Últimas tendencias en cirugía protésica de rodilla

En los últimos años hemos asistido a una importante evolución en los diseños protésicos de la artroplastia total de rodilla. Todos ellos tienen como finalidad mejorar los satisfactorios resultados de este procedimiento. La búsqueda del par de fricción ideal en este implante ha dado como resultado las mejoras en el proceso de fabricación del inserto e incluso la incorporación de nuevos materiales empleados con éxito en otras articulaciones, pero cuyos beneficios en la rodilla todavía requieren de experiencia. Los objetivos quirúrgicos de precisión y reproductibilidad de resultados ha dado lugar a la incorporación de la robótica en este proceso. Asimismo, la necesidad de restablecer la cinemática articular ha supuesto la evolución a diseños que preservan el pivot central de la rodilla o cuya constricción es variable entre los dos compartimentos. No obstante, debemos ser cautos a la hora de evaluar los beneficios derivados de estas supuestas mejoras.We have attended to an amazing development in total knee replacement designs for the last years. Everyone grows with the idea of improving the good outcomes of this procedure. The search an ideal friction torque has assumed a better manufacturing of the insert and even the usage of new materials with great success in other joints, but whose profits in the knee must be tested. Accuracy and outcomes reproducibility led to add robotic to this procedure. Likewise the need to recreate joint kinematics provoked the evolution to designs with preservation of cruciate ligaments or with different constriction in each compartment. However, we must be careful when analysing benefits of these improvements

Resultados preliminares de la prótesis total de rodilla Performance: inserto tibial fijo versus rotatorio

Se intervino un grupo homogéneo de 100 pacientes mediante prótesis total de rodilla colocándose aleatoriamente a 50 un inserto tibial fijo y a 50 un inserto móvil. Todos los pacientes siguieron el mismo protocolo posquirúrgico de rehabilitación y seguimiento. Al año de evolución la movilidad media fue de 105º sin observarse diferencias significativas entre los grupos. No se observaron diferencias significativas en el resultado subjetivo medido mediante la encuesta de Oxford entre los dos tipos de inserto. No hubo casos de infección ni inestabilidad, en dos casos hubo limitación de la movilidad siendo necesario en uno manipularlo bajo anestesia y en otro (artrofibrosis) fue necesario realizar un recambio a prótesis en bisagra. No hubo signos radiográficos de aflojamiento protésico. En conclusión, la artroplastia total de rodilla con patillo tibial rotatorio ofrece a corto plazo tan buenos resultados clínicos como la que lleva platillo fijo. Estudios a largo plazo desvelarán las ventajas en términos de supervivencia del platillo rotatorio.One hundred total knee arhtroplasties were implanted comparing fixed versus mobile bearing tibial insert. Patients were randomly assigned to one of both groups, the same postoperative and follow-up protocol were followed in all cases. At one-year of follow-up mean flexion was 105º and no differences were detected between both types of tibial insert. There were no differences regarding subjective outcome assessed by the Oxford questionnaire. There were no cases of infection or instability, two patients had motion limitation, one of them required mobilization under anesthesia and the other arthroplasty was reviewed to a rotating hinge. The were no radiographic signs of loosening. In conclusion, early results of total knee arthroplasty using mobile bearing offer the same good results as fixed bearing, with no increase of complications. Long-term studies are required to disclose the advantages of mobile bearing inserts

Pseudotumor simulando lesiones malignas en lactantes

Se presentan dos casos clínicos, en dos lactantes, de tumoración de partes blandas de crecimiento rápido y aparición espontánea. Fue necesario emplear técnicas invasivas, dadas las dificultades en el diagnóstico diferencial con tumor de estirpe maligna, para llegar al tranquilizador diagnóstico de hematoma en evolución. Se discute la utilidad de la RM en el estudio de este tipo de lesiones.Two cases of soft tissue tumoration with fast growth and spontaneus apparition in suckling infants are reported. Develop invasive methods to achieve the easeful final diagnosis of evolutive haematoma was necessary because of differential diagnosis with soft tissue sarcoma. There is a discusion on the use of MR in the study of this kind of lesion

Autotransfusión predepósito en artroplastia total de cadera como programa de ahorro de sangre alogénica

Las necesidades transfusionales en Cirugía Ortopédica y Traumatología son elevadas, condicionando un alto coste. Existen diferentes técnicas de ahorro de sangre alogénica siendo la autotransfusión predepósito sin duda el patrón oro en la actualidad. Realizamos un estudio retrospectivo con el objeto de valorar si las técnicas de ahorro de sangre y especialmente la autotransfusión predepósito disminuyen las necesidades de transfusión alogénica en cirugía ortopédica programada de cadera. El mayor inconveniente de la autotransfusión fue el alto coste-efectividad. El principal factor que ancarece la técnica es la gran cantidad de unidades donadas y no transfundidas, que genera un rendimiento bajo de la misma. La anemización preoperatoria y la sobretransfusión pueden ser evitadas de forma sencilla con claros criterios de transfusión poco liberales. La optimización del ahorro de sangre alogénica se puede establecer mediante un programa interdisciplinar e individualizado según el tipo de cirugía y las características del paciente como la hemoglobina basal y el sexo. La autotransfusión predepósito es adecuada en cirugía ortopédica programada de cadera por su efectividad en el ahorro de sangre alogénica, su buena tolerancia y por la inocuidad del proceso.Transfusion requirements in orthopaedic surgery are raised and therefore costs are high. There are different allogenic blood saving techniques but predeposit auto- transfusion is the gold-standard at present. We performed a retrospective study with the objective of valuing the requie- rement decreasement of allogenic transfusion in hip pro- gram orthopaedic surgery through blood saving methods, specially predeposit autologous transfusion. Autologous transfusion's great problem was the raised cost-effective- ness. The main reason for the price increase of techniques used is the high number of donned units and not transfused after surgery which you end up with a low productive met- hod. Anaemia pre-surgery and overtransfusion can easily be avoided with clear inclusion lines in blood saving programs and no liberal transfusion protocols. The best way to save allogenic blood in total hip arthroplasty can be established by means of an interdisciplinar program but individualized for specific tipe of surgery and for patient's characteristics like initial haemoglobin and sex. Predeposit autologous transfusion is adequate in hip program orthopaedic surgery because its effectiveness in allogenic blood saving, its good tolerance and it is a safe method

Sinovitis villonodular pigmentada: dificultad diagnóstica y terapéutica

La sinovitis villonodular pigmentada (SVNP) es una proliferación benigna, localmente agresiva del tejido sinovial, caracterizada por depósitos de hemosiderina, que afecta con mayor frecuencia a la rodilla y a pacientes adultos jóvenes. Entre 1985 y 2007 se han tratado en nuestro servicio 9 pacientes con SVNP, 8 formas difusas y una localizada, siendo la rodilla la localización más frecuente (7 casos). El tratamiento realizado en todos los casos fue sinovectomía abierta anterior, asociando sinoviortesis con Y90 en uno de los casos. Se detectó un caso de recidiva, localizado en la rodilla, que requirió la realización de una segunda sinovectomía abierta. Un paciente requirió una artroplastia total de rodilla a los 3 años de la sinovectomía. El principal problema es su alta tasa de recidivas debido a la dificultad para una sinovectomía completa del tejido afectado.Pigmented villonodular synovitis (SVNP) is a benign proliferative disorder, locally aggressive of the synovium, characterized by haemosiderin deposits, and affects the knee most often and young adults patients. Between 1985 and 2007, 9 patients with SVNP were treated in our service, 8 diffusse forms and one localized, and most frequent location was the knee (7 cases). Anterior open synovectomy was the treatment in all cases, combined with Y 90 synoviorthesis in one of cases. One case of recurrence was detected, involving the knee, and second open synovectomy was required. One patient required a total knee arthroplasty within 3 years after the synovectomy. Its high rate of recurrence is the main problem due to difficulty to complete synovectomy of the affected tissue

Osteocondritis disecante de astrágalo : a propósito de un caso clínico tratado mediante técnica mínimamente invasiva

Osteochondritis dissecans of the talus in adults is quite common; on the contrary, the juvenile forms are unusual and are usually associated with sportive activities. It is a subject not very studied yet, because the majority of the treatment guides and studies are based on adult cases. The treatment in juvenile forms is still controversial. A conservative treatment of the osteochondritis dissecans of the talus is usually indicated in I and II stage lesions of the Berndt and Harty classification. In these stages, good results have been observed in knee and elbow, nevertheless, in the talus, the studies have shown big percentage of failure. The aim of a surgical treatment of this type of lesions with intact cartilage is the vascularization of the damaged zone using vascular channels formation by drilling. However, dorsomedial lesions of the talus are frequently inaccessible to anterior arthroscopic drilling without damaging the intact cartilage. This is why retrograde drilling techniques have been developed. A clinical case of a child presenting osteocondritis dissecans of the talus, in medial location is presented. A conservative treatment was at first attempted and due to the failure of the above mentioned treatment, a surgical approach by retrograde drilling was performed with an arthroscopic technique

Dielectric behaviour of Hf-doped CaCu3Ti4O12 ceramics obtained by conventional synthesis and reactive sintering

CaCu3(Ti4xHfx)O12 ceramics (JC = 0.04, 0.1 and 0.2) were prepared by conventional synthesis (CS) and through reactive sintering (RS), in which synthesis and sintering of the material take place in one single step. The microstructure and the dielectric properties of Hf-doped CCTO (CCTOHf) have been studied by XRD, FE-SEM, AFM, Raman and impedance spectroscopy (IS) in order to correlate the structure, microstructure and the electrical properties. Samples prepared by reactive sintering show slightly higher dielectric constant than those prepared by conventional synthesis in the same way than the pure CCTO. Dielectric constant and dielectric losses decrease slightly increasing Hf content. For CCTOHf ceramics with x> 0.04 for CS and x> 0.1 for RS, a secondary phase HfTi04 appears. As expected, the reactive sintering processing method allows a higher incorporation of Hf in the CCTO lattice than the conventional synthesis one

Osteocondritis disecante de localización troclear : a propósito de un caso.

Osteochondritis dissecans of the knee represents a complex pathology which is very frequently diagnosed late. It is therefore a challenge for the orthopaedic surgeon to avoid such delay in the diagnosis, and to provide a suitable early treatment for the patient. We present the case of a patient with osteochondritis dissecans of trochlear grove localization, which is characterized by the uncommon location of the pathology (approximately 1% according to the series consulted). The patient is a 13-year-old male suffering from pain and repetition spills in his left knee of more than 2 years of evolution, which doesn?t allow normal sports activity. Even though the literature related to the osteochondritis dissecans of the knee located in the medial femoral condyle is abundant and its treatment and rehabilitation algorithms are clear, they are not for the rest of its much less frequent location

Neuroimaging and serum biomarkers of neurodegeneration and neuroplasticity in Parkinson’s disease patients treated by intermittent theta-burst stimulation over the bilateral primary motor area: a randomized, double-blind, sham-controlled, crossover trial study

Background and objectivesIntermittent theta-burst stimulation (iTBS) is a patterned form of excitatory transcranial magnetic stimulation that has yielded encouraging results as an adjunctive therapeutic option to alleviate the emergence of clinical deficits in Parkinson’s disease (PD) patients. Although it has been demonstrated that iTBS influences dopamine-dependent corticostriatal plasticity, little research has examined the neurobiological mechanisms underlying iTBS-induced clinical enhancement. Here, our primary goal is to verify whether iTBS bilaterally delivered over the primary motor cortex (M1) is effective as an add-on treatment at reducing scores for both motor functional impairment and nonmotor symptoms in PD. We hypothesize that these clinical improvements following bilateral M1-iTBS could be driven by endogenous dopamine release, which may rebalance cortical excitability and restore compensatory striatal volume changes, resulting in increased striato-cortico-cerebellar functional connectivity and positively impacting neuroglia and neuroplasticity.MethodsA total of 24 PD patients will be assessed in a randomized, double-blind, sham-controlled crossover study involving the application of iTBS over the bilateral M1 (M1 iTBS). Patients on medication will be randomly assigned to receive real iTBS or control (sham) stimulation and will undergo 5 consecutive sessions (5 days) of iTBS over the bilateral M1 separated by a 3-month washout period. Motor evaluation will be performed at different follow-up visits along with a comprehensive neurocognitive assessment; evaluation of M1 excitability; combined structural magnetic resonance imaging (MRI), resting-state electroencephalography and functional MRI; and serum biomarker quantification of neuroaxonal damage, astrocytic reactivity, and neural plasticity prior to and after iTBS.DiscussionThe findings of this study will help to clarify the efficiency of M1 iTBS for the treatment of PD and further provide specific neurobiological insights into improvements in motor and nonmotor symptoms in these patients. This novel project aims to yield more detailed structural and functional brain evaluations than previous studies while using a noninvasive approach, with the potential to identify prognostic neuroprotective biomarkers and elucidate the structural and functional mechanisms of M1 iTBS-induced plasticity in the cortico-basal ganglia circuitry. Our approach may significantly optimize neuromodulation paradigms to ensure state-of-the-art and scalable rehabilitative treatment to alleviate motor and nonmotor symptoms of PD

Suicidios de indígenas en Valle del Cauca, Cauca y Nariño (Colombia) antes (2018-2019) y durante la pandemia de la COVID-19 (2020- 2021)

Introduction: The Center for Disease Control and Prevention (CDC) defines suicide as an act of self-harm with the intent to cause a voluntary death. In indigenous peoples from countries such as Canada, Australia, Greenland, the United States, New Zealand, Brazil and Siberia, it is evident that this event occurs more frequently than in the general population, mainly as a consequence of colonialism and difficulties faced by indigenous communities, factors that are now considered as common throughout the world. Methods: A retrospective, descriptive, quantitative and retrospective study that analyzes 48 cases of suicide in indigenous people from Southwestern Colombia during the COVID-19 pre-pandemic (2018-2019) and pandemic (2020-2021) periods and registered in the National Institute of Legal Medicine and Forensic Sciences of the departments of Valle del Cauca, Cauca and Nariño. Results: In the studied region more people committed suicide during the pandemic period (2020-2021). The victims were, predominantly, males of young ages (between 19 and 26 years), with a primary and high school educational level, of primary and high school, with farmer or student occupations, use of hanging as the main modality, and conflict with partner or ex-partner as the most frequently cited reason. Conclusions: The suicide rate among indigenous people in the departments of Cauca Valley, Cauca and Nariño was higher than that recorded in the general population of the same departments during the COVID-19 pandemic (2020-2021). It is necessary to consider sociocultural factors and the trajectories of the suicide event within each distinctly studied community.Introducción: El Centro para el Control y Prevención de Enfermedades (CDC) define el suicidio como el acto de autoagresión con la intención de causar la muerte propia de manera voluntaria. En pueblos indígenas de países como Canadá, Australia, Groenlandia, Estados Unidos, Nueva Zelanda, Brasil y Siberia, se evidencia que este eventosucede con mayor frecuencia que en la población general, principalmente como consecuencia del colonialismo y las dificultades que enfrentan las comunidades indígenas, factores que se citan hoy como comunes a nivel mundial. Método: Estudio cuantitativo, descriptivo y retrospectivo en el que se analizaron 48 casos de suicidios de indígenas del suroccidente colombiano, ocurridos durante el período de prepandemia (2018-2019) y pandemia de la COVID-19 (2020-2021), registrados en el Instituto Nacional de Medicina Legal y Ciencias Forenses (INMLYCF) de los departamentos de Valle del Cauca, Cauca y Nariño. Resultados: En la región estudiada se suicidaron más personas durante el período pandémico (2020-2021). Las víctimas fueron, predominantemente, individuos del sexo masculino, de edad joven (entre 19 y 26 años), con estudios de primaria y bachillerato, que tenían ocupación de agricultores o estudiantes, que usaron el ahorcamiento como modalidad principal para acabar con su vida, y cuya razón de suicidio más frecuente era el conflicto con la pareja o expareja. Conclusiones: La tasa de suicidio en indígenas en el Valle del Cauca, Cauca y Nariño fue más alta que la registrada en la población general de los mismos departamentos durante la pandemia de la COVID-19 (2020-2021). Es necesario considerar factores socioculturales y trayectorias del evento suicida en el seno de cada comunidad distintivamente estudiada