Search

Resumen: Objetivo: El objetivo principal de este estudio es comparar proporcionalmente la incidencia de artroplastia total de tobillo (ATT) frente a artrodesis de tobillo y determinar las variables que han podido influir en su indicación. El objetivo secundario es analizar la tendencia en el uso de ATT utilizando un análisis de base poblacional y comparar nuestros resultados con los informados por los registros nacionales de otros países. Material y método: Se realizó una revisión retrospectiva del conjunto mínimo básico de datos de 1997-2017. Los sujetos fueron categorizados según el procedimiento quirúrgico. Se analizo su evolución temporal y se identificaron las variables hospitalarias asociadas con la indicación (edad, sexo, complejidad del hospital). Para poder comparar la tendencia en España con respecto a otros países se estandarizó la información como número de procedimientos por cada 100.000 habitantes/año y se realizó la proyección para el quinquenio 2020-2025. Resultados: En el periodo 1997-2017 se realizaron 11.669 artrodesis de tobillo y 1.049 ATT. La tendencia fue creciente y significativa para ambos procedimientos, sin embargo, en los últimos 10 años analizados la tendencia proporcional de ATT decreció de manera significativa. El ser mujer (OR 1,32), tener 65 o más años (OR 1,50) y ser intervenido en un hospital complejo (OR 1,31) se asociaban con la indicación de una ATT. Comparativamente con el resto de los países, España presenta tasas de utilización de ATT mucho más bajas y para el año 2025 se estima un crecimiento mínimo. Conclusión: A pesar de que ha aumentado el uso de ATT, su crecimiento ha sido menor que el de la artrodesis de tobillo y proporcionalmente su tendencia actual es decreciente, estando asociados con la indicación de ATT el sexo femenino, la edad ≥ 65 años y que el paciente sea intervenido en un hospital de media/alta complejidad. Comparativamente con otros países, España presenta tasas de utilización mucho más bajas y su proyección en el próximo quinquenio, aunque creciente, se prevé que será mínima. Abstract: Objective: The main objective of this study is to compare proportionally the incidence of total ankle arthroplasty (TAA) versus ankle arthrodesis and to determine the variables that may have influenced its indication. The secondary objective is to analyse the trend in the use of TAA using a population-based analysis and to compare our results with those reported by national registries in other countries. Material and method: A retrospective review of the Minimum Basic Data Set from 1997-2017 was performed. Subjects were categorised according to surgical procedure. Their temporal evolution was analysed and hospital variables associated with the indication (age, sex, hospital complexity) were identified. In order to compare the trend in Spain with respect to other countries, the information was standardised as number of procedures per 100,000 inhabitants/year and a projection was made for the five-year period 2020-2025. Results: In the period 1997-2017, 11,669 ankle arthrodesis and 1,049 TAAs were performed. The trend was increasing and significant for both procedures, however, in the last 10 years analysed the proportional trend of TAA decreased significantly. Being female (OR 1.32), being 65 years or older (OR 1.50) and being operated in a complex hospital (OR 1.31) were associated with the indication for a TAA. Compared to other countries, Spain has much lower rates of TAA utilisation, with minimal growth estimated for the year 2025. Conclusion: Although the use of TAA has increased, its growth has been lower than that of ankle arthrodesis and its current trend is proportionally decreasing, with female sex, age ≥ 65 years and the patient being operated in a medium/high complexity hospital being associated with the indication for TAA. Compared with other countries, Spain has much lower rates of use and its projection over the next five years, although increasing, is expected to be minimal.

PURPOSE: The main objective was to analyze the computer-assisted navigation (CAN)-specific complications that forced to switch to conventional procedure in primary total knee replacement (TKR). The secondary objective was to determine the influence of those complications on TKR short-term survival. METHODS: Retrospective study of 878 primary TKR in 753 patients. Two consecutive versions of the OrthoPilot navigation system (Braun Aesculap, Germany) were used during the study time. Specific complications of CAN were defined as those due to the instrumentation (hardware or software failures), which were classified in one of two categories according to whether they occurred during the registration or tracking process. RESULTS: There were 20 (2.3%) complications related to the navigation system use that forced to switch to conventional surgery: in 11 (1.2%) knees due to loosening of the tracking pins, and in the other nine (1.0%) there were information system failures. There was a trend for a higher conversion rate to conventional surgery with the use of the first version of the software. There were no fractures, infections, or nerve injuries at the pin site. We found no differences in the distribution of baseline variables among those with or without conversion to conventional surgery. There was no significant difference (p = 0.488) in the two year survival between patients with or without conversion. CONCLUSION: CAN for primary TKR is a safe method with few specific complications that forced to switch from the navigated to the conventional procedure. Conversion to conventional surgery did not affect the short-term survival of TKR.

Objective Assessment of the treatment trends of Spanish surgeons in clinical practice by making clinical assumptions in Dupuytren's disease (DD). Material and Method A survey was sent to the members of the Spanish Society for Surgery of the Hand (Sociedad Española de Cirugía de la Mano, SECMA) posing primary and secondary clinical cases. A relationship is established between the selected treatment, the characteristics of the participating surgeons, and the characteristics of the primary clinical cases. Treatment preferences in recurrences are assessed descriptively. Results In total, 127 surveys were answered. 62.2% of the participants had experience with the use of collagenase and were the basis of the analysis. In primary cases, surgeons with more practice time tended to choose collagenase as treatment for DD. Surgeons who reported higher frequency of collagenase use (67.4% vs. 25.7%) were up to 6 times more likely to indicate such treatment. The patient's age under 50 years was the variable with the greatest association strength for the choice of collagenase treatment (OR = 3.8; CI95% 1.9–7.6). In recurrences, among all clinical cases, the most common answer given by the surgeons was partial fasciectomy. Conclusions Partial fasciectomy continues to be the most widely used treatment for DD in Spain. In primary cases, collagenase is an alternative adopted by experienced surgeons, and in treatments for young patients. In recurrences, partial fasciectomy is the preferred technique.

Objective To evaluate the use of WhatsApp as a clinical tool and determine the perception of orthopaedic surgeons of its usefulness. Material and methods Orthopaedic surgeons attending a scientific meeting were invited to complete an anonymous and structured survey on the use of the application in the clinical setting. Results A total of 41 (38%) surveys were correctly completed. Of the respondents, 100% had been either senders or receivers of clinical information via the application. Ninety-three per-cent had used the application to consult in relation to a clinical case. Of the respondents, 78% belonged to a WhatsApp group in which clinical information is shared: 71% agreed that communication between clinicians through WhatsApp is a useful tool for making therapeutic decisions. Conclusion The use of WhatsApp for clinical purposes by orthopaedic surgeons is widespread. Most consider it a useful tool in therapeutic decision making.

Resumen Objetivo Existe una tendencia actual en la poblacion sobre la busqueda de informacion medica no cualificada en Internet que puede influir sobre las recomendaciones aportadas en una consulta especializada. El objetivo de este estudio fue analizar la tendencia de la poblacion espanola sobre la busqueda de informacion no cualificada en Internet respecto de los tratamientos actuales de la artrosis. Material y metodo Para analizar la informacion recabada en Internet se utilizo la herramienta informatica Google Trends, combinando potenciales terminos clave de busqueda que se relacionaban con el tratamiento actual de la artrosis. Para cada termino, se calculo el volumen relativo de busquedas, y su tendencia entre 2009 y 2019. La direccion de la tendencia se estudio mediante la correlacion de Spearman. Resultados Todos los metodos de infiltracion tuvieron tendencias crecientes sin encontrar diferencias estadisticamente significativas entre ellos (p = 0,769). El termino que mostraba una mejor correlacion a lo largo del tiempo fue «prp», con un valor para la correlacion de Spearman de 0,90 y el que mayor volumen relativo de busquedas tuvo fue «factores de crecimiento». El tratamiento protesico genero mas interes que los tratamientos conservadores, fue mayor para la sustitucion protesica de rodilla que para la de cadera (p Conclusion En Espana, la busqueda de informacion no cualificada sobre el tratamiento de la artrosis se ha incrementado en los ultimos 10 anos. El interes sobre el tratamiento protesico es mayor que sobre tratamientos mas conservadores. La protesis de rodilla genera mayor interes que la de cadera. No hay diferencias respecto a los distintos metodos de infiltracion intraarticular.

Resumen Objetivo Evaluar el uso del WhatsApp como una herramienta clinica y determinar la percepcion de los cirujanos ortopedicos sobre su utilidad. Material y metodo Se invito a los cirujanos ortopedicos asistentes a una reunion cientifica a completar in situ una encuesta anonima y estructurada sobre el uso de la aplicacion en el ambito clinico. Resultados En total 41 (38%) encuestas fueron correctamente completadas. La totalidad de los que respondieron habian sido emisores o receptores de informacion clinica a traves de la aplicacion. El 93% habia utilizado la aplicacion para consultar con relacion a un caso clinico. El 78% pertenecian a un grupo de WhatsApp en el cual se compartia informacion clinica. El 71% se mostro de acuerdo con que la comunicacion entre clinicos a traves del Whatsapp es una herramienta util para la toma de decisiones terapeuticas. Conclusion El uso del WhatsApp para fines clinicos de los cirujanos ortopedicos esta generalizado. La mayoria de estos lo consideran una herramienta util en la toma de decisiones terapeuticas.

Resumen Fundamento y objetivo Valorar la utilidad de una la escala de riesgo basada en la procalcitonina serica (PCT) comparada con la escala Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) en la discriminacion precoz entre la fascitis necrosante (FN) y la celulitis en las extremidades. Material y metodo Estudio retrospectivo de pacientes consecutivos con diagnostico confirmado de FN en una extremidad (n = 11). Ese grupo de estudio fue comparado con 23 pacientes consecutivos con diagnostico de celulitis severa en miembros en el mismo periodo. Se analizaron los datos clinicos y los parametros rutinarios de laboratorio, siendo la variable principal el nivel serico de PCT al ingreso. La capacidad de discriminacion para el diagnostico de FN de los dos metodos —nivel de PCT y puntuacion de la escala LRINEC— fue evaluada mediante la curva COR y determinada por el calculo del area bajo la curva (ABC). Resultados El ABC fue significativamente mayor con la medicion de la PCT, tanto como variable continua como cuando el riesgo era categorizado. El punto de corte para el nivel de PCT con mayor ABC bajo la curva fue a partir de 0,87 ng/ml (sensibilidad 90,9%; especificidad 82,6%), mientras que alcanzaba una puntuacion de 5 en la escala LRINEC (sensibilidad 72,7%; especificidad 82,6%). Conclusion La medicion de la PCT fue un metodo mas efectivo que la escala LRINEC para discriminar precozmente entre FN y celulitis de las extremidades. Un nivel bajo de PCT, asociado al cuadro clinico y a la exploracion fisica, es de especial utilidad para descartar el diagnostico precoz de FN.

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 Objetivo Identificar los factores con influencia sobre la aparicion de necrosis avascular de cabeza femoral (NACF) en pacientes con fracturas del cuello femoral no desplazadas tratadas con fijacion interna. Material y metodo Estudio retrospectivo de casos y controles. Se incluyeron las fracturas de cuello femoral no desplazada, tratadas con fijacion interna, y que presentaron NACF tras un seguimiento postoperatorio de al menos 2 anos. Se registraron las variables basales, las comorbilidades activas de los pacientes, asi como el tiempo para la cirugia y el numero de tornillos utilizados para la osteosintesis. Se realizaron comparaciones entre los grupos, aquellos que presentaron NACF y los que no. Mediante el area bajo la curva se localizaron los puntos de corte de las variables edad y tiempo para la cirugia. Resultados No encontramos asociacion entre el sexo, las comorbilidades activas y el numero de tornillos utilizados y el desarrollo de NACF. Los puntos de corte para la edad y el tiempo para la cirugia fueron ≤ 69 anos y ≤ 43 h, respectivamente. No encontramos asociacion estadisticamente significativa para el punto de corte del tiempo para la cirugia. En el analisis multivariante, la edad ≤ 69 anos fue un predictor significativo de desarrollo de NACF (OR 4,6; IC 95% 1,1-17,9; p = 0,028). Conclusiones Los pacientes con una edad igual o menor de 69 anos presentaban un mayor riesgo de desarrollar NACF tras fractura no desplazada del cuello femoral tratada con fijacion percutanea atornillada.

Objective To identify the factors with influence on the development of avascular necrosis of the femoral head (ANFH) in patients with non-displaced femoral neck fractures treated with internal fixation. Material and method Retrospective study of cases and controls. We included non-displaced femoral neck fractures treated with internal fixation, and that presented ANFH with a postoperative follow-up of at least 2 years. The baseline variables, active comorbidities of the patients, the time for surgery and the number of screws used for osteosynthesis were recorded. Comparisons were made between the groups, those that presented ANFH and those that did not. By area under the curve, the cut-offs of age and time for surgery were located. Results An association between sex, active comorbidities and number of screws used and the development of ANFH was not observed. The cut-off points for age and time for surgery were ≤69 years and ≤43 h, respectively. No significant correlation was observed for the cut-off time for surgery. In the multivariate analysis, age ≤69 years was a significant predictor of the development of ANFH (OR 4.6; 95% CI 1.1–17.9; P = .028). Conclusions The patients aged 69 years or younger were at increased risk of developing ANFH after undisplaced femoral neck fracture treated with percutaneous screws.

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.

BACKGROUND: Standard resections according to the TKR manufacturers can lead to unnecessary bone resections in some patients. The objective of this study was to determine in which patients is recommended to perform a minimal tibial resection (MTR) that could restore the joint line height (JLH). METHODS: Navigation records of 108 consecutive posterior cruciate-substituting TKR performed by one surgeon were analyzed. Optimal tibial resection depth to restore the JLH (0 mm) was calculated by an algorithm. Postoperatively, the knees were distributed in two groups: those in which a MTR (depth = 8 mm) would have been enough to restore the JLH and those in which a standard resection depth would have been necessary. ROC curves and Youden index were used to determine the cutoff point of the coronal and sagittal mechanical axis that predicted a MTR restoring the JLH. Multivariate analysis was used to identify independent factors associated with requiring an MTR. RESULTS: A MTR could be required in 20 (18.5%) knees. In the ROC curve analyses, the cutoff points that best discriminated between minimal and standard tibial resection was = 3° of varus and < 2° of flexion preoperative deformity. Multivariate analysis showed that female gender and preoperative flexion < 2° were significant predictors of requiring a MTR to restore JLH. CONCLUSION: A MTR with the JLH restoration could be possible in female patients with a preoperative sagittal deformity less than 2° of flexion. Preoperative coronal alignment had no influence to discriminate when a MTR is required.

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.

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.

The objective was to assess aseptic complications and functional outcome using a primary total hip arthroplasty with modular neck. Prospective cohort of 317 consecutive patients. The mean age was 61.1 (range, 41–84) years. The H-Max-M model (Lima, Italy) system was used in all patients. The functional assessment was made by the Harris Hip Score, Short Form-36 (SF-36), Western Ontario and McMaster Universities Osteoarthritis Index and visual analogue scale for pain. Radiological outcomes were also assessed, and adverse events and complications were noted. The mean follow-up was 6.1 (range, 2–8) years. Functional outcome significantly improved in most patients. There were 3 deep infections (0.9%) and 17 aseptic complications (5.3%) including 1 intraoperative acetabular fracture, 3 later periprosthetic femoral fractures, 1 broken ceramic insert, 1 acetabular loosening, 3 femoral loosening and 1 broken titanium modular neck in a obese patient. No pseudotumors or elevated serum levels of metal ions were found among the patients with radiolucent lines or aseptic loosening. The findings in the present study showed that the H-MAX-M stem provided satisfactory functional outcome in most patients with a low rate of complications attributable to the modular neck design. We consider that using this novel modular neck-stem coupling design can be an alternative to the conventional monoblock stems in patients without overweight.

ResumenEs importante que todos los especialistas que tratan a pacientes afectados de artritis reumatoide (AR), conozcan las distintas opciones terapéuticas disponibles, tanto médicas como quirúrgicas, y su manejo en las distintas fases del tratamiento. Nuestro objetivo es actualizar lo que como cirujanos debemos saber sobre el tratamiento médico de la enfermedad, cómo manejar los fármacos durante la programación de la cirugía y cuál es la evidencia sobre las distintas opciones quirúrgicas que podemos barajar ante diversas situaciones originadas por un aparente mismo patrón: la sinovitis.

Objetivo Evaluar los resultados clínicos y radiográficos de una serie de pacientes sometidos a una artroplastia de Scheker. Material y Método Estudio descriptivo de 16 pacientes con artrosis TMC. Se valoró el estado clínico y funcional según el cuestionario DASH, la movilidad del pulgar según la escala de Kapandji y el dolor según la escala visual analógica (EVA). A nivel radiográfico, se cuantificó el colapso del espacio remanente tras la exéresis del trapecio. Resultados La edad promedio de los pacientes fue 64,9 años, 81% fueron mujeres. El tiempo de seguimiento medio fue de 19 meses. La puntuación DASH preoperatoria fue de 67,68 puntos y postoperatoria 34,88 (p Conclusión La artroplastia descrita por Scheker, es una alternativa quirúrgica que elimina el dolor y preserva la movilidad del pulgar. No evita el colapso del espacio dejado tras la exéresis del trapecio. No hubo diferencia en el resultado clínico entre los pacientes en los que se presentó un colapso leve o moderado.

Resumen La intoxicacion por cobalto despues de la revision de una artroplastia total de cadera es poco comun, pero una complicacion potencialmente devastadora. Los sintomas incluyen: cardiomiopatia, hipotiroidismo, erupciones en la piel, alteraciones visuales, cambios en la audicion, policitemia, debilidad, fatiga, deterioro cognitivo y neuropatia. Presentamos el caso de un varon de 74 anos que tras recambio a par ceramica-ceramica y dos episodios de luxacion protesica se decidio nuevo recambio a par polietileno-metal. A los 6 meses de la reintervencion comenzo con clinica de intoxicacion por cobalto, confirmada mediante determinacion analitica, presentando niveles pico de cobalto en suero de 651,2 μg/l. Tras retirada protesica y reimplante, se normalizaron los niveles de cromo y cobalto en sangre y orina, encontrandose el paciente actualmente asintomatico. Recomendamos el uso de pares ceramica-ceramica en las cirugias de revision de cadera tras rotura de componentes ceramicos para reducir al minimo el riesgo de toxicidad por cobalto.

Symptomatic cobalt toxicity from a failed total hip replacement is a rare, but devastating complication. Potential clinical findings include cardiomyopathy, hypothyroidism, skin rash, visual and hearing impairment, polycythaemia, weakness, fatigue, cognitive impairment, and neuropathy. The case is presented of a 74 year-old man in whom, after a ceramic–ceramic replacement and two episodes of prosthetic dislocation, it was decided to replace it with a polyethylene–metal total hip arthroplasty (THA). At 6 months after the revision he developed symptoms of cobalt toxicity, confirmed by analytical determination (serum cobalt level = 651.2 μg/L). After removal of the prosthesis, the levels of chromium and cobalt in blood and urine returned to normal, with the patient currently being asymptomatic. It is recommended to use a new ceramic on ceramic bearing at revision, in order to minimise the risk of wear-related cobalt toxicity following breakage of ceramic components.

Objective There is a current trend in the population to search the internet for unqualified medical information that may affect the recommendations given in specialist consultation. The aim of this study was to analyse the tendency of the Spanish population to search the internet for unqualified information on current treatments for osteoarthritis. Material and method Google Trends was used to analyse the information gathered from the Internet, combining potential key search terms related to the current treatment of osteoarthritis. For each term the Relative Search Volume (RSV) was calculated, and its trend between 2009 and 2019. Spearman’s correlation (SC) was used to study the direction of the trend. Results All the infiltration methods had increasing trends and no statistically significant differences were found between them (p = .769). The term that showed the best correlation over time was “prp” with SC = .90, and the term with the highest RSV was “growth factors”. Prosthetic treatment generated more interest than conservative treatments, where there was more interest in knee replacement than hip replacement (p Conclusion In Spain, the search for unqualified information on the treatment of osteoarthritis has increased over the past 10 years. There is more interest in prosthetic treatment than the more conservative treatments. There is more interest in knee replacement than hip replacement. There are no differences with regard to the different methods of joint injections.

Background and objective: To assess the usefulness of a risk scale based on serum procalcitonin (PCT) compared to the Laboratory Risk Indicator for Necrotising Fasciitis (LRINEC) scale in the early discrimination between necrotising fasciitis (NF) and cellulitis of the extremities. Materials and methods: Retrospective study of consecutive patients with confirmed diagnosis of NF in one limb (n = 11). This study group was compared with 23 consecutive patients with a diagnosis of severe limbs cellulitis during the same period. The clinical data and laboratory parameters were analysed, the main variable was the serum level of PCT upon admission. The capacity for NF diagnosis of the two methods, PCT level and LRINEC scale score, were evaluated by ROC curve and determined by the calculation of the area under the curve (AUC). Results: The AUC was significantly higher with PCT measurement, both as a continuous variable and when the risk was categorised. The cut-off point for the PCT level with the highest AUC under the curve was from 0.87 ng/ml (sensitivity 90.9%, specificity 82.6%), whereas it was a score of 5 on the LRINEC scale (sensitivity 72.7%, specificity 82.6%). Conclusion: PCT measurement was a more effective method than the LRINEC score for early discrimination between NF and cellulitis of the extremities. A low level of PCT, associated with the patient's clinical status and physical examination is especially useful to rule out an early diagnosis of NF. (C) 2019 Elsevier Espafia, S.L.U. All rights reserved.

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.

Resumen La infeccion profunda de la herida despues del reemplazo de la articulacion de la cadera es una de las complicaciones mas devastadoras que enfrentan tanto el medico como el paciente, El cemento oseo mezclado con antibiotico esta bien aceptado para el tratamiento de una infeccion establecida. Sin embargo, su papel en la profilaxis de la infeccion sigue siendo controvertido debido a cuestiones relacionadas con el aumento de la resistencia bacteriana, la eficacia y el coste. Hemos revisado la bibliografia sobre el uso extendido del cemento oseo mezclado con antibioticos. Concluimos que se debe valorar el riesgo-beneficio individual en el momento de indicar el uso del cemento mezclado con antibioticos en la profilaxis de protesis de cadera.