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Language Revista española de cirugía osteoarticular, 2000, vol. 35, no. 201
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- El cotilo de impactación en las artroplastias de cadera(2000) Hernández Vaquero, Daniel; Olay Gayoso, M. J.; Barrera Cadenas, J. L.Entre los diferentes sistemas de fijación de la cúpula acetabular entre las artroplastias no cementadas, la impactación tiene múltiples ventajas. Permite un mejor contacto entre implante y hueso y no necesita destrucción de la superficie ósea receptora. Los nuevos diseños para impactación están fabricados en aleaciones de titanio y poseen una superficie rugosa recubierta a su vez con hidroxiapatita. Algunos modelos como la artroplatia Bihapro poseen aletas estabilizadoras en su reborde externo para evitar la movilización rotatoria inicial. El sistema de impactación está mostrando buenos resultados de la experiencia conocida y aunque los periodos de seguimiento son aún cortos, la integración ósea conseguida es satisfactoria. Se presentan los resultados de 1107 cúpulas Bihapro con una evolución entre uno y siete años, que han seguido un protocolo de seguimiento informatizado. En sólo un caso se presentó movilización del componente que precisó cirugía de revisión.
- Historia natural del componente acetabular en la prótesis de Charnley: Factores de riesgo(2000) García Cimbrelo, Eduardofour hundred and fifty two Charnley cups were assessed with a mean follow-up period of 20 years. Seventy-five of them were loosed. Migration was observed in 21% and 33% showed demarcation in the whole contour of the cup. There was a statistically correlation between the grade of initial demarcation and migration (p<0.0001). the mean acetabular wear rate was 0,13 mm/years. Annual wear over 0,2 mm was related with an age under 50 years, and weight over 80 kg. Of the 75 loosened cups, 35 were diagnosed within 10 years of the operation (early loosening), and 40 after 10 years (late loosening). Early loosening was related to poor acetabular bone stock, with cup migration and pain as frequent findings. Late loosening was related with acetabular wear of more than 2 mm, with less incidence of migration and pain.
- Vástago recubierto de hidroxiapatita: Revisión a 5 años(2000) Cachero Bernárdez, D.; Alejandro Corral, I. F.; Gutiérrez Goyeneche, A.The clinical and radiological results of 65 proximally HA-coated femoral stems were assessed after a minimum follow-up period of five years. The relationship between remodelative changes and the stress patterns was clearly disclosed by finite element modelling. Mean age was 56 years. The most common etiology was osteoarthritis in 38 cases and vascular necrosis in 15. Radiographic and clinical assessment was done after Johnston and col's protocol and the numeric rating of Merle D'Aubigne respectively. The mean preoperative score was 8,5 points, becoming 17,4 points out of 18 at the 5 years review. Occasional or absent pain was fount in 98% of the cases. There were radiolucency lines surrounding the polished and sharp distal stem in 89%, but they were not present at the HA-coated zones. Reactive cortical hypertrophy was present in 14 % and proximal small osteolytics features in 11%. According Engh's criteria, the 100% of the stems were osteintegrated.
- La fijación protésica de la hidroxiapatita(2000) Murcia Mazón, Antonio; Paz Jiménez, José; Maestro Fernández, AntonioWe assessed the results alter 810 total hip arthroplasties with no cementation using an implant with hidroxyapatite coating in two different hospitals. The index procedure was indicated in primary hip osteoarthritis in 65.3% of the cases, and pain was the reason for operation in 83.2% of cases. Seven deep infections were recorded. Thigh pain was present in twenty-seven patients (3,3%), half of them during the immediate postoperative period associated with a collapse of femoral component (between 2 and 3 mm). Initial radiolucency areas were progressively filled and disappeared. This phenomenon has been interpreted as one of the beneficial features of hidroxypatite (osteoconduction); total disappearance occurs between the 8th and 10th weeks. These findings allow us to state the benefit of implant surface coating with hidroxiapatite, since it favours a better and earlier implant to bone fixation.
- Indicaciones del vástago cementado en la cirugía de revisión de prótesis total de cadera(2000) Lizaur Utrilla, AlejandroThe most frequent cause of failure in primary total hip arthroplasties is the aseptic loosening of the femoral component, either in the cemented or uncemented stems, occurring by different causes. In the cemented stems the first cause is mechanical due to weakening of the cement mantle whereas uncemented stems loosen because of fibrous tissue ingrowths into the pores instead of bone. In cemented femoral stems, loosening tends to begin lately, but once it occurs the progression in fast. Uncemented stems may show radiolucent lines early, but is progression is slower. After a revision femoral component, the most common complication continues being aseptic loosening in both types of stems. Several advantage support the use of cemented femoral stems; the cement can be associated to antibiotics while obstructing the migration of polyethylene particles can be achieved with bony poor quality. The disadvantage of using uncemented stems are the possible bone ingrowth on a refreshed bone bed or bone grafts, and that the extraction of the stem in the event of failure is less difficult. However, bone ingrowth into the pores requires such good contact between the implant and the recipient that is difficult to obtain in revision surgery with poor bone quality. In the literature, the results in revision surgery with one or other type of stem are very contradictors, but a consensus seem to exist in that the election of the type of femoral component depends on several factors like life expectancy, activity requirement, obesity, bone quality, quantity of remnant bone stock and geometry of the proximal femur. The most important factor in the durability of revision hip arthroplasty is the bone quality: with good bone quality the results tend be favourable, regardless of the type of used stem; but with poor bone quality the results tend be worse with no cemented femoral components.
- Aflojamiento de los cotilos roscados en las prótesis de cadera(2000) Vaquero, JavierWe report our long-term results using a threaded acetabular cup (Lord, Howmedica) in 145 hips with a follow-up longre than 10 years. Ten patients died during this period of time (12 cups) and we have reviewed 65 implants with a mean age at operation of 60 years. The clinical results according to Merle d'Aubigne score, showed that the hip is still pain free, but there was a loss in walking ability of 0,6 pints (p<0.001). fourteen cups were revised for aseptic loosening (21%) and revision was pending at the most recent follow-up examination in additional two cups. The overall percentage of symptomatic migration was 24%. We conclude that long term stability of threaded cups is not warranted and different factors can influence the revision rate (design, biomechanic and technical factors), indicating that further use of these acetabular components cannot be recommended.
- Rotura de cotilo en artroplastia total de cadera(2000) Canillas del Rey, F.M.; Corbatón Blasco, V.; Muñoz Campos, J.; Sanjurjo Navarro, J.Describimos dos casos de rotura de cotilos de expansión de prótesis de cadera tipo CLS de origen no traumático. Ambos casos sucedieron a los seis años de cirugía y no se apreció desgaste o rotura del polietileno en ninguno de ellos. En nuestra opinión la hipótesis más probable es que la falta de contacto entre la zona polar del cotilo y el fondo del acetábulo produzca una zona de inestabilidad en los segmentos de la prótesis y rotura por fatiga del material. Creemos que es obligado su recambio aunque el paciente no presente sintomatología actual, ya que la rotura del acetábulo conducirá a un aflojamiento y a una osteolisis secundaria.
- Necrosis de la cabeza femoral tras fractura del cuello femoral tratada mediante osteosíntesis(2000) Martínez Martín, Angel Antonio; Panisello Sebastiá, Juan José; Lallana Duplá, J.; Herrera Rodríguez, AntonioSe presenta un análisis retrospectivo de las necrosis aparecidas en 233 pacientes con fractura de cuello femoral fijada con tornillos de esponjosa. La edad media fue de 80,6 años. Setenta y un pacientes (26%) tuvieron una fractura no desplazada (Garden I o II) y 172 (74%) una fractura desplazada (Garden III o IV). Seis meses tras la cirugía 170 pacientes sobrevivían (72,9%). Treinta y cuatro de ellos (20%) habían desarrollado necrosis y 10 (5,9%) colapso. Tras un seguimiento de 12 meses 114 pacientes sobrevivían (48,9%). Veinticuatro de ellos (21%) tenía una necrosis y 18 (15,7%) un colapso. Dos años tras la intervención, 103 pacientes sobrevivían (44,2%). Siete de ellos habían desarrollado una necrosis (7,6%) y 25 un colapso (27,2%). En el último seguimiento (a los 3 años) 84 pacientes sobrevivían (36%). Se halló un colapso en 8 de ellos (9,5%). Observamos una relación significativa entre los pacientes que tenían una fractura desplazada, una mala reducción, una fijación inestable, y el desarrollo posterior de necrosis o colapso tardío.
- Aloinjerto triturado en revisión acetabular: 3-7 años de seguimiento(2000) García Cimbrelo, EduardoWe assessed 96 cases of revision surgery in cementless and cementad cups using morsellized allograft according to bone defect. A cementless porous hemispherical cup was used in acetabula with less than 30% bone defect (42 cups) while a cemented cup as used in hips with a defect greater than 30% (54 cups). The mean follow-up was 5.6 years. There were no further revised cups and no migration. Radiolucent lines were uncommon in both groups. Although graft remodelling was difficult to evaluate, only 8 hips showed minor resorption. Middleterm results are favourable with impacted allograft and cementless cup in acetabular bone defects of less than 30% and with impacted allograft and cemented all-polyethylene cup in defects greater than 30%.
- Neuritis por virus zoster simulando una lesión yatrogénica del nervio ciático(2000) Baixauli Perelló, Emilio José; Gabarda Llorens, R.; Baixauli Castellá, Francisco; Baixauli García, FranciscoSe describe un caso de fractura-luxación posterior de cadera sin alteraciones neurovasculares asociadas, que a las 2 semanas de la intervención se presentó un cuadro de radiculalgia. Inicialmente se sospechó una lesión neurológica relacionada con el acto quirúrgico con el proceso de cicatrización de la herida. El estudio electromiográfico, las características clínicas y la respuesta al tratamiento con aciclovir permitieron identificar la neuritis del nervio ciático por virus varicela zoster. Ante una radiculopatía postoperatoria no se debe olivar la posibilidad de un origen inflamatorio o infeccioso. El acto quirúrgico puede provocar una reactivación de la infección latente por virus varicela zoster.
