Artroplastia de rodilla: nuestra experiencia

Se presenta una casuística de 209 prótesis tricompartimentales de deslizamiento respetando el LCP, de las que 52 fueron PCA y 150 AGC, cementadas y sin cementar y 7 ICLH, implantadas desde 1980 a 1990, con un seguimiento medio de 4.5 años, obteniendo un 40% de Muy Buenos Resultados, un 51% de Buenos Resultados, 5% Regulares y 4% de Malos. No se encontraron diferencias significativas entre cementadas y sin cementar. Se presentaron complicaciones en 9,56% de los casos. Se expone la técnica quirúrgica así como las conclusiones prácticas de nuestra experiencia.A series of 209 prosthesis with three sliding compartiments retaining the PCL are presented, of these 52 were PCA and 150 AGC, with or without cement, and 7 ICLH, implanted between 1980 and 1990, with and average follow-up of 4.5 years. The results wer e 40% very good, 51% good, 5% fair and 4% poor. No singnificant difference was seen between those cemented and cementlers. Complications occurred in 9.56% of theese patients. The surgical technique used and practical conclusions drown, are described

Tratamiento quirúrgico de la luxación recidivante de rótula mediante técnica combinada de realineación proximal y distal

Los autores presentan su experiencia en el tratamiemto quirúrgico de la luxación recidivante de rótula, en una serie de 26 pacientes esqueléticamente maduros (27 rodillas), intervenidos tras fracaso de un periodo mínimo de seis meses de tratamiento conservador. El tiempo medio de seguimiento postoperatorio fue de 20 meses. La técnica quirúrgica realizada fue la realineación proximal según Insall, asociada a realineación distal tipo Emslie-Trillat. La patología intraarticular concomitante se resolvió mediante artroscopia previa en el mismo tiempo quirúrgico. Las complicaciones encontradas fueron, un caso de hematoma postoperatorio, dos cicatrices queloides, y cuatro casos de rigidez articular. Los resultados fueron excelentes en 21 pacientes. En cinco casos se objetivó clínica de sufrimiento patelar, postquirúrgico. Los buenos resultados obtenidos parecen tener relación con la seguridad que proporciona la técnica de realineación combinada proximal y distal unida a un programa meticuloso de rehabilitación precoz.We review our experience on the surgical treatment of the recurrent dislocation of the patella in a series of 26 mature patients (27 knees) operated on after failure of conservative treatment. The average period of postoperative follow-up was 20 mouths. As for surgical technique we performed proximal realignment according to Insall, associated to EmslieTrillat's distal realignment. Intraarticular concomitant pathology was treated by previous arthroscopy. Complications were found in one case with postoperative haematoma, two cases of queloid scar, and four cases of joint stiffness. Excellent results were achieved in 21 patients. In other five cases patellar complains persisted after surgery. The satisfactory results obtained seems to be due to the safety of the combined proximal-distal realignment procedure together with a meticulous programme for early rehabilitation

Roturas agudas de L.C.A. de la rodilla: refuerzo con cordón RD.S

Se presenta la técnica de reconstrucción en las roturas agudas del L.C.A. mediante reparación con cordón de P.D.S., así como los criterios seguidos por los autores ante las roturas agudas de dicho ligamento. Expone una casuística de 24 intervenciones, con un seguimiento de 1.5 años, sin haber encontrado complicaciones destacables y con un 75% de Muy Buenos Resultados y un 25% de Buenos Resultados.The technique used in the repair of acute rupture of the ACL with a band of PDS, together with the criteria followed by our department in such cases both acute are decribed. The describe 24 operations performed by them, with a follow-up of 1.5 years, with no major complications, 75% excellent results and 25% good results

Plastia sustitutiva del LCA con tendones de la pata de ganso cuadruples

Se han estudiado retrospectivamente 44 casos de pacientes a los que se les realizó por vía artrocóspica una plastia sustitutiva intraticular de reconstrucción del LCA, con tendones de Semitendinoso y Recto Interno antólogos, en 4 fascículos. La edad media de los pacientes fue de 25 años. Los resultados a corto plazo (2 años) obtenidos con KT-1000 a 30 Ib han sido excelente-bueno en 40 casos y aceptable en 4 casos. Cuatro casos referían sensación de inestabilidad. Los test de Lachman y Pívot-Shift fueron positivos en 3 casos. Con el test de Lysholm se obtuvo resultado excelente-bueno en 36 casos, regular en 6 y malo en 2 casos. Este tipo de plastia presenta una baja morbilidad de la zona dadora del injerto, comparativamente con la plastia HTH patelar antóloga, y sin alteración del aparato extensor.A retrospective study of 44 patients, who underwent an arthroscopically assisted ACL (anterior cruciata ligament) reconstruction with quadrupled semitendinosus/gracilis tendon autografts was performed. The mean age was 25 years. Short term outcomes of knee stability (2 years follow-up) with KT-1000 arthrometer at 30 pounds were excellent or good in 40 cases and acceptable in 4. Pain or joint swelling were not found. Instability complaints were found in 4 cases. Lachman and Pivot-shift were found positive in 3 cases. Lysholm questionnaire scores were excellent or good in 36 cases, fair in 6 cases and per in two cases, the donor site morbidity associated with hamstring harvest seems to be minimal compared with bonepatellar tendon-bone autograft without impairment of the extensor mechanism

Laxitud crónica de ligamento lateral externo de tobillo : plastia de Castaing modificada

Twenty cases of chronic laxitude of the external Iigament of the ankle, using the Castaing's technique for surgery, are reviewed. The authors describe the procedure abd show the excellent results obtained from the usage of this technique

Conoropatia rotuliana : tratamiento mediante la técnica emslie- trillat modificada

Twenty-six eases of Patella ehondromalacia operated with Emslie- Trillat's teehnique to which a modifieation of the T T A elevation is associated using a graft taken from the tibia are presented. The results were satisfactory and the technique easy to perform

Inestabilidad crónica anterior de rodilla : sustitución de ligamento cruzado anterior mediante prótesis de Dacron por vía artroscópica. Técnica intra y extraarticular

The authors describe 51 cases operated on for chronic anterior laxity of the knee, using a Dacron prosthesis inserted through on arthroscope perfoming on extraarticular plasty and on intraarticular prosthesis. Very satisfactory results were obteined witbout requiring plastering and with early rehabilitation. The importance of careful selection of the sites of femoral and tibial perforation is emphasised, together with complete absence of ruptures

Rotura degenerativa de Tendón de Aquiles. : Reparación quirúrgica mediante técnica de Teuffer

Los autores presentan 14 casos de rotura degenerativa de Tendón de Aquiles reparados quirúrgicamente mediante técnica de TEUFFER con tendón de peroneo lateral corto. Descripción de la técnica haciendo resaltar los buenos resultados obtenidos con una rehabilitación precoz

Profilaxis antibiotica en la fractura subcapital del anciano

A doubJe blind study of antibiotic prophyllaxls in fractures of rhe neck uf rhe íernur in elderly patients, was made for the following reasons: - the high incidence in this hospital. - the great riske of infection in elderly patients with their associatcd pruhlerns IIf general health, nutrition... - slnce it is an example of replacement surgery, these results may be applied ro total arthroplasty of the hipo After study of the literature, and consideration of the pharmacokinetics IIf the cephalosporins most frequently used, together with the epidemiology IIf the Trauma and Orthopaedics ward of this Hospital (with computerized antibiograms), «cefaznlin» was chosen for prophyllaxis. The treatement was as follows: 1 gram intravenously 15 minutes preoperatively. 1 gram intravenously every 6 hours for the following 3 days. The incidence of infection in the control group which received no antibiotic treatement was of 12'5 %, this was reduced to 3'S % in the group receiving antibiotic prophyllaxis. It should be pointed out that all patients received the same type of prothesis and the same therapeutic route for the antibiotic. These cases were all treated by the same surgical team

Artroscopia quirúrgica de la rodilla : (nuestra experiencia en 500 intervenciones)

El objeto de este trabajo es presentar la experiencia y la valoración estadística en 500 artroscopias quirúrgicas de rodilla realizadas por los autores, describiendo la patología hallada,· técnica empleada y complicaciones per y postoperatorias