Rodilla/Knee/Knie: implante de colágeno en las meniscectomías antíguas

Comparison of the collagen meniscus implant with partial meniscectomy. A prospective randomized trial.

Rodkey WG, DeHaven KE, Montgomery WH 3rd, Baker CL Jr, Beck CL Jr, Hormel SE, Steadman JR, Cole BJ, Briggs KK.

J Bone Joint Surg Am. 2008 Jul;90(7):1413-26.

BACKGROUND: Loss of meniscal tissue leads to increased pain and decreased clinical function and activity levels. We hypothesized that patients receiving a collagen meniscus implant would have better clinical outcomes than patients treated with partial medial meniscectomy alone.

METHODS: Three hundred and eleven patients with an irreparable injury of the medial meniscus or a previous partial medial meniscectomy, treated by a total of twenty-six surgeon-investigators at sixteen sites, were enrolled in the study. There were two study arms, one consisting of 157 patients who had had no prior surgery on the involved meniscus (the "acute" arm of the study) and one consisting of 154 patients who had had one, two, or three prior meniscal surgical procedures (the "chronic" arm). Patients were randomized either to receive the collagen meniscus implant or to serve as a control subject treated with a partial meniscectomy only. Patients underwent frequent clinical follow-up examinations over two years and completed validated outcomes questionnaires over seven years. The patients who had received a collagen meniscus implant were required by protocol to have second-look arthroscopy at one year to determine the amount of new tissue growth and to perform a biopsy to assess tissue quality. Reoperation and survival rates were determined.

RESULTS: In the acute group, seventy-five patients received a collagen meniscus implant and eighty-two were controls. In the chronic group, eighty-five patients received the implant and sixty-nine were controls. The mean duration of follow-up was fifty-nine months (range, sixteen to ninety-two months). The 141 repeat arthroscopies done at one year showed that the collagen meniscus implants had resulted in significantly (p = 0.001) increased meniscal tissue compared with that seen after the original index partial meniscectomy. The implant supported meniscus-like matrix production and integration as it was assimilated and resorbed. In the chronic group, the patients who had received an implant regained significantly more of their lost activity than did the controls (p = 0.02) and they underwent significantly fewer non-protocol reoperations (p = 0.04). No differences were detected between the two treatment groups in the acute arm of the study.

CONCLUSIONS: New biomechanically competent meniscus-like tissue forms after placement of a collagen meniscus implant, and use of the implant appears safe. The collagen meniscus implant supports new tissue ingrowth that appears to be adequate to enhance meniscal function as evidenced by improved clinical outcomes in patients with a chronic meniscal injury. The collagen meniscus implant has the utility to be used to replace irreparable or lost meniscal tissue in patients with a chronic meniscal injury. The implant was not found to have any benefit for patients with an acute injury.

Cadera/Hip/Hüfte: Choque isquiofemoral, una solución quirúrgica

Ischiofemoral impingement of the hip: a novel approach to treatment.

Safran M, Ryu J.

Knee Surg Sports Traumatol Arthrosc. 2014 Apr;22(4):781-5

Abstract

Ischiofemoral impingement (IFI) is an uncommon source of hip pain recently described in the non-surgical hip, associated with decreased space between the lesser trochanter and the ischium. There are no reports in the English literature of surgical treatment of this problem. We describe a case of IFI in a 19-year-old female who failed conservative management and underwent endoscopic surgical intervention to increase the space between her ischium and proximal femur. More than 2 years later, the patient is doing very well with an improvement of her iHOT score of 53 points to 85.

 Level of evidence IV.

Cadera/Hip/Hüfte: para los peques PTC no cementada cerámica/cerámica

The results of uncemented total hip replacement in children with juvenile idiopathic arthritis at ten years.

Daurka JS, Malik AK, Robin DA, Witt JD.

J Bone Joint Surg Br. 2012 Dec;94(12):1618-24

Abstract

The inherent challenges of total hip replacement (THR) in children include the choice of implant for the often atypical anatomical morphology, its fixation to an immature growing skeleton and the bearing surface employed to achieve a successful long-term result. 

We report the medium-term results of 52 consecutive uncemented THRs undertaken in 35 paediatric patients with juvenile idiopathic arthritis.

The mean age at the time of surgery was 14.4 years (10 to 16). The median follow-up was 10.5 years (6 to 15). 

During the study period 13 THRs underwent revision surgery. With revision as an endpoint, subgroup analysis revealed 100% survival of the 23 ceramic-on-ceramic THRs and 55% (16 of 29) of the metal- or ceramic-on-polyethylene. This resulted in 94% (95% CI 77.8 to 98.4) survivorship of the femoral component and 62% (95% CI 41.0 to 78.0) of the acetabular component. 

Revision of the acetabular component for wear and osteolysis were the most common reasons for failure accounting for 11 of the 13 revisions. The success seen in patients with a ceramic-on-ceramic articulation seems to indicate that this implant strategy has the potential to make a major difference to the long-term outcome in this difficult group of patients.

Hombro/Shoulder/Schulter: no parece mejor añadir L-PRP al reparar el manguito rotador

Does autologous leukocyte-platelet-rich plasma improve tendon healing in arthroscopic repair of large or massive rotator cuff tears?

Charousset C, Zaoui A, Bellaïche L, Piterman M

Arthroscopy 2014 Apr; 30(4):428-35.

Abstract

PURPOSE

To evaluate the clinical and magnetic resonance imaging (MRI) outcome of arthroscopic rotator cuff repair with the use of leukocyte-platelet-rich plasma (L-PRP) in patients with large or massive rotator cuff tears.

METHODS

A comparative cohort of patients with large or massive rotator cuff tears undergoing arthroscopic repair was studied. Two consecutive groups of patients were included: rotator cuff repairs with L-PRP injection (group 1, n = 35) and rotator cuff repairs without L-PRP injection (group 2, n = 35). A double-row cross-suture cuff repair was performed by a single surgeon with the same rehabilitation protocol. Patients were clinically evaluated with the Constant score; Simple Shoulder Test score; University of California, Los Angeles (UCLA) score; and strength measurements by use of a handheld dynamometer. Rotator cuff healing was evaluated by postoperative MRI using the Sugaya classification (type 1 to type 5).

RESULTS

We prospectively evaluated the 2 groups at a minimum 2-year follow-up. The results did not show differences in cuff healing between the 2 groups (P = .16). The size of recurrent tears (type 4 v type 5), however, was significantly smaller in group 1 (P = .008). There was no statistically significant difference in the recurrent tear rate (types 4 and 5) between the 2 groups (P = .65). There was no significant difference between group 1 and group 2 in terms of University of California, Los Angeles score (29.1 and 30.3, respectively; P = .90); Simple Shoulder Test score (9.9 and 10.2, respectively; P = .94); Constant score (77.3 and 78.1, respectively; P = .82); and strength (7.5 and 7.0, respectively; P = .51).

CONCLUSIONS

In our study the use of autologous L-PRP did not improve the quality of tendon healing in patients undergoing arthroscopic repair of large or massive rotator cuff tears based on postoperative MRI evaluation. The only significant advantage was that the L-PRP patients had smaller iterative tears. However, the functional outcome was similar in the 2 groups of patients.

LEVEL OF EVIDENCE

Level III, case-control study

Ciencia/Science/Wissenshaft: ¿robots especialistas que nos manden al paro?

¿Paraíso perdido? ¿Paraíso recuperado? Nanotecnología, el hombre y la máquina

Sandip Tiwari

https://www.bbvaopenmind.com/articulo/paraiso-perdido-paraiso-recuperado-nanotecnologia-el-hombre-y-la-maquina/?fullscreen=true

Con las capacidades de aprendizaje que adquirirán, las máquinas se convertirán, en un primer momento, en ayudantes expertos de los médicos para convertirse, más tarde, en sustitutos para las tareas más habituales y, finalmente, en especialistas. Estos son ejemplos en los que la máquina está adquiriendo cada vez más capacidades según van apareciendo elementos de menor tamaño que ofrecen la posibilidad de adquirir, asimilar y formar dicho conjunto de datos clasificados así como los patrones relevantes que integran.

(Os recomiendo la lectura completa del artículo)

Rodilla/Knee/Knie: indicación clara de la meniscectomía parcial

Does Arthroscopic Knee Surgery Work?

Krych AJ, Carey JL, Marx RG, Dahm DL, Sennett BJ, Stuart MJ, Levy BA

Arthroscopy. 2014 Mar 15. [Epub ahead of print]

Abstract

A recent randomized trial from the Finnish Degenerative Meniscal Lesion Study Group was published in the New England Journal of Medicine and attempted to determine the efficacy of partial meniscectomy without osteoarthritis. Patients were randomized to either arthroscopic partial meniscectomy or sham surgery. The authors concluded that the clinical outcomes after arthroscopic partial meniscectomy were no better than those after the sham surgical procedure. However, there are several important limitations of this trial that make it difficult to generalize to the 700,000 arthroscopic partial meniscectomies performed in the United States each year. In this small sample of 146 patients, patients with traumatic meniscal tears and locking symptoms-those most likely to benefit from a partial meniscectomy-were excluded. In addition, although patients with radiographic arthritis were excluded, most of the patients in the study had degenerative changes at the time of arthroscopy. Therefore it is difficult to determine whether the patients were symptomatic from their chondral degeneration or their degenerative meniscal tear. In our opinion this study does not change the role of surgery in current clinical practice. The primary indication for arthroscopic partial meniscectomy remains symptoms of well-localized joint line pain with acute onset and mechanical symptoms such as catching or locking that have failed comprehensive nonoperative management.

Hombro/Shoulder/Schulter: Propionibacterium muy difícil de demostrar

Origin of Propionibacterium in Surgical Wounds and Evidence-Based Approach for Culturing Propionibacterium from Surgical Sites

Frederick A. Matsen, III; Susan Butler-Wu; Bradley C. Carofino; Jocelyn L. Jette; Alexander Bertelsen; Roger Bumgarner

J Bone Joint Surg Am, 2013 Dec 04;95(23)

Abstract

Background: 

To explore the origin of Propionibacterium in surgical wounds and to suggest an optimized strategy for culturing this organism at the time of revision surgery, we studied the presence of this organism on the skin and in the surgical wounds of patients who underwent revision arthroplasty for reasons other than apparent infection.

Methods: 

Specimens were cultured in broth and on aerobic and anaerobic media. The presence and degree of positivity of Propionibacterium cultures were correlated with sex. The results of dermal and deep cultures were correlated. Times to positivity and the yields of each media type and specimen source were investigated.

Results: 

Propionibacterium grew in twenty-three of thirty cultures of specimens obtained preoperatively from the unprepared epidermis over the area where a skin incision was going to be made for a shoulder arthroplasty; males had a greater average degree of positivity than females (p < 0.002). Twelve of twenty-one male subjects and zero of twenty female subjects who had cultures of dermal specimens obtained during revision shoulder arthroplasty had positive findings for Propionibacterium (p = 0.0001). Twelve of twenty male subjects and only one of twenty female subjects had positive deep cultures (p = 0.0004). The positivity of dermal cultures for Propionibacterium was significantly associated with the positivity of deep cultures for this organism (p = 0.0001). If Propionibacterium was present in deep tissues, it was likely that it would be recovered by culture if four different specimens were obtained and cultured for a minimum of seventeen days on three different media: aerobic, anaerobic, and broth.

Conclusions: 

Because the surgical incision of dermal sebaceous glands may be a source of Propionibacterium in deep wounds, strategies for minimizing the risk of Propionibacterium infections may need to be directed at minimizing the contamination of surgical wounds from these bacteria residing in rather than on the skin. Obtaining at least four specimens, observing them for seventeen days, and using three types of culture media optimize the recovery of Propionibacterium at the time of revision surgery.

Topics

propionibacterium ; wounds and injuries ; evidence-based practice ; epidermis ; shoulder region