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Introduction: the presentation of this case provides a new vision of how to address one of the most common traumatic diseases of the elderly in Cuba. Case report: a 77 year-old elderly patient is presented with a fall. On physical examination, shortening, abduction and external rotation of the lower limb were found, then hip fracture was diagnosed. The patient stated that, for religious reasons, she did not wish to be transfused if necessary; fixation with a plate and screws was indicated. It was decided to perform minimally invasive surgery. Conclusions: minimally invasive techniques can be considered for hip fracture surgery in order to save blood and achieve less exposure, minor scarring, lower morbidity and fewer complications. [ABSTRACT FROM AUTHOR]

Introduction: one of the fundamental characteristics of ageing is falling, which is the main cause of accidents in the elderly. Objective: to describe the behavior of the post-fall syndrome in the older adult operated for hip fracture in the Municipality of Sagua la Grande. Methods: we conducted a cross-sectional descriptive study to describe the behavior of the post-fall syndrome in older adults who had hip fracture surgery in the municipality of Sagua la Grande during the period between 2015 and 2016. The population was constituted by 40 older adults, the sample was selected by an intentional non-probabilistic sampling by criteria and was of 24 older adults. The information was collected through document review, questionnaires to the elderly and observation of the households. Results: Most of the older adults (15, 62.5%) who suffered falls had level II function and a predominance of risk factors related to alterations in the osteomyoarticular system (21, 87.5%) and cardiovascular diseases (14, 58.3%). All of the older adults (24, 100%) presented post-fall syndrome. Conclusions: falls and injuries due to falls are responsible for a considerable part of morbidity and mortality in older adults. One of the consequences not directly derived from the injuries produced in the fall, but that affects the older person and his/her environment, is the so-called post-fall syndrome. [ABSTRACT FROM AUTHOR]

Regional anesthesia is increasingly being performed in patients with hip fracture, offering better analgesia and lower consumption of opioids reducing their side effects. Recently, the sensitive innervation of the hip joint and the mechanism of action of different nerve blocks have been studied. This has led us to develop a novel ultrasound-guided approach for blockade of articular branches of the hip nerves, pericapsular nerve group. Which blocks only the sensory articular branches unilaterally. Technique: with the patient in the dorsal position, the transverse convex transducer is placed on the anterior inferior iliac spine, then align with the Iliopectineal eminence of the pubic branch rotating it 45° counter clockwise. An 80 mm flat needle is inserted lateral to medial and the local anesthetic is deposited deep in the psoas tendon. Discussion: The identification of sonoanatomy is fundamental in the PENG block, it is not an advanced block, but the anesthesiologist could have an unsuccessful block and lose all the benefits of this technique. Therefore, we present the images in detail of the procedure. [ABSTRACT FROM AUTHOR]

The incidence rate of peripros-thetic fractures has increased in the past decade. Osteolysis, age and preoperative function are factors that influence morbidity. Treatment options include conservative and surgical treatment. Objectives: To conduct a study analyzing the functional results of the surgical treatment of periprosthetic hip fractures at the ABC Medical Center considering preoperative and postoperative variables. Material and methods: Cross-sectional retrospective study of patients with a diagnosis of periprosthetic hip fracture between January 2000 and December 2011, classified using the Vancouver system. The Oxford Hip Score was used pre- and postoperatively as a functional measure. The variables to evaluate included age, sex, surgical technique, and the time elapsed between primary surgery and the periprosthetic fracture. Results: Twenty-five patients were analyzed; frequency was 3.3 cases per year. 80% of periprosthetic fractures were postoperative; 72% were total hip arthroplasties. The time elapsed between primary surgery and the traumatic event was 2 to 4 years (68%), with a mean of 4.5 years for hemiarthroplasties and 3.9 years for total arthroplasties. Patients who according to the Oxford Hip Score had good function maintained their results; 75% of those with moderate function maintained their score. Patients with poor function improved. Conclusions: At the ABC Medical Center, the outcomes of the treatment of periprosthetic hip fractures are considered as good according to the Oxford Hip Score. funcionalidad. Conclusiones: En el Centro Médico ABC, el tratamiento de las fracturas periprotésicas de cadera mediante la valoración del Oxford Hip Score se considera con un desenlace bueno. [ABSTRACT FROM AUTHOR]

Hip dislocation is the second most common complication of Total Hip Arthroplasty followed by aseptic loosening, is the second most common complication of THA presenting with an incidence of 2.4-3.9% in primary procedures and an incidence of up to 28% in revision surgeries. The hip dislocations can be classified into 3 groups: Early, middle and late. Generally early dislocations respond favorably to nonsurgical treatment and have low recurrence rate. In this case the need for revision surgery is much higher. The diagnosis of a dislocated hip is relatively easy to perform because the clinical picture is very typical. Having identified a dislocated hip the first step is to make an attempt to reduce a closed manner. Among the options are the following: Change of modular components, trochanteric progress, review of component orientation and ultimately the use of constrained components. One of the most common problems for which the patient presents early recurrent instability is inadequate orientation of the prosthetic components. The THA is one of the most useful and most successful surgeries the last 100 years, however requires a refined surgical technique, proper patient selection and planning to meet the expectations of it. It currently has a range of possible treatments for problem resolution, with the intent of restoring a stable and functional hip. [ABSTRACT FROM AUTHOR]

Case report of an 89 year-old patient who had cardiorespiratory arrest during cemented hip hemiarthroplasty and required cardiopulmonary resuscitation. This complication occurred immediately after using the carbon dioxide-based lavage system known as CarboJet® and was attributed to gas embolism once other entities were ruled out. The possible factors that may contribute to this surgical complication are discussed. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study is to characterize the clinico-epidemiologic variables of patients with hip fracture and assess the presence of complications, whether dependent or independent of performing surgery within 48 hours of the fracture. Methods: A descriptive applied cross-sectional study of patients who underwent hip surgery was performed. Five hundred patients were included; females were predominant as they accounted for 68% (339); mean age was 75.5 years. Hypertension and diabetes mellitus were the most frequent conditions. Pertrochanteric fractures represented 56% (257) and were predominant. Results: Mean operative time was 1.2 hours; and partial hip prosthesis accounted for 25.6% (128) and was the most common surgery performed, followed by plate osteosynthesis, which accounted for 25.4% (127) of the 457 procedures performed. The complication rate was 17%, with bronchopneumonia (2%) as the most frequent one; reoperation was the most frequent surgical complication (7.4%). Mean waiting time before surgery ranged from 72 hours to 14 days (73.2%) and mean hospital stay ranged between 7 and 15 days (37%). Conclusions: The highest incidence of fractures occurs in females over age 75. The most frequent fracture is the pertrochanteric one, with a high incidence of chronic-degenerative conditions that results in increased postoperative complications when surgical treatment is provided after 48 hours. [ABSTRACT FROM AUTHOR]

An increasing number of patients require a prosthesis as a result of the increased physical demand seen in older patients, and the earlier diagnosis of conditions associated with hip arthrosis. It's therefore essential to know the activity of various physiologic variables affecting the perioperative behavior of patients undergoing total hip arthroplasty. Material and methods: An epidemiologic study was conducted to identify the absolute and relative frequencies of various variables during the perioperative period of total hip arthroplasty. The medical records of 142 patients who underwent total hip arthroplasty were analyzed. Results: Of the 142 records analyzed, 91 cases were females (64.1%) and 51 males (35.9%); mean BMI was 27.16 kg/m² (SD ± 3.98); 101 patients (71.1%) were overweight. The median preoperative Hb was 14.61 g/dl (range: 11-18.8 g/dl); the mean postoperative Hb was 10.76 g/dl (SD ± 1.56). The mean maximum permissible bleeding was 1,433.88 ml (SD ± 436.39). The median operative time was 150 minutes (range: 90-420 min). Conclusion: We have to find ways to decrease the risk of major bleeding and thus avoid blood transfusions by knowing the characteristics of patients about to undergo total hip arthroplasty. [ABSTRACT FROM AUTHOR]

Introduction: This days, medical treatment for thos patients with congenital hip dislocation should be open reduction of dislocated hip. Objective: Demonstrate that it is possible to do a concentric closed reduction of dislocated hip. Design: Partially retrospective, descriptive, observational and longitudinal. Scenario: Pediatrics Orthopedics of Traumatología y Ortopedia Lomas Verdes, Hospital of Instituto Mexicano del Seguro Social México. Patients: We studied 74 patients for May 1999 to April 2000. This patients had a congenital hip dislocation grade III and IV in Tonnis scale, ages between 18 and 60 months. Gendered 16% male, 84% female. We studied 96 hips overall. Methodology: We did an aductors muscle dissection, thenotomy for psoasiliac muscle, closed reduction and holding this position with a cast. We calculated concentric reduction, and this patients hand follow up for the next twelve months. Results: We got a concentric hip reduction in 86% of the hips studied. 13% of the patients required open reduction, with a statistically significant difference (p < 0.00050). Conclusion: It is possible to do a close concentrical reduction of dislocated hip in patients whom had already started walking, as shown in this study. [ABSTRACT FROM AUTHOR]

Background: Due to its immunomodulating effects mediated by leukocytes and interleukins, heterologous allogeneic blood transfusion has been considered as a risk factor for both morbidity and mortality in patients undergoing orthopedic surgery, including hip surgery. This research analyzed whether heterologous allogeneic blood transfusion is a risk factor associated with the adverse course or complication of the surgical wound in patients undergoing primary hip surgery due to fracture at a general hospital in 2008-2009. Material and methods: Forty-nine patients who had a complication (cases) and 207 with no complications (controls) were identified and both groups were compared with a bivariate and multivariate analysis, and demographic and clinical data, including having undergone blood transfusion or not. Results: Not having received a blood transfusion was identified as a variable that reduced the risk of surgical wound complications (OR = 0.05, 95% confidence interval [CI 95%] 0.0067 to 0.16; ?2 with p < 0.001). The multivariate model excluded as clinically significant variables the duration of surgery (OR = 1.01, CI 95% 0.99 to 1.02; p = 0.12) and certain chronic conditions (OR = 0.54, CI 95% 0.13 to 2.24 for diabetes mellitus, OR = 1.16, CI 95% 0.29 to 4.60 for chronic hypertension, OR = 1.21, CI 95% 0.19 to 7.51 for various heart diseases). Conclusions: Not having received a blood transfusion reduced 95% the risk of surgi- cal wound complications. Neither the duration of surgery nor a specific comorbid condition were associated with the former event. [ABSTRACT FROM AUTHOR]

Giant cell tumor (GCT) is an aggressive benign neoplasia that accounts for 5% of primary bone tumors and 20% of all benign bone tumors. It appears almost exclusively after skeletal maturation, between 20 and 40 years of age, and is predominant among females. We report the case of a 39 year-old male patient who in 1988 sustained a left hip fracture in a pathological area. On July 20, 1988 he underwent excisional biopsy and curettage; on January 13, 1989 broad resection and arthrodesis of the left hip were performed with a cobra plate. The histopathologic diagnosis was GCT. On October 2, 1990 the cobra plate was removed due to fatigue. The patient was referred to our service with a fl oating hip joint and left knee anchylosis. On February 11, 1991 he underwent unconventional hip arthroplasty with a long stem up to the femoral supracondylar area. On February 2, 1995 the implant was removed due to fatigue. On February 16, 1995 an unconventional prosthesis with a long stem was reimplanted for knee arthrodesis. Final shortening was 10 cm. On November 17, 2010 he had radiographic signs of acetabular loosening and fatigue of the arthrodesis stem. On March 17, 2011 the unconventional prosthesis was removed, en-bloc resection of the distal femur was performed, and acetabular and femoral components were put in place. He is currently painless, walks with crutches and has 5.5 cm of shortening. The proximal femur is an infrequent site for GCT. Controlling the neoplasia and limb preservation are the major challenges that orthopedic surgeons and patients face. There are only a few published papers on revision of unconventional arthroplasty. There are no cases published on unconventional hip arthroplasty with ipsilateral knee arthrodesis. [ABSTRACT FROM AUTHOR]

Introduction: Historically, only substantial nutritional deficiencies have been recognized on time in surgical patients due to the technical difficulty of making the diagnosis. Preoperative nutritional assessment with biochemical and immunologic variables helps detect patients with malnutrition. The purpose of our study was to find out the role of the lymphocyte count in the preoperative complete blood count as a factor associated with delayed healing in hip surgery, and thus detect the patients at risk of complications. Methods: A study was conducted in patients undergoing hip surgery, from December 2008 to May 2009, and who were followed-up at the outpatient service. Results: A total of 48 patients were assessed; 21 patients (43.8%) underwent surgery due to an orthopedic condition, and 27 (56.3%) due to trauma. Lymphocyte counts included a minimum of 200 and a maximum of 9,600. Twenty-six patients had lymphocytes < 1,500 with healing ranges from 10 to 30 days, and 22 patients had a count > 1,500 with healing ranges from 10 to 25 days. No differences were found in gender or in the traumatic or orthopedic condition. There was a statistically significant difference in favor of the group with lymphocytes > 1,500 cells/mm³. Conclusions: A strong relation was found between delayed healing and patients with lymphocytes < 1,500 cells/mm³. [ABSTRACT FROM AUTHOR]

Introduction: The quality of life of patients with periprosthetic fracture is complex; it interacts with the severity of the lesion, their independence level, and available resources, all of which could cause alterations secondary to their condition. Objective: To know the quality of life and clinical course of patients after periprosthetic hip fracture surgery. Material and methods: Patients with periprosthetic hip fracture were assessed. Physical exam was performed and the SF-36 questionnaire was applied. Results: A total of 15 patients were included, 8 (53.3%) females and 7 (46.7%) males, with mean age 74 years (SD 12.51). Concerning underlying conditions, 5 patients had none (33.3%), one had hypertension (6.7%), one had a neoplasia (epidermoid), and 8 had more than one underlying condition. A predictive variable model was designed. In the overall score a 75.6% positive correlation was found, and a 57.2% determination coefficient. There was no statistical significance (p = 0.162). The same variables as in the previous model were included. Correlation was 0.678 and determination 45.9%, without statistical significance, p = 0.332. Conclusions: Patients reported feeling fair from the perspective of their overall health, physical function, physical role, emotional role, and social function; mental health wise, 50% reported feeling calm and full of life, and 50% reported anxiety and fear. [ABSTRACT FROM AUTHOR]

Improvement of the gluteal and hip contour in patients seeking a more feminine shape is difficult to achieve, specially for those who don't have enough fat to transfer from other areas of the body. We describe the surgical technique used to improve hips and buttocks contour in a genetic male transsexual. This patient previously underwent two unsuccessful surgeries to feminize his hip and buttock contour. Our successful approach involved the use of an oval-shaped cohesive silicone gel implants placed in both, the hip and buttock areas, along with fat injection in the areas between the two implants. A natural, feminine contour was achieved using the combination of buttock and hip implants with lipofilling using patient's own fat. These procedures completely eliminated the male contour previously noted in the gluteal trochanteric region. This surgical combination presents a new option, not previously reported, for the treatment of transsexual patients seeking a more natural feminine gluteal contour. The results are both gratifying and predictable. The combined use of gluteal and hip implants helps us to improve the deficiencies present in male patients when compared with the natural feminine buttock and hip contour. [ABSTRACT FROM AUTHOR]

Many problems caused by loosening, fracture dislocation and hip modular system are due to wear, incompatibility with the environment, cytotoxicity and corrosion of materials used for joint replacement. The previous limitations usually induce the formation of hazardous wastes, causing serious injury to bone tissue, directly affecting patient health and reducing the life of the implant, leading to the risk of further surgery, for early withdrawal of the prosthesis. The aim of this study was characterize the materials of modular hip implants to determine possible causes of early retirement, in samples from different clinics in the city of Barranquilla. The materials found in different modular pairs removed were polymer-ceramic and polymer-metal type, such as PMMA, UHMWPE, Ti6Al4V and Co-Cr-Mo. The characterization was developed from medical diagnosis in order to analyze the possible causes and conditions with greater impact, causing the early retirement of hip implants. The samples were characterized by X-Ray Diffraction, Optical Microscopy and Scanning Electron Microscopy. In the case of polymeric component, this was characterized by TGA. The results showed topographical similarities between modular pairs polymer-metal type. The presence of microcracks shows additional embrittlement in the structure of the implant due to environment. The other hand the polymeric component showed cracks and scratchs due to third body wear in the bearing zone and significant evidence of fracture in the femoral component. In the acetabular component were observed different patterns of adhesive and corrosive wear. [ABSTRACT FROM AUTHOR]

Objective: To determine the annual number and trend of prostheses implanted in patients with rheumatoid arthritis (RA) at our hospital during the past decade. Materials and methods: Retrospective observational study. Patients were collected through an extensive search of the database of the Clinical Documentation Service between 1998 and 2007. The data was extracted from medical records using a predesigned questionnaire. Statistical analysis of longitudinal prostheses was made by Cochrane's Q test and the Kaplan-Meier method. Results: Sixty-one RA patients were operated on with 78 prostheses as a direct result of their disease at our hospital between 1998 and 2007. Most were women (80%) with positive rheumatoid factor (84%). The mean age was 58 years, and the average time since onset of RA was 13 years. All hut one had previously received antirheumatic drugs (88% methotrexate), hut only 11% had biological therapy. No changes were observed in the number of arthroplasties as a whole over a decade, although there was a trend towards reduction in the number of patients that required a knee replacement for the first time (Cochrane Q, P = o.o5). Conclusion: We observed no significant changes in trends in the number of new joint replacement procedures as a whole in the past decade at our hospital, although the number of patients that required knee replacement for the first time as a direct result of their underlying disease seems to have declined in the last decade. [ABSTRACT FROM AUTHOR]

Introduction: The approach for total hip arthroplasty (THA) using a mini-incision has been used progressively to decrease morbidity, achieve prompt patient recovery without an increased risk and shorten the hospital stay. However, the advantages and probable complications of these approaches are not clear. The objective of this paper is to compare the preliminary perioperative results of two groups of patients undergoing THA, one using the standard approach and the second one with a mini-incision. Material and methods: 170 patients underwent surgery; they were divided into two groups. In group I (GI) patients an anterolateral mini-incision was performed, and in group II (GII) patients a standard Watson-Jones incision was used. Mean incision length was 8 cm in GI and 20 cm in GII. Results: No statistically significant differences were found between both groups in the clinical and radiographic results and in the complications; however, a significant difference was found in the need for transfusions, wound size and hospital stay. Conclusions: This study showed that primary THA with a mini-incision was a safe procedure that reduced the operative time without increasing the complications. [ABSTRACT FROM AUTHOR]

Introduction: Klippel-Tranaunay syndrome is a rare congenital condition characterized by skin angiomas with arteriovenous malformations and hypertrophy of the soft and bone tissues of one extremity. The clinical case presented herein involved total hip replacement due to arthrosis secondary to avascular necrosis of the femoral head, which resulted in the hypervascularity that occurs with this syndrome. A 37 year-old female was diagnosed with grade IV hip arthrosis and Klippel-Trenaunay syndrome. Laboratory and imaging tests were performed to determine the local conditions for the surgical approach to the hip. The preoperative MR angiography identified the arteriovenous malformation tract to determine the limits of the approach. Discussion: The arteriovenous malformations that occur in this syndrome turn the approach into a challenging one due to the potential bleeding, thus extreme prophylactic and technical measures must be applied. There are very few reports in the literature on this treatment. [ABSTRACT FROM AUTHOR]

Introduction: The surgery of hip can produce intense a post-operative pain. The use of intravenous opioids or in epidural infusion produces an amount of adverse effects in the boy that limit their utility. Due to this technical alternatives have looked for to provide a suitable post-operative analgesia as it is the blockade of the compartment of psoas. Material and methods: A group of 60 paediatric patients realized blockade to them of the compartment of psoas according to the technique of Hadzick (distance (0.5 x weight) + 20 mm), 2.5 anesthetic doses of mg/kg volume 0.5 mL/kg, realized blockade guided by neuroestimulator. Intensity of the pain to 4 was evaluated, 8 and 24 hours, presence of complications, duration of the analgesia and depth of plexus. Results: 60 patients included themselves did not appear complications in no patient, the intensity of the pain went of zero to the 4 and 8 hours and the 24 hours of 4 ± 1.7 points. The duration of the analgesia was of 20.7 ± 1.2 hours, the depth of plexus was of 2.8 ± 1 cm. Discussion: This is an effective and safe analgesic technique in the paediatric population during the first 24 post-operative hours in surgery of hip. [ABSTRACT FROM AUTHOR]

Aunque las conclusiones del debate sobre la cirugía de cadera mínimamente invasiva todavía no son convincentes, la información publicada hasta la fecha sobre sus riesgos y beneficios ha centrado el asunto en temas de calidad y en los resultados. Los abordajes quirúrgicos a través de una pequeña incisión puede ser: posterior, anterolateral, anterior directo y con dos incisiones. La navegación mediante ordenador puede ayudar a trazar el mapa en la artroplastia de cadera. La obesidad es un factor de riesgo, habiéndose comprobado que aumenta las complicaciones. El grado de instrucción del paciente, el tratamiento del dolor y la rehabilitación también son importantes para la recuperación tras una artroplastia de cadera mínimamente invasiva. La artroplastia total de cadera puede realizarse satisfactoriamente mediante incisiones pequeñas, aunque la mejoría funcional, el alta hospitalaria, la satisfacción del paciente y la necesidad de antibióticos son similares cualquiera que sea la longitud de la incisión realizada. [ABSTRACT FROM AUTHOR]

Total hip replacement is one of the most successful procedures in orthopaedic surgery. There are two different technologies for implant fixation in total hip replacement: cemented and cementless, both can be combined, which is called Hybrid arthroplasty. Long term implant stability results in long term function. The most important factor that limits longevity of well-fixed implants is the wear of the articular surfaces. Wear of the polyethylene from the acetabulum generates particles that access the implant bone or the implant-cement-bone interface. This produces an inflammatory reaction, osteolysis and implant loosening. Polyethylene of higher resistance to wear and prosthetic articulations without polyethylene (hard on hard bearings), have been introduced to improve wear particle generation. Minimally invasive surgical techniques minimize surgical trauma to sort tissue around the hip joint, facilitating a better and more rapid recovery. [ABSTRACT FROM AUTHOR]

Introduction. A new approach has been developed recently that considerable decreases the size of the skin incision and that has led to controversy around the advantages it offers. Objective. To analyze the immediate postoperative course of patients considering the following parameters: operative time, blood loss, postoperative pain. To report the complications that occurred. Material and methods. Thirty six patients, with a mean age of 48 years, with a diagnosis of grade IV coxarthrosis. Twenty-four patients underwent uncemented total hip arthroplasty, and 12 total hybrid hip arthroplasty. The preoperative Harris clinical assessment was applied and a lateral approach was used in all cases. The initial incision was 6 cm long (100%). Results. The final incision was 6.5 cm in 26 patients (72.22%), 7 cm in 10 patients. Necrosis of wound commissures occurred in 12 patients, superficial necrosis of wound margins in 10 patients; no wound infections were reported. The mean operative time was 65 minutes for uncemented hips and 80 minutes for hybrid hips. Mean intraoperative bleeding was 150 ml. Mean postoperative pain was 3 in the VAS. Complications included performing a neo-acetabulum in one case, and a false passage of the femur component in one case. Conclusion. The minimally invasive approach for total hip replacement is indicated for patients with special characteristics. It is less invasive, safe, involves minimal bleeding, shorter operative time, and is reproduccible. Moreover, it offers significant benefits during the immediate postoperative period when compared with the standard incision, since it involves less pain and mobility is resumed sooner. [ABSTRACT FROM AUTHOR]

Fibromatosis that involves locally aggressive lesions with a common histology may invade neurovascular structures. Surgical treatment depends on the location. Extensive dissection is the treatment of choice for small and anatomically accessible lesions. Radical surgery is indicated for recurrence, large tumors and tumors that involve neurovascular structures. Material and methods. Case report and literature review. The purpose of this paper is to show a surgical treatment modality emphasizing the reconstructive aspects of the foot of a patient with fibromatosis. Radical surgery was considered at the beginning because the imaging tests showed an apparently inoperable tumor. A conservative procedure was planned and performed; the four-year follow-up is reported. Results. Twenty-six year-old female patient who underwent conservative left foot surgery for aggressive musculoaponeurotic fibromatosis; she also had contralateral developmental hip dysplasia. The 4-year follow-up reported no tumor activity and appropriate gait. Conclusions. The imaging showed an apparently inoperable tumor. However, the careful surgical exploration performed in agreement with the oncologic criteria led to a conservative surgery with a tumor-free bed. Although the vascular supply of the foot may be compromised by the tumor, the foot may develop collateral blood flow that may allow conservative surgery with the integration of the bone graft. Reconstruction of the midfoot with an autologous graft is possible and results in an anatomical foot that biomechanically permits ambulation. [ABSTRACT FROM AUTHOR]

Objective. Determine the radiological graft integration; analyze the graft integration rate, and describe the technical features that favor a better graft integration. Introduction: Acetabular dysplasia has represented a problem for cementless total hip replacement, in terms of both covering the acetabular implant and achieving the right orientation. Reports show that en-bloc grafts may result in increased patient morbidity. Methods: Coverage of the superolateral region of dysplastic acetabular was done with a head and neck graft harvested from the patient at the time of surgery and fixed with screws to the iliac bone; then reaming was performed to place the acetabular implant. Acetabular coverage was done in 18 patients using this procedure, 17 females and one male; mean age was 39 years, and mean follow-up was 52 months. Results: Patients were clinically evaluated from the standpoint of symptoms, muscle strength, mobility and regular x-rays. All patients had 100% integration of the head and neck bone graft and the expected acetabular coverage was achieved. Conclusion: Many of the techniques described to provide acetabular coverage in dysplastic hips undergoing replacement may involve increased patient morbidity. Autografts have always been safer and reduce the risk of morbidity. [ABSTRACT FROM AUTHOR]

Introduction. Hemiarthroplasty is still an important procedure and represents a treatment resource when only the femur head is affected. However, relevant complications that warrant consideration may arise, like the ones described in this paper. Objective. To describe the late complications that occurred in two cases using the Thompson and Austin Moore endoprosthesis, to review the literature and find out which are the most frequent complications resulting from hip replacement surgery. Material and methods. Two cases with infrequent complications are presented herein. Case one was a male, 70-year-old patient with central hip fracture dislocation and associated intestinal subocclusion syndrome. Case two sustained a prosthetic subcapital fracture at postoperative year two. Both cases were reoperated on and underwent total hip replacement. Results. The most frequent postoperative complications of hip hemiarthroplasty include prosthetic dislocation, early erosion of the acetabular base, periprosthetic fracture, and central dislocation. There are no cases in the literature like the second case presented herein. Conclusions. The most frequently reported complications of hip hemiarthroplasty include dislocation, early erosion of the acetabular base, and periprosthetic fracture, particularly when hemiarthroplasty is performed in patients with considerable physical activity. The two cases we describe were unusual when they occurred. Each of them should be analyzed and the use of a femur endoprosthesis should be more carefully assessed. [ABSTRACT FROM AUTHOR]

Osteoarthritis (OA) is the most expensive and most prevalent of articular diseases in adults. In 60 years and over adult populations, hip OA prevalence has a range of 17% in men and 9% in women. Hip OA has an important morbility, total hip replacement is frequently needed in 3050% of patients after 10 years of disease. Different treatment options for OA have been analyzed including Pharmacological and non- pharmacological therapies. Among most prescribed drugs, non-steroid anti-inflammatory drugs (NSAIDs) are highlighted and are widely recommended by physicians in OA because it provides relief for mild and moderate symptoms. At present, alternative medical therapies are being developed based upon a better understanding of regulation of cartilage metabolism, directly involved in the pathogenesis of the disease. Nowadays knowledge points at the presence and actions of metalloproteases of the matrix. Other sources point at the evidence that cytokines IL-1B and the tumoral necrosis factor (TNF), represent the most important catabolic systems which are the most important sources of articular tissues degradation. Meloxicam is a derivate of enolic acid with good anti-inflammatory properties and tolerability profile. Diacerein is a purified compound with anthraquinone structure which has proven to inhibit in vivo and in vitro the production and activity of IL-1 and metalloproteases secretion without changing prostaglandins synthesis but exerting a remodeling mechanism of articular cartilage. Patients and methods. Clinical criteria to select patient: The presence of symptomatic disease defined as knee pain and/ or hip for at least one month, radiological inclusion criteria with articular space of 1-3 mm width. Results. 100 patients received the treatment (meloxicam/ diacerein). After 60 days total patients (n = 50) of Group 1 continued with the treatment. Group 2, 48 patients continued the treatment. Main reason for exclusion was 2 patients did not fulfill with programmed appointments to " visit 3". Conclusions. Meloxicam/diacerein study demonstrated efficacy in controlling signs and symptoms: mobility and pain as well as a good tolerability profile. [ABSTRACT FROM AUTHOR]

Introduction. The total hip arthroplasty, is a surgical procedure that is useful to relieve pain, to improve movement in patients with coxarthrosis, and to resolve 31B and 31C (AO/ASIF) fractures. The infection in this patients it's a fulminant complication. The treatment in the THR (total hip replacement) infection goes from local/systemic antibiotic therapy, wound irrigation, deep irrigation, antibiotic loaded chains of cement, one or two stage exchange with antibiotic impregnated cement, thru Girdlestone arthroplasty. Methods. 20 patients expedients were analyzed, who was performed primary THR Surgery that went thru infection, and received a surgical treatment at one stage exchange with vancomycin impregnated cement, 3 patients couldn't be able to get the files, and 1 discharged from de Hospital by himself. A close statistically relation exist comparing the one stage arthroplasty with the date of the last out-patient service visit, and the infection eradication. With 0.683 and P > 0.07. Conclusions. The one stage surgery with vancomycin impregnated cement it's an effective procedure to eradicate the infection in 14 patients (70%) of the 20 patients studied with deep infection after primary TH. [ABSTRACT FROM AUTHOR]

In Mexico about 20,000 fractures of hip exist to the year, of which a high percentage is solved for hemiarthroplasty of hip. Objective. To compare clinic and radiographic the reaming and not reaming acetabular in this type of surgery. Material and methods. There were studied all the patients in whom they realized of hemiarthroplasty hip among January from 1987 until December from 1996, meeting a whole of 66 patients, of whom reamed the acetabulum in 25 and unreamed in 41. Results. There was no significant difference in the clinic (Harris) not in the radiographies (Sotelo-Garza and Charnley) nor at of six weeks, six months, one year, two and three years (p = 0.06). The average of the qualifications of the test of Harris improved in the course of time in both groups. The results in accordance with the location of fracture showed that between more proximal it was the fracture, better were the results in both groups. Discussion. These results turn out to be excellent, since patients were included only with appropriate indication and good surgical skill, knowingly that the principal objective was to evaluate the pain and the erosion acetabular caused by the implant. [ABSTRACT FROM AUTHOR]

El artículo explora los métodos de tratamiento para la necrosis avascular de la cadera. La trayectoria del tratamiento empieza con una operación para los pacientes entre los 30-40 años de edad. Se menciona que la implementación de prótesis en estos pacientes son desalentadores. El artículo examina los varios métodos de conservación ósea, como el injerto de peroné vascularizado.

Until the present time the method of valuation of the bony integration of a cementless prostheses hip has been carried out with conventional X-rays, valuing indirect signs of bony integration initially, like it is the offspring's non sinking, and long term radiological signs as it is the condensation bony periprosthesic it is for that reason that a protocol of study with TAC was elaborated in the period of April from the 2000 to February of the 2002, being carried out courts at metaphyseal level of a spaced thickness of 2.5 mm each 5 mm, in all the cases we use the same modular stem had of hydroxyapatite coated. So far 53 prostheses has been studied in 43 patients to which have been carried out TAC before with the cuts described immediate between the 1° and 7° day after surgery and to the 4 and 5 months and during the pursuit they were carried out radiological controls, at the 3, 6, 12 months and annual, being observed in the TAC studies ingrowth bony periprosthesic in all the cases being able to check a jump distance until of 4 mm that X-rays these changes are not observed. [ABSTRACT FROM AUTHOR]

The objective of our study is to present the cementlees femoral stem preliminary results and interlocking in the revision surgery (IRH) implanted in the hospital Vail d' Hebron of the City of Barcelona, in 45 patients (47 hips), 24 rights, 19 lefts, 2 bilateral, 31 patients of the feminine sex and 14 of the masculine sex, with a half age of 67.8, with a pursuit average of 27.5 months (9-48 months of range), obtaining excellent or good postoperative evaluations with the scale of Merle D' Aubigne and Postel et al, inside the complications that we had they are the fracture transoperatory of the trochanteric osteotomy in 5 cases, it diaphyseal fracture in 1 case, 1 superficial infection of the surgical wound and 1 migration of the fastener distal; the results obtained so far are satisfactory so much clinical as radiographic, highlighting advantages in the stability of the primary anchorage, annulling the sinking or migration of the offspring observed in other not implants cemented, we restore the dysmetria and the muscular balance (pelvitrochanteric), diminishing the time of hospitalization and recovery, and thanks to their total cover of hydroxyapatite a secondary anchorage of biological integration has been observed with regeneration of the bony loss. [ABSTRACT FROM AUTHOR]

Introduction: Hip osteoarthritis is one of the most debilitating pathology from of the motor system. Its surgical procedure via total arthroplasty of the hip creates an important economic influx. Hanging hip operation and viscosuplementation provide a therapeutic alternative to those patients for whom prosthesis functions are not recommended due to their physical activity. Objective: To determine the clinical outcome of the hanging hip operation unattached of the hip and viscosuplementation of the hip. Design: Retroactive, longitudinal, descriptive, cause & effect, observational. Locations: Hospital of Trauma and Orthopedics Lomas Verdes, Instituto Mexicano del Seguro Social. Proof: Six female patients with a coxartrosis condition of hanging hip operation and viscosuplementation unattached of the hip and between August 1999 and August 2001. Results: The clinical evaluation of the hip according to Harris classification reported 33.3% of the results were satisfactories, and less favorable results were reported in 66.6%. The pain associated with patients of less favorable results can be moderately controlled with medication. Discussion: Hanging hip operation and viscosuplementation is a surgical procedure with poors clinical outcome. Conclusions: Hanging hip operation and viscosuplementation is not a therapeutical management for those patients with hip osteoarthritis. [ABSTRACT FROM AUTHOR]

Hip disease has a high social impact because it affects a big number of patients, it is highly limitant and the treatment is expensive. Hip arthroscopy is a useful minimally invasive procedure that helps better understand the origin of hip pathology and has the potential of treating it before the onset of advanced degenerative joint disease. It is a safe and standard procedure if the proper technique for portal placement and arthroscopic examination is used. Specially designed instrumentation is required. Close follow-up will validate the role of arthroscopic treatment of hip pathology in the future. [ABSTRACT FROM AUTHOR]

114 total hip arthroplasties practiced on 109 patients with ages ranging from 39 to 87 years -with an average age of 62 years- between January 1996 and July 2000 have been reviewed. The control of the mentioned arthroplasties was realized between 5.5 and one year, with an average of 37 months. In all of them a type ABG prosthesis of spherical cotyla covered with hydroxyapatite in circumference in their proximal third was implanted. Just in one case, the rechanging was necessary due to the femoral component loosening (99.1% survival). The clinical results have been satisfactory, with a Merle d'Aubigné elevation which rose from an average mark of 2.3 points in pre-operative to 17.7 in post-operative, keeping in time. Harris' values went from an average of 48 points in pre-operative and reached 87 points after the surgery. Only three cases (2.6%) referred thigh pains, even though they were not very important and decreased along time. A hundred and ten patients expressed they were completely satisfied with the procedure. The observed X-ray modifications talk about a discharge in Gruen 1 and 7 zones and its transference and the prosthesis osteointegration at the level of the zones 1 and 6, with a lack of distal fixing and without a sharp end phenomenon. All of this is the result of the ABG system design and conception, which allows us to get acceptable and well-distributed levels of femur (thigh-bone) requests and necessities. This produces a positive osseous-adaptable remolding process during the first months that keeps on in equilibrium during the time the series has been followed and observed. [ABSTRACT FROM AUTHOR]

Objective. The aim of present study is to investigate the analgesic effect of preoperative skin traction in patients who have recent fracture of the hip. Material and methods. A series of 100 patients who were classified into four groups is reported. Groups were as follows: trochanteric fracture and preop, skin traction, trochanteric fracture with no skin traction, femoral neck fracture and preop, skin traction and femoral neck fracture with no skin traction. Trochanteric fractures were treated by hipscrew bone fixation while femoral neck fractures were treated by partial hip prosthesis, either mono or bipolar. The standard time-span between admision and surgery was lesser than 48 hours in 90 cases (90%). In the remaining 10, such a period was 6.2 days in average (3 to 10), as concominat diseases required to delay operation. No difference there existed between groups for preoperative period. Skin traction remained on place either in cases of standard or longer periods. Results. No significant preoperative pain control difference was found between any group at 2, 4 or 8 hours after traction application or even 15 minutes before surgery. Analgesic prescription was the same for all groups. No specific transoperative complications appeared in any case in regard to preoperative traction or its absence. No pulmonary embolism ocurred in any case of the whole series. Pressure sores were found in 10 cases of skin traction while no case of sores ocurred in non-traction patients. Finally, nursing care was somewhat more difficult in the groups of skin traction patients. Conclusion. There is no reason to perform skin preoperative traction as a routine in patients awaiting for hip fracture surgery, since it does not provide significant pain relief, or other advantage for patients and for the hospital. [ABSTRACT FROM AUTHOR]

A prospective, longitudinal study is carried out from 1997 at 1999, of 10 surgical interventions carried out with the Bado technique, in patients diagnosed with Legg-Calve-Perthes disease, with clinical-radiological pursuit of 24 months starting from the surgical procedure. Eight males and 2 women, with an average age of 5.5 (interval of 4 to 9 years); in the clinical evaluation pain, test of Trendelenburg, arches of mobility, muscular mass of the proximal thigh, and GSS (Globular Sedimentation speed) were analyzed; the radiological study included anteroposterior projection and of Lowestein, valuing Wiberg's center-edge angle, stages according to Catterall, as well as remodeling the sphericity of the head according to the Mose method; the postsurgical handling is carried out differing the support with discharge belt and abduction therapy. The clinical control reported pain absence, normal march, negative Trendelenburg test, recovery of muscular mass, complete movement arches and normal globular sedimentation speed (GSS) in 100% of the cases; in the radiological evaluation the recovery of the sphericity was achieved in 70% of the cases, 20% discreet elliptic head and only 10% with coxa plana presence, without luxation data to articulate. This preliminary report demonstrates the effectiveness of the Bado surgery, in the good presage of the bony remodeling, as well as in the normal functional recovery and we believe that the precise follow-up and the narrow surveillance are fundamental to reach success. [ABSTRACT FROM AUTHOR]