The use of a cementless tapered stem in young patients affected of secondary hip arthritis

Introduction: The Wagner cone stem was designed for uncemented hip arthroplasty in difficult proximal femoral conditions or femoral deformities. The most common indications for the use of this stem are secondary hip arthritis due to developmental hip dysplasia, septic arthritis or congenital malformations. We present a case series of patients that underwent hip arthroplasty with the use of a Wagner cone stem. Materials and methods: A retrospective chart review of 17 patients (15 women and 2 men) was performed with a mean age of 39 (25-62). Clinical evaluation was rated with the Merlé D´Aubigné score. Radiographic evaluation consisted in antero posterior and axial views of the hip. One patient was operated bilaterally, with a total of 18 hips operated, and mean follow up of 8 years (5-12). Results: Diagnosis of secondary arthritis was: developmental hip dysplasia in 12 patients, septic arthritis sequelae in 3 patients and other causes of hip arthritis in 3 patients. Average Merlé-D´Aubigné score was 9,9 (8-13) preoperatively and 16,10 (13-18) at last follow-up. One patient presented crural nerve paresia after surgery, which was recovered completely and one stem was reviewed due to aseptic loosening. Discussion: The Wagner cone stem has successfully resolved cases with abnormalities in the proximal femur in patients with secondary hip arthritis. Although this procedure is not exempt of complications, it has shown good stability which translates into good results in the medium to long term

Cobalt chloride allergy. Diagnosis and treatment of a rare cause of early hip prosthesis mobilization

Purpose: Discovering the cause of early hip prosthesis mobilization is a challenge for the orthopedic surgeon. Infection is one possible cause of early prosthesis failure, but there are other causes that orthopedic surgeons should also consider. Case report: We present the case of a 61-year-old male patient with early hip failure due to cobalt allergy and describe the different diagnosis steps that led to this diagnosis. Discussion: Collaboration between departments was fundamental in order to reach the diagnosis. Revision surgery using components without the allergenic metal and using different surface bearing materials (ceramic-ceramic) gave satisfactory results

Voluntary Bilateral Scapulothoracic Dissociation

tudy design: Case report. Objective: To report a rare case of voluntary scapulothoracic dislocation and its treatment. Background data: Scapulothoracic dissociation is a rare condition. We report a case of a teenager who could volun- tarily dislocate her scapulae. Results: The patient was treated surgically by fixating her scapula to the contralateral transverse process and carrying out associated muscle plication. Now, after a 12-year follow-up, the patient is asymptomatic. Conclusions: Fixation of the scapula to the contralateral transverse process and plication of associated muscles is a valid treatment for this condition

Vertebral Body Height Changes in Acute Symptomatic Osteoporotic Vertebral Compression Fractures Treated with Vertebral Cement Augmentation—Which Factors Affect Vertebral Body Height during Follow-up? A Multiple Linear Regression Study

Changes in vertebral body height depend on various factors which were analyzed in isolation and not as a whole. The aim of this study is to analyze what factors might influence the restoration of the vertebral body height after vertebral augmentation. We analyzed 48 patients (108 vertebrae) with osteoporotic vertebral fractures who underwent vertebral augmentation when a conservative treatment proved to be unsatisfactory. The analyses were carried out at the time of the fracture, during surgery (pre-cementation and post-cementation), at the first medical check-up (6 weeks post-surgery) and at the last medical check-up. The average vertebral height was measured, and the differences from the preoperative values were calculated at each timepoint. A Pearson correlation coefficient and a linear multivariable regression were carried out at different timepoints. The time since the vertebral fracture was 60.4 ± 41.7 days. The patients’ average age was 73.8 ± 7 years. The total follow-up period was 1.43 ± 1 year. After vertebral cementation, there was an increase in the vertebral body height of +0.3 cm (13.6%). During the post-operative follow-up, there was a progressive collapse of the vertebral body, and the pre-surgical height was reached. The factors that most influenced the vertebral height restoration were: a grade III collapse, an intervertebral-vacuum-cleft (IVVC) and the use of a flexible trocar before cement augmentation. The factor that negatively influenced the vertebral body height restoration was the location of the thoracolumbar spine

Permanencia de antineoplásico intravertebral utilizando cemento acrílico con cisplatino o metotrexate. Estudio experimental en cerdos

Diseño del estudio: Estudio experimental. Objetivo: Determinar la eficacia de la difusión local y sistémica tras vertebroplastia utilizando cemento acrílico con cisplatino o metrotexato. Introducción: Entre los usos del cemento acrílico (polimetilmetacrilato, PMMA) está la posibilidad de utilizar como vehículo para la difusión de fármacos. Esta capacidad es de interés en el tratamiento de fracturas patológicas. Al efecto tóxico del cemento sobre el tumor (citotoxicidad del monómero e incremento de temperatura) se suma el efecto antineoplásico de los fármacos. Material y métodos: 2 grupos de 10 cerdos fueron sometidos a una intervención mediante vertebroplastia utilizando cemento mezclado con 500mg de cisplatino o 1000 mg de metotrexato en polvo. La vertebroplastia se realizo en dos vertebras lumbares no consecutivas con inyección bipedicular de cemento. Posteriormente realizamos una biopsia transpedicular semanalmente para medir niveles de antineoplásico en tejido óseo y plasma sanguíneo. Los niveles de cisplatino se midieron con espectrometría de absorción atómica y los niveles de metotrexato mediante inmunoensayo de polarización fluorescente. Además se realizaron controles de la función renal y hepática semanales. Resultados: Encontramos niveles de cisplatino y metotrexato en tejido óseo más allá de la quinta semana tras la intervención. El pico máximo de cisplatino ocurrió en la 3ª semana (media 1269 μg/g hueso) y el de metotrexato en la primera semana (media 862,76 μg/g hueso). Encontramos niveles plasmaticos hasta 72 horas después de la vertebroplastia, con un pico máximo de cisplatino a las 24 horas (media 0.23 μmol/L) y a la media hora para el metotrexato (media 0.92 μmol/L). Ninguno de los animales falleció durante el estudio. En los animales con escapes intracanal no se evidenciaron alteraciones neurológicas. Los estudios de hemograma, función renal y hepática permanecieron dentro de los niveles normales. Conclusiones: Existe difusión local de fármacos antineoplásicos desde el cemento a hueso y a plasma sanguíneo. Encontramos niveles de fármaco en hueso hasta pasadas 5 semanas de la vertebroplastia, comparables a estudios in vitro previos. A la dosis administrada no hemos encontrado mielosupresión, toxicidad renal o hepática. Palabras clave: vertebroplastia, cemento acrílico, cisplatino, metotrexate, difusión, metastasis, tratamiento, experimental, cerdos

Permanencia de antineoplásico intravertebral utilizando cemento acrílico con cisplatino o metotrexate. Estudio experimental en cerdos

Diseño del estudio: Estudio experimental. Objetivo: Determinar la eficacia de la difusión local y sistémica tras vertebroplastia utilizando cemento acrílico con cisplatino o metrotexato. Introducción: Entre los usos del cemento acrílico (polimetilmetacrilato, PMMA) está la posibilidad de utilizar como vehículo para la difusión de fármacos. Esta capacidad es de interés en el tratamiento de fracturas patológicas. Al efecto tóxico del cemento sobre el tumor (citotoxicidad del monómero e incremento de temperatura) se suma el efecto antineoplásico de los fármacos. Material y métodos: 2 grupos de 10 cerdos fueron sometidos a una intervención mediante vertebroplastia utilizando cemento mezclado con 500mg de cisplatino o 1000 mg de metotrexato en polvo. La vertebroplastia se realizo en dos vertebras lumbares no consecutivas con inyección bipedicular de cemento. Posteriormente realizamos una biopsia transpedicular semanalmente para medir niveles de antineoplásico en tejido óseo y plasma sanguíneo. Los niveles de cisplatino se midieron con espectrometría de absorción atómica y los niveles de metotrexato mediante inmunoensayo de polarización fluorescente. Además se realizaron controles de la función renal y hepática semanales. Resultados: Encontramos niveles de cisplatino y metotrexato en tejido óseo más allá de la quinta semana tras la intervención. El pico máximo de cisplatino ocurrió en la 3ª semana (media 1269 μg/g hueso) y el de metotrexato en la primera semana (media 862,76 μg/g hueso). Encontramos niveles plasmaticos hasta 72 horas después de la vertebroplastia, con un pico máximo de cisplatino a las 24 horas (media 0.23 μmol/L) y a la media hora para el metotrexato (media 0.92 μmol/L). Ninguno de los animales falleció durante el estudio. En los animales con escapes intracanal no se evidenciaron alteraciones neurológicas. Los estudios de hemograma, función renal y hepática permanecieron dentro de los niveles normales. Conclusiones: Existe difusión local de fármacos antineoplásicos desde el cemento a hueso y a plasma sanguíneo. Encontramos niveles de fármaco en hueso hasta pasadas 5 semanas de la vertebroplastia, comparables a estudios in vitro previos. A la dosis administrada no hemos encontrado mielosupresión, toxicidad renal o hepática. Palabras clave: vertebroplastia, cemento acrílico, cisplatino, metotrexate, difusión, metastasis, tratamiento, experimental, cerdos

Cobalt chloride allergy. Diagnosis and treatment of a rare cause of early hip prosthesis mobilization

Purpose: Discovering the cause of early hip prosthesis mobilization is a challenge for the orthopedic surgeon. Infection is one possible cause of early prosthesis failure, but there are other causes that orthopedic surgeons should also consider. Case report: We present the case of a 61-year-old male patient with early hip failure due to cobalt allergy and describe the different diagnosis steps that led to this diagnosis. Discussion: Collaboration between departments was fundamental in order to reach the diagnosis. Revision surgery using components without the allergenic metal and using different surface bearing materials (ceramic-ceramic) gave satisfactory results

Voluntary Bilateral Scapulothoracic Dissociation

tudy design: Case report. Objective: To report a rare case of voluntary scapulothoracic dislocation and its treatment. Background data: Scapulothoracic dissociation is a rare condition. We report a case of a teenager who could volun- tarily dislocate her scapulae. Results: The patient was treated surgically by fixating her scapula to the contralateral transverse process and carrying out associated muscle plication. Now, after a 12-year follow-up, the patient is asymptomatic. Conclusions: Fixation of the scapula to the contralateral transverse process and plication of associated muscles is a valid treatment for this condition

Reconstruction of the extensor mechanism with fresh-frozen tendon allograft in total knee arthroplasty

Purpose: Patellar tendon rupture after total knee replacement is a rare and highly limiting injury with multifactorial aetiology. Many reconstruction techniques have been described with not very predictable results. The use of allografts has been accepted as a suitable solution. Methods: A series of seven patients with patellar tendon rupture treated with fresh-frozen tendon allograft reconstruction after knee arthroplasty is presented. Results: Median follow-up is 25 months (20-31). Functional assessment improved, and the knee society score and knee functional score improved from 26 and 16 to 82 and 55, respectively. Median extension lag was 5° (0°-20°), with a median range of motion of 95° (70-100). Radiological study showed a rise of the patella of 22.26 mm. Conclusion: The use of fresh-frozen allografts as a solution to patellar tendon ruptures after knee arthroplasty seems to provide acceptable results. Increased patellar height does not seem to affect functionality

The efficacy of an intramedullary nitinol implant in the correction of claw toe or hammertoe deformities

Introduction: A multitude of procedures has been described in the literature for the treatment of lesser toe deformities and there is currently no general consensus on the optimal method of fixation. The aim of this study is to assess the clinical and radiological outcomes of an intramedullary nitinol implant for the correction of lesser toe deformities, and to determine if the distal interphalangeal (DIP) joint and metatarsophalangeal (MTP) joint are modified during patient follow-up after correction of the PIP joint. Materials and methods: A prospective analysis of 36 patients with claw toe or hammertoe who were treated with an intramedullary nitinol implant. Clinical manifestations and angulation of the metatarsophalangeal, proximal and distal interphalangeal (MTP, PIP, DIP) joints were evaluated in radiographic studies preoperatively, at first medical revision post-surgery, and after a minimum of 1 year of follow-up. Complications such as non-union rate, implant rupture, and implant infection were also evaluated during follow-up. Results: All patients were women with an average age of 65.5 (range 47-82) years. The average follow-up time was 2.4 (range 1-5.7) years. Fifty intramedullary nitinol implants were used. The MTP joint extension and PIP joint flexion decreased by 15.9° (95% CI - 19.11 to - 12.63) and 49.4° (95% CI - 55.29 to - 43.52), respectively, at the end of follow-up. Moreover, the DIP joint flexion increased progressively during follow-up (13.7° pre-surgery versus 35.6 in last medical check-up, 95% CI 13.24-30.57). There were four (8%) asymptomatic implant ruptures. The rate of fusion was 98%. Conclusion: The reduction of the PIP joint using an intramedullary nitinol implant is a good option in lesser toe deformities, with few complications and a high rate of arthrodesis. Moreover, the PIP joint reduction affects both the MTP and DIP joints