Search

Resumen: Las artroplastias de cadera con par de fricción metal-metal (M-M) debido a su bajo índice de fricción han resultado una opción atractiva en pacientes jóvenes con alta demanda funcional, aunque actualmente han experimentado un descenso en su uso debido a las complicaciones de algunos modelos y a las reacciones fisiológicas adversas relacionadas con la elevación de iones metálicos en sangre. Nuestro objetivo es revisar los pacientes con par M-M intervenidos en nuestro centro, correlacionando el nivel de iones con la posición del componente acetabular y con el tamaño de la cabeza. Material y métodos: Revisión retrospectiva de 166 prótesis de cadera M-M intervenidas entre 2002 y 2011. Se descartaron 65 por diferentes causas (fallecimiento, perdida de seguimiento, no control actual de iones, no radiografía u otros), quedando una muestra de 101 pacientes a analizar. Se registró el tiempo de seguimiento, el ángulo de inclinación del cótilo, el nivel de iones en sangre, el Harris Hip Score (HHS) y las complicaciones. Resultados: Ciento un pacientes (25 mujeres y 76 hombres), 55 años de edad media (entre 26-70); de estos, 8 fueron prótesis de superficie. El tiempo medio de seguimiento fue de 10 años (entre 5 y 17 años). La media de los diámetros cefálicos fue de 46,25 mm (entre 38 y 56). La inclinación media de los cótilos fue de 45,7° (entre 26 y 71°). La fuerza de correlación entre la verticalidad del cótilo y el aumento de iones es moderada r = 0,31 para el Cr y leve r = 0,25 para el Co. La fuerza de correlación entre el tamaño de la cabeza y el aumento de iones es débil e inversa r = −0,14 para Cr y r = 0,1 para Co. Cinco pacientes (4,9%) precisaron revisión (2 [1%] por aumento de iones con pseudotumor). El tiempo medio hasta la revisión fue de 6,5 años, en los que aumentaron los iones. El HHS medio fue de 94,01 (entre 55,8 y 100). En la revisión de pacientes hallamos 3 con aumento importante de iones que no habían seguido controles, y los 3 presentaban un HHS de 100. Los ángulos de los componentes acetabulares fueron de 69°, 60° y 48°, y el diámetro de la cabeza fue de 48, 42 y 48 mm, respectivamente. Discusión y conclusiones: Las prótesis M-M han sido una opción válida en pacientes con elevada demanda funcional. Un seguimiento analítico bianual es recomendable, ya que en nuestro caso hemos detectado 3 pacientes con HHS 100 que presentaban elevación inadmisible de cobalto > 20 μ/l (según la SECCA) de los iones y 4 con elevación muy anormal de cobalto ≥ 10 μ/l (según la SECCA), todos ellos con ángulos de orientación del cótilo > 50°. Con nuestra revisión podemos concluir que hay una correlación moderada entre la verticalidad del componente acetabular y el aumento de iones en sangre, y que el seguimiento de los pacientes con ángulos > 50° es imprescindible. Abstract: Due to their low friction index, hip arthroplasties with metal-metal (M-M) friction torque have been an attractive option in young patients with high functional demand, currently they have suffered a decrease in their use due to the complications of some models and physiological reactions adverse reactions related to the elevation of metal ions in the blood. Our objective is to review the patients with M-M pair operated in our center, correlating the ion level with the position of the acetabular component and with the size of the head. Material and methods: Retrospective review of 166 M-M hip prostheses operated between 2002 and 2011. Sixty five ruled out for different causes (death, loss of follow-up, no current ion control, no radiography or others), leaving a sample of 101 patients to be analyzed. Follow-up time, cup inclination angle, blood ion level, Harris Hip Score (HHS), and complications were recorded. Results: One hundred and one patients (25 women and 76 men), 55 years of average age (between 26 and 70), of these 8 were surface prostheses and 93 total prostheses. The mean follow-up time was 10 years (between 5 and 17 years). The mean head diameters was 46.25 (between 38 and 56). The mean inclination of the butts was 45.7° (between 26° and 71°). The correlation force between the verticality of the cup and the increase in ions is moderate r = 0.31 for Cr and slight r = 0.25 for Co. The correlation force between head size and ion increase is weak and inverse r = −0.14 for Cr and r = 0.1 for Co. Five patients (4.9%) required revision (2 [1%] due to increased ions with pseudotumor). The mean time to revision was 6.5 years in which the ions increased. The mean HHS was 94.01 (between 55.8 and 100). In the review of patients, we found 3 with a significant increase in ions who had not followed controls, all 3 had an HHS of 100. The angles of the acetabular components were 69°, 60° and 48° and the diameter of the head was 48.42 and 48 mm, respectively. Discussion and conclusions: M-M prostheses have been a valid option in patients with high functional demand. A bi-annual analytical follow-up is recommended, since in our case we have detected 3 patients with HHS 100 who presented unacceptable elevation of cobalt > 20 μm/L (according to SECCA) of the ions and 4 with very abnormal elevation of cobalt ≥ 10 μm/L (according to SECCA), all of them with cup orientation angles > 50°. With our review we can conclude that there is a moderate correlation between the verticality of the acetabular component and the increase in blood ions and that the follow-up of this patient with angles > 50° is essential.

Due to their low friction index, hip arthroplasties with metal–metal (M–M) friction torque have been an attractive option in young patients with high functional demand, currently they have suffered a decrease in their use due to the complications of some models and physiological reactions adverse reactions related to the elevation of metal ions in the blood. Our objective is to review the patients with M–M pair operated in our centre, correlating the ion level with the position of the acetabular component and with the size of the head. Material and methods: Retrospective review of 166 M–M hip prostheses operated between 2002 and 2011. Sixty five ruled out for different causes (death, loss of follow-up, no current ion control, no radiography or others), leaving a sample of 101 patients to be analysed. Follow-up time, cup inclination angle, blood ion level, Harris Hip Score (HHS), and complications were recorded. Results: One hundred and one patients (25 women and 76 men), 55 years of average age (between 26 and 70), of these 8 were surface prostheses and 93 total prostheses. The mean follow-up time was 10 years (between 5 and 17 years). The mean head diameter was 46.25 (between 38 and 56). The mean inclination of the butts was 45.7° (between 26° and 71°). The correlation force between the verticality of the cup and the increase in ions is moderate r = 0.31 for Cr and slight r = 0.25 for Co. The correlation force between head size and ion increase is weak and inverse r = −0.14 for Cr and r = 0.1 for Co. Five patients (4.9%) required revision (2 [1%] due to increased ions with pseudotumor). The mean time to revision was 6.5 years in which the ions increased. The mean HHS was 94.01 (between 55.8 and 100). In the review of patients, we found 3 with a significant increase in ions who had not followed controls, all 3 had an HHS of 100. The angles of the acetabular components were 69°, 60° and 48° and the diameter of the head was 48.42 and 48 mm, respectively. Discussion and conclusions: M–M prostheses have been a valid option in patients with high functional demand. A bi-annual analytical follow-up is recommended, since in our case we have detected 3 patients with HHS 100 who presented unacceptable elevation of cobalt >20 μm/l (according to SECCA) of the ions and 4 with very abnormal elevation of cobalt ≥10 μm/l (according to SECCA), all of them with cup orientation angles >50°. With our review we can conclude that there is a moderate correlation between the verticality of the acetabular component and the increase in blood ions and that the follow-up of this patient with angles >50° is essential. Resumen: Las artroplastias de cadera con par de fricción metal-metal (M-M) debido a su bajo índice de fricción han resultado una opción atractiva en pacientes jóvenes con alta demanda funcional, aunque actualmente han experimentado un descenso en su uso debido a las complicaciones de algunos modelos y a las reacciones fisiológicas adversas relacionadas con la elevación de iones metálicos en sangre. Nuestro objetivo es revisar los pacientes con par M-M intervenidos en nuestro centro, correlacionando el nivel de iones con la posición del componente acetabular y con el tamaño de la cabeza. Material y métodos: Revisión retrospectiva de 166 prótesis de cadera M-M intervenidas entre 2002 y 2011. Se descartaron 65 por diferentes causas (fallecimiento, pérdida de seguimiento, no control actual de iones, no radiografía u otros), quedando una muestra de 101 pacientes a analizar. Se registró el tiempo de seguimiento, el ángulo de inclinación del cótilo, el nivel de iones en sangre, el Harris Hip Score (HHS) y las complicaciones. Resultados: Ciento un pacientes (25 mujeres y 76 hombres), 55 años de edad media (entre 26-70); de estos, 8 fueron prótesis de superficie. El tiempo medio de seguimiento fue de 10 años (entre 5 y 17 años). La media de los diámetros cefálicos fue de 46,25 mm (entre 38 y 56). La inclinación media de los cótilos fue de 45,7° (entre 26 y 71°). La fuerza de correlación entre la verticalidad del cótilo y el aumento de iones es moderada r = 0,31 para el Cr y leve r = 0,25 para el Co. La fuerza de correlación entre el tamaño de la cabeza y el aumento de iones es débil e inversa r = −0,14 para Cr y r = 0,1 para Co. Cinco pacientes (4,9%) precisaron revisión (2 [1%] por aumento de iones con seudotumor). El tiempo medio hasta la revisión fue de 6,5 años, en los que aumentaron los iones. El HHS medio fue de 94,01 (entre 55,8 y 100). En la revisión de pacientes hallamos 3 con aumento importante de iones que no habían seguido controles, y los 3 presentaban un HHS de 100. Los ángulos de los componentes acetabulares fueron de 69, 60 y 48°, y el diámetro de la cabeza fue de 48, 42 y 48 mm, respectivamente. Discusión y conclusiones: Las prótesis M-M han sido una opción válida en pacientes con elevada demanda funcional. Un seguimiento analítico bianual es recomendable, ya que en nuestro caso hemos detectado 3 pacientes con HHS de 100 que presentaban elevación inadmisible de cobalto >20 μ/l (según la SECCA) de los iones y 4 con elevación muy anormal de cobalto ≥10 μ/l (según la SECCA), todos ellos con ángulos de orientación del cótilo >50°. Con nuestra revisión podemos concluir que hay una correlación moderada entre la verticalidad del componente acetabular y el aumento de iones en sangre, y que el seguimiento de los pacientes con ángulos >50° es imprescindible.

The objective of our study was to evaluate the association between acute periprosthetic joint infection (APJI) and radiographic measurement of soft-tissue thickness in elective total hip replacement surgery. A case-control study was conducted to compare the soft-tissue thickness radiographic measurement (SRM) at the hip in patients diagnosed with APJI based on Tsukayama et al. (2003) criteria after total hip replacement with patients that were not infected, at a single institution from 2013 to 2019. To minimize selection bias, each case was matched with two controls using the following methodology: patients of the same sex, with an age variation of ± 5 years, and nearest in surgery date to the cases were selected. All postoperative radiographs were performed in the first 24 h after total hip arthroplasty (THA) surgery as it is protocolized in our institution. Soft-tissue thickness radiographic measurement was defined as the distance from the tip of the greater trochanter to the skin following a perpendicular line to the femoral diaphysis in postoperative anteroposterior hip radiographs. In total, 78 patients were included (26 cases and 52 controls). The SRM median of the cases was 76.19 mm (SD: 26.518) and 53.5 mm (SD: 20.47) in controls. A multivariate logistic regression model showed an independent association between APJI and SRM (odds ratio (OR) = 1.033, 95 % confidence interval (CI) 1.007–1.059, p=0.012). Patients with an SRM greater than 60 mm had a 7-fold increase in the odds of APJI (OR = 7.295, 95 % CI = 2.364–22.511, p.001). The results of our study suggest an association between large SRM at the hip and the risk of APJI in patients with primary total hip arthroplasty. SRM may be a helpful and easy tool for evaluating the risk of APJI before elective primary total hip replacement surgery.

Resumen: Antecedentes y objetivo: Durante la pandemia COVID-19, la actividad de los servicios quirúrgicos se ha visto obligada a adaptarse y transformarse. La telemedicina se está implantando como nunca antes en esta nueva situación, en la que los pacientes están confinados y los profesionales sanitarios presentan riesgo de infectarse.El objetivo es mostrar que una reestructuración combinada telemática y presencial de las visitas, permite asegurar la asistencia médica, garantizando la protección del personal sanitario y de los pacientes. Material y método: Estudio descriptivo observacional sobre el seguimiento de pacientes durante la pandemia por COVID-19, combinando la consulta telefónica con la presencial. Resultados: Se realizaron un total de 5.031 llamadas telefónicas, diferenciando entre derivaciones, visitas de atención primaria especializada y consulta externa hospitalaria.Se registraron como: efectivas, tributarias de visita presencial y no se logra contacto telefónico. Y las dividimos en dos grupos: resueltas y no resueltas.Del total de visitas no presenciales telefónicas fueron efectivas un 53%. Conclusiones: La medicina telemática es una opción factible en un servicio de traumatología, y de manera adecuada será una opción interesante de mantener tras la pandemia.Futuras líneas de investigación deberían ser abiertas para mejorar la capacidad de resolución de este sistema, analizar su relación coste-efectividad y subsanar los conflictos legales que pudieran existir. Abstract: Background and aim: The current COVID-19 pandemic scenario has driven surgical departments to a transformation.The worldwide spread of the disease has led to a public health quarantine where health care professionals are at high risk of infection. In this context, telemedicine has been promoted and scaled up to reduce the risk of transmission. This study aims to demonstrate that a combined framework based on telematics and in-person clinical encounter not only ensures medical care but the safety of healthcare professionals and patients. Material and method: Descriptive observational study on the follow-up of patients during the COVID19 Pandemic, combining telephone and traditional. Results: A total of 5031 telephone calls were made, differentiating between medical referrals, specialized primary care visits, and outpatient consultation.They were classified as successful, required an in-person visit, or no successful telephone contact. Furthermore, we divided them into 2 groups: resolved and unresolved.53% of all telematic visits were successful. Conclusions: Telematic medical systems are a feasible option in a orthopedics department and an interesting resource to preserve once the pandemic is resolved. Future lines of research should be opened to improve system success, analyze its cost-effectiveness ratio, and correct any legal conflicts that may exist.

Purpose: Preoperative planning has become essential in performance of total hip arthroplasty (THA). However, data regarding the effect of the planner's experience on the accuracy of digital preoperative planning is limited. The objective of this study was to assess the accuracy of digital templating in THA based on the surgeon's experience. Materials and Methods: A retrospective study was conducted. An analysis of 98 anteroposterior pelvic radiographs, which were individually templated by four surgeons (two hip surgeons and two orthopaedic residents) using TraumaCad® digital planning, was performed. A comparison of preoperatively planned sizes with implanted sizes was performed to evaluate the accuracy of predicting component size. The results of preoperative planning performed by hip surgeons and orthopaedic residents were compared for testing of the planner's experience. Results: Femoral stem was precisely predicted in 32.4% of cases, acetabular component in 40.3%, and femoral offset in 76.7%. Prediction of cup size showed greater accuracy than femoral size among all observers. No differences in any variable were observed among the four groups (acetabular cup P =0.07, femoral stem P =0.82, femoral offset P =0.06). All measurements showed good reliability (intraclass correlation coefficient [ICC] acetabular cup: 0.76, ICC femoral stem: 0.79). Conclusion: The results of this study might suggest that even though a surgeon's experience supports improved precision during the planning stage, it should not be restricted only to surgeons with a high level of experience. We consider preoperative planning an essential part of the surgery, which should be included in training for orthopaedics residents. [ABSTRACT FROM AUTHOR]

Due to their low friction index, hip arthroplasties with metal-metal (M-M) friction torque have been an attractive option in young patients with high functional demand, currently they have suffered a decrease in their use due to the complications of some models and physiological reactions adverse reactions related to the elevation of metal ions in the blood. Our objective is to review the patients with M-M pair operated in our center, correlating the ion level with the position of the acetabular component and with the size of the head., Material and Methods: Retrospective review of 166 M-M hip prostheses operated between 2002 and 2011. Sixty five ruled out for different causes (death, loss of follow-up, no current ion control, no radiography or others), leaving a sample of 101 patients to be analyzed. Follow-up time, cup inclination angle, blood ion level, Harris Hip Score (HHS), and complications were recorded., Results: One hundred and one patients (25 women and 76 men), 55years of average age (between 26 and 70), of these 8 were surface prostheses and 93 total prostheses. The mean follow-up time was 10years (between 5 and 17years). The mean head diameters was 46.25 (between 38 and 56). The mean inclination of the butts was 45.7° (between 26° and 71°). The correlation force between the verticality of the cup and the increase in ions is moderate r=0.31 for Cr and slight r=0.25 for Co. The correlation force between head size and ion increase is weak and inverse r=-0.14 for Cr and r=0.1 for Co. Five patients (4.9%) required revision (2 [1%] due to increased ions with pseudotumor). The mean time to revision was 6.5years in which the ions increased. The mean HHS was 94.01 (between 55.8 and 100). In the review of patients, we found 3 with a significant increase in ions who had not followed controls, all 3 had an HHS of 100. The angles of the acetabular components were 69°, 60° and 48° and the diameter of the head was 48.42 and 48mm, respectively., Discussion and Conclusions: M-M prostheses have been a valid option in patients with high functional demand. A bi-annual analytical follow-up is recommended, since in our case we have detected 3patients with HHS100 who presented unacceptable elevation of cobalt >20μm/L (according to SECCA) of the ions and 4 with very abnormal elevation of cobalt ≥10μm/L (according to SECCA), all of them with cup orientation angles >50°. With our review we can conclude that there is a moderate correlation between the verticality of the acetabular component and the increase in blood ions and that the follow-up of this patient with angles >50° is essential., (Copyright © 2022 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.)