Sergi Sastre

Total knee replacement and health-related quality of life: Factors influencing long-term outcomes

OBJECTIVE To evaluate health-related quality of life (HRQOL) in patients with osteoarthritis undergoing total knee replacement (TKR); identify the influence of sociodemographic, clinical, intraoperative, and postoperative variables on HRQOL; and determine patient perceptions at 7 years. METHODS We conducted a prospective study with 7 years of followup. HRQOL measures (Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC] and Short Form 36 [SF-36]); sociodemographic, clinical, intraoperative, inpatient, and postoperative data; patient perceptions of TKR outcomes; and physical activity at 7 years were determined. Associations were analyzed using linear regression models. RESULTS Of 146 eligible patients, 112 (86 women, mean age 67.3 years) completed followup data. There were significant differences between pre- and postoperative WOMAC pain, stiffness, and function scores (P < 0.001). Variables retained in each of the models explained 14-32% (adjusted R(2)) of variability of the WOMAC dimensions. Obesity and postdischarge complications were associated with worse scores in all WOMAC dimensions (P < 0.05). Eighty-six percent of patients were satisfied with TKR, 80% would undergo the operation again, and 56% did regular physical activity and had better WOMAC scores (P < 0.05, except for stiffness [not significant]). Mean +/- SD SF-36 scores for men and women at 7 years were 55.1 +/- 27.1 and 39.5 +/- 22.9 for physical function, 71.2 +/- 36.5 and 51.5 +/- 42.7 for physical role, 66.2 +/- 26 and 55.6 +/- 28.9 for bodily pain, and 60.7 +/- 17.1 and 50.7 +/- 21.2 for general health, respectively. CONCLUSION WOMAC dimension scores, especially pain, significantly improved at 7 years and were negatively influenced by obesity and postdischarge complications. HRQOL measures may help identify an increased risk of negative outcomes after TKR.

Osteochondritis of the femoral condyles in children and adolescents: our experience over the last 28 years.

A study of 67 cases was carried out amongst children and adolescents suffering from osteochondritis of the femoral condyle (with open or closed knee physis). All attended our orthopaedic and traumatology centre over a 28-year period (1973–2001). A total of 67 patients have been treated. Arthrotomy and drilling of the affected area was performed on 12 patients; 48 patients were treated with arthroscopic multiple-perforations of the affected articular cartilage and the remaining seven evolved correctly with conservative treatment. Our study has taken into account the symptomatology and the period of preoperative evolution, radiological forms of presentation and the state of the lesion. Follow-up has varied between 12 and 72 months, with an average of 39 months. Despite controversy regarding the usefulness of multiple perforations, we believe it to be the best method of treatment during childhood and adolescence, especially for patients with an open physis.

Health-Related Quality of Life and Direct Costs in Patients With Anterior Cruciate Ligament Injury: Single-Bundle Versus Double-Bundle Reconstruction in a Low-Demand Cohort—A Randomized Trial With 2 Years of Follow-up

PURPOSE To evaluate health-related quality of life (HRQL) in patients undergoing anterior cruciate ligament (ACL) reconstructive surgery by use of 2 procedures and to estimate the direct costs of surgery. METHODS We performed a 2-year randomized, prospective intervention study of 2 surgical ACL reconstruction techniques (anatomic single bundle [SB] v double bundle [DB]). Fifty-five consecutive outpatients, with a mean age of 30.88 years, were randomized to SB or DB ACL reconstruction. The Medical Outcomes Study 36-item Short Form Health Survey (SF-36) was used to measure HRQL (primary outcome). ACL injuries were assessed by the International Knee Documentation Committee (IKDC) score (secondary outcome). The use of medical resources and their costs were evaluated. RESULTS We included 52 patients in the final analyses (23 in the SB group and 29 in the DB group). At baseline, there were no significant differences in study variables. At 2 years of follow-up, there were no significant differences in SF-36 and IKDC scores between groups. However, compared with baseline, the SF-36 physical function, physical role, bodily pain, social function, and emotional role scores were significantly better in the SB group (P < .05), whereas only the physical function dimension score was better in the DB group (P = .047). IKDC scores at 2 years improved significantly in the SB group (P < .001) and DB group (P = .004) compared with baseline. There was a significant correlation between the SF-36 physical function, physical role, and bodily pain dimensions and the IKDC score at 2 years (P < .05). The costs were € 3,251 for the SB group and € 4,172 for the DB group. CONCLUSIONS HRQL and medical outcomes were similar between SB and DB ACL reconstruction techniques, 2 years after surgery. However, the SB technique was more cost-effective.

Meniscal repair using the FasT-Fix device in patients with chronic meniscal lesions

The aim of this prospective study was to evaluate meniscal suturing using the FasT-Fix device for chronic meniscal tears. This procedure was carried out on 25 patients between 2006 and 2007. Nineteen patients were male and the median age was 31 (14–47) years. The median waiting time to surgery was 27 (6–80) months and the median follow-up was 20 (14–29) months. Eleven patients (44%) required reconstruction of an associated anterior cruciate ligament (ACL) injury. 20 patients (80%) showed medial meniscus tears. All tears were located in the red zone or red–white zone. According to Barett’s criteria, meniscal tear healing was achieved in 21 patients (84%). Lysholm and Tegner scale scores improved from 60 (47–77) preoperatively to 95 (58–100) postoperatively and from 3 (2–6) preoperatively to 6 (3–9) postoperatively, respectively. There were no neurovascular complications. Revision surgery was necessary in one patient, in whom a partial meniscectomy was performed. The results obtained suggest that chronic meniscal tears in the zones described can be healed.

Suprascapular nerve palsy after arthroscopic Latarjet procedure: a case report and review of literature

The Bristow and Latarjet procedures have become popular among orthopaedic surgeons thanks to the development of new instruments that allow the use of arthroscopic techniques to treat cases of glenohumeral instability with bone defects or capsular deficiency. Nonetheless, several complications have been reported after Latarjet procedures, including neurological injuries. This report describes surgical damage to the suprascapular nerve, an unusual complication. Level of evidence Expert opinion, Level V.

Prevalence of knee osteoarthritis and analysis of pain, rigidity, and functional incapacity.

Knee osteoarthritis is one of the most prevalent health problems in our society. It accounts for 10% of all primary care visits in general medicine and 30% of outpatient appointments. The objectives of this cross-sectional descriptive study of 100 patients suffering from gonarthritis were to assess pain, functional capacity, and joint damage in patients diagnosed with knee osteoarthritis, as well as the possible repercussions for subsequent surgical treatment. Sociodemographic, clinical, and radiological data were collected, and pain and functional capacity were evaluated by using the Western Ontario and McMaster Universities Osteoarthritis Index. The majority (71) of patients were women, mean age 71 years (SD=7.84), of low educational (66%) and financial (89%) status, with mean disease duration of 11.8 years. Of the total, 87% presented with comorbidity. Radiographs revealed a varus malalignment in 31% of patients and a valgus malalignment in 17%, with bone collapse in 39% of these. The factors that most affect surgery and subsequent rehabilitation are closely linked to social status, the general state of the patient, and the radiological severity of gonarthritis. Most of the patients were obese and suffered from comorbid conditions, and some presented with psychopathology. These factors may influence surgery, and thus improvements in primary care should be made as a way of offering a simpler and more effective treatment for gonarthritis.

The effect of percutaneous release of the medial collateral ligament in arthroscopic medial meniscectomy on functional outcome

BACKGROUND Pie crusting (PC) of the medial collateral ligament (MCL) in the knee has been used empirically to achieve more space in the medial compartment during knee arthroscopy. However, there are no reported studies analyzing the functional results of the application of the PC technique to the MCL in patients undergoing arthroscopic meniscectomy of the medial meniscus, and to determine the rate of iatrogenic injury and associated morbidity. DESCRIPTION OF TECHNIQUE The patient was in a supine position with a tourniquet and a side post. Percutaneous controlled release of the posterior part of the MCL was performed using an intramuscular needle, and a mild valgus force was applied while viewing with the arthroscope of the controlled progressive gain in medial compartment space. PATIENTS AND METHODS A retrospective clinical study of 140 patients undergoing arthroscopic meniscectomy with or without MCL PC was conducted. Tegner and Lysholm tests and visual analogue scales were used to assess pain and functional results. RESULTS The patients in the group with meniscectomy and PC had higher scores on the Lysholm scale, less pain at rest after two months, and achieved significantly better pain control during physical activity at six months. No complication, residual instability, or iatrogenic injury to the cartilage were observed in the meniscectomy plus PC group. CONCLUSION The MCL PC technique for medial meniscectomy is a safe and effective way to reduce iatrogenic injury to the cartilage and does not affect knee stability. Decompression of the medial compartment results in better functional outcomes at two months and lesser pain during physical activity at six months.

Knee osteotomy: navigation guided and arthroscopy assisted

The aim of this work is to describe the procedure used, which combines navigation, arthroscopy and fluoroscopic control, and to evaluate its usefulness in complex osteotomies around the knee. The consolidation of the osteotomy was obtained without complications by obtaining a correct axis of the limb in three spatial planes. This is a precise and reproducible technique. It does not need computer support, associated with specific navigation. Simultaneous arthroscopy also allows the correction of certain intra-articular defects in the same operation, and the precise evaluation of the cartilage’s state.

Total Knee Arthroplasty in the Context of Severe and Morbid Obesity in Adults

Medical treatment for knee osteoarthritis proves insufficient in a considerable number of patients, who thus require surgical intervention, with arthroplasty being one of the most common procedures. The rate of knee replacement is consequently higher in the obese population. Obese patients who undergo knee arthroplasty face a larger number of associated comorbidities than do non-obese individuals, and this greater comorbidity can lead to more postoperative complications and worse outcomes. Given that obesity defined according to BMI would cover a large proportion of the population (a quarter of adults have a BMI > 30 kg/m 2 in some western societies) attention has focused on which sub- groups might present the greatest problems. It appears that morbidly obese patients (BMI > 40 kg/m 2 ) are most at risk of complications. Some authors suggest the need to study more precise methods for component alignment in these patients. The use of an intramedullary guide made surgical intervention easier and was associated with a significantly shorter tourniquet time. Although the studies refer greater surgical difficulties on the basis of their BMI, the difficulty of surgery will ultimately depend on the morphology of the knee. The factors associated with a worse postoperative WOMAC score in severely and morbidly obese patients were the number of comorbidities, infrapatellar anthropometric index below percentile 75, greater intraoperative difficulty and the number of postoperative complications. When starting from a comparable preoperative status, severely and morbidly obese patients show a similar improvement than other patients.

Lung carcinoma with metastasis to biceps muscle: report of a case and review of literature

A case of intramuscular metastasis in biceps muscle due to a squamous cell carcinoma of the lung (Pancoast) is presented. One year after treatment of the lung disease, the patient complained of pain and a sensation of swelling in the anterior aspect of her right arm. The excision of the infiltrated muscles showed proliferation of carcinomatous tissue.RésuméUne métastase intramusuclaire de cancer du poumon localisée au niveau du biceps brachial est rapportée. Douleur et tuméfaction du bras sont apparus un an après le début du traitement du cancer pulmonaire. L’examen histologique de la pièce de résection a confirmé le tissu carcinomateux.