Pablo A Slullitel | Universidad Nacional de Rosario (UNR) Argentina (original) (raw)
Papers by Pablo A Slullitel
Revista de la Asociación Argentina de Ortopedia y Traumatología, 2021
Objetivo: Describir la técnica quirúrgica, las indicaciones y los resultados iniciales de la oste... more Objetivo: Describir la técnica quirúrgica, las indicaciones y los resultados iniciales de la osteotomía periacetabular bernesa para tratar la displasia del desarrollo de la cadera. Materiales y Métodos: Entre mayo de 2011 y mayo de 2020, se realizaron 44 osteotomías periacetabulares bernesas en 44 pacientes (35 mujeres, edad promedio 30 años [rango 23-38]). Todos tenían diagnóstico de displasia de cadera sintomática. El ángulo centro-borde promedio fue de 17° (rango 9°-20°) y el índice acetabular promedio, de 18° (rango 15°-20°). En 22 casos, se evaluaron y repararon los hallazgos intrarticulares por artroscopia en el mismo acto quirúrgico. Se evaluaron la corrección obtenida, la consolidación de la osteotomía y los resultados funcionales al final del seguimiento. Resultados: En 22 pacientes, se detectó hipertrofia y rotura del labrum acetabular asociadas a displasia de cadera. Diez pacientes tenían quistes paralabrales. El ángulo centro-borde promedio posoperatorio fue de 32° (rang...
Revista de la Asociación Argentina de Ortopedia y Traumatología, 2021
Objetivos: El tratamiento de elección para las fracturas femorales periprotésicas Vancouver B3 aú... more Objetivos: El tratamiento de elección para las fracturas femorales periprotésicas Vancouver B3 aún no está definido. Por este motivo, nos propusimos analizar la tasa de complicaciones de la técnica de injerto óseo impactado con un vástago cementado cuando se utiliza para tratar estas fracturas. Materiales y Métodos: Estudiamos retrospectivamente 33 fracturas femorales periprotésicas B3 tratadas con la técnica de injerto óseo impactado operados entre 2000 y 2016, analizando la tasa de complicaciones. La mediana de seguimiento fue de 75 meses (RIC 36-111). La mediana de edad fue de 78 años (RIC 74-83). La mediana del defecto óseo femoral fue 3 (RIC 3-3) según la clasificación de la Endo-Klinik. Se realizó un análisis de regresión múltiple para determinar los factores de riesgo asociados a complicaciones, las variables incluidas fueron: cantidad de cirugías previas, diámetro de la nueva cabeza femoral y defecto óseo femoral. Resultados: Se realizó una cirugía de revisión en dos etapas ...
European Journal of Orthopaedic Surgery & Traumatology, 2021
This study aimed to report the initial results of the cementless UNITED hip system in primary tot... more This study aimed to report the initial results of the cementless UNITED hip system in primary total hip arthroplasty (THA) with a minimum follow-up of 2 years. We retrospectively studied a consecutive series of 203 cementless THAs in 180 patients operated between 2015–2017. We included 89 female and 91 male patients with a mean age of 67 (28 to 89) years. The mean follow-up was 40 (29 to 62) months. Clinical outcome scores and radiographs were measured. Survival was calculated defining failure as the need for any further femoral or acetabular revision, irrespective of the reason. No femoral component loosening was detected. One patient had a Vancouver-B1 intraoperative periprosthetic femoral fracture treated with implant retention and cerclage wires. Two acetabular components were revised for aseptic loosening. Three patients suffered an acute infection treated with debridement, antibiotics, and implant retention. The mean Merle d'Aubigné et Postel scores improved from 13 (4 to 16) points preoperatively to 17 (12 to 18) points at the latest follow-up (p < 0.001). At a mean time of 40 months of follow-up, the survival was 99% and 100% for the acetabular and the femoral components, respectively. This cementless design showed excellent preliminary outcomes in terms of fixation and patient satisfaction, comparable to that of other well-known similar systems.
This study aimed to report the initial results of the cementless UNITED hip system in primary tot... more This study aimed to report the initial results of the cementless UNITED hip system in primary total hip arthroplasty (THA) with a minimum follow-up of 2 years. Methods We retrospectively studied a consecutive series of 203 cementless THAs in 180 patients operated between 2015-2017. We included 89 female and 91 male patients with a mean age of 67 (28 to 89) years. The mean follow-up was 40 (29 to 62) months. Clinical outcome scores and radiographs were measured. Survival was calculated de ning failure as the need for any further femoral or acetabular revision, irrespective of the reason. Results No femoral component loosening was detected. One patient had a Vancouver-B1 intraoperative periprosthetic femoral fracture treated with implant retention and cerclage wires. Two acetabular components were revised for aseptic loosening. Three patients suffered an acute infection treated with debridement, antibiotics, and implant retention. The mean Merle d'Aubigné et Postel scores improved from 13 (4 to 16) points preoperatively to 17 (12 to 18) points at the latest follow-up (p < 0.001). At a mean time of 40 months of follow-up, the survival was 99% and 100% for the acetabular and the femoral components, respectively. Conclusion This cementless design showed excellent preliminary outcomes in terms of xation and patient satisfaction, comparable to that of other well-known similar systems.
Following a total hip arthroplasty (THA), early hospital readmission rates of 3–8% are considered... more Following a total hip arthroplasty (THA), early hospital readmission rates of 3–8% are considered as ‘acceptable’ in terms of medical care cost policies. Surprisingly, the impact of readmissions on mortality has not been priorly portrayed. Therefore, we aimed to analyse the mortality of unplanned readmissions after primary THA at a high-volume Argentinian center. We prospectively analysed 90-day readmissions of 815 unilateral, elective THA patients operated between 2010–2014 whose medical insurance was the one offered by our institution. Mean follow-up was 51 months (range, 37–84). Median age was 69 (IQR, 62–77). We stratified our sample into readmitted and non-readmitted cohorts. Through a Cox proportional hazard model, we compared demographic characteristics, clinical comorbidities, surgical outcomes and laboratory values between both groups in order to determine association with mortality. We found 37 (4.53%) readmissions at a median time of 40.44 days (IQR: 17.46–60.69). Factors associated with readmi...
Arthroplasty Today, 2020
Background This study aims to analyze the ability to restore hip biomechanics in patients who und... more Background This study aims to analyze the ability to restore hip biomechanics in patients who undergo total hip arthroplasty for displaced femoral neck fractures operated by either hip surgeons (HSs) or orthopaedic residents (ORs). Methods We retrospectively compared 95 patients treated by HSs (group A) with 110 patients treated by ORs (group B). Leg-length discrepancy, femoral offset (FO), center of rotation (COR), acetabular inclination, and acetabular anteversion were evaluated on postoperative radiographs using the healthy contralateral hip as control. Results The median leg-length discrepancy was 2 mm for both groups (P = .74). The leg length was increased in 54% of the HS group and 57% of the OR group (P = .13). The median FO difference of groups A and B were 7 mm and 5.5 mm, respectively (P = .14). FO was increased in 80% of the HS group and 69% of the OR group (P = .19). Median discrepancies of the horizontal and vertical CORs were not statistically relevant, with P-values o...
Femoral offset restoration is related to low rates of wear and dislocation. Replication of the na... more Femoral offset restoration is related to low rates of wear and dislocation. Replication of the native hip anatomy improves prosthesis survival, whereas increasing the femoral offset elevates the torque stresses, thus inducing a risk of suboptimal stem fixation. Although the Corail (DePuy Synthes, St Priest, France) uncemented stem has an excellent record of fixation, an unexpectedly number of aseptic loosenings has been noted in our institution. We sought to characterize the clinical parameters observed in a group of patients who have experienced metaphyseal aseptic loosenings with the collarless version of the Corail uncemented femoral component; describe the radiographic findings in this group of patients; expose the intraoperative findings in the cases that needed revision surgery and to calculate a possible frequency of this complication. We present a series of 15 metaphyseal debondings of the collarless version of the Corail uncemented stem in primary total hip arthroplasty. El...
The Bone & Joint Journal, 2021
Aims There is a paucity of long-term studies analyzing risk factors for failure after single-stag... more Aims There is a paucity of long-term studies analyzing risk factors for failure after single-stage revision for periprosthetic joint infection (PJI) following total hip arthroplasty (THA). We report the mid- to long-term septic and non-septic failure rate of single-stage revision for PJI after THA. Methods We retrospectively reviewed 88 cases which met the Musculoskeletal Infection Society (MSIS) criteria for PJI. Mean follow-up was seven years (1 to 14). Septic failure was diagnosed with a Delphi-based consensus definition. Any reoperation for mechanical causes in the absence of evidence of infection was considered as non-septic failure. A competing risk regression model was used to evaluate factors associated with septic and non-septic failures. A Kaplan-Meier estimate was used to analyze mortality. Results The cumulative incidence of septic failure was 8% (95% confidence interval (CI) 3.5 to 15) at one year, 13.8% (95% CI 7.6 to 22) at two years, and 19.7% (95% CI 12 to 28.6) at ...
The Bone & Joint Journal, 2021
Aims We aimed to compare the implant survival, complications, readmissions, and mortality of Vanc... more Aims We aimed to compare the implant survival, complications, readmissions, and mortality of Vancouver B2 periprosthetic femoral fractures (PFFs) treated with internal fixation with that of B1 PFFs treated with internal fixation and B2 fractures treated with revision arthroplasty. Methods We retrospectively reviewed the data of 112 PFFs, of which 47 (42%) B1 and 27 (24%) B2 PFFs were treated with internal fixation, whereas 38 (34%) B2 fractures underwent revision arthroplasty. Decision to perform internal fixation for B2 PFFs was based on specific radiological (polished femoral components, intact bone-cement interface) and clinical criteria (low-demand patient). Median follow-up was 36.4 months (24 to 60). Implant survival and mortality over time were estimated with the Kaplan-Meier method. Adverse events (measured with a modified Dindo-Clavien classification) and 90-day readmissions were additionally compared between groups. Results In all, nine (8.01%) surgical failures were detec...
The Bone & Joint Journal, 2021
Aims We aimed to report the mid- to long-term rates of septic and aseptic failure after two-stage... more Aims We aimed to report the mid- to long-term rates of septic and aseptic failure after two-stage revision surgery for periprosthetic joint infection (PJI) following total hip arthroplasty (THA). Methods We retrospectively reviewed 96 cases which met the Musculoskeletal Infection Society criteria for PJI. The mean follow-up was 90 months (SD 32). Septic failure was assessed using a Delphi-based consensus definition. Any further surgery undertaken for aseptic mechanical causes was considered as aseptic failure. The cumulative incidence with competing risk analysis was used to predict the risk of septic failure. A regression model was used to evaluate factors associated with septic failure. The cumulative incidence of aseptic failure was also analyzed. Results There were 23 septic failures at final follow-up, with a cumulative incidence of 14% (95% confidence interval (CI) 8% to 22%) at one year, 18% (95% CI 11% to 27%) at two years, 22% (95% CI 14% to 31%) at five years, and 23% (95%...
The Journal of Arthroplasty, 2021
BACKGROUND The ideal dose of intravenous glucocorticoids to control pain in total hip arthroplast... more BACKGROUND The ideal dose of intravenous glucocorticoids to control pain in total hip arthroplasty (THA) remains unclear. This randomized controlled trial compared postoperative pain and tramadol requirement in patients undergoing unilateral primary THA who received one versus two perioperative doses of dexamethasone. METHODS Patients consented to undergo blinded, simple randomization to either one (at anesthetic induction [1D-group]: 54 patients) or two (with an additional dose 8 hours after surgery [2D-group]: 61 patients) perioperative doses of 8-mg intravenous dexamethasone. Pain was evaluated with visual analog scale at 8, 16, and 24 hours postoperatively and with tramadol requirement. The secondary outcomes included postoperative nausea and vomiting, time to ambulation, and length of stay. RESULTS Age (mean, 66 ± 13 years), body mass index (mean, 29 ± 5), gender (60% female), and history of diabetes were similar between groups (P >.05). Pain was higher at 16 (4 [interquartile range {IQR} 3-5] vs 2 [IQR 1-3]; P <.001) and 24 (2.5 [IQR 2-3] vs 1 [IQR 0-1] P <.001) hours postoperatively in the 1D-group patients. 1D-group patients had significantly more tramadol consumption (50 [IQR 50-100] vs 0 [IQR 0-50]; P = .01), as well as postoperative nausea and vomiting (18 [33.3%] vs 5 [8.2%]; P = .001). Fifty-five (90%) patients in the 2D-group and 32 (59%) in the 1D-group ambulated on postoperative day 0 (P = .0002). Fifty-eight (95%) patients in the 2D-group and 37 (68%) in the 1D-group were discharged on postoperative day 1 (P = .0002). CONCLUSION An additional dose of dexamethasone at 8 hours postoperatively significantly reduced pain, tramadol consumption, time to ambulation, and length of stay after primary THA.
Revista de la Facultad de Ciencias Médicas de Córdoba, 2020
Introduction: Postoperative complications (PCs) constitute any deviation from the normal postoper... more Introduction: Postoperative complications (PCs) constitute any deviation from the normal postoperative course. Reporting of PCs remains a challenge, multiple classification systems have been proposed, however these have not been validated across surgical specialties. Clavien and Dindo (DCCS) developed a system for General Surgery and has been adopted in different fields. Nonetheless, this classification has not been adapted to Orthopedics. The objective of this study was to adapt the Clavien-Dindo classification to orthopedic scenarios and to determine the intra and interobserver reliability. Methods: The designer team adapted the Clavien Dindo classification to orthopedic scenarios. Ten orthopedic observers with different degrees of training and experience were selected to evaluate the classification. 48 simulated clinical scenarios of complications and another negative outcomes such as failure to cure and sequelae were sent by electronic format independently. A second round of sco...
Revista Española de Cirugía Ortopédica y Traumatología, 2020
INTRODUCTION Since arthroscopy remains a controversial treatment of hip dysplasia, our objective ... more INTRODUCTION Since arthroscopy remains a controversial treatment of hip dysplasia, our objective was to analyse its clinical and radiological results in a cohort of patients with dysplasia and compare them to controls with femoroacetabular impingement (FAI). MATERIAL AND METHODS We retrospectively analysed a series of patients who underwent hip arthroscopy for the treatment of labral pathology; 29 of them with borderline hip dysplasia and 197 with FAI, comparing reoperations and joint survival. The diagnosis of borderline dysplasia was made with a lateral centre-edge angle greater than 18° but less than 25°. The average follow-up was 43 months. We performed a multivariate regression analysis to evaluate the association of reoperations with different demographic, radiological and intraoperative variables. RESULTS Seven complications were registered in the FAI group (1 medically treated superficial wound infection, 3 pudendal nerve paraesthesias, 1 deep vein thrombosis and 2 heterotopic ossifications) and none in the dysplasia group. While 5 patients from the FAI group required a new surgery, none of the dysplasia group was re-operated (p=.38). After adjusting for confounders, reoperation showed a very strong association with the finding of osteochondral lesions during index surgery, with a coefficient of .12 (p<.001, 95%CI=.06-.17). CONCLUSION Hip arthroscopy was useful in the treatment of borderline dysplasia, without non-inferior survival compared to the FAI group. We suggest indicating it carefully in dysplasia cases, whenever the symptoms of femoroacetabular friction prevail over those of instability.
International Orthopaedics, 2020
Purpose To analyse the impact of prolonged mandatory lockdown due to COVID-19 on hip fracture epi... more Purpose To analyse the impact of prolonged mandatory lockdown due to COVID-19 on hip fracture epidemiology. Methods Retrospective case-control study of 160 hip fractures operated upon between December 2019 and May 2020. Based on the date of declaration of national lockdown, the cohort was separated into two groups: 'pre-COVID time' (PCT), including 86 patients, and 'COVID time' (CT), consisting of 74 patients. All CT patients tested negative for SARS-CoV-2. Patients were stratified based on demographic characteristics. Outcome measures were 30-day complications, readmissions and mortality. A logistic regression model was run to evaluate factors associated with mortality. Results Age, female/male ratio, body mass index and American Society of Anaesthesia score were similar between both groups (p > 0.05). CT patients had a higher percentage of Charlson ≥ 5 and Rockwood Frailty Index ≥ 5 scores (p < 0.05) as well as lower UCLA and Instrumental Activities of Daily Living scores (p < 0.05). This translated into a higher hemiarthroplasty/total hip arthroplasty ratio during CT (p = 0.04). Thromboembolic disease was higher during CT (p = 0.02). Readmissions (all negative for SARS-CoV-2) were similar between both groups (p = 0.34). Eight (10.8%) casualties were detected in the CT group, whereas no deaths were seen in the control group. Logistic regression showed that frailer (p = 0.006, OR 10.46, 95%CI 8.95-16.1), less active (p = 0.018, OR 2.45, 95%CI 1.45-2.72) and those with a thromboembolic event (p = 0.005, OR 30, 95%CI 11-42) had a higher risk of mortality.
Techniques in Orthopaedics, 2020
When femoral head chondropaties are located medially or parafoveal, they pose a challenge to arth... more When femoral head chondropaties are located medially or parafoveal, they pose a challenge to arthroscopically reach the affected area through commonly used portals. Though surgical hip dislocation remains as the gold standard for treatment of such lesions, many patients reject surgery for its potential complications and postoperative demanding rehabilitation protocol. We aimed to describe the surgical technique for microfracturing osteochondral lesions of the femoral head with a 3.2-mm drill in an arthroscopically assisted manner and to describe the outcome of this procedure. We describe 9 transtrochanteric drillings throughout an otherwise uneventful arthroscopic treatment of femoroacetabular impingement pathology. All of them had a parafoveal osteochondral lesion unapproachable with curved awls through routinely used portals. After debriding the cartilage flap with a chondrotome, the surgical technique consisted of a minimally invasive 3.2-mm drilling through the femoral lateral cortex fluoroscopically guided. Mean follow-up was 55.8 months (range, 43 to 113mo). Outcome was evaluated with the modified Harris Hip Score (mHHS) and healing was assessed through magnetic resonance imaging findings. Overall, all patients showed better results when comparing preoperative and postoperative mHHS (43.8 vs. 79.5; P=0.0008). No complications were reported due to the surgical technique. Complete healing of the osteochondral lesion was confirmed in 7 of 9 cases, and partially in one. One patient with Tönnis 2 preoperative changes required conversion to total hip arthroplasty at 80-month followup. Retrograde drilling was a valid option for treating small-sized medially located osteochondral lesions of the femoral head which are difficult to treat through standard arthroscopic portals.
HIP International, 2019
Objectives: Compare the clinical and radiological outcome of CFP stem with the MiniHip design in ... more Objectives: Compare the clinical and radiological outcome of CFP stem with the MiniHip design in a prospective series, with special interest in intraoperative periprosthetic fracture (IPPF). Methods: We prospectively followed 101 cases treated with the MiniHip stem (Group 1) and 89 with the CFP stem (Group 2) operated between 2010 and 2014. No significant demographic differences were observed between both groups. Median follow-up was 72 months. Average stem length was 41% shorter in the MiniHip group ( p
![Research paper thumbnail of Reemplazo total de cadera con un tallo corto no cementado tipo 2B: resultados a los 2-5 años de seguimiento. [Total hip replacement with a short cementless stem type 2B: Results of 2 to 5 years of follow-up]](https://attachments.academia-assets.com/89953012/thumbnails/1.jpg)
](Revista de la Asociación Argentina de Ortopedia y Traumatología, 2019
Objetivo: Determinar los resultados clínicos, la supervivencia y la incidencia de fractura peripr... more Objetivo: Determinar los resultados clínicos, la supervivencia y la incidencia de fractura periprotésica intraoperatoria con un tallo corto tipo 2B de fijación cervicometafisaria.Métodos: Se analizaron prospectivamente los primeros 100 tallos (84 pacientes) MiniHipTM (Corin, Cirencester, Reino Unido) colocados, en forma consecutiva, por un mismo cirujano. La edad promedio fue de 47 años. La indicación para un tallo corto fue: edad <55 años (85 casos) o la participación previa en deportes de impacto en pacientes de entre 56 y 60 años (15 casos). El diagnóstico inicial fue artrosis primaria de cadera en el 82% de los casos. El seguimiento promedio fue de 42 meses. Resultados: El puntaje en la escala de Harris modificada mejoró de 55 a 96 al final del…
EFORT Open Reviews, 2018
Acute peri-prosthetic joint infection (PJI) following total hip arthroplasty (THA) is a potential... more Acute peri-prosthetic joint infection (PJI) following total hip arthroplasty (THA) is a potentially devastating and undesired complication, with a prevalence of 0.3% to 2.9%. Its suspicion begins with a meticulous physical examination and anamnesis. Diagnosis should be made on the basis of the Musculoskeletal Infection Society criteria. Serum and synovial biomarkers are very useful tools when major criteria are absent. Although sometimes not possible due to medical conditions, surgery is usually the first line of treatment. Although its outcome is highly correlated with the isolated microorganism, irrigation and debridement with implant retention (DAIR) is the gold standard for treatment. Ideally, the prior approach should be proximally and distally extended to augment the field of view and remove all of the prosthetic modular components, that is, femoral head and acetabular insert. Given DAIR’s unclear control of infection, with successful outcomes in the range of 30% to 95%, one- ...
International Orthopaedics, 2018
Background Following a total hip arthroplasty (THA), early hospital re-admission rates of 3-11% a... more Background Following a total hip arthroplasty (THA), early hospital re-admission rates of 3-11% are considered as 'acceptable' in terms of medical care cost policies. Surprisingly, the impact of re-admissions on mortality has not been priorly portrayed. Therefore, we sought to determine the mortality rate after 90-day re-admissions following a THA in a series of patients from a captive medical care program. Patients and methods We prospectively analysed 90-day readmissions of 815 unilateral, elective THA patients operated upon between 2010 and 2014 whose medical care was the one offered by our institution. We stratified our sample into readmitted and nonreadmitted cohorts. Through a Cox proportional hazards model, we compared demographic characteristics, clinical comorbidities, surgical outcomes and laboratory values between both groups in order to determine association with early and late mortality. Results We found 37 (4.53%) re-admissions at a median time of 40.44 days (IQR 17.46-60.69). Factors associated with readmission were hospital stay (p = 0.00); surgical time (p = 0.01); chronic renal insufficiency (p = 0.03); ASA class 4 (p = 0.00); morbid obesity (p = 0.006); diabetes (p = 0.04) and a high Charlson index (p = 0.00). Overall mortality rate of the series was 3.31% (27/815). Median time to mortality was 455.5 days (IQR 297.58-1170.65). One-third (11/37) of the re-admitted patients died, being sepsis non-related to the THA the most common cause of death. After adjusting for confounders, 90-day readmissions remained associated with mortality with an adjusted HR of 3.14 (CI95% 1.05-9.36, p = 0.04). Conclusions Unplanned re-admissions were an independent risk factor for future mortality, increasing three times the risk of mortality.
Orthopaedic Journal of Sports Medicine, 2018
Introduction: The idyllic treatment of hip dysplasia is periacetabular osteotomy (PAO). Since the... more Introduction: The idyllic treatment of hip dysplasia is periacetabular osteotomy (PAO). Since the indication of arthroscopy as a unique action is controversial in the treatment of dysplasia, our objective was to analyze its clinical and radiological results in a cohort of patients with borderline dysplasia and compare them with controls with femoroacetabular impingement (FAI). Material and methods: We retrospectively analyzed a group of 29 patients with a labral lesion secondary to borderline hip dysplasia (group 1) and another group of 197 patients with FAI (group 2) treated with hip arthroscopy, evaluating reoperations and joint survival as the main outcomes. Only patients with both diagnoses treated with hip arthroscopy and with a minimum follow-up of 2 years were included. We excluded patients with coxa profunda, patients who only underwent labral debridement, revisions, cases with dysplasia initially treated with PAO and those with previous ipsilateral hip pathology such as loc...
Revista de la Asociación Argentina de Ortopedia y Traumatología, 2021
Objetivo: Describir la técnica quirúrgica, las indicaciones y los resultados iniciales de la oste... more Objetivo: Describir la técnica quirúrgica, las indicaciones y los resultados iniciales de la osteotomía periacetabular bernesa para tratar la displasia del desarrollo de la cadera. Materiales y Métodos: Entre mayo de 2011 y mayo de 2020, se realizaron 44 osteotomías periacetabulares bernesas en 44 pacientes (35 mujeres, edad promedio 30 años [rango 23-38]). Todos tenían diagnóstico de displasia de cadera sintomática. El ángulo centro-borde promedio fue de 17° (rango 9°-20°) y el índice acetabular promedio, de 18° (rango 15°-20°). En 22 casos, se evaluaron y repararon los hallazgos intrarticulares por artroscopia en el mismo acto quirúrgico. Se evaluaron la corrección obtenida, la consolidación de la osteotomía y los resultados funcionales al final del seguimiento. Resultados: En 22 pacientes, se detectó hipertrofia y rotura del labrum acetabular asociadas a displasia de cadera. Diez pacientes tenían quistes paralabrales. El ángulo centro-borde promedio posoperatorio fue de 32° (rang...
Revista de la Asociación Argentina de Ortopedia y Traumatología, 2021
Objetivos: El tratamiento de elección para las fracturas femorales periprotésicas Vancouver B3 aú... more Objetivos: El tratamiento de elección para las fracturas femorales periprotésicas Vancouver B3 aún no está definido. Por este motivo, nos propusimos analizar la tasa de complicaciones de la técnica de injerto óseo impactado con un vástago cementado cuando se utiliza para tratar estas fracturas. Materiales y Métodos: Estudiamos retrospectivamente 33 fracturas femorales periprotésicas B3 tratadas con la técnica de injerto óseo impactado operados entre 2000 y 2016, analizando la tasa de complicaciones. La mediana de seguimiento fue de 75 meses (RIC 36-111). La mediana de edad fue de 78 años (RIC 74-83). La mediana del defecto óseo femoral fue 3 (RIC 3-3) según la clasificación de la Endo-Klinik. Se realizó un análisis de regresión múltiple para determinar los factores de riesgo asociados a complicaciones, las variables incluidas fueron: cantidad de cirugías previas, diámetro de la nueva cabeza femoral y defecto óseo femoral. Resultados: Se realizó una cirugía de revisión en dos etapas ...
European Journal of Orthopaedic Surgery & Traumatology, 2021
This study aimed to report the initial results of the cementless UNITED hip system in primary tot... more This study aimed to report the initial results of the cementless UNITED hip system in primary total hip arthroplasty (THA) with a minimum follow-up of 2 years. We retrospectively studied a consecutive series of 203 cementless THAs in 180 patients operated between 2015–2017. We included 89 female and 91 male patients with a mean age of 67 (28 to 89) years. The mean follow-up was 40 (29 to 62) months. Clinical outcome scores and radiographs were measured. Survival was calculated defining failure as the need for any further femoral or acetabular revision, irrespective of the reason. No femoral component loosening was detected. One patient had a Vancouver-B1 intraoperative periprosthetic femoral fracture treated with implant retention and cerclage wires. Two acetabular components were revised for aseptic loosening. Three patients suffered an acute infection treated with debridement, antibiotics, and implant retention. The mean Merle d'Aubigné et Postel scores improved from 13 (4 to 16) points preoperatively to 17 (12 to 18) points at the latest follow-up (p < 0.001). At a mean time of 40 months of follow-up, the survival was 99% and 100% for the acetabular and the femoral components, respectively. This cementless design showed excellent preliminary outcomes in terms of fixation and patient satisfaction, comparable to that of other well-known similar systems.
This study aimed to report the initial results of the cementless UNITED hip system in primary tot... more This study aimed to report the initial results of the cementless UNITED hip system in primary total hip arthroplasty (THA) with a minimum follow-up of 2 years. Methods We retrospectively studied a consecutive series of 203 cementless THAs in 180 patients operated between 2015-2017. We included 89 female and 91 male patients with a mean age of 67 (28 to 89) years. The mean follow-up was 40 (29 to 62) months. Clinical outcome scores and radiographs were measured. Survival was calculated de ning failure as the need for any further femoral or acetabular revision, irrespective of the reason. Results No femoral component loosening was detected. One patient had a Vancouver-B1 intraoperative periprosthetic femoral fracture treated with implant retention and cerclage wires. Two acetabular components were revised for aseptic loosening. Three patients suffered an acute infection treated with debridement, antibiotics, and implant retention. The mean Merle d'Aubigné et Postel scores improved from 13 (4 to 16) points preoperatively to 17 (12 to 18) points at the latest follow-up (p < 0.001). At a mean time of 40 months of follow-up, the survival was 99% and 100% for the acetabular and the femoral components, respectively. Conclusion This cementless design showed excellent preliminary outcomes in terms of xation and patient satisfaction, comparable to that of other well-known similar systems.
Following a total hip arthroplasty (THA), early hospital readmission rates of 3–8% are considered... more Following a total hip arthroplasty (THA), early hospital readmission rates of 3–8% are considered as ‘acceptable’ in terms of medical care cost policies. Surprisingly, the impact of readmissions on mortality has not been priorly portrayed. Therefore, we aimed to analyse the mortality of unplanned readmissions after primary THA at a high-volume Argentinian center. We prospectively analysed 90-day readmissions of 815 unilateral, elective THA patients operated between 2010–2014 whose medical insurance was the one offered by our institution. Mean follow-up was 51 months (range, 37–84). Median age was 69 (IQR, 62–77). We stratified our sample into readmitted and non-readmitted cohorts. Through a Cox proportional hazard model, we compared demographic characteristics, clinical comorbidities, surgical outcomes and laboratory values between both groups in order to determine association with mortality. We found 37 (4.53%) readmissions at a median time of 40.44 days (IQR: 17.46–60.69). Factors associated with readmi...
Arthroplasty Today, 2020
Background This study aims to analyze the ability to restore hip biomechanics in patients who und... more Background This study aims to analyze the ability to restore hip biomechanics in patients who undergo total hip arthroplasty for displaced femoral neck fractures operated by either hip surgeons (HSs) or orthopaedic residents (ORs). Methods We retrospectively compared 95 patients treated by HSs (group A) with 110 patients treated by ORs (group B). Leg-length discrepancy, femoral offset (FO), center of rotation (COR), acetabular inclination, and acetabular anteversion were evaluated on postoperative radiographs using the healthy contralateral hip as control. Results The median leg-length discrepancy was 2 mm for both groups (P = .74). The leg length was increased in 54% of the HS group and 57% of the OR group (P = .13). The median FO difference of groups A and B were 7 mm and 5.5 mm, respectively (P = .14). FO was increased in 80% of the HS group and 69% of the OR group (P = .19). Median discrepancies of the horizontal and vertical CORs were not statistically relevant, with P-values o...
Femoral offset restoration is related to low rates of wear and dislocation. Replication of the na... more Femoral offset restoration is related to low rates of wear and dislocation. Replication of the native hip anatomy improves prosthesis survival, whereas increasing the femoral offset elevates the torque stresses, thus inducing a risk of suboptimal stem fixation. Although the Corail (DePuy Synthes, St Priest, France) uncemented stem has an excellent record of fixation, an unexpectedly number of aseptic loosenings has been noted in our institution. We sought to characterize the clinical parameters observed in a group of patients who have experienced metaphyseal aseptic loosenings with the collarless version of the Corail uncemented femoral component; describe the radiographic findings in this group of patients; expose the intraoperative findings in the cases that needed revision surgery and to calculate a possible frequency of this complication. We present a series of 15 metaphyseal debondings of the collarless version of the Corail uncemented stem in primary total hip arthroplasty. El...
The Bone & Joint Journal, 2021
Aims There is a paucity of long-term studies analyzing risk factors for failure after single-stag... more Aims There is a paucity of long-term studies analyzing risk factors for failure after single-stage revision for periprosthetic joint infection (PJI) following total hip arthroplasty (THA). We report the mid- to long-term septic and non-septic failure rate of single-stage revision for PJI after THA. Methods We retrospectively reviewed 88 cases which met the Musculoskeletal Infection Society (MSIS) criteria for PJI. Mean follow-up was seven years (1 to 14). Septic failure was diagnosed with a Delphi-based consensus definition. Any reoperation for mechanical causes in the absence of evidence of infection was considered as non-septic failure. A competing risk regression model was used to evaluate factors associated with septic and non-septic failures. A Kaplan-Meier estimate was used to analyze mortality. Results The cumulative incidence of septic failure was 8% (95% confidence interval (CI) 3.5 to 15) at one year, 13.8% (95% CI 7.6 to 22) at two years, and 19.7% (95% CI 12 to 28.6) at ...
The Bone & Joint Journal, 2021
Aims We aimed to compare the implant survival, complications, readmissions, and mortality of Vanc... more Aims We aimed to compare the implant survival, complications, readmissions, and mortality of Vancouver B2 periprosthetic femoral fractures (PFFs) treated with internal fixation with that of B1 PFFs treated with internal fixation and B2 fractures treated with revision arthroplasty. Methods We retrospectively reviewed the data of 112 PFFs, of which 47 (42%) B1 and 27 (24%) B2 PFFs were treated with internal fixation, whereas 38 (34%) B2 fractures underwent revision arthroplasty. Decision to perform internal fixation for B2 PFFs was based on specific radiological (polished femoral components, intact bone-cement interface) and clinical criteria (low-demand patient). Median follow-up was 36.4 months (24 to 60). Implant survival and mortality over time were estimated with the Kaplan-Meier method. Adverse events (measured with a modified Dindo-Clavien classification) and 90-day readmissions were additionally compared between groups. Results In all, nine (8.01%) surgical failures were detec...
The Bone & Joint Journal, 2021
Aims We aimed to report the mid- to long-term rates of septic and aseptic failure after two-stage... more Aims We aimed to report the mid- to long-term rates of septic and aseptic failure after two-stage revision surgery for periprosthetic joint infection (PJI) following total hip arthroplasty (THA). Methods We retrospectively reviewed 96 cases which met the Musculoskeletal Infection Society criteria for PJI. The mean follow-up was 90 months (SD 32). Septic failure was assessed using a Delphi-based consensus definition. Any further surgery undertaken for aseptic mechanical causes was considered as aseptic failure. The cumulative incidence with competing risk analysis was used to predict the risk of septic failure. A regression model was used to evaluate factors associated with septic failure. The cumulative incidence of aseptic failure was also analyzed. Results There were 23 septic failures at final follow-up, with a cumulative incidence of 14% (95% confidence interval (CI) 8% to 22%) at one year, 18% (95% CI 11% to 27%) at two years, 22% (95% CI 14% to 31%) at five years, and 23% (95%...
The Journal of Arthroplasty, 2021
BACKGROUND The ideal dose of intravenous glucocorticoids to control pain in total hip arthroplast... more BACKGROUND The ideal dose of intravenous glucocorticoids to control pain in total hip arthroplasty (THA) remains unclear. This randomized controlled trial compared postoperative pain and tramadol requirement in patients undergoing unilateral primary THA who received one versus two perioperative doses of dexamethasone. METHODS Patients consented to undergo blinded, simple randomization to either one (at anesthetic induction [1D-group]: 54 patients) or two (with an additional dose 8 hours after surgery [2D-group]: 61 patients) perioperative doses of 8-mg intravenous dexamethasone. Pain was evaluated with visual analog scale at 8, 16, and 24 hours postoperatively and with tramadol requirement. The secondary outcomes included postoperative nausea and vomiting, time to ambulation, and length of stay. RESULTS Age (mean, 66 ± 13 years), body mass index (mean, 29 ± 5), gender (60% female), and history of diabetes were similar between groups (P >.05). Pain was higher at 16 (4 [interquartile range {IQR} 3-5] vs 2 [IQR 1-3]; P <.001) and 24 (2.5 [IQR 2-3] vs 1 [IQR 0-1] P <.001) hours postoperatively in the 1D-group patients. 1D-group patients had significantly more tramadol consumption (50 [IQR 50-100] vs 0 [IQR 0-50]; P = .01), as well as postoperative nausea and vomiting (18 [33.3%] vs 5 [8.2%]; P = .001). Fifty-five (90%) patients in the 2D-group and 32 (59%) in the 1D-group ambulated on postoperative day 0 (P = .0002). Fifty-eight (95%) patients in the 2D-group and 37 (68%) in the 1D-group were discharged on postoperative day 1 (P = .0002). CONCLUSION An additional dose of dexamethasone at 8 hours postoperatively significantly reduced pain, tramadol consumption, time to ambulation, and length of stay after primary THA.
Revista de la Facultad de Ciencias Médicas de Córdoba, 2020
Introduction: Postoperative complications (PCs) constitute any deviation from the normal postoper... more Introduction: Postoperative complications (PCs) constitute any deviation from the normal postoperative course. Reporting of PCs remains a challenge, multiple classification systems have been proposed, however these have not been validated across surgical specialties. Clavien and Dindo (DCCS) developed a system for General Surgery and has been adopted in different fields. Nonetheless, this classification has not been adapted to Orthopedics. The objective of this study was to adapt the Clavien-Dindo classification to orthopedic scenarios and to determine the intra and interobserver reliability. Methods: The designer team adapted the Clavien Dindo classification to orthopedic scenarios. Ten orthopedic observers with different degrees of training and experience were selected to evaluate the classification. 48 simulated clinical scenarios of complications and another negative outcomes such as failure to cure and sequelae were sent by electronic format independently. A second round of sco...
Revista Española de Cirugía Ortopédica y Traumatología, 2020
INTRODUCTION Since arthroscopy remains a controversial treatment of hip dysplasia, our objective ... more INTRODUCTION Since arthroscopy remains a controversial treatment of hip dysplasia, our objective was to analyse its clinical and radiological results in a cohort of patients with dysplasia and compare them to controls with femoroacetabular impingement (FAI). MATERIAL AND METHODS We retrospectively analysed a series of patients who underwent hip arthroscopy for the treatment of labral pathology; 29 of them with borderline hip dysplasia and 197 with FAI, comparing reoperations and joint survival. The diagnosis of borderline dysplasia was made with a lateral centre-edge angle greater than 18° but less than 25°. The average follow-up was 43 months. We performed a multivariate regression analysis to evaluate the association of reoperations with different demographic, radiological and intraoperative variables. RESULTS Seven complications were registered in the FAI group (1 medically treated superficial wound infection, 3 pudendal nerve paraesthesias, 1 deep vein thrombosis and 2 heterotopic ossifications) and none in the dysplasia group. While 5 patients from the FAI group required a new surgery, none of the dysplasia group was re-operated (p=.38). After adjusting for confounders, reoperation showed a very strong association with the finding of osteochondral lesions during index surgery, with a coefficient of .12 (p<.001, 95%CI=.06-.17). CONCLUSION Hip arthroscopy was useful in the treatment of borderline dysplasia, without non-inferior survival compared to the FAI group. We suggest indicating it carefully in dysplasia cases, whenever the symptoms of femoroacetabular friction prevail over those of instability.
International Orthopaedics, 2020
Purpose To analyse the impact of prolonged mandatory lockdown due to COVID-19 on hip fracture epi... more Purpose To analyse the impact of prolonged mandatory lockdown due to COVID-19 on hip fracture epidemiology. Methods Retrospective case-control study of 160 hip fractures operated upon between December 2019 and May 2020. Based on the date of declaration of national lockdown, the cohort was separated into two groups: 'pre-COVID time' (PCT), including 86 patients, and 'COVID time' (CT), consisting of 74 patients. All CT patients tested negative for SARS-CoV-2. Patients were stratified based on demographic characteristics. Outcome measures were 30-day complications, readmissions and mortality. A logistic regression model was run to evaluate factors associated with mortality. Results Age, female/male ratio, body mass index and American Society of Anaesthesia score were similar between both groups (p > 0.05). CT patients had a higher percentage of Charlson ≥ 5 and Rockwood Frailty Index ≥ 5 scores (p < 0.05) as well as lower UCLA and Instrumental Activities of Daily Living scores (p < 0.05). This translated into a higher hemiarthroplasty/total hip arthroplasty ratio during CT (p = 0.04). Thromboembolic disease was higher during CT (p = 0.02). Readmissions (all negative for SARS-CoV-2) were similar between both groups (p = 0.34). Eight (10.8%) casualties were detected in the CT group, whereas no deaths were seen in the control group. Logistic regression showed that frailer (p = 0.006, OR 10.46, 95%CI 8.95-16.1), less active (p = 0.018, OR 2.45, 95%CI 1.45-2.72) and those with a thromboembolic event (p = 0.005, OR 30, 95%CI 11-42) had a higher risk of mortality.
Techniques in Orthopaedics, 2020
When femoral head chondropaties are located medially or parafoveal, they pose a challenge to arth... more When femoral head chondropaties are located medially or parafoveal, they pose a challenge to arthroscopically reach the affected area through commonly used portals. Though surgical hip dislocation remains as the gold standard for treatment of such lesions, many patients reject surgery for its potential complications and postoperative demanding rehabilitation protocol. We aimed to describe the surgical technique for microfracturing osteochondral lesions of the femoral head with a 3.2-mm drill in an arthroscopically assisted manner and to describe the outcome of this procedure. We describe 9 transtrochanteric drillings throughout an otherwise uneventful arthroscopic treatment of femoroacetabular impingement pathology. All of them had a parafoveal osteochondral lesion unapproachable with curved awls through routinely used portals. After debriding the cartilage flap with a chondrotome, the surgical technique consisted of a minimally invasive 3.2-mm drilling through the femoral lateral cortex fluoroscopically guided. Mean follow-up was 55.8 months (range, 43 to 113mo). Outcome was evaluated with the modified Harris Hip Score (mHHS) and healing was assessed through magnetic resonance imaging findings. Overall, all patients showed better results when comparing preoperative and postoperative mHHS (43.8 vs. 79.5; P=0.0008). No complications were reported due to the surgical technique. Complete healing of the osteochondral lesion was confirmed in 7 of 9 cases, and partially in one. One patient with Tönnis 2 preoperative changes required conversion to total hip arthroplasty at 80-month followup. Retrograde drilling was a valid option for treating small-sized medially located osteochondral lesions of the femoral head which are difficult to treat through standard arthroscopic portals.
HIP International, 2019
Objectives: Compare the clinical and radiological outcome of CFP stem with the MiniHip design in ... more Objectives: Compare the clinical and radiological outcome of CFP stem with the MiniHip design in a prospective series, with special interest in intraoperative periprosthetic fracture (IPPF). Methods: We prospectively followed 101 cases treated with the MiniHip stem (Group 1) and 89 with the CFP stem (Group 2) operated between 2010 and 2014. No significant demographic differences were observed between both groups. Median follow-up was 72 months. Average stem length was 41% shorter in the MiniHip group ( p
Revista de la Asociación Argentina de Ortopedia y Traumatología, 2019
Objetivo: Determinar los resultados clínicos, la supervivencia y la incidencia de fractura peripr... more Objetivo: Determinar los resultados clínicos, la supervivencia y la incidencia de fractura periprotésica intraoperatoria con un tallo corto tipo 2B de fijación cervicometafisaria.Métodos: Se analizaron prospectivamente los primeros 100 tallos (84 pacientes) MiniHipTM (Corin, Cirencester, Reino Unido) colocados, en forma consecutiva, por un mismo cirujano. La edad promedio fue de 47 años. La indicación para un tallo corto fue: edad <55 años (85 casos) o la participación previa en deportes de impacto en pacientes de entre 56 y 60 años (15 casos). El diagnóstico inicial fue artrosis primaria de cadera en el 82% de los casos. El seguimiento promedio fue de 42 meses. Resultados: El puntaje en la escala de Harris modificada mejoró de 55 a 96 al final del…
EFORT Open Reviews, 2018
Acute peri-prosthetic joint infection (PJI) following total hip arthroplasty (THA) is a potential... more Acute peri-prosthetic joint infection (PJI) following total hip arthroplasty (THA) is a potentially devastating and undesired complication, with a prevalence of 0.3% to 2.9%. Its suspicion begins with a meticulous physical examination and anamnesis. Diagnosis should be made on the basis of the Musculoskeletal Infection Society criteria. Serum and synovial biomarkers are very useful tools when major criteria are absent. Although sometimes not possible due to medical conditions, surgery is usually the first line of treatment. Although its outcome is highly correlated with the isolated microorganism, irrigation and debridement with implant retention (DAIR) is the gold standard for treatment. Ideally, the prior approach should be proximally and distally extended to augment the field of view and remove all of the prosthetic modular components, that is, femoral head and acetabular insert. Given DAIR’s unclear control of infection, with successful outcomes in the range of 30% to 95%, one- ...
International Orthopaedics, 2018
Background Following a total hip arthroplasty (THA), early hospital re-admission rates of 3-11% a... more Background Following a total hip arthroplasty (THA), early hospital re-admission rates of 3-11% are considered as 'acceptable' in terms of medical care cost policies. Surprisingly, the impact of re-admissions on mortality has not been priorly portrayed. Therefore, we sought to determine the mortality rate after 90-day re-admissions following a THA in a series of patients from a captive medical care program. Patients and methods We prospectively analysed 90-day readmissions of 815 unilateral, elective THA patients operated upon between 2010 and 2014 whose medical care was the one offered by our institution. We stratified our sample into readmitted and nonreadmitted cohorts. Through a Cox proportional hazards model, we compared demographic characteristics, clinical comorbidities, surgical outcomes and laboratory values between both groups in order to determine association with early and late mortality. Results We found 37 (4.53%) re-admissions at a median time of 40.44 days (IQR 17.46-60.69). Factors associated with readmission were hospital stay (p = 0.00); surgical time (p = 0.01); chronic renal insufficiency (p = 0.03); ASA class 4 (p = 0.00); morbid obesity (p = 0.006); diabetes (p = 0.04) and a high Charlson index (p = 0.00). Overall mortality rate of the series was 3.31% (27/815). Median time to mortality was 455.5 days (IQR 297.58-1170.65). One-third (11/37) of the re-admitted patients died, being sepsis non-related to the THA the most common cause of death. After adjusting for confounders, 90-day readmissions remained associated with mortality with an adjusted HR of 3.14 (CI95% 1.05-9.36, p = 0.04). Conclusions Unplanned re-admissions were an independent risk factor for future mortality, increasing three times the risk of mortality.
Orthopaedic Journal of Sports Medicine, 2018
Introduction: The idyllic treatment of hip dysplasia is periacetabular osteotomy (PAO). Since the... more Introduction: The idyllic treatment of hip dysplasia is periacetabular osteotomy (PAO). Since the indication of arthroscopy as a unique action is controversial in the treatment of dysplasia, our objective was to analyze its clinical and radiological results in a cohort of patients with borderline dysplasia and compare them with controls with femoroacetabular impingement (FAI). Material and methods: We retrospectively analyzed a group of 29 patients with a labral lesion secondary to borderline hip dysplasia (group 1) and another group of 197 patients with FAI (group 2) treated with hip arthroscopy, evaluating reoperations and joint survival as the main outcomes. Only patients with both diagnoses treated with hip arthroscopy and with a minimum follow-up of 2 years were included. We excluded patients with coxa profunda, patients who only underwent labral debridement, revisions, cases with dysplasia initially treated with PAO and those with previous ipsilateral hip pathology such as loc...