Prótesis total y unicompartimental en el manejo de artrosis grave de rodilla

ResumenLa artrosis grave de rodilla es una patología prevalente y puede ser en algunos casos invalidante. Se revisan los fundamentos e historia sobre cómo la prótesis de rodilla ha llegado a ser el tratamiento de elección para eliminar el dolor y recuperar función, mejorando la calidad de vida de los pacientes. Se muestran las alternativas actuales que incluyen las prótesis Unicompartamentales, de creciente uso en los últimos años y se señalan también las mejoras en los cuidados perioperatorios y rehabilitación que han permitido una mejora significativa de los resultados.SummaryOsteoarthritis of the knee is a prevalent problem in our community given invalidant symptoms in the most serius cases. We review the evolution of the prostheses and how it becomes the treatment of choice in those cases, pointing out wich are the current design including unicompartimental knee. We also discuss the inprovement in the surgery and related care which has been the main reason of the increase number ofpatient who can be benefit from this surgery

Actividad deportiva en pacientes con artroplastía total de rodilla

La cirugía protésica de rodilla se ha transformado en la cirugía más frecuente de reemplazo articular en el primer mundo, haciendo que las cifras sigan creciendo en forma permanente debido al envejecimiento de la población con más prevalencia de enfermedades articulares invalidantes. Esta cirugía es la forma de mejorar la calidad de vida y el estado de salud general de estos pacientes, al recuperar la capacidad de actividad física perdida. Por esto es importante conocer y difundir entre los pacientes y médicos qué restricciones y cuidados se debe tener en estos pacientes para las recomendaciones de actividad física y práctica deportiva que no comprometan la durabilidad del implante, siendo el objetivo de este artículo recalcar estos puntos

Robotic-assisted surgery in medial unicompartmental knee arthroplasty: does it improve the precision of the surgery and its clinical outcomes? Systematic review

There is a high prevalence of knee osteoarthritis that affects only the medial tibiofemoral compartment. In this group of patients with severe disease, the medial unicompartmental knee arthroplasty (UKA) is an excellent choice. However, this technique has a great learning curve due to the lower tolerance of improper positioning and alignment. In this context, the robotic-assisted surgery (RAS) arises as an option to improve the accuracy and secondarily enhance the clinical outcomes related to the UKA. The objective in this study is to determine if there are significant advantages with the use of RAS over conventional surgery (CS). In the systematic review of the literature, classification of the results in three main subjects: (A) precision and alignment; (B) functional results and clinical parameters; (C) survivorship. We found 272 studies, of which 15 meet the inclusion and exclusion criteria. There is mostly described that RAS significantly improves the accuracy in position (80-100% of planned versus performed P < 0.05), alignment (2-3 times less error variance P < 0.05) and selection of the proper size of the implants (69.23% of correct size femoral implants versus 16.67% using CS P < 0.0154). Recently, there is mild evidence about benefits in the early rehabilitation and post-operative pain, but in all studies reviewed, there is no advantages of RAS in the long-term functional evaluation. There is no strong literature that supports a longer survival of the prothesis with RAS, being the longest mean follow-up reported of 29.6 months. RAS is a useful tool in increasing the precision of the medial UKA implant placement. However, there is still a lack of evidence that properly correlates this improvement in accuracy with better clinical, functional and survival results

Meniscal Ramp Lesion Repair Using an All-Inside Technique

Posteromedial meniscotibial ligament lesions, known as meniscal ramp lesions, are typically associated with ACL injuries, but frequently underdiagnosed. When correctly diagnosed, repair is mandatory in most cases. Retraction of the soft tissues makes it difficult to repair and leads to suture failure. Previously described techniques include all-inside and inside-out meniscal sutures, but do not ensure correct meniscotibial closure because of the soft tissue retraction. The purpose of this Technical Note is to describe a meniscal ramp lesion arthroscopic repair with an all-inside technique with the Fast-Fix 360 device, detailing the use of the accessory posteromedial portal, and the addition of an arthroscopic grasper that raises the retracted meniscotibial ligament, to allow correct fixation