-
[show abstract]
[hide abstract]
ABSTRACT: Subtrochanteric femoral fractures are expected to increase in the coming years. Despite the improvement of implants and surgical
techniques, failures due to complications are still considerable. This article reports a retrospective review of patients
who showed a subtrochanteric femoral fracture and who were treated consecutively with the Long Proximal Femoral Nail (LPFN)
from January 2001 to August 2004, or with the Long Trochanteric Femoral Nail (LTFN) from January 2005 to January 2008. A total
of 43 patients with 44 subtrochanteric femoral fractures were included in the study: 23 were treated with the LPFN and 21
with the LTFN. The number of complications related to the LPFN was eight (two re-interventions) against only one related to
the LTFN (no re-interventions). haemoglobin decrease was on average higher in the group treated with the LPFN (35.5g/L) than
with the LTFN (30.4g/L), and so was the number of patients needing for red blood cell concentrates transfusion (15 and 9,
respectively). Mortality at the sixth-month follow up was higher in the group treated with the LTFN. The average surgery time
was similar in both groups. The percentage of patients capable of walking within the first postoperative week was similar
in both groups as well as time to discharge and the consolidation time. Both the LPFN and the LTFN are reliable implants for
the treatment of subtrochanteric fractures of the femur. New features related to the LTFN might decrease the number of complications
as well as the need for red blood cell concentrates transfusion.
KeywordsSubtrochanteric–Femur–Fractures–Trochanteric fixation nail–Proximal femoral nail–Long nail
European Journal of Orthopaedic Surgery & Traumatology 04/2012; 21(7):511-516. · 0.10 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Although HIV-infected patients are at greater risk of presenting with ischaemic necrosis of the femoral head, there have been concerns about whether total hip arthroplasty (THA) may have worse outcomes than expected.
From the Orthopedic and Trauma Surgery database we identified all patients who had undergone THA because of ischaemic necrosis of the femoral head from January 2001 until March 2010. Patient's diagnosis of HIV infection was confirmed at the time of arthroplasty by cross-matching with the HIV unit database. For every THA in HIV-infected patients, two THAs in patients not known to be HIV-infected, with the same diagnosis of ischaemic necrosis of the femoral head and having undergone surgery over the same period, were randomly selected. THAs were compared in HIV- and non-HIV-infected patients for surgical procedure, in-patient stay and long-term prognosis.
There were 18 THAs in 13 HIV-infected patients and 36 THAs in 27 non-HIV-infected patients. No significant differences were observed in the mean time spent in surgery (106 vs. 109 minutes, respectively; P = 0.66), the need for red cell transfusion (1 vs. 4, respectively; P = 0.48) or the mean duration of hospitalization (7.8 vs. 9.4 days, respectively; P = 0.48). The two groups showed similar postoperative functional results, which were maintained until the end of the follow-up period (median 3.3 years in the HIV-positive group and 5.8 years in the HIV-negative group).
Our study suggests that the outcome of THA in HIV-positive patients is not worse than that of HIV-negative patients, although future research on larger numbers of patients is required to confirm this.
HIV Medicine 04/2012; 13(10):623-9. · 3.01 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Linezolid has proven valuable in musculoskeletal infections, however, failure and resistance have been described and toxicity is worrisome when more than 28 days are necessary. We describe the first 5 cases in whom linezolid trough serum concentrations were weekly measured and its relationship with clinical outcome and toxicity.
Revista espanola de quimioterapia: publicacion oficial de la Sociedad Espanola de Quimioterapia 09/2011; 24(3):151-3. · 0.81 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Fungal periprosthetic infectionis a rare entity. The aim of this report was to review our experience in two different educational hospitals.
patients with documented prosthetic joint infection due to Candida spp. from February 2002 to October 2010 were retrospectively reviewed. Demographics, microbiological data, treatment and outcome of each patient was recorded.
Ten patients, 8 women and 2 men, with a meanage of 77.7 (range 66-92) years were identified. Nine patients had previous bacterial infection, received antibiotic treatment for more than 15 days and required multiple surgeries. The most frequent species was C. albicans with 6 cases. All patients received fluconazole and surgical treatment consisted of debridement without removing the implant in 3 cases and 2-stage exchange with a spacer in 7. The first surgical and antifungal approach failed in all cases and a second debridement was necessary in one case, a resection arthroplasty in 8 and chronic suppressive treatment with fluconazol in one. After a mean follow-up of 31 (range 2-67) months, two patients were free of infection.
Prosthetic joint infection was associated with long-term antibiotic treatment and multiples previous surgeries. Treatment with fluconazol and debridement or two stage replacement with a spacer was associated with a high failure rate.
Revista espanola de quimioterapia: publicacion oficial de la Sociedad Espanola de Quimioterapia 03/2011; 24(1):37-41. · 0.81 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Experience with debridement and prosthesis retention in early prosthetic joint infections (PJI) due to Staphylococcus aureus is scarce. The present study aimed to evaluate the outcome and predictors of failure. Patients prospectively registered with an early PJI due to S. aureus and 2 years of follow-up were reviewed. Demographics, co-morbidity, type of implant, clinical manifestations, surgical treatment, antimicrobial therapy and outcome were recorded. Remission was defined when the patient had no symptoms of infection, the prosthesis was retained and C-reactive protein (CRP) was ≤ 1 mg/dL. Univariate and multivariate analysis were performed. Fifty-three patients with a mean ± SD age of 70 ± 10.8 years were reviewed. Thirty-five infections were on knee prosthesis and 18 were on hip prosthesis. The mean ± SD duration of intravenous and oral antibiotics was 10.6 ± 6.7 and 88 ± 45.9 days, respectively. After 2 years of follow-up, 40 (75.5%) patients were in remission. Variables independently associated with failure were the need for a second debridement (OR 20.4, 95% CI 2.3-166.6, p 0.006) and a CRP > 22 mg/dL (OR 9.8, 95% CI 1.5-62.5, p 0.01). The onset of the infection within the 25 days after joint arthroplasty was at the limit of significance (OR 8.3, 95% CI 0.8-85.6, p 0.07). Debridement followed by a short period of antibiotics is a reasonable treatment option in early PJI due to S. aureus. Predictors of failure were the need for a second debridement to control the infection a CRP > 22 mg/dL and the infection onset within the first 25 days after joint arthroplasty.
Clinical Microbiology and Infection 03/2011; 17(3):439-44. · 4.54 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The aim of our study was to compare the effectiveness of high-pressure pulsatile lavage and low-pressure lavage in patients with an orthopaedic implant infection treated with open débridement followed by antibiotic treatment.
Patients with an orthopaedic implant infection requiring open débridement from January 2008 to August 2009 were randomized prospectively to a low-pressure or a high-pressure pulsatile lavage arm. Relevant information about demographics, co-morbidity, type of implant, microbiology data, surgical treatment, and outcome were recorded. Comparison of proportions was made using χ(2) test or Fisher exact test when necessary. The Kaplan-Meier survival method was used to estimate the cumulative probability of treatment failure from open débridement to the last visit.
Seventy-nine patients were included. There were no differences between the main characteristics between both groups (p > 0.05). Mean (SD) age of the whole cohort was 70.2 (11.9) years. There were 46 infections on knee prosthesis, 17 on hip prosthesis, 7 on hip hemiarthroplasties and 9 on osteosynthesis devices. There were 69 acute post-surgical infections, 8 acute haematogenous infections and 2 chronic infections. The most common microorganisms isolated were coagulase-negative Staphylococci in 34 cases, Staphylococcus aureus in 26 and Escherichia coli in 19 cases. There were 30 polymicrobial infections. A total of 42 and 37 patients were randomized to a high-pressure pulsatile or a low-pressure lavage, respectively. There was no difference in the success rate between both arms (80.9 vs. 86.5%, p = 0.56).
The use of a high-pressure pulsatile lavage during open débridement of implant infections had a similar success rate as a low-pressure lavage.
Archives of Orthopaedic and Trauma Surgery 03/2011; 131(9):1233-8. · 1.37 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: This retrospective study reports on the clinical results of a group of 23 patients with subtrochanteric femoral fractures using the Long Trochanteric Fixation Nail (LTFN).
Between January 2005 and January 2008, 23 patients (20 women, 3 men; average age: 64.8 years old) with subtrochanteric femoral fractures were treated surgically. According to the AO/ASIF Classification, the most frequent fracture type was an 32-A1. They were also classified regarding the Seinsheimer Classification, in which the commonest type was the IIB. Of the 23 fractures, 14 of them had been the result of an unexpected fall, 2 were the result of a high-energy trauma and 7 consisted of pathologic fractures.
All the patients were treated using the LTFN device and they all received clinical and radiological follow-ups at least until their fractures were consolidated. The average surgery time, average decrease in haemoglobin in the first 24 hours post- surgery, average need for red blood cell transfusion, postoperative mortality at a 6th month follow-up, time to autonomous deambulation, most frequent destination at the time of discharge, average time for consolidation of the fracture and average follow-up time were reported. Intraoperative and postoperative complications were also recorded.
The average surgery time from cut to stitch was 97.45 minutes with the decrease in haemoglobin averaging 26.45 g/L and, on average, the need for red blood cell transfusion was 1.12 concentrates. In the first postoperative week, 57.1% of the total number patients were capable of deambulation. The time to hospital discharge was 12.9 days. After an average follow-up of 13.9 months, total weightbearing was achieved in the 64.7% of the patients. The average consolidation time was 21.6 weeks and none of the patients developed pseudoarthrosis. Technical failures were seen in 4.3% of the cases: 1 patient suffered a migration of the distal locking screw. There were no cases of deep infection, cut-out, bending/breaking of the implant, malrotation or fracture of the femoral shaft at the tip of the implant.
From a mechanical point of view the use of a long intramedullary nail in combination with a blade or a screw seems to be the most appropriate treatment for subtrochanteric fractures of the femur. Despite the improvement of implants and surgical techniques, failures due to complications are still considerable. The low distal shaft diameter of the LTFN, in combination with an extremely precise positioning of the blade in the middle of the femoral head, can prevent mechanical complications. Open reduction and cerclage cabling may be required so as to obtain a correct alignment of the fracture.
We conclude that the LTFN is a safe and reliable intramedullary device for the treatment of subtrochanteric fractures of the femur. Deambulation within the first postoperative surgery is possible when positioned properly. Its implantation requires more surgical time than the standard nails.
Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca 12/2009; 76(6):451-5. · 1.63 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To obtain images of the articular surface of fresh osteochondral grafts using an environmental scanning electron microscope (ESEM). To evaluate and compare the main morphological aspects of the chondral surface of the fresh grafts. To develop a validated classification system on the basis of the images obtained via the ESEM. The study was based on osteochondral fragments from the internal condyle of the knee joint of New Zealand rabbits, corresponding to fresh chondral surface. One hundred images were obtained via the ESEM and these were classified by two observers according to a category system. The Kappa index and the corresponding confidence interval (CI) were calculated. Of the samples analysed, 62-72% had an even surface. Among the samples with an uneven surface 17-22% had a hillocky appearance and 12-16% a knobbly appearance. As regards splits, these were not observed in 92-95% of the surfaces; 4-7% showed superficial splits and only 1% deep splits. In 78-82% of cases no lacunae in the surface were observed, while 17-20% showed filled lacunae and only 1-2% presented empty lacunae. The study demonstrates that the ESEM is useful for obtaining and classifying images of osteochondral grafts.
Journal of Materials Science Materials in Medicine 06/2009; 20(11):2181-7. · 2.32 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Alumina ceramic-on-ceramic total hip arthroplasty (THA) has been widely used due to its advantages such as low wear, scratch resistance, wettable surface and relatively low biological reactivity of the wear particles. Nevertheless, this material in THA still persists to be one of the major concerns about the risk of fracture, due to its brittleness. Many authors have reported a fracture of the ceramic head but few reported a fracture of the ceramic acetabular insert. In order to reduce the rigidity of the ceramic-on-ceramic coupling and prevent an impingement between the rim of the ceramic liner and the metal neck of the femoral stem, a modular acetabular component with a sandwich insertion (alumina/polyethylene/titanium) was proposed. We report the fracture of the ceramic acetabular liner of such a ceramic sandwich cup due to a slightly retroverted position of the cup that causes an impingement between the femoral stem and the rim of the insert. The fracture occurred 3 years after the operation without trauma. At revision the entire cup was replaced using a polyethylene liner without inner ceramic liner.
Archives of Orthopaedic and Trauma Surgery 01/2008; 128(8):783-5. · 1.37 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The best antibiotic regimen for acute prosthetic joint infection, treated without removal of the implant, has not been well-defined. This study describes the use of a protocol based on oral rifampicin combinations to treat 47 cases that were followed prospectively for a 2-year period. The regimen used most commonly was levofloxacin 500 mg/24 h plus rifampicin 600 mg/24 h for a mean duration of 2.7 +/- 1 months. The cure rate was 76.9%, and the only independent risk-factor associated with treatment failure was infection caused by methicillin-resistant Staphylococcus aureus or Enterococcus spp. (OR 17.6, p 0.003). Overall, the results suggested that use of oral antibiotics, including rifampicin, for 2-3 months was a good treatment option.
Clinical Microbiology and Infection 10/2006; 12(9):930-3. · 4.54 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: In order to gather more data on the use of teicoplanin for reducing MRSA infections in high-risk populations, the present study was conducted. At a hospital in Barcelona, Spain, there was a high prevalence of MRSA infections among patients who underwent surgery for femoral neck fracture during the first 5 months of 2002 (period A) when cefuroxime was the antibiotic prophylaxis. During the following 12 months (period B) 600 mg of teicoplanin was added to cefuroxime. The rates of overall and MRSA infection during period A were 5.07 and 2.73%, respectively. Pulsed-field gel electrophoresis demonstrated there was no clonal relationship among MRSA strains. No nasal carriers of MRSA were detected among health workers. During period B the rates of overall and MRSA infection were 2.36 and 0.19%, respectively. Both rates were statistically significantly lower than those in period A (p<0.05). These results suggest teicoplanin may be useful in patients undergoing orthopedic surgery when the prevalence of MRSA is high.
European Journal of Clinical Microbiology 02/2006; 25(1):35-8. · 2.86 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Check the agreement of a preoperative digital templating, compared with the final result in the postoperative radiograph.
The study was carried out on a 55 total hip prosthesis. A templating-software Neteous(®) (Socincer(®), Gijón, Spain) was used. Agreement was measured using the Kappa Index for the stem offset or Lin Index for others variables: stem size, cup size, femoral neck length, and the distance from the center of rotation of the femoral head to the lesser trochanter. The percentage of accurate hits was also described.
Stem size: The exact success or error of only one size was of 61.6%. Quantitatively the Lin Index was 0.64 (substantial). Horizontal offset: satisfactory agreement was obtained (Kappa index of 0.75). In 6 cases (10.90%) was changed to lateralized during surgery, for more joint stability. Size of the cup: the agreement obtained was 0.67 (substantial) with a hit grade of 43.6%. Prosthetic neck length: the exact hit or error of only one size were found in 50.9%, moderate level of agreement. Distance from the center of rotation to the lesser trochanter: was observed for almost perfect agreement with Lin Index of 0.95. The exact percentage of hits or gap error less than 5mm was 74.5%.
In ours hands, the preoperative templating software analyzed, has provided acceptable agreement rates, when compared with the postoperative result. But it takes more works verified by independent observers.
Revista Espanola de Cirugia Ortopedica y Traumatologia 56(6):471-7.
-
D Fuster,
J Duch,
A Soriano,
S García,
X Setoain, G Bori,
S Rubí,
D Rodríguez,
B Doménech,
C Piera,
J Mensa,
F Pons
[show abstract]
[hide abstract]
ABSTRACT: To evaluate the usefulness of (99m)Tc-Sulphur colloid when combined with leukocyte scintigraphy in suspected prosthetic hip infection, comparing the results with information from (99m)Tc-HMPAO-leukocyte scintigraphy alone.
Seventy patients (42 women, 28 men; mean age 68 +/- 13 years) with painful hip prostheses and suspicion of infection were evaluated prospectively. All patients had bone scintigraphy, (99m)Tc-HMPAO-labelled white blood cell scintigraphy and (99m)Tc-Sulphur colloid bone marrow scintigraphy. ESR and CRP levels were measured in all patients. The final diagnosis was made with microbiological findings or by clinical follow up of at least 12 months.
Infections were diagnosed in 12 of the 70 patients (3 coagulase-negative Staphylococcus, 2 Staphylococcus aureus, 2 Staphylococcus epidermidis, 2 enterococcus and 3 polymicrobial agents). ESR and CRP values were higher in patients with infection than in patients without infection (51.8 +/- 29.4 vs. 25.4 +/- 16.4 and 2.8 +/- 2.2 vs. 1.1 +/- 1.3, respectively; p < 0.05). Bone scintigraphy did not show a characteristic pattern to differentiate infection from aseptic loosening. The pool phase of the bone scintigraphy was positive in only 3/12 patients with infection (25 %). Sensitivity and specificity of the leukocyte scintigraphy was 83 % and 57 %, respectively. When the results of the bone marrow scintigraphy were added, these values increased to 92 % and 98 %, respectively.
Performing bone marrow scintigraphy significantly improves results when compared with leukocyte scintigraphy alone in the diagnosis of infected hip prostheses. Bone scintigraphy did not help to differentiate aseptic loosening from infection in this series.
Revista Española de Medicina Nuclear 27(6):430-5. · 0.89 Impact Factor
