Prosthetic joint infection (PJI) is one of the most devastating complications of orthopedic surge... more Prosthetic joint infection (PJI) is one of the most devastating complications of orthopedic surgery. However, not all patients are equally at the risk of severe infection. The incidences of PJI vary with the host and surgery-related risk factors. It is now generally accepted that some important medical comorbidities may predispose the patients to a high risk of PJI. Time-consuming and invasive surgical procedures, such as revision arthroplasties, are also associated with a high incidence of PJI, presumably due to the increased risk of surgical site contamination. Effective infection-preventing strategies should begin with identifying and optimizing the patients at a high risk of infection prior to surgery. Optimizing the operating room environment and antibiotic prophylaxis are also essential strategies that help minimize the overall incidence of infection in orthopedic surgery. The ideal antibiotic prophylaxis is still under debate, and discussions have emerged about whether variat...
Background The appropriate degree of constraint in knee prosthetic revision is unknown, necessita... more Background The appropriate degree of constraint in knee prosthetic revision is unknown, necessitating the use of the lowest possible constraint. This study aimed to compare the long-term clinical and survival results of revision with rotation hinge knee (RHK) VS constrained condylar constrained knee (CCK) implants. Methods Overall, 117 revision case were prospectively reviewed and dividing into two groups based on the degree of constraint used, using only one prosthetic model in each group (61 CCK vs 56 RHK). All implants were evaluated for a minimum of 10 years. Survival of both implants at the end of follow-up, free from revision for any cause, aseptic loosening, and septic cause was compared. Results Better results were seen with use of the RHK in joint ranges of (p = 0.023), KSCS (p = 0.015), KSFS (p = 0.043), and KOOS (p = 0.031). About 22.2% of the cases required repeat surgery (11.7% RHK vs 29.6% CCK, p = 0.023). Constrained condylar implants had a significantly lower surviva...
Purpose Microencapsulation techniques have allowed the addition of rifampicin to bone cement, but... more Purpose Microencapsulation techniques have allowed the addition of rifampicin to bone cement, but its in vivo efficacy has not been proven. The aim of our study is to determine the superiority of cement containing gentamicin and rifampicin microcapsules in the treatment of PJI versus cement exclusively containing gentamicin. Methods An S. aureus PJI was induced in 15 NZW rabbits. A week after inoculation, the first stage of replacement was carried out, and the animals were divided into two groups: group R received a spacer containing gentamicin and rifampicin microcapsules, and group C received a spacer containing gentamicin. Intra-articular release curve of rifampicin and infection and toxicity markers were monitored for four weeks post-operatively, when microbiological analysis was performed. Results The microbiological cultures showed a significantly lower growth of S. aureus in soft tissue (2.3·104 vs 0; p = 0.01) and bone (5.7·102 vs 0; p = 0.03) in the group with rifampicin mi...
Background Greater trochanteric pain syndrome encompasses a range of causes of lateral hip pain i... more Background Greater trochanteric pain syndrome encompasses a range of causes of lateral hip pain including greater trochanteric bursitis, tendinopathy and tears of the gluteus minimus and medius, and lateral snapping hip (LSH). Surgical options for LSH range from open surgery to endoscopic surgery, including a diamond-shaped cut or a simple transversal release to gluteus maximus tendon release. Resection of an area of proximal iliotibial band (ITB) and step-cut or z-plasty lengthening have not proven superior to transverse release of the ITB. Therefore, making a complete and effective transverse cut guided by ultrasound may represent a potential advance over endoscopic surgery. Purpose In this case series study, we describe how to perform proximal release of the ITB guided by ultrasound. Methods The surgical technique—either z-plasty or transverse section of the ITB—was first validated on 10 cadaver specimens and then used in clinical practice. Fourteen patients (5 males and 9 female...
La artroplastia de cadera es una alternativa a la artroplastia convencional, que esta indicada en... more La artroplastia de cadera es una alternativa a la artroplastia convencional, que esta indicada en pacientes jovenes y activos. Los buenos resultados y la prevencion de complicaciones dependen de una minuciosa tecnica quirurgica asi como de una correcta seleccion de pacientes. Presentamos un caso de un paciente de 43 anos que tras ser sometido a una sustitucion de cadera bilateral con protesis de recubrimiento sufrio una fractura en ambos cuellos femorales de manera no simultanea, por necrosis avascular, que tuvo que ser tratada mediante la colocacion de un vastago de anclaje metafisario. Las radiografias postoperatorias mostraron una buena colocacion del implante sin muescas en el cuello («notching» femoral), con discreta alineacion de 7o valgo del componente femoral. La movilidad pasiva y activa era dolorosa. El estudio radiografico mostro una fractura cervical del femur derecho. (La cabeza femoral estaba unida al implante no encontrando metalosis ni aflojamiento de los componentes...
Los sistemas de bloque de corte especificos (BCE) se han presentado como una interesante medida p... more Los sistemas de bloque de corte especificos (BCE) se han presentado como una interesante medida para obtener una correcta alineacion en la artroplastia de rodilla, aunque se desconoce cual de todos los metodos existentes para realizar la planificacion es el adecuado. Material y metodos: Se ha disenado un estudio prospectivo comparando dos sistemas de BCE con planificaciones diferentes (Signature con TAC + teleradiografia; Visionaire con RMN) con el sistema convencional de alineacion. Se analizaron parametros radiograficos, funcionales preoperatorios y postoperatorios, estancia hospitalaria, necesidad de transfusion, tiempo quirurgico y complicaciones asociadas. Resultados: Un total de 10 pacientes fueron intervenidos por cada grupo. No se observaron diferencias estadisticamente significativas entre los dos sistemas de alineamiento especificos y el sistema convencional (p > 0.05), aunque se objetivo una mayor precision con estos sistemas, siendo discretamente superior en el sistem...
Background 3D printing technology in hospitals facilitates production models such as point-of-car... more Background 3D printing technology in hospitals facilitates production models such as point-of-care manufacturing. Orthopedic Surgery and Traumatology is the specialty that can most benefit from the advantages of these tools. The purpose of this study is to present the results of the integration of 3D printing technology in a Department of Orthopedic Surgery and Traumatology and to identify the productive model of the point-of-care manufacturing as a paradigm of personalized medicine. Methods Observational, descriptive, retrospective and monocentric study of a total of 623 additive manufacturing processes carried out in a Department of Orthopedic Surgery and Traumatology from November 2015 to March 2020. Variables such as product type, utility, time or materials for manufacture were analyzed. Results The areas of expertise that have performed more processes are Traumatology, Reconstructive and Orthopedic Oncology. Pre-operative planning is their primary use. Working and 3D printing h...
Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine, Jan 4, 2017
High-resolution ultrasonography (US) can play an important role in studying nerves, as it has sev... more High-resolution ultrasonography (US) can play an important role in studying nerves, as it has several advantages. Entrapments of distal tibial nerve branches can be mapped out or diagnosed with selective anesthetic blocks, and US can guide therapeutic procedures, such as radiofrequency ablation and selective infiltrations of specific nerve branches. The aim of this study was to verify that US is an effective method for accurately locating the posterior tibial nerve and its terminal branches, such as the medial calcaneal branch, the first calcaneal branch, and the medial and lateral plantar nerves. In this study, we analyzed the correlation between US mapping and real anatomy after cadaveric dissection, assessing the distribution and variability of the tibial nerve and its terminal branches. We used 12 fresh anatomic specimens of the foot and ankle, including the calf. A high-resolution US study of the tibial nerve and its branches was performed. The results of the US studies of the ...
Isolated gastrocnemius contracture is thought to lead to numerous conditions. Although many techn... more Isolated gastrocnemius contracture is thought to lead to numerous conditions. Although many techniques have been described for gastrocnemius recession, potential anesthetic, cosmetic, and wound-related complications can lead to patient dissatisfaction. Open and endoscopic recession techniques require epidural anesthesia, lower limb ischemia, and stitches and may lead to damage of the sural nerve, which is not under the complete control of the surgeon at all stages of the procedure. The purpose of this study was to evaluate the safety and efficacy of a new technique based on ultrasound-guided ultra-minimally invasive gastrocnemius recession. We performed a pilot study with 22 cadavers to ensure that the technique was effective and safe. In the second phase, we prospectively performed gastrocnemius recession in 23 patients (25 cases) with chronic non-insertional Achilles tendinopathy, equinus foot, and other indications. In the clinical study, we evaluated the range of dorsiflexion be...
Patient-specific cutting blocks (PSCB) have been proposed as an interesting option to achieve app... more Patient-specific cutting blocks (PSCB) have been proposed as an interesting option to achieve appropriate alignment in knee arthroplasty. However, there is no information as to which of the available planning methods is the right one. A prospective study was designed to compare two, PSCB systems using different planning methods (Signature with CAT scan + teleradiography; Visionaire with MRI) with the standard alignment method. Radiographic and functional pre- and postoperative parameters were analyzed, together with hospital stay, blood transfusion needs, operative time and associated complications. A total of 10 patients per group were operated on. No statistically significant differences were observed between both of the patient-specific alignment systems and the standard system (p > 0.05). However, greater precision was achieved with the former systems and the Signature system was slightly more accurate. Operative time was shorter in patients in whom PSCBs were used, and it wa...
Prosthetic joint infection (PJI) is one of the most devastating complications of orthopedic surge... more Prosthetic joint infection (PJI) is one of the most devastating complications of orthopedic surgery. However, not all patients are equally at the risk of severe infection. The incidences of PJI vary with the host and surgery-related risk factors. It is now generally accepted that some important medical comorbidities may predispose the patients to a high risk of PJI. Time-consuming and invasive surgical procedures, such as revision arthroplasties, are also associated with a high incidence of PJI, presumably due to the increased risk of surgical site contamination. Effective infection-preventing strategies should begin with identifying and optimizing the patients at a high risk of infection prior to surgery. Optimizing the operating room environment and antibiotic prophylaxis are also essential strategies that help minimize the overall incidence of infection in orthopedic surgery. The ideal antibiotic prophylaxis is still under debate, and discussions have emerged about whether variat...
Background The appropriate degree of constraint in knee prosthetic revision is unknown, necessita... more Background The appropriate degree of constraint in knee prosthetic revision is unknown, necessitating the use of the lowest possible constraint. This study aimed to compare the long-term clinical and survival results of revision with rotation hinge knee (RHK) VS constrained condylar constrained knee (CCK) implants. Methods Overall, 117 revision case were prospectively reviewed and dividing into two groups based on the degree of constraint used, using only one prosthetic model in each group (61 CCK vs 56 RHK). All implants were evaluated for a minimum of 10 years. Survival of both implants at the end of follow-up, free from revision for any cause, aseptic loosening, and septic cause was compared. Results Better results were seen with use of the RHK in joint ranges of (p = 0.023), KSCS (p = 0.015), KSFS (p = 0.043), and KOOS (p = 0.031). About 22.2% of the cases required repeat surgery (11.7% RHK vs 29.6% CCK, p = 0.023). Constrained condylar implants had a significantly lower surviva...
Purpose Microencapsulation techniques have allowed the addition of rifampicin to bone cement, but... more Purpose Microencapsulation techniques have allowed the addition of rifampicin to bone cement, but its in vivo efficacy has not been proven. The aim of our study is to determine the superiority of cement containing gentamicin and rifampicin microcapsules in the treatment of PJI versus cement exclusively containing gentamicin. Methods An S. aureus PJI was induced in 15 NZW rabbits. A week after inoculation, the first stage of replacement was carried out, and the animals were divided into two groups: group R received a spacer containing gentamicin and rifampicin microcapsules, and group C received a spacer containing gentamicin. Intra-articular release curve of rifampicin and infection and toxicity markers were monitored for four weeks post-operatively, when microbiological analysis was performed. Results The microbiological cultures showed a significantly lower growth of S. aureus in soft tissue (2.3·104 vs 0; p = 0.01) and bone (5.7·102 vs 0; p = 0.03) in the group with rifampicin mi...
Background Greater trochanteric pain syndrome encompasses a range of causes of lateral hip pain i... more Background Greater trochanteric pain syndrome encompasses a range of causes of lateral hip pain including greater trochanteric bursitis, tendinopathy and tears of the gluteus minimus and medius, and lateral snapping hip (LSH). Surgical options for LSH range from open surgery to endoscopic surgery, including a diamond-shaped cut or a simple transversal release to gluteus maximus tendon release. Resection of an area of proximal iliotibial band (ITB) and step-cut or z-plasty lengthening have not proven superior to transverse release of the ITB. Therefore, making a complete and effective transverse cut guided by ultrasound may represent a potential advance over endoscopic surgery. Purpose In this case series study, we describe how to perform proximal release of the ITB guided by ultrasound. Methods The surgical technique—either z-plasty or transverse section of the ITB—was first validated on 10 cadaver specimens and then used in clinical practice. Fourteen patients (5 males and 9 female...
La artroplastia de cadera es una alternativa a la artroplastia convencional, que esta indicada en... more La artroplastia de cadera es una alternativa a la artroplastia convencional, que esta indicada en pacientes jovenes y activos. Los buenos resultados y la prevencion de complicaciones dependen de una minuciosa tecnica quirurgica asi como de una correcta seleccion de pacientes. Presentamos un caso de un paciente de 43 anos que tras ser sometido a una sustitucion de cadera bilateral con protesis de recubrimiento sufrio una fractura en ambos cuellos femorales de manera no simultanea, por necrosis avascular, que tuvo que ser tratada mediante la colocacion de un vastago de anclaje metafisario. Las radiografias postoperatorias mostraron una buena colocacion del implante sin muescas en el cuello («notching» femoral), con discreta alineacion de 7o valgo del componente femoral. La movilidad pasiva y activa era dolorosa. El estudio radiografico mostro una fractura cervical del femur derecho. (La cabeza femoral estaba unida al implante no encontrando metalosis ni aflojamiento de los componentes...
Los sistemas de bloque de corte especificos (BCE) se han presentado como una interesante medida p... more Los sistemas de bloque de corte especificos (BCE) se han presentado como una interesante medida para obtener una correcta alineacion en la artroplastia de rodilla, aunque se desconoce cual de todos los metodos existentes para realizar la planificacion es el adecuado. Material y metodos: Se ha disenado un estudio prospectivo comparando dos sistemas de BCE con planificaciones diferentes (Signature con TAC + teleradiografia; Visionaire con RMN) con el sistema convencional de alineacion. Se analizaron parametros radiograficos, funcionales preoperatorios y postoperatorios, estancia hospitalaria, necesidad de transfusion, tiempo quirurgico y complicaciones asociadas. Resultados: Un total de 10 pacientes fueron intervenidos por cada grupo. No se observaron diferencias estadisticamente significativas entre los dos sistemas de alineamiento especificos y el sistema convencional (p > 0.05), aunque se objetivo una mayor precision con estos sistemas, siendo discretamente superior en el sistem...
Background 3D printing technology in hospitals facilitates production models such as point-of-car... more Background 3D printing technology in hospitals facilitates production models such as point-of-care manufacturing. Orthopedic Surgery and Traumatology is the specialty that can most benefit from the advantages of these tools. The purpose of this study is to present the results of the integration of 3D printing technology in a Department of Orthopedic Surgery and Traumatology and to identify the productive model of the point-of-care manufacturing as a paradigm of personalized medicine. Methods Observational, descriptive, retrospective and monocentric study of a total of 623 additive manufacturing processes carried out in a Department of Orthopedic Surgery and Traumatology from November 2015 to March 2020. Variables such as product type, utility, time or materials for manufacture were analyzed. Results The areas of expertise that have performed more processes are Traumatology, Reconstructive and Orthopedic Oncology. Pre-operative planning is their primary use. Working and 3D printing h...
Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine, Jan 4, 2017
High-resolution ultrasonography (US) can play an important role in studying nerves, as it has sev... more High-resolution ultrasonography (US) can play an important role in studying nerves, as it has several advantages. Entrapments of distal tibial nerve branches can be mapped out or diagnosed with selective anesthetic blocks, and US can guide therapeutic procedures, such as radiofrequency ablation and selective infiltrations of specific nerve branches. The aim of this study was to verify that US is an effective method for accurately locating the posterior tibial nerve and its terminal branches, such as the medial calcaneal branch, the first calcaneal branch, and the medial and lateral plantar nerves. In this study, we analyzed the correlation between US mapping and real anatomy after cadaveric dissection, assessing the distribution and variability of the tibial nerve and its terminal branches. We used 12 fresh anatomic specimens of the foot and ankle, including the calf. A high-resolution US study of the tibial nerve and its branches was performed. The results of the US studies of the ...
Isolated gastrocnemius contracture is thought to lead to numerous conditions. Although many techn... more Isolated gastrocnemius contracture is thought to lead to numerous conditions. Although many techniques have been described for gastrocnemius recession, potential anesthetic, cosmetic, and wound-related complications can lead to patient dissatisfaction. Open and endoscopic recession techniques require epidural anesthesia, lower limb ischemia, and stitches and may lead to damage of the sural nerve, which is not under the complete control of the surgeon at all stages of the procedure. The purpose of this study was to evaluate the safety and efficacy of a new technique based on ultrasound-guided ultra-minimally invasive gastrocnemius recession. We performed a pilot study with 22 cadavers to ensure that the technique was effective and safe. In the second phase, we prospectively performed gastrocnemius recession in 23 patients (25 cases) with chronic non-insertional Achilles tendinopathy, equinus foot, and other indications. In the clinical study, we evaluated the range of dorsiflexion be...
Patient-specific cutting blocks (PSCB) have been proposed as an interesting option to achieve app... more Patient-specific cutting blocks (PSCB) have been proposed as an interesting option to achieve appropriate alignment in knee arthroplasty. However, there is no information as to which of the available planning methods is the right one. A prospective study was designed to compare two, PSCB systems using different planning methods (Signature with CAT scan + teleradiography; Visionaire with MRI) with the standard alignment method. Radiographic and functional pre- and postoperative parameters were analyzed, together with hospital stay, blood transfusion needs, operative time and associated complications. A total of 10 patients per group were operated on. No statistically significant differences were observed between both of the patient-specific alignment systems and the standard system (p > 0.05). However, greater precision was achieved with the former systems and the Signature system was slightly more accurate. Operative time was shorter in patients in whom PSCBs were used, and it wa...
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