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OBJECTIVE To analyze the clinical and radiologic results, the survival and complications obtained in 70 year or older patients who underwent cementless total knee arthroplasty (TKA). MATERIAL AND METHOD An observational study of patients operated between January 2014 and December 2016 was carried out according to the Natural Knee model (Zimmer®, USA). The main variables were the Oxford Knee Score, the visual analog scale, the presence of radiolucencies, complications, survival and reasons for revision. RESULTS Of 104 TKA, 86 were available for revision. The median age was 76 years. The mean follow-up was 5.4 years (range 3.7-6.9). The Oxford Knee Score punctuation showed a median of 17 presurgical (range 0-40) and 37 post surgical (range 5-48), P

Resumen: Introducción: Una de las patologías más frecuentemente atendida en nuestro medio son las lesiones tendinosas que afectan al manguito rotador del hombro. Existen diferentes modalidades de tratamiento para las roturas masivas o irreparables. Desde hace unos años, se introdujo en el mercado una técnica poco invasiva basada en la colocación de un espaciador subacromial biodegradable. El objetivo del trabajo es analizar los resultados de nuestra experiencia con el uso de este dispositivo (InSpace®). Material y método: En el estudio se recogen los resultados obtenidos en 25 pacientes con roturas irreparables del manguito rotador definidas mediante resonancia magnética (RM), en los que se les implantó un balón subacromial en nuestro centro en el periodo comprendido entre enero de 2015 hasta diciembre de 2017. Todos los pacientes fueron evaluados preoperatoriamente y un año después de la cirugía incluyendo la escala visual analógica (EVA), el test de Constant (CS) y el QuickDASH (QD). Resultados: De los 25 pacientes, cinco pacientes (20%) fueron intervenidos mediante artroscopia y 20 (80%) mediante abordaje abierto (mini-open). Un total de 22 pacientes completaron el año de seguimiento. A los 12 meses, el 64% (14/22) de los pacientes obtuvo una mejoría de al menos 10 puntos en el CS. Los pacientes partían de un CS promedio inicial de 32 puntos que mejoró hasta los 54,9 puntos de media en la evaluación postoperatoria a los 12 meses (Promedio de mejoría 22,9 puntos; p < 0,05). En cuanto a la evaluación del dolor, en nuestro estudio, el 87% (19/22) de los pacientes obtuvo una mejoría de al menos 2 puntos en la EVA a los 12 meses de seguimiento (p < 0,05). Los pacientes partían de una EVA media inicial de 8,7 que mejoró hasta los 3,7 puntos de media a los 12 meses. Un 73% de los pacientes contestaron estar satisfechos con la intervención y volverían a someterse a la cirugía. Conclusión: Los resultados obtenidos en nuestra serie a un año de seguimiento hablan en favor de la utilización del balón subacromial de tipo InSpace®, como opción terapéutica disponible para pacientes con roturas irreparables del manguito rotador. Puede ser utilizado como procedimiento provisional, retrasando la necesidad de una cirugía más invasiva, o definitivo en los pacientes médicamente no candidatos a una artroplastia inversa. Es importante tener claras las indicaciones de este procedimiento para no cometer errores. Abstract: Introduction: One of the most frequently treated pathologies in our department are tendon lesions that affect the rotator cuff of the shoulder. There are different types of treatment for massive or irreparable tears. For a few years, a low-invasive technique was introduced based on the placement of a biodegradable subacromial spacer. The objective of the work is to analyse the results of our experience with the use of this device (InSpaceTM). Material and method: The study collects the results obtained in 25 patients with irreparable ruptures of rotator cuff defined by RM, in which they were implanted a balloon subacromial in our centre in the period from January 2015 – until December 2017. All patients were evaluated preoperatively and one year after surgery including the visual analogue scale (VAS), the Constant test (CS) and the QuickDASH (QD). Results: Of the 25 patients, 5 patients (20%) were operated by arthroscopy and 20 (80%) By open approach (mini-open). A total of 22 patients completed the follow-up year. At 12 months, 64% of the patients obtained an improvement of at least 10 points in the CS. Patients departed from an initial average CS of 32 points that improved to 54.9 points of average in the postoperative evaluation at 12 months (average improvement 22.9 points; Value-p < 0.05). In terms of pain assessment, in our study, 87% of patients obtained an improvement of at least 2 points in the EVA at 12 months of follow-up (P-value < 0.05). Patients departed from an initial average EVA of 8.7 that improved to 3.7 points average at 12 months. 73% of the patients responded to be satisfied with the intervention and would return to the surgery. Conclusión: The results obtained in our series to one year of follow-up speak in favour of the use of the Subacromial Balloon (InSpaceTM), as a therapeutic option available for patients with irreparable ruptures of the rotator cuff. It can be used as an interim procedure, delaying the need for more invasive surgery, or as a definitive procedure in patients medically non-candidates for reverse arthroplasty. It is important to have clear indications of this procedure in order not to make mistakes.

Introduction: One of the most frequently treated pathologies in our department are tendon lesions that affect the rotator cuff of the shoulder. There are different types of treatment for massive or irreparable tears. For a few years, a low-invasive technique was introduced based on the placement of a biodegradable subacromial spacer. The objective of the work is to analyse the results of our experience with the use of this device (InSpace™). Material and method: The study collects the results obtained in 25 patients with irreparable ruptures of rotator cuff defined by RM, in which they were implanted a balloon subacromial in our centre in the period from January 2015 — until December 2017. All patients were evaluated preoperatively and one year after surgery including the visual analogue scale (VAS), the Constant test (CS) and the QuickDASH (QD). Results: Of the 25 patients, 5 patients (20%) were operated by arthroscopy and 20 (80%) By open approach (mini-open). A total of 22 patients completed the follow-up year. At 12 months, 64% of the patients obtained an improvement of at least 10 points in the CS. Patients departed from an initial average CS of 32 points that improved to 54.9 points of average in the postoperative evaluation at 12 months (average improvement 22.9 points; value-p

Introduction In the Spanish population, previous studies related to mortality after hip fracture are based on patients aged 60–102 years and did not stratify patients according to the type of fracture. The objective of this study was to identify the factors with influence on mortality at one postoperative year in patients aged 80 years or older after a femoral neck fracture. Material and method Retrospective study of cases and controls. Consecutive patients operated between 2015 and 2016 were included. Baseline characteristics, medical history and previous medication, analytical parameters, Charlson index, ASA scale, Barthel index and Pfeiffer questionnaire were studied. Surgical data and complications were recorded during follow-up. Survival was assessed by the Kaplan–Meier method and the variables that affected it by Cox regression. Results Mortality one year postoperatively was 21.1% and mean survival 10.3 months (95% CI: 9.7–10.9). The Cox regression showed that age >87 years, Barthel score ≤ 85 and the combination of anticoagulants with INR ≥ 1.5 were significant predictors of mortality during the first year of follow-up. Conclusion The predictors of mortality during the first postoperative year after femoral neck fracture in octogenarian or older patients were: age >87 years, physical dependence measured by a Barthel index score ≤ 85, and the use of anticoagulants with a INR ≥ 1.5 at admission.

Resumen Introduccion En la poblacion espanola los estudios previos relacionados con la mortalidad tras fractura de cadera estan basados en pacientes con edades entre 60 a 102 anos y no estratificaban los pacientes de acuerdo con el tipo de fractura. El objetivo de este estudio fue identificar los factores con influencia sobre la mortalidad al ano postoperatorio en pacientes de 80 anos o mas que sufrieron una fractura cervical de cadera. Material y metodo Estudio retrospectivo de casos y controles. Fueron incluidos los pacientes consecutivos intervenidos entre 2015 y 2016. Se estudiaron las caracteristicas basales, los antecedentes y la medicacion previa, los parametros analiticos, el indice de Charlson, la escala ASA, el indice de Barthel y el cuestionario Pfeiffer. Se registraron los datos quirurgicos y las complicaciones durante el seguimiento. La supervivencia se evaluo mediante el metodo de Kaplan-Meier y las variables que la afectaban mediante la regresion de Cox. Resultados La mortalidad al ano postoperatorio fue del 21,1% y la supervivencia media de 10,3 meses (IC 95%: 9,7-10,9). La regresion de Cox mostraba que la edad > 87 anos, la puntuacion de Barthel ≤ 85 y la combinacion de anticoagulantes con INR ≥ 1,5 eran predictores significativos de mortalidad durante el primer ano de seguimiento. Conclusion Los factores predictores de mortalidad durante el primer ano postoperatorio por fractura cervical de cadera en pacientes octogenarios o mayores fueron la edad > 87 anos, la dependencia fisica medida a traves de una puntuacion en el indice de Barthel ≤ 85 y el uso de anticoagulantes con un INR ≥ 1,5 al ingreso.

Resumen Introduccion Una complicacion frecuente tras una artroplastia total de cadera es el sangrado, y para reducirlo se utiliza el acido tranexamico (TXA) intravenoso. Recientemente se han publicado los beneficios de su aplicacion topica. Consideramos necesario realizar un estudio que justifique que via de administracion resulta superior. Material y metodo Estudio prospectivo, controlado, aleatorizado en 2 brazos realizado entre febrero de 2017 a febrero de 2018. En el grupo A se administro 15 mg/kg TXA intravenoso y en el B 2 g TXA intraarticular. Se evaluo los valores de hemoglobina y hematocrito a las 24-72 horas, volumen de sangre drenado, volumen de sangre perdida, transfusiones y complicaciones. Resultados Fueron incluidos 78 pacientes, 31 con tratamiento intravenoso y 47 intraarticular. La hemoglobina descendio 3,15 ± 1,64 g/dl en 24 horas y 3,75 ± 1,56 g/dl en 72 horas en el grupo intravenoso, el hematocrito descendio un 10,4% ± 4,17% en 24 horas y 11,85% ± 4,15% en 72 horas. En el intraarticular se observo una caida de hemoglobina de 3,03 ± 1,30 g/dl en 24 horas y de 3,22 ± 1,2 g/dl en 72 horas y el hematocrito descendio 10,66% ± 3,6% y 12,11% ± 3,29% en 24 y 72 horas (p > 0,05). El drenaje medio en 24 horas fue 195,80 ml en el grupo A frente a 253,93 ml en el grupo B (p > 0,05) y a las 48 horas 225,33 ml en el grupo A y de 328,19 ml en el grupo-B (p = 0,009). En el grupo intravenoso perdieron una media de 1.505 ml de sangre frente a 1.280 ml del grupo intraarticular. Fueron necesarias un 5,1% de transfusiones. No tuvimos complicaciones secundarias. Conclusiones Las diferentes vias de administracion del TXA en la artroplastia total de cadera tienen un efecto similar en la reduccion del sangrado postoperatorio sin evidenciar un incremento de complicaciones.

Resumen Objetivo Evaluar los resultados clinicos y la supervivencia de las protesis de cadera primarias con par ceramica-ceramica ( C -C) de cuarta generacion implantadas en nuestro centro con un seguimiento minimo de 5 anos. Material y metodo Se estudiaron 205 artroplastias primarias de cadera realizadas entre 2008 y 2012. Los resultados clinicos, prequirurgicos y a los 5 anos de seguimiento fueron evaluados mediante el Harris Hip Score (HHS), el Short Form-36 (SF-36), el Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) y la escala analogica visual (EVA). Radiologicamente se estudiaron la posicion de los componentes protesicos, la osteolisis periprotesica, el aflojamiento de los componentes protesicos y las roturas de los componentes ceramicos. Se registraron los eventos adversos relacionados con el par segun su diametro, con especial atencion a las luxaciones protesicas y a la presencia de ruidos. La supervivencia con punto final como revision protesica por cualquier causa fue estimada mediante el metodo de Kaplan-Meier. Resultados Se obtuvieron mejorias significativas del HHS (88,7% de resultados buenos o excelentes), SF-36, WOMAC y EVA, p Conclusiones Las protesis primarias de cadera con par de friccion ceramica-ceramica de cuarta generacion han mostrado una buena supervivencia a medio plazo y buenos resultados clinicos.

Objective To assess the radiological and functional outcome of arthrodesis of the 4th and 5th finger using the APEX™ (Extremity Medical, Parsippany, NJ) intermedullary interlocking screw system in patients with severe recurrence of Dupuytren's disease. Materials and method The DASH questionnaire and the VAS scale were used to assess the clinical outcomes. The angle of arthrodesis, fusion time and implant fixation were evaluated on X-rays. The patients were monitored for complications during surgery and the follow-up period. Results The sample comprised 6 patients. Mean follow up was 19.6 months. All of the patients presented clinical and radiological evidence of fusion at 8 weeks, with fusion angles of 30° (3) and 45° (3). There were no complications and none of the implants had to be removed. The functional outcomes in these patients were poor. Conclusion The system offers a reliable method for IPJ arthrodesis at a precise angle. It promotes stable fixation that does not require prolonged immobilisation. It can be used together with other procedures on the hand with severe recurrence of DD. The functional outcomes for this group of patients using this device were poor.

Resumen Objetivo Valorar el resultado radiologico y funcional de la artrodesis de la articulacion IFP del 4.° o 5.° dedo de la mano mediante el sistema intramedular de tornillos entrelazados a compresion APEX™ (Extremity Medical, Parsippany, NJ) en pacientes afectos de recidiva grave de la enfermedad de Dupuytren. Material y metodo Los resultados clinicos se valoraron mediante el cuestionario DASH y la escala EVA. En las radiografias se evaluo el angulo de artrodesis, el tiempo de fusion osea y la fijacion del implante. Se observo cualquier complicacion encontrada durante la cirugia o en el periodo de seguimiento. Resultados La muestra estuvo representada por 6 pacientes. El seguimiento medio fue de 19,6 meses. Todos presentaron evidencia clinica y radiologica de fusion en 8 semanas, con un angulo de fusion de 30° (3) y 45° (3). No se presentaron complicaciones y no se tuvo que retirar ningun implante. Los resultados funcionales en este tipo de pacientes fueron pobres. Conclusion El sistema proporciona un metodo fiable para la artrodesis de la IFP en un angulo preciso. Promueve una fijacion estable que no requiere inmovilizacion prolongada. Puede usarse junto con otros procedimientos en la mano afecta por recidiva grave de ED. Los resultados funcionales con el uso de este dispositivo en este grupo de pacientes fueron pobres.

Introduction One of the most frequent complications after a total hip arthroplasty (THA) is bleeding, intravenous tranexamic acid (TXA) is used to reduce it. We considered it necessary to carry out a study to clarify which administration route is superior. Material and method Prospective, controlled and randomized study in 2 arms carried out between February 2017 and February 2018. 15 mg/kg of intravenous TXA were administered in group A and 2 g of intra-articular TXA in group B. The values of haemoglobin and haematocrit were evaluated at 24 h-72 h, blood loss volume, drained blood volume, transfusions and complications. Results 78 patients were included, 31 with intravenous treatment and 47 with intra-articular. The decrease of haemoglobin in the intravenous group was 3.15 ± 1.64 g/dl in 24 h and 3.75 ± 1.56 g/dl in 72 h, the haematocrit decreased by 10.4 ± 4.17% in 24 h and 11.85 ± 4.15% in 72 h. In the intra-articular group there was a haemoglobin fall of 3.03 ± 1.30 g/dl in 24 h and 3.22 ± 1.2 g/dl in 72 h and the haematocrit fell by 10.66 ± 3.6% and 12.11 ± 3.29% in 24 and 72 h (p > .05). The mean drainage in 24 h was 195.80 ml in group A versus 253.93 ml in group B (p > .05) and in 48 h it was 225.33 ml in group A and 328.19 ml in group B (p = .009). The intravenous group lost an average of 1505 ml of blood compared to the 11,280 ml of the intra-articular group. In 5.1% of the cases, transfusions were necessary. We had no secondary complications. Conclusions The different routes of administration of TXA in THA have a similar effect in the reduction of postoperative bleeding. There was no evidence of an increase in complications.

Objective To evaluate the clinical results and survival of primary hip prosthesis with ceramic delta bearings (C-C) with a minimum follow-up of 5 years. Material and method A total of 205 primary hip arthroplasties performed between 2008 and 2012 were studied. The clinical results, pre-surgical and at 5 years of follow-up were evaluated using the Harris Hip Score (HHS), the Short Form-36 (SF-36), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and the visual analogue scale (VAS). The position of the prosthetic components, periprosthetic osteolysis, loosening of the prosthetic components and ruptures of the ceramic components were studied radiologically. The adverse events related to bearings were recorded according to their diameter, paying special attention to prosthetic dislocations and the presence of noise. Survival with an endpoint of prosthetic revision for any cause was estimated using the Kaplan–Meier method. Results Significant improvements were obtained in the HHS (88.7% of good/excellent results), SF36, WOMAC and EVA, p Conclusions Primary hip prostheses with fourth-generation ceramic bearings showed good survival in the medium term, and good clinical results.

Objective The purpose of this study is to assess the need to lock the Gamma 3 nail (Stryker, Mahwah, New Jersey, USA) distally for intertrochanteric fractures of femur 31-A1 and 31-A2 of the AO. Materials and methods Details were recorded on a sample of 177 patients with intertrochanteric femoral fractures treated in our hospital by a standard Gamma nail between June 2011 and January 2013. A prospective study was conducted by randomizing patients by year of birth, even numbers with, or odd numbers without, and distal locking, forming two groups of 90 and 87 fractures, respectively. Results The patients treated with a distal locking nail had an increased incidence of medical complications, a lower incidence of biomechanical complications, and an increase in the fracture collapse compared with the control group, with statistical significance ( P P Conclusions Based on the results found in this work, the use of distal locking screw in the Gamma 3 nails should be restricted to unstable trochanteric fractures after reduction where additional stability to the intramedullary nail is required, and may decrease the risk of complications from use.

Objetivo El propósito de este estudio es valorar la necesidad de bloquear distalmente los clavos Gamma 3 (Stryker. Mahwah, New Jersey. USA) en fracturas pertrocantéreas de fémur 31-A1 y 31-A2 de la AO. Material y métodos Desde junio de 2011 hasta enero de 2013 se recoge una muestra formada por 177 pacientes con fractura pertrocantérea de fémur tratados en nuestro centro mediante osteosíntesis con clavo Gamma 3 estándar. Es un estudio prospectivo y aleatorizado según el año de nacimiento de cada paciente, par con bloqueo o impar sin bloqueo distal del clavo, formando dos grupos de 90 y 87 fracturas respectivamente. Resultados En los pacientes intervenidos mediante clavo con bloqueo distal se observó una mayor incidencia de complicaciones médicas, una menor incidencia de complicaciones biomecánicas y un aumento en el colapso del foco de fractura en comparación con el grupo control, siendo estas diferencias estadísticamente significativas (p < 0,05). También se observa en el grupo con bloqueo distal un mayor requerimiento transfusional y una mayor tasa de éxitus presentando diferencias estadísticamente significativas (p < 0,05), sin embargo esta significación desaparece al ajustar los resultados por otras características relacionadas con los pacientes. Conclusiones Basándonos en los resultados hallados en este trabajo, el uso del tornillo de bloqueo distal en los clavos Gamma 3 debe restringirse a fracturas pertrocantéreas inestables tras reducción donde se requiera una estabilidad adicional al clavo intramedular, pudiendo así disminuir el riesgo de complicaciones derivadas de su uso. Objective The purpose of this study is to assess the need to lock the Gamma 3 nail (Stryker, Mahwah New Jersey USA) distally for intertrochanteric fractures of femur 31-A1 and 31-A2 of the AO. Material and methods Details were recorded on a sample of 177 patients with intertrochanteric femoral fractures treated in our hospital by a standard Gamma nail between June 2011 and January 2013. A prospective study was conducted by randomizing patients by year of birth, even numbers with, or odd number without, distal locking, forming two groups of 90 and 87 fractures, respectively. Results The patients treated with a distal locking nail had an increased incidence of medical complications, a lower incidence of biomechanical complications, and an increase in the fracture collapse compared with the control group, with statistical significance (p < 0.05). It is also observed in the group with distal locking increased transfusion requirement and a higher death rate, with statistically significant differences (p < 0.05), but this significance disappears when adjusting for other patient-related characteristics. Conclusions Based on the results found in this work, the use of distal locking screw in the Gamma 3 nails should be restricted to unstable trochanteric fractures after reduction where additional stability to the intramedullary nail is required, and may decrease the risk of complications from use.