Acta ortopedica mexicana最新文献

Introduction: the presence of implants that occupy the femoral canal is frequent in patients undergoing ipsilateral total knee replacement (TKR). The use of electronic alignment and robotic assistance make intramedullary alignment unnecessary and could be adequate in situations with an occupied femoral canal (OFC).

Material and methods: we present a prospective cohort of 25 patients who underwent robotic alignment TKR and had prior ipsilateral surgery in the femur that resulted in occupied femoral canal.

Results: we had 21 female, four male patients, with an average age of 62 years. There were 14 left knees, and 11 right knees. Twenty-two patients had a hip arthroplasty and three had femur osteosynthesis. Alignment prior to surgery was 16 valgus knees (average 11°, 3-22°) and nine varus knees (average 9.5°, 0.5-18.5°). TKR alignment was five neutral (0° as measured with the robot), 11 valgus 1.3° (range 0.5-3.5°) and 8 varus 1.5° (range 0.5- 2.5°). The average preoperative WOMAC scores was 43 points, postoperative 14 points.

Conclusions: we present a cohort of patients with moderate to severe varus and valgus knee deformities with an occupied femoral canal that were electronic alignment during robot-assisted (RA) TKR without the use of an intramedullary alignment (IMA) rod. We conclude electronic alignment of TKR can be performed successfully in patients with occupied femoral canal.

Rotator cuff injuries are common and procedures of repair have evolved from open techniques to minimally invasive and arthroscopic ones. Despite these advances, the biomechanics, biology, and value of transosseous repairs remain superior, leading to the development of innovative devices that enable the utilization of this technique without the use of anchors, improving both the efficiency and safety of the procedure. This article reviews the latest advances in transosseous rotator cuff repair, highlighting its biomechanical advantages, as well as the factors that enhance recovery and offer more consistent long-term outcomes. In addition, the surgical technique developed by Dr. Brett Sanders is analyzed. This technique eliminates or reduces the use of anchors with a specialized reusable device, depending on the clinical scenario and surgeon discretion. Besides, not only presents biomechanical benefits but also offers economic and clinical advantages, especially in developing countries where access to advanced treatments may be limited. Comparative studies between transosseous and transosseous-equivalent techniques have demonstrated a significant reduction in postoperative pain and statistically equivalent or superior long-term clinical outcomes with the arthroscopic transosseous tunnel technique (ATOT), reinforcing its viability as a superior option for value-based care. Finally, a detailed economic analysis is presented, showing significant cost savings in surgical procedures which could greatly benefit public healthcare systems in Latin America, highlighting advanced suture management that would enhance rotator cuff repair.

Introduction: anatomical deformities such as developmental dysplasia of the hip (DDH) and Perthes disease represent a challenge for reconstruction. The use of 3D-printed models can be helpful for assessing the deformity, bone mass, implant size, and orientation.

Objectives: to prospectively evaluate the outcomes of 3D simulation in primary total hip arthroplasty.

Material and methods: between January 2019 and March 2020, 22 patients received a trabecular titanium cup and a neck preserving stem after preoperative planning with 3D plastic models and surgery simulation. Inclusion criteria: sequelae of Perthes, hip dysplasia type I and II Crowe classification. Exclusion criteria: fractures, previous infection, remaining metal implants. Demographic data, surgery time, blood loss, and complications were recorded. Preoperative and postoperative Harris Hip Score (HHS) and subjective satisfaction using the Roles and Maudsley scale were evaluated, along with radiographic findings and Moore's criteria for osteointegration.

Results: the average patient age was 35 years (range: 18-57), with 15 women and seven men. The 3D modeling process, from CT scan acquisition to final model production, took an average of 3.4 hours, and the surgery simulation lasted an average of 32 minutes. In all cases, the acetabular cup size was correct, with only one discrepancy in the femoral stem size. The average follow-up was 40.7 months. The average HHS increased from 37.5 ± 5.8 preoperatively to 90.0 ± 2.3 at the final follow-up. The average surgery time was 71 minutes, and the average blood loss was 260 ml. Complications included one case of temporary paresthesia (resolved by 50 days postoperatively), one superficial infection, and one deep infection. All components were stable at the final follow-up.

Conclusions: 3D simulation allowed for accurate implant placement with significant improvement in both functional and subjective scores.

Talus is the second largest bone in the posterior region of the foot and participates in the talocrural (ankle), subtalar, and talonavicular joints. Talar fractures account for only one percent of all feet and ankle fractures, being the fracture of the medial tubercle of the posterior process of the talus an uncommon injury, caused by the rupture of the posterior talotibial ligament after dorsiflexion and traumatic pronation. Such fractures may not be radiographically evident, as described in this rare case of fracture of the medial tubercle of the posterior process of the talus with a satisfactory outcome without the need for surgical treatment.

Introduction: the relationship between digestive ostomies and the risk of prosthetic joint infection following total hip arthroplasty (THA) is not well-established. This study aimed to assess prosthesis survival, clinical outcomes, and infectious complications in patients with a digestive ostomy undergoing THA.

Material and methods: a single-center, retrospective observational study was conducted, including patients with digestive ostomies who underwent THA between 2005 and 2018, with at least one year of follow-up. Data collected included the site and type of ostomy, underlying disease, type of THA, clinical outcomes measured by the Merle d'Aubigné-Postel (MAP) Score, postoperative infections, and the need for revision surgery.

Results: seven patients with a mean age of 63 years (range 45-80) and a mean follow-up of 10.1 years were included. The most common cause of the ostomy was colon cancer. The average MAP Score one year postoperatively was 17.1. There were no postoperative complications or infections.

Conclusions: the study concludes that THA in patients with digestive ostomies results in favorable clinical outcomes and does not increase the risk of periprosthetic joint infections.

Introduction: hip osteoarthritis is one of the most disabling conditions affecting the quality of life in the elderly, with a current prevalence of 10%. Advanced treatment for this condition generally involves total hip arthroplasty. Recently, there has been a shift from using cemented stems to uncemented stems due to the excellent clinical and radiological outcomes achieved with the latter.

Material and methods: a retrospective review was conducted of 578 total hip arthroplasties using a tapered uncemented stem performed between 2003 and 2018. The average age of the patients was 62.92 years, with a mean follow-up of 14.03 years. Follow-up ranged from 5 to 20 years.

Results: the revision rate for any reason was 2.3%, with a polyethylene wear rate of 1.0%, a deep infection rate of 0.9%, and a dislocation rate of 0.3%. No revisions were reported for aseptic loosening. The survival rate for aseptic loosening was 100%, and the overall survival rate was 97.7%. The rate of complications that did not require revision was 5.0%, while the total complication rate was 7.2%.

Conclusion: the third generation tapered uncemented titanium stem shows excellent short- and medium-term results, with adequate osteointegration. It is expected to continue showing favorable long-term results, with aseptic loosening being the primary reason for revision.

Introduction: artificial intelligence and deep learning in orthopedics have gained mass interest in recent years. In prior studies, researchers have demonstrated different applications, from radiographic assessment to bone tumor diagnosis. The purpose of this review is to analyze the current literature on AI and deep learning tools to identify the most used tools in the risk assessment, outcome assessment, imaging, and basic science fields.

Material and methods: searches were conducted in PubMed, EMBASE and Google Scholar from January 2020 up to October 31st, 2023. We identified 862 studies, 595 of which were included in the systematic review. A total of 281 studies about radiographic assessment, 102 about spine-oriented surgery, 95 about outcome assessment, 84 about fundamental AI orthopedic education, and 33 basic science applications were included. Primary outcomes were diagnostic accuracy, study design and reporting standards reported in the literature. Estimates were pooled using random effects meta-analysis.

Results: 53 different imaging methods were used to measure radiographic aspects. A total of 185 different machine learning algorithms were used, with the convolutional neural network architecture being the most common (73%). To improve diagnostic accuracy and speed were the most commonly achieved results (62%).

Conclusion: heterogeneity was high among the studies, and extensive variation in methodology, terminology and outcome measures was noted. This can lead to an overestimation of the diagnostic accuracy of DL algorithms for medical imaging. There is an immediate need for the development of artificial intelligence-specific guidelines to provide guidance around key issues in this field.

Introduction: high-energy bicondylar tibial plateau fractures involve extensive soft tissue damage and present significant postoperative risks, such as infections, venous thrombosis, and compartment syndrome. There is controversy regarding whether to manage these fractures with definitive surgical intervention or by using an external fixator as part of a staged management approach.

Material and methods: this was a retrospective cohort study. Twenty-two patients with complex tibial plateau fractures were analyzed during the study period. Patients were assigned to three groups based on surgical management: group A (external fixator followed by definitive osteosynthesis), group B (definitive external fixator), and group C (definitive osteosynthesis). Sociodemographic variables, fracture type, and postoperative complications were evaluated, with statistical analysis used to compare outcomes.

Results: most fractures were closed and resulted from motor vehicle accidents. Surgery was performed at an average of 7.86 days, with definitive osteosynthesis being the most common treatment (54.5%). Complications such as thromboembolism and infections were reported, but there were no immediate postoperative complications. Fracture consolidation was achieved in 95% of patients, with an average range of motion of 102 degrees, with no significant differences between treatments.

Discussion: Schatzker V and VI fractures present significant challenges. Although fixation methods have their advantages and disadvantages, functional outcomes are positive with good consolidation and recovery of mobility.

Conclusion: the choice of fixation type and timing of intervention should be based on a comprehensive evaluation of the patient and the fracture, considering potential complications to ensure adequate rehabilitation.

Chondroblastoma is a benign bone tumor that arises from cartilaginous tissue in the long bones. It has a low incidence, and can be asymptomatic, or even presenting as a pathological bone fracture. The importance of diagnosis lies in extension, recurrence and risk of dissemination. Our objective is to show the evolution of a patient, who followed a favorable course after an episode of recurrence. A 15-year-old patient is presented who, after mild discomfort in her left knee for 6 months, suffered a level fall, with pain and functional impotence. X-rays and CT showed a fracture of the left distal femur, with an infiltrative lytic lesion in the distal epiphysis. Curettage was performed with local bone graft, open biopsy, electrofulguration, adjuvant therapy with alcohol and closure with osteoconductive matrix. The biopsy indicated a chondroblastoma without atypia, and the dissemination study was negative. She remained in periodic controls, and after 7 months an MRI was obtained with an image suggestive of recurrence in the adjacent metaphysis. A new curettage with biopsy was performed, which indicated a recurrence of chondroblastoma. Currently, she is being monitored, 5 years after the first intervention. In the last appointment, she reported anterior knee pain, without radiological signs of recurrence, which responded correctly to physical management, showing her complete current functional capacity, good exercise tolerance, and no limitations in daily life.