology, osteoporosis and gluteal weakness hinder orientation, increase fracture risk and reduce implant stability. The aim of this study is to describe a series of patients with RP treated by THA. MATERIAL AND METHODS: Retrospective descriptive study of patients with RP treated with THA between 1999 and 2021 in a tertiary hospital, with clinical and radiological follow-up and functional and complication evaluation until present or death, with a minimum of 12 months. RESULTS: Sixteen patients underwent surgery, with 13 THA implanted in the paretic limb, 6 for fracture and 7 for osteoarthritis, while the remaining 3 were implanted in the contralateral limb. Four dual mobility cups were implanted as an antiluxation measure. At 1 year postoperatively, 11 had complete range of motion with no increase in Trendelenburg cases. The Harris hip score (HHS) improved 32.1 points, the visual analogue scale (VAS) 5.25 points, and the Merlé-d'Augbiné-Poste scale 6 points. The length discrepancy correction was 13.77mm. Median follow-up was 3.5 years (1-24). Two cases were revised for polyethylene wear and two for instability, with no infections, periprosthetic fractures, or cup or stem loosening. CONCLUSIONS: THA in patients with RP allows improvement of the clinico-functional situation with an acceptable complication rate. The risk of dislocation could be minimised with dual mobility cups.

Primary total hip arthroplasty in patients with sequelae of poliomyelitis. / Artroplastia total de cadera primaria en pacientes con secuelas de poliomielitis.

INTRODUCTION: Total hip arthroplasty (THA) in patients with residual poliomyelitis (RP) is a surgical challenge. Dysplastic morphology, osteoporosis and gluteal weakness hinder orientation, increase fracture risk and reduce implant stability. The aim of this study is to describe a series of patients with RP treated by THA. MATERIAL AND METHODS: Retrospective descriptive study of patients with RP treated with THA between 1999 and 2021 in a tertiary hospital, with clinical and radiological follow-up and functional and complication evaluation until present or death, with a minimum of 12months. RESULTS: Sixteen patients underwent surgery, with 13THA implanted in the paretic limb, 6 for fracture and 7 for osteoarthritis, while the remaining 3 were implanted in the contralateral limb. Four dual mobility cups were implanted as an antiluxation measure. At 1year postoperatively, 11 had complete range of motion with no increase in Trendelenburg cases. The Harris hip score (HHS) improved 32.1points, the visual analog scale (VAS) 5.25 points, and the Merlé-d'Augbiné-Poste scale 6 points. The length discrepancy correction was 13.77mm. Median follow-up was 3.5years (1-24). Two cases were revised for polyethylene wear and two for instability, with no infections, periprosthetic fractures, or cup or stem loosening. CONCLUSIONS: THA in patients with RP allows improvement of the clinico-functional situation with an acceptable complication rate. The risk of dislocation could be minimized with dual mobility cups.

¿Cuándo se reanuda la conducción después del reemplazo total de cadera primario? / When to resume driving after primary total hip arthroplasty?

Resumen: Introducción: la literatura actual relaciona el regreso a la conducción vehicular con múltiples variables. Sin embargo, los datos actuales sobre el tiempo de regreso a la conducción luego de una artroplastía total de cadera (ATC) son diversos e incluso contradictorios. Por lo tanto, nos hemos planteado el objetivo de determinar el tiempo requerido para volver a conducir en un grupo de pacientes sometidos a una ATC primaria mediante un abordaje posterolateral, centrándonos específicamente en vehículos de marcha manual. Material y métodos: hemos estudiado los resultados clínico-funcionales de 112 pacientes sometidos a una ATC primaria entre Enero de 2019 y Enero de 2020 en un hospital de alta complejidad en Cádiz, Andalucía, España. Resultados: la mediana del tiempo de regreso a la conducción fue de tres semanas (RIC 2-4). Hemos identificado que 89.3% de los pacientes pudo volver a conducir antes de la sexta semana posterior a la cirugía. Además, en 92% de los casos, los pacientes se sintieron aún más seguros al conducir después de la ATC que antes de la intervención. Conclusión: consideramos que a la sexta semana de una ATC es seguro reanudar la conducción de un vehículo.

Abstract: Introduction: the current literature relates the return to driving with multiple variables. For various reasons, the current data on the time to return to driving after a total hip arthroplasty (THA) are diverse and even contradictory. We have proposed the objective of determining the time required to drive a manual gear vehicle again in a group of patients who underwent primary THA through a posterolateral approach with focus on manual gear cars. Material and methods: we have studied the functional results of 112 patients who underwent primary THA between January 2019 and January 2020 in a high level in Cadiz, Andalusia, Spain. Results: the median return to driving was three weeks (IQR 2-4). We have identified that 89.3% of the patients were able to drive again before the sixth week after surgery and in 92% of the cases they did so feeling even safer than before the THA. Conclusion: we consider that after the sixth week of an THA it is safe to resume driving a vehicle.

Factores de riesgo asociados a infección periprotésica en el paciente con fractura del cuello femoral: estudio de casos y controles / Risk factors associated with periprosthetic infection in patients with femoral neck fracture: A case-control study

Antecedentes y objetivo: La infección es una de las complicaciones locales más importantes en el paciente con fractura del cuello femoral tratada con una artroplastia. El objetivo del presente estudio es describir y analizar posibles factores de riesgo que podrían estar implicados en la infección periprotésica del paciente con fractura del cuello femoral. Material y métodos: Se realizó un estudio de casos y controles retrospectivo que incluye a pacientes con fractura del cuello femoral tratada con una artroplastia en el periodo comprendido entre enero de 2015 y diciembre de 2017. Se definieron como casos a los pacientes con fractura del cuello femoral que tras someterse a una artroplastia (hemiartroplastia o artroplastia total de cadera) tuvieron como desenlace una infección periprotésica, cuyo diagnóstico se llevó a cabo atendiendo a los criterios mayores y menores descritos en el Consenso Internacional de Infecciones Musculoesqueléticas (Philadelphia 2018). Con la intención de atenuar la influencia de variables que podrían considerarse confusoras, se realizó un análisis multivariante. Resultados: Se apreció una asociación estadísticamente significativa entre infección periprotésica y determinadas variables presentes en el momento del ingreso, entre las que se encuentran la presencia de anemia moderada o severa (OR: 10,91; IC95%: 1,07-111,50; p=0,007), trombocitopenia (OR: 27,72; IC95%: 3,48-221,01; p=0,002), el antecedente tromboembólico (OR: 8,80; IC95%: 1,31-59,38; p=0,026), el trastorno ansioso-depresivo en tratamiento con 2 o 3 fármacos (OR: 21,36; IC95%: 3,65-125,12; p=0,001) y la hepatopatía (OR: 32,04; IC95%: 2,59-396,29; p=0,007). Conclusiones: La infección periprotésica en el paciente con fractura del cuello femoral tratado con una artroplastia podría relacionarse con la presencia de determinadas variables en el momento del ingreso hospitalario, entre las que se encuentran la anemia moderada o severa...(AU)

Background: Infection is one of the most important local complications in the patient with femoral neck fracture treated with arthroplasty. The aim of the present study is to describe and analyze possible risk factors that could be involved in periprosthetic infection in the patient with femoral neck fracture. Methods: A retrospective case-control study was performed including patients with femoral neck fractures treated with arthroplasty in the period between January 2015 and December 2017. Cases were defined as patients with femoral neck fracture who after undergoing arthroplasty (hemiarthroplasty or total hip arthroplasty) had a periprosthetic infection, whose diagnosis was carried out according to the major and minor criteria described in the International Consensus on Musculoskeletal Infections (Philadelphia 2018). In order to mitigate the influence of variables that could be considered confounding variables, a multivariate analysis was carried out. Outcomes: A statistically significant association was found between periprosthetic infection and certain variables present at the time of admission, including the presence of moderate or severe anaemia (OR: 10.91; 95%CI: 1.07-111.50; P=.007), thrombocytopenia (OR: 27.72; 95%CI: 3.48-221.01; P=.002), history of thromboembolism event (OR: 8.80; 95%CI: 1.31-59.38; P=.026), anxious-depressive disorder in treatment with two or three drugs (OR: 21.36; 95%CI: 3.65-125.12; P=.001) and liver disease (OR: 32.04; 95%CI: 2.59-396.29; P=.007). Conclusions: Periprosthetic infection in the patient with femoral neck fracture treated with arthroplasty could be related to the presence of certain variables at the time of hospital admission, including moderate or severe anaemia, thrombocytopenia, history of thromboembolic event, anxious-depressive disorder in treatment with two or three drugs or liver disease.(AU)

[Translated article] Risk factors associated with periprosthetic infection in patients with femoral neck fracture: A case–control study / Factores de riesgo asociados a infección periprotésica en el paciente con fractura del cuello femoral: estudio de casos y controles

Antecedentes y objetivo: La infección es una de las complicaciones locales más importantes en el paciente con fractura del cuello femoral tratada con una artroplastia. El objetivo del presente estudio es describir y analizar posibles factores de riesgo que podrían estar implicados en la infección periprotésica del paciente con fractura del cuello femoral. Material y métodos: Se realizó un estudio de casos y controles retrospectivo que incluye a pacientes con fractura del cuello femoral tratada con una artroplastia en el periodo comprendido entre enero de 2015 y diciembre de 2017. Se definieron como casos a los pacientes con fractura del cuello femoral que tras someterse a una artroplastia (hemiartroplastia o artroplastia total de cadera) tuvieron como desenlace una infección periprotésica, cuyo diagnóstico se llevó a cabo atendiendo a los criterios mayores y menores descritos en el Consenso Internacional de Infecciones Musculoesqueléticas (Philadelphia 2018). Con la intención de atenuar la influencia de variables que podrían considerarse confusoras, se realizó un análisis multivariante. Resultados: Se apreció una asociación estadísticamente significativa entre infección periprotésica y determinadas variables presentes en el momento del ingreso, entre las que se encuentran la presencia de anemia moderada o severa (OR: 10,91; IC95%: 1,07-111,50; p=0,007), trombocitopenia (OR: 27,72; IC95%: 3,48-221,01; p=0,002), el antecedente tromboembólico (OR: 8,80; IC95%: 1,31-59,38; p=0,026), el trastorno ansioso-depresivo en tratamiento con 2 o 3 fármacos (OR: 21,36; IC95%: 3,65-125,12; p=0,001) y la hepatopatía (OR: 32,04; IC95%: 2,59-396,29; p=0,007). Conclusiones: La infección periprotésica en el paciente con fractura del cuello femoral tratado con una artroplastia podría relacionarse con la presencia de determinadas variables en el momento del ingreso hospitalario, entre las que se encuentran la anemia moderada o severa...(AU)

Background: Infection is one of the most important local complications in the patient with femoral neck fracture treated with arthroplasty. The aim of the present study is to describe and analyze possible risk factors that could be involved in periprosthetic infection in the patient with femoral neck fracture. Methods: A retrospective case-control study was performed including patients with femoral neck fractures treated with arthroplasty in the period between January 2015 and December 2017. Cases were defined as patients with femoral neck fracture who after undergoing arthroplasty (hemiarthroplasty or total hip arthroplasty) had a periprosthetic infection, whose diagnosis was carried out according to the major and minor criteria described in the International Consensus on Musculoskeletal Infections (Philadelphia 2018). In order to mitigate the influence of variables that could be considered confounding variables, a multivariate analysis was carried out. Outcomes: A statistically significant association was found between periprosthetic infection and certain variables present at the time of admission, including the presence of moderate or severe anaemia (OR: 10.91; 95%CI: 1.07-111.50; P=.007), thrombocytopenia (OR: 27.72; 95%CI: 3.48-221.01; P=.002), history of thromboembolism event (OR: 8.80; 95%CI: 1.31-59.38; P=.026), anxious-depressive disorder in treatment with two or three drugs (OR: 21.36; 95%CI: 3.65-125.12; P=.001) and liver disease (OR: 32.04; 95%CI: 2.59-396.29; P=.007). Conclusions: Periprosthetic infection in the patient with femoral neck fracture treated with arthroplasty could be related to the presence of certain variables at the time of hospital admission, including moderate or severe anaemia, thrombocytopenia, history of thromboembolic event, anxious-depressive disorder in treatment with two or three drugs or liver disease.(AU)