Jenaro A. Fernández-Valencia

Alignment guided by computer navigation of the femoral component in hip resurfacing

Surgical navigation systems are offered to provide more precise implantation of the femoral component in hip resurfacing (HR), allowing to reduce the risk of malpositioning and of femoral neck fracture and notching. We conducted a retrospective analysis of 30 HR divided into two cohorts and compared the results of a nonnavigated group (15 hips) with those of a navigated group (15 hips). The BrainLAB Computer Navigation System was used in all cases. No notching occurred in either group. The femoral component did not show better positioning in the navigated group, but more outlier cases were observed in the nonnavigated group (7, versus 3 in the navigated group). Although there are no long-term studies showing that surgical navigation increases the survival of HR, the avoidance of outlier values justifies its use, especially during the surgical learning curve, which is a difficult and lengthy one.

Pasteurella multocida septic shock after a cat scratch in an elderly otherwise healthy woman: a case report

Pasteurella multocida, a gram-negative coccobacillus, is a commensal in the nasopharynx of many animals. P. multocida infections most commonly involve the skin, soft tissues, and respiratory tract, particularly in immunosuppressed patients. The present case illustrates a severe articular infection caused by this bacterium, leading to septic shock, in an elderly, otherwise healthy woman, after a simple scratch of a cat.

Plate Osteosynthesis for Severe Olecranon Fractures

Purpose. To review outcomes of 10 patients who underwent plate osteosynthesis for severe olecranon fractures. Methods. Records of 7 men and 3 women aged 33 to 73 years who underwent plate osteosynthesis for severe olecranon fractures were reviewed. All had some degree of soft-tissue injury; 6 presented with associated fractures. Seven patients were treated with a limited contact dynamic compression plate, and the remaining 3 received a locking compression plate. Patients were followed up for fracture healing, range of motion, nerve damage, heterotopic ossification, infection, hardware complaints, and the need of a secondary surgical procedure. The Mayo Elbow Performance Score (MEPS) was determined at the final follow-up. The patient-answered questionnaire (PAQ) portion of the Liverpool Elbow Score (LES) was evaluated 2 to 37 months later by telephone. Results. All patients had bone union. None had nerve damage or heterotopic ossification. Patients 4, 6, and 8 with type-IIIB fractures developed deep infections and severe soft-tissue swelling; all had been treated with the limited contact dynamic compression plate. Four patients underwent plate removal owing to hardware complaints. One patient underwent a secondary procedure to restore complete range of elbow motion. The mean MEPS score was 84 (range, 35–100); 5 patients attained excellent scores, one good, 2 satisfactory, and 2 unsatisfactory. The mean PAQ portion of the LES score was 31 (range, 23–36). Conclusion. Plate osteosynthesis achieves satisfactory results for severe olecranon fractures. The deep infection rate is higher in patients with severe soft-tissue injury.

Assessment of Patients with a DePuy ASR Metal-on-Metal Hip Replacement: Results of Applying the Guidelines of the Spanish Society of Hip Surgery in a Tertiary Referral Hospital.

The prognosis associated with the DePuy ASR hip cup is poor and varies according to the series. This implant was withdrawn from use in 2010 and all patients needed to be assessed. We present the results of the assessment of our patients treated with this device, according to the Spanish Society of Hip Surgery (SECCA) algorithm published in 2011. This retrospective study evaluates 83 consecutive ASR cups, followed up at a mean of 2.9 years. Serum levels of chromium and cobalt, as well as the acetabular abduction angle, were determined in order to assess their possible correlation with failure, defined as the need for revision surgery. The mean Harris Hip Score was 83.2 (range 42–97). Eight arthroplasties (13.3%) required revision due to persistent pain and/or elevated serum levels of chromium/cobalt. All the cups had a correct abduction angle, and there was no correlation between elevated serum levels of metal ions and implant failure. Since two previous ASR implants were exchanged previously to the recall, the revision rate for ASR cups in our centre is 18.2% at 2.9 years.

Allograft reconstruction of the distal humerus after resection of a breast solitary metastasis: eleven years follow-up.

Resection is a rare indication for the treatment of solitary skeletal metastasis (SSM), and provides an opportunity to cure the oncologic patient. Reconstruction after resection can imply a difficult problem depending on the size and the location of the metastasis. In the reported case, an en-bloc resection of a SSM of a breast cancer located in the distal humerus was performed in 1990. Reconstruction of the osteoarticular defect has been achieved with a massive allograft. At eleven years follow-up the patient remains free of illness and shows a good functional result. With the result obtained in the reported case, we suggest that osteoarticular allograft can be of considerable value for reconstruction after excision of SSM in the distal humerus, and that cure can be achieved with the radical resection of a SSM of breast cancer.

Metal-on-polyethylene is not an option after the fracture of a ceramic component of a total hip arthroplasty.

1. Trebše R, Mihelič A, Levašič V, Cör A, Milošev I. Results of revision of total hip arthroplasty for alumina ceramic-on-ceramic bearing fracture. Hip Int. 2016;26(3):237-243. 2. Sharma V, Ranawat AS, Rasquinha VJ, Weiskopf J, Howard H, Ranawat CS. Revision total hip arthroplasty for ceramic head fracture: a long-term follow-up. J Arthroplasty. 2010;25(3): 342-347. 3. Cheung AC, Banerjee S, Cherian JJ, et al. Systemic cobalt toxicity from total hip arthroplasties: review of a rare condition Part 1 history, mechanism, measurements, and pathophysiology. Bone Joint J. 2016;98-B(1):6-13. 4. Zywiel MG, Cherian JJ, Banerjee S, et al. Systemic cobalt toxicity from total hip arthroplasties: review of a rare condition Part 2. measurement, risk factors, and step-wise approach to treatment. Bone Joint J. 2016;98-B(1):14-20. 5. Zagra L, Maccario C, Mondini A, Bianchi L. Treatment of failures related to articulation material in THA. A comprehensive algorithm of surgical options and open questions. Hip Int. 2014;24(Suppl 10):S48-S57. 6. Zywiel MG, Brandt JM, Overgaard CB, Cheung AC, Turgeon TR, Syed KA. Fatal cardiomyopathy after revision total hip replacement for fracture of a ceramic liner. Bone Joint J. 2013; 95-B(1):31-37.

Las prótesis de cadera en el adulto joven. Prótesis de superficie y prótesis de vástago corto

The poor results obtained in young patients when using a conventional prosthesis led to the resurgence of hip resurfacing to find less invasive implants for the bone. Young patients present a demand for additional activity, which makes them a serious challenge for the survival of implants. In addition, new information technologies contribute decisively to the preference for non-cemented prostheses. Maintaining quality of life, preserving the bone and soft tissues, as well as achieving a very stable implant, are the goals of every hip orthopaedic surgeon for these patients. The results in research point to the use of smaller prostheses, which use the metaphyseal zone more and less the diaphyseal zone, and hence the large number of the abovementioned short stem prostheses. Both models are principally indicated in the young adult. Their revision should be a more simple operation, but this is only true for hip resurfacing, not for short stems.

Preliminary Results After Changing From Two-Stage to One-Stage Revision Arthroplasty Protocol Using Cementless Arthroplasty for Chronic Infected Hip Replacements

BACKGROUND The objective of our study is to evaluate our preliminary results after changing from a 2-stage revision arthroplasty protocol to a 1-stage revision arthroplasty protocol using cementless arthroplasty for all patients with chronic infected hip replacements. METHODS Prospective study of all hip arthroplasties that were diagnosed with chronic infection and were treated using the 1-stage revision without taking into account the traditional criteria used to determine the use of a 1-stage revision was conducted. There were 2 main variables evaluated: infection control and costs. The definitive diagnosis of infection of the revision was determined using the criteria proposed by the Musculoskeletal Infection Society. The costs were calculated using average cost in USD, excluding social expenses, as described by Klouche (2010) for 1-stage or 2-stage revisions. RESULTS Nineteen patients were included in the study and the infection was controlled in 18 patients. The total economic savings for our hospital for these 19 patients was 391.609 USD. CONCLUSION This clinical success has led to an important change in our hospital in treating chronic infected hip replacements and an important cost reduction from an economic point of view.

Relationship between Femoral Offset and Dislocation in Preformed Antibiotic-Loaded Cement Spacers (Spacer-G®)

Introduction A reduction in femoral offset may decrease muscle tension and lead to spacer dislocations even though proximal femur, musculature and acetabulum remain intact. In this study, we aimed to determine whether postoperative lateral femoral offset (LFO) and modified vertical femoral offset (MVFO) values affect the risk of dislocation of a hip spacer. Materials and methods We measured LFO and MVFO in properly centred, postoperative, anteroposterior radiographs of the pelvis in 66 patients (71 spacers). We then compared the operated and non-operated sides and recorded any dislocations. Results Although LFO decreased (p<0.001), the reduction was not associated with dislocation (p = 0.471). MVFO remained unchanged after spacer implantation (p = 0.277) and was not associated with dislocation (p = 0.418). Conclusions In conclusion, the preformed spacer decreased LFO but not MVFO compared with the contralateral hip. The variations did not significantly affect the dislocation rate.

Perspectives about the Use of Autografts and Allografts for the Acetabular Component of a Total Hip Arthroplasty

Autografts and allografts have been valuable for the reconstruction of the acetabulum both in primary and revision surgery of total hip arthroplasty. The increasing use of highly porous metals supplements could decrease its indication in the future. The present article reviews its indications.