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For the past two decades arthroscopic surgery has revolutionized the treatment of acute traumatic knee injuries with patients returning sooner to activities of daily living. However, there are factors that delay this goal, such as... more
For the past two decades arthroscopic surgery has revolutionized the treatment of acute traumatic knee injuries with patients returning sooner to activities of daily living. However, there are factors that delay this goal, such as postoperative intraarticular bleeding, and the swelling and pain that restrain immediate articular mobility. This paper analyzes such factors and their pathophysiologic processes. This led us to formulating a preparation for intraarticular use called RV023. The report of an original, prospective, longitudinal trial is presented herein, assessing the functional results of preparation RV023 in a 60-patient sample selected based on the following inclusion criteria: knee pain lasting 2 years and unresponsive to NSAID treatment, an MRI showing an Outerbridge grade I chondral injury without evidence of ligament or meniscal injury or fracture, and having undergone arthroscopic knee surgery. A significant difference was found in the articular function of subjects treated with the preparation as compared with those in whom it was not used. The articular function recovery curves of individuals treated with the preparation were virtually symmetrical to the curves for healthy controls. On the other hand, no allergic reactions, unwanted or side effects were reported. We therefore conclude that the safety and the benefits seen with preparation RV023 in experimental models are enough to support its use in humans.
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Periprosthetic fractures have had an increasing incidence in the past decades; their resolution is a difficult challenge even for the most experienced orthopedist surgeons. The Vancouver classification has contributed to a great extent to... more
Periprosthetic fractures have had an increasing incidence in the past decades; their resolution is a difficult challenge even for the most experienced orthopedist surgeons. The Vancouver classification has contributed to a great extent to their better characterization and therapeutic guidance. The purpose of this paper is to make a review of the most recent advances on the topic and present our experience in the treatment of these fractures. Material and methods: We describe the characteristics of a sample of 20 patients with periprosthetic femur fractures treated at our hospital from March 2008 to March 2010 and typed according to the Vancouver classification. Results: Mean age was 74.5 years with a range of 65-87 years. Females were predominant (70%). Five cases were type A in the classification, 10 cases type B, and 5 cases type C. Nineteen underwent surgical treatment. The mean total length of stay was 7 days, with a range of 5-12. The mean healing time for types B and C was 4 months (range 3-6 months). Four patients had complications. The resolution was assessed as excellent in 5 cases (25%), good in 11 cases (55%), and poor in 4 cases (20%). Conclusions: A thorough individual assessment based on the Vancouver classification, age and the patient's functional requirements are the major parameters for treatment success.
Research Interests: Incidence Geometry, Medicine, Hospitals, Mexico, Humans, and 9 moreFemur, Female, Pubmed, Male, Follow-up studies, Aged, Time Factors, MEXICO, and Femoral Fractures
The defects of the spinal cord enclose diverse malformations that go from spina bifida to myelomeningocele but there is also a rare variant that is the intercalary bone. The incidence of this phenomenon may vary in 1 to 1,000 to 5,000. At... more
The defects of the spinal cord enclose diverse malformations that go from spina bifida to myelomeningocele but there is also a rare variant that is the intercalary bone. The incidence of this phenomenon may vary in 1 to 1,000 to 5,000. At our knowledge, there are no cases reported where it can be an association of intercalary bone and a bifid spine in different levels. In this article we report the case of one patient that coincide with an intercalary cervical bone, bifid spine in lumbar column and bifid spine in sacral column. The objective of this article is also to comment how the clinical symptoms are unspecific, the chronic pain is the frequent symptom, and how the physiotherapy and anti-inflammatory drugs can provide excellent results in a short and medium term.
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Introduction: Carpal tunnel syndrome is the most prevalent compressive neuropathy and its medical costs in the United States exceed one billion dollars per year. Occurrence increases with age; prevalence is 0.6% in males and as much as... more
Introduction: Carpal tunnel syndrome is the most prevalent compressive neuropathy and its medical costs in the United States exceed one billion dollars per year. Occurrence increases with age; prevalence is 0.6% in males and as much as 5.8% in females, in ages between 45 and 54 years. Besides a thorough case history, there are other more reliable diagnostic methods such as electrophysiological tests that include electromyography and conduction velocity tests. Material and methods: A prospective, longitudinal analysis was conducted of patients with a diagnosis of Carpal tunnel syndrome confirmed with electromyography and evoked potentials. They were treated at Hospital Español de México in 2008-2009. Results: Forty-seven patients were detected, representing 60 cases of carpal tunnel syndrome; 36 females, 11 males. In forty-seven percent of patients the right hand was involved; in 15% the left hand; 38% of patients had bilateral involvement. They underwent medical treatment and the results of the electrodiagnostic tests were good (61%), moderate (33%), and poor (6%). Discussion: Isolated electromyography does not measure the true magnitude of the damage; however, motor conduction velocity becomes a relevant diagnostic method as it detects almost 50% of the patients at the time diagnosis. Patients with motor abnormalities had very favorable postoperative results compared to those with sensory abnormalities.
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Research Interests: Humanities and Medicine
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Common peroneal nerve injury is present in 40% of knee dislocations, and foot drop is the principal complication. Posterior tibial tendon transfer is a viable solution to replace the function of the anterior tibial tendon (ATT) in the... more
Common peroneal nerve injury is present in 40% of knee dislocations, and foot drop is the principal complication. Posterior tibial tendon transfer is a viable solution to replace the function of the anterior tibial tendon (ATT) in the mid-foot. Several techniques for posterior tibial tendon transfer exist today, with variable results reported. However, adding augmentation with side-to-side tenorrhaphy of ATT to the transferred posterior tibial tendon (PTT) enhances anterior tissue balance and load sharing stress between native ATT enthesis and PTT tenodesis, allowing early rehabilitation and improving functional outcomes. Side-to-side tenorrhaphy is performed after PTT tenodesis in the lateral cuneiform to improve reliability in foot drop. This technique allows shorter immobilization time (from 6 to 2 weeks), earlier rehabilitation, sooner weight-bearing, and decreased risk of arthrofibrosis, scar formation, and muscle atrophy.
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Arthroscopic surgery of the hip has rapidly evolved and is considered a safe technique. The overall major complication rate is low compared with minor complications, in general is less than 1.5%, suggesting the procedure is safe.... more
Arthroscopic surgery of the hip has rapidly evolved and is considered a safe technique. The overall major complication rate is low compared with minor complications, in general is less than 1.5%, suggesting the procedure is safe. Cartilage lesions are probably the most frequent but are underreported and usually small and apparently of little consequence. Neuropraxias due to traction are one of the most common complications following hip arthroscopy, but most of them are expected to be transient. Surgeons’ learning curves play an important role; a careful insertion of instruments will help to avoid traumatic injuries to intra-articular structures and chondral surfaces.
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Periprosthetic fractures have had an increasing incidence in the past decades; their resolution is a difficult challenge even for the most experienced orthopedist surgeons. The Vancouver classification has contributed to a great extent to... more
Periprosthetic fractures have had an increasing incidence in the past decades; their resolution is a difficult challenge even for the most experienced orthopedist surgeons. The Vancouver classification has contributed to a great extent to their better characterization and therapeutic guidance. The purpose of this paper is to make a review of the most recent advances on the topic and present our experience in the treatment of these fractures. We describe the characteristics of a sample of 20 patients with periprosthetic femur fractures treated at our hospital from March 2008 to March 2010 and typed according to the Vancouver classification. Mean age was 74.5 years with a range of 65-87 years. Females were predominant (70%). Five cases were type A in the classification, 10 cases type B, and 5 cases type C. Nineteen underwent surgical treatment. The mean total length of stay was 7 days, with a range of 5-12. The mean healing time for types B and C was 4 months (range 3-6 months). Four ...
Research Interests: Incidence Geometry, Medicine, Hospitals, Mexico, Humans, and 9 moreFemur, Female, Pubmed, Male, Follow-up studies, Aged, Time Factors, MEXICO, and Femoral Fractures
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IntroductionSevere acute respiratory syndrome–coronavirus 2 (SARS-CoV-2) infection triggers inflammatory clinical stages that affect the outcome of patients with coronavirus disease 2019 (COVID-19). Disease severity may be associated with... more
IntroductionSevere acute respiratory syndrome–coronavirus 2 (SARS-CoV-2) infection triggers inflammatory clinical stages that affect the outcome of patients with coronavirus disease 2019 (COVID-19). Disease severity may be associated with a metabolic imbalance related to amino acids, lipids, and energy-generating pathways. The aim of this study was to characterize the profile of amino acids and acylcarnitines in COVID-19 patients. A multicenter, cross-sectional study was carried out. A total of 453 individuals were classified by disease severity. Levels of 11 amino acids, 31 acylcarnitines, and succinylacetone in serum samples were analyzed by electrospray ionization–triple quadrupole tandem mass spectrometry. Different clusters were observed in partial least squares discriminant analysis, with phenylalanine, alanine, citrulline, proline, and succinylacetone providing the major contribution to the variability in each cluster (variable importance in the projection >1.5). In logist...
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The preservation of the chondrogenic phenotype and hypoxia-related physiological microenvironment are major challenges in the 2D culture of primary human chondrocytes. To address this problem, we develop a 3D culture system generating... more
The preservation of the chondrogenic phenotype and hypoxia-related physiological microenvironment are major challenges in the 2D culture of primary human chondrocytes. To address this problem, we develop a 3D culture system generating scaffold-free spheroids from human chondrocytes. Our results highlight the chondrogenic potential of cultured human articular chondrocytes in a 3D system combined with hypoxia independently of the cartilage source. After 14 days of culture, we developed spheroids with homogenous diameter and shape from hyaline cartilage donors. Spheroids generated in hypoxia showed a significantly increased glycosaminoglycans synthesis and up-regulated the expression of SOX9, ACAN, COL2A1, COMP, and SNAI1 compared to those obtained under normoxic conditions. Therefore, we conclude that spheroids developed under hypoxic conditions modulate the expression of chondrogenesis-related genes and native tissue features better than 2D cultures. Thus, this scaffold-free 3D cultu...
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The purpose of this study is to investigate whether robotic guidance in total hip arthroplasty (THA) can consistently correct native femoral version. One hundred seventy-five consecutive patients who underwent MAKO® (Stryker, Kalamazoo,... more
The purpose of this study is to investigate whether robotic guidance in total hip arthroplasty (THA) can consistently correct native femoral version. One hundred seventy-five consecutive patients who underwent MAKO® (Stryker, Kalamazoo, Michigan) robotic-guidance THA were included in the study. The study population had a mean age of 57.9 years and a mean body mass index (BMI) of 30.41. Forty-eight percent of the population was male and 74% of the procedures were performed through an anterior approach. Robotic guidance in THA was effective in correcting native femoral version toward a target of 15°. This can be achieved using both the anterior and posterior approach; it is not affected by BMI.
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Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is responsible for the current coronavirus disease 2019 (COVID-19) pandemic, affecting more than 219 countries and causing the death of more than 5 million people worldwide. The... more
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is responsible for the current coronavirus disease 2019 (COVID-19) pandemic, affecting more than 219 countries and causing the death of more than 5 million people worldwide. The genetic background represents a factor that predisposes the way the host responds to SARS-CoV-2 infection. In this sense, genetic variants of ACE and ACE2 could explain the observed interindividual variability to COVID-19 outcomes. In order to improve the understanding of how genetic variants of ACE and ACE2 are involved in the severity of COVID-19, we included a total of 481 individuals who showed clinical manifestations of COVID-19 and were diagnosed by reverse transcription PCR (RT-PCR). Genomic DNA was extracted from peripheral blood and saliva samples. ACE insertion/deletion polymorphism was evaluated by the high-resolution melting method; ACE single-nucleotide polymorphism (SNP) (rs4344) and ACE2 SNPs (rs2285666 and rs2074192) were genotyped ...
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Background Preservation of acetabular bone during primary total hip arthroplasty (THA) is important, because proper stability of cementless acetabular cup during primary THA depends largely on the amount of bone stock left after... more
Background Preservation of acetabular bone during primary total hip arthroplasty (THA) is important, because proper stability of cementless acetabular cup during primary THA depends largely on the amount of bone stock left after acetabular reaming. Eccentric or excessive acetabular reaming can cause soft tissue impingement, loosening, altered center of rotation, bone-to-bone impingement, intraoperative periprosthetic fracture, and other complications. Furthermore, loss of bone stock during primary THA may adversely affect subsequent revision THA. Questions/Purposes We sought to compare the conventional THA (CTHA) approach to robotic-guided THA (RGTHA) to determine which of these techniques preserves more acetabular bone, as interpreted from the size of the acetabular component compared with the size of the native femoral head. Methods Patients who received RGTHA were matched to a control group of patients who received CTHA, in terms of pre-operative native femoral head size (47.8mm ...
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The last decade has seen a tremendous increase in hip arthroscopy. As the number of procedures increase, surgeons have come to appreciate the various risks and complications associated with hip arthroscopy. As such, traction-related... more
The last decade has seen a tremendous increase in hip arthroscopy. As the number of procedures increase, surgeons have come to appreciate the various risks and complications associated with hip arthroscopy. As such, traction-related complications have become more noticeable in this patient population. To combat this issue, in recent years, surgeons have developed effective methods of postless traction to reduce these complications. However, many of these methods rely on extra equipment and its economic costs to the health care delivery. We present a novel technique of postless traction for hip arthroscopy using a fracture table (Maquet), thereby highlighting a practical and economical alternative to the various other techniques of postless traction that have been described in the literature.
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Hip arthroscopic surgery is intended to treat multiple abnormalities in an effort to delay the progression to osteoarthritis, especially in young patients. However, the length of time in which patients experience joint pain before seeking... more
Hip arthroscopic surgery is intended to treat multiple abnormalities in an effort to delay the progression to osteoarthritis, especially in young patients. However, the length of time in which patients experience joint pain before seeking a specialist for a diagnosis can delay hip preservation surgery and influence clinical outcomes. To investigate the relationship between age at symptom onset and findings during hip arthroscopic surgery as well as outcomes after 2 years of clinical follow-up. Cohort study; Level of evidence, 3. From February 2008 to March 2015, data were prospectively collected on all patients undergoing hip arthroscopic surgery at a single institution. Anatomic and pathological characteristics were recorded intraoperatively. The mean age at onset of symptoms was calculated and correlated with intraoperative findings using Pearson correlation and logistic regression. All patients were assessed preoperatively and postoperatively with 4 patient-reported outcome measu...
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The primary purpose of this study was to report the prevalence of femoral head articular damage in patients with a central acetabular osteophyte (CAO) that was identified during hip arthroscopy and compare it with that in a matched... more
The primary purpose of this study was to report the prevalence of femoral head articular damage in patients with a central acetabular osteophyte (CAO) that was identified during hip arthroscopy and compare it with that in a matched control group without a CAO. A secondary purpose was to identify rates of coexisting intra-articular pathology in both patient groups. Intraoperative data were collected prospectively on all hip arthroscopy patients at our institution between 2008 and 2015. The inclusion criteria for this study were CAOs identified during hip arthroscopy for a labral tear and/or femoroacetabular impingement. The exclusion criteria were Tönnis grade greater than 0, previous hip conditions, and prior surgical interventions. The matched control group was selected based on sex, age ± 5 years, body mass index, and Workers' Compensation claim at a 3:1 ratio and comprised patients who underwent hip arthroscopy for a labral tear and/or femoroacetabular impingement without a C...
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Background: Advancements in instrumentation and techniques have extended the scope of hip arthroscopic surgery to treat complex osseous deformities that were previously best addressed with an open approach. Global pincer-type... more
Background: Advancements in instrumentation and techniques have extended the scope of hip arthroscopic surgery to treat complex osseous deformities that were previously best addressed with an open approach. Global pincer-type femoroacetabular impingement is an example of an abnormality requiring osseous correction with a technically challenging access point. Purpose: To report on the patterns of clinical presentation and intra-articular derangements, radiological associations, and minimum 2-year outcomes after hip arthroscopic surgery in patients with a lateral center edge angle (LCEA) >40° and profunda acetabulae in comparison with matched controls with normal acetabular coverage. Study Design: Cohort study; Level of evidence, 3. Methods: Data were collected on all patients undergoing hip arthroscopic surgery during the study period from April 2008 to April 2013. All patients who had undergone hip arthroscopic surgery for symptomatic labral tears not responsive to a minimum of 3...
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Background: Hip pain remains a challenge given the multiple factors that can cause damage to the articular cartilage, such as traumatic injury, metabolic damage, and morphologic variations such as femoroacetabular impingement (FAI) and... more
Background: Hip pain remains a challenge given the multiple factors that can cause damage to the articular cartilage, such as traumatic injury, metabolic damage, and morphologic variations such as femoroacetabular impingement (FAI) and that can contribute to progression of osteoarthritis. However, a direct relationship between patient characteristics, the extent of acetabular chondral damage, and topologic characteristics of chondral lesions has not been established. Purpose: To compare the grade of acetabular chondral damage, measured in terms of acetabular labrum articular disruption (ALAD) classification, to the size and position of the chondral lesions, matching patients’ demographic factors such as age and body mass index (BMI). Study Design: Cross-sectional study; Level of evidence, 3. Methods: This study included all hip arthroscopies performed by the corresponding author from August 7, 2008, to November 19, 2014, in which acetabular chondral lesions were intraoperatively ide...
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PurposeThis study aims to present 3 patients’ results after undergoing gluteus maximus and tensor fascia lata (TFL) transfer for chronic abductor tears unable to be repaired primarily.Methods3 patients were identified intraoperatively as... more
PurposeThis study aims to present 3 patients’ results after undergoing gluteus maximus and tensor fascia lata (TFL) transfer for chronic abductor tears unable to be repaired primarily.Methods3 patients were identified intraoperatively as having an abductor tear unable to be repaired primarily. The anterior 1/3 of the gluteus maximus and the posterior 1/3 of the TFL were mobilised and transferred to the greater trochanter in order to reproduce the normal force vector of the gluteus medius and minimus. Data was prospectively collected for changes in gait, abductor strength, and the following patient reported outcomes (PROs): modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), Hip Outcome Score-Sports Specific Subscale (HOS-SSS), Hip Outcome Score-Activities of Daily Living (HOS-ADL), visual analogue scale (VAS), and satisfaction.ResultsThe patients were female, 63-75 years old, with BMIs of 23-28. All patients had follow-up at mean 2.1 years (1.25-2.5) with positive Trend...
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This article describes the arthroscopic approach and management of a "reverse contre-coup" injury to the hip labrum. The injury occurs in the setting of posterolateral acetabular rim over-coverage impinging on the distal femoral... more
This article describes the arthroscopic approach and management of a "reverse contre-coup" injury to the hip labrum. The injury occurs in the setting of posterolateral acetabular rim over-coverage impinging on the distal femoral neck in extension causing the femoral head to lever out anteriorly against the labrum. Ligamentous laxity and associated loss of anterior capsular restraint allow increased femoral head translation, adding further insult to the anterior labrum. The arthroscopic approach entails not only a labral repair with correction of the osseous conflict but also restoration of soft-tissue stability to minimize anterior femoral translation.
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To compare the acetabular component size relative to the patient's native femoral head size between conventional THA (CTHA) approach and robotic-arm assisted THA (RTHA) to infer which of these techniques preserved more acetabular... more
To compare the acetabular component size relative to the patient's native femoral head size between conventional THA (CTHA) approach and robotic-arm assisted THA (RTHA) to infer which of these techniques preserved more acetabular bone. Patients were included if they had primary osteoarthritis (OA) and underwent total hip replacement between June 2008 and March 2014. Patients were excluded if they had missing or rotated postoperative anteroposterior radiographs. RTHA patients were matched to a control group of CTHA patients, in terms of preoperative native femoral head size, age, gender, body mass index (BMI) and approach. Acetabular cup size relative to femoral head size was used as a surrogate for amount of bone resected. We compared the groups according to 2 measures describing acetabular cup diameter (c) in relation to femoral head diameter (f): (i) c-f, the difference between cup diameter and femoral head diameter and (ii) (c-f)/f, the same difference as a fraction of femora...
Research Interests: Risk assessment, Medicine, Osteoarthritis, Humans, Female, and 15 moreMale, Aged, Middle Aged, Radiography, Adult, Retrospective Studies, Hip, Risk Assessment, prosthesis Design, Case Control Studies, Acetabulum, Severity of Illness Index, Recovery of Function, femoral head, and Total hip arthroplasty
To report clinical outcomes in patients with borderline dysplasia undergoing an arthroscopic technique of labral seal restoration with minimal acetabular rim resection and capsular plication. Patients younger than 40 years with a lateral... more
To report clinical outcomes in patients with borderline dysplasia undergoing an arthroscopic technique of labral seal restoration with minimal acetabular rim resection and capsular plication. Patients younger than 40 years with a lateral center-edge angle of 18° greater and 25° or less and 2-year follow-up after undergoing an arthroscopic technique of labral seal restoration with minimal rim resection (≤2 mm) and capsular plication (3-5 sutures placed in an oblique orientation to create an imbrication and inferior shift) were included. Patients underwent arthroscopy for symptoms that had marginal improvement with a minimum 6-week structured physical therapy program. Patients with a Tönnis grade of 1 or greater, a center-edge angle of 17° or less, and Legg-Calvé-Perthes disease were excluded. The following patient-reported outcomes (PROs) were recorded prospectively but retrospectively reviewed: modified Harris Hip Score, Non-Arthritic Hip Score, Hip Outcome Score-Sports-Specific Sub...
Research Interests: Surgery, Adolescent, Medicine, Humans, Female, and 15 moreMale, Arthroscopy, Hip Arthroscopy, Young Adult, Patient Satisfaction, Labrum, Clinical Sciences, Femoroacetabular Impingement, Adult, Articular Cartilage Wear, Debridement, Hip dislocation, Harris Hip Score, Visual Analog Scale, and Hip Joint
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To assess 2-year clinical outcomes of patients who underwent hip arthroscopy for central acetabular osteophytes (CAO) treated with central acetabular decompression (CAD), and to compare these outcomes with those of a matched control... more
To assess 2-year clinical outcomes of patients who underwent hip arthroscopy for central acetabular osteophytes (CAO) treated with central acetabular decompression (CAD), and to compare these outcomes with those of a matched control group. Data were prospectively gathered for patients undergoing CAD during hip arthroscopy from February 2008 to July 2012. All patients were assessed pre- and postoperatively at 3 months, 1 year, and 2 years with modified Harris Hip Score, Non-Arthritic Hip Score, Hip Outcome Score-Activities of Daily Living, Hip Outcome Score-Sport-Specific Subscale, and visual analog scale (VAS) for pain. Patient satisfaction (0 to 10) was collected. A matched control group of patients without CAOs who did not undergo CAD was selected on a 1:3 ratio. Forty-nine hips were included in the CAD group and 147 in the control group. The mean change in patient-reported outcome (PRO) scores at 2-year follow-up in the CAD group for modified Harris Hip Score, Hip Outcome Score-A...
Research Interests: Surgery, Medicine, Patient reported outcome measures, Prospective studies, Humans, and 15 moreFemale, Male, Arthroscopy, Hip Arthroscopy, Follow-up studies, Patient Satisfaction, Clinical Sciences, Visual Analogue Scale, Middle Aged, Adult, Decompression, Acetabulum, Harris Hip Score, Visual Analog Scale, and Hip Joint
There are limited studies on the effect of mild osteoarthritis (OA) on outcomes of hip arthroscopic surgery. To conduct a matched-pair analysis with a minimum 2-year follow-up to evaluate outcomes after hip arthroscopic surgery in... more
There are limited studies on the effect of mild osteoarthritis (OA) on outcomes of hip arthroscopic surgery. To conduct a matched-pair analysis with a minimum 2-year follow-up to evaluate outcomes after hip arthroscopic surgery in patients with Tönnis grade 1 OA. Cohort study; Level of evidence, 3. Data were prospectively collected on patients who underwent hip arthroscopic surgery between April 2008 and December 2012. Patients were excluded if they had previous hip conditions. The remaining patients were divided into either Tönnis 0 or 1 grade OA groups and were matched in a 1-to-1 ratio according to age within 5 years, sex, body mass index category, labral treatment, and capsular treatment. Four patient-reported outcome (PRO) scores, as well as the visual analog scale (VAS) score for pain, patient satisfaction, and rates of revision arthroscopic surgery and conversion to total hip arthroplasty (THA), were recorded. A total of 1412 hip arthroscopic procedures were performed during ...