pablo sanz ruiz | Universidad Complutense de Madrid (original) (raw)
Papers by pablo sanz ruiz
Arthroplasty
Prosthetic joint infection (PJI) is one of the most devastating complications of orthopedic surge... more Prosthetic joint infection (PJI) is one of the most devastating complications of orthopedic surgery. However, not all patients are equally at the risk of severe infection. The incidences of PJI vary with the host and surgery-related risk factors. It is now generally accepted that some important medical comorbidities may predispose the patients to a high risk of PJI. Time-consuming and invasive surgical procedures, such as revision arthroplasties, are also associated with a high incidence of PJI, presumably due to the increased risk of surgical site contamination. Effective infection-preventing strategies should begin with identifying and optimizing the patients at a high risk of infection prior to surgery. Optimizing the operating room environment and antibiotic prophylaxis are also essential strategies that help minimize the overall incidence of infection in orthopedic surgery. The ideal antibiotic prophylaxis is still under debate, and discussions have emerged about whether variat...
Journal of Orthopaedic Surgery and Research, 2022
Background The appropriate degree of constraint in knee prosthetic revision is unknown, necessita... more Background The appropriate degree of constraint in knee prosthetic revision is unknown, necessitating the use of the lowest possible constraint. This study aimed to compare the long-term clinical and survival results of revision with rotation hinge knee (RHK) VS constrained condylar constrained knee (CCK) implants. Methods Overall, 117 revision case were prospectively reviewed and dividing into two groups based on the degree of constraint used, using only one prosthetic model in each group (61 CCK vs 56 RHK). All implants were evaluated for a minimum of 10 years. Survival of both implants at the end of follow-up, free from revision for any cause, aseptic loosening, and septic cause was compared. Results Better results were seen with use of the RHK in joint ranges of (p = 0.023), KSCS (p = 0.015), KSFS (p = 0.043), and KOOS (p = 0.031). About 22.2% of the cases required repeat surgery (11.7% RHK vs 29.6% CCK, p = 0.023). Constrained condylar implants had a significantly lower surviva...
International Orthopaedics, 2022
Purpose Microencapsulation techniques have allowed the addition of rifampicin to bone cement, but... more Purpose Microencapsulation techniques have allowed the addition of rifampicin to bone cement, but its in vivo efficacy has not been proven. The aim of our study is to determine the superiority of cement containing gentamicin and rifampicin microcapsules in the treatment of PJI versus cement exclusively containing gentamicin. Methods An S. aureus PJI was induced in 15 NZW rabbits. A week after inoculation, the first stage of replacement was carried out, and the animals were divided into two groups: group R received a spacer containing gentamicin and rifampicin microcapsules, and group C received a spacer containing gentamicin. Intra-articular release curve of rifampicin and infection and toxicity markers were monitored for four weeks post-operatively, when microbiological analysis was performed. Results The microbiological cultures showed a significantly lower growth of S. aureus in soft tissue (2.3·104 vs 0; p = 0.01) and bone (5.7·102 vs 0; p = 0.03) in the group with rifampicin mi...
Journal of Orthopaedic Surgery and Research, 2021
Background Greater trochanteric pain syndrome encompasses a range of causes of lateral hip pain i... more Background Greater trochanteric pain syndrome encompasses a range of causes of lateral hip pain including greater trochanteric bursitis, tendinopathy and tears of the gluteus minimus and medius, and lateral snapping hip (LSH). Surgical options for LSH range from open surgery to endoscopic surgery, including a diamond-shaped cut or a simple transversal release to gluteus maximus tendon release. Resection of an area of proximal iliotibial band (ITB) and step-cut or z-plasty lengthening have not proven superior to transverse release of the ITB. Therefore, making a complete and effective transverse cut guided by ultrasound may represent a potential advance over endoscopic surgery. Purpose In this case series study, we describe how to perform proximal release of the ITB guided by ultrasound. Methods The surgical technique—either z-plasty or transverse section of the ITB—was first validated on 10 cadaver specimens and then used in clinical practice. Fourteen patients (5 males and 9 female...
La artroplastia de cadera es una alternativa a la artroplastia convencional, que esta indicada en... more La artroplastia de cadera es una alternativa a la artroplastia convencional, que esta indicada en pacientes jovenes y activos. Los buenos resultados y la prevencion de complicaciones dependen de una minuciosa tecnica quirurgica asi como de una correcta seleccion de pacientes. Presentamos un caso de un paciente de 43 anos que tras ser sometido a una sustitucion de cadera bilateral con protesis de recubrimiento sufrio una fractura en ambos cuellos femorales de manera no simultanea, por necrosis avascular, que tuvo que ser tratada mediante la colocacion de un vastago de anclaje metafisario. Las radiografias postoperatorias mostraron una buena colocacion del implante sin muescas en el cuello («notching» femoral), con discreta alineacion de 7o valgo del componente femoral. La movilidad pasiva y activa era dolorosa. El estudio radiografico mostro una fractura cervical del femur derecho. (La cabeza femoral estaba unida al implante no encontrando metalosis ni aflojamiento de los componentes...
Los sistemas de bloque de corte especificos (BCE) se han presentado como una interesante medida p... more Los sistemas de bloque de corte especificos (BCE) se han presentado como una interesante medida para obtener una correcta alineacion en la artroplastia de rodilla, aunque se desconoce cual de todos los metodos existentes para realizar la planificacion es el adecuado. Material y metodos: Se ha disenado un estudio prospectivo comparando dos sistemas de BCE con planificaciones diferentes (Signature con TAC + teleradiografia; Visionaire con RMN) con el sistema convencional de alineacion. Se analizaron parametros radiograficos, funcionales preoperatorios y postoperatorios, estancia hospitalaria, necesidad de transfusion, tiempo quirurgico y complicaciones asociadas. Resultados: Un total de 10 pacientes fueron intervenidos por cada grupo. No se observaron diferencias estadisticamente significativas entre los dos sistemas de alineamiento especificos y el sistema convencional (p > 0.05), aunque se objetivo una mayor precision con estos sistemas, siendo discretamente superior en el sistem...
BMC Musculoskeletal Disorders, 2021
Background 3D printing technology in hospitals facilitates production models such as point-of-car... more Background 3D printing technology in hospitals facilitates production models such as point-of-care manufacturing. Orthopedic Surgery and Traumatology is the specialty that can most benefit from the advantages of these tools. The purpose of this study is to present the results of the integration of 3D printing technology in a Department of Orthopedic Surgery and Traumatology and to identify the productive model of the point-of-care manufacturing as a paradigm of personalized medicine. Methods Observational, descriptive, retrospective and monocentric study of a total of 623 additive manufacturing processes carried out in a Department of Orthopedic Surgery and Traumatology from November 2015 to March 2020. Variables such as product type, utility, time or materials for manufacture were analyzed. Results The areas of expertise that have performed more processes are Traumatology, Reconstructive and Orthopedic Oncology. Pre-operative planning is their primary use. Working and 3D printing h...
Orthopedic Research and Reviews, 2020
There is growing body of evidence that important patient-, procedure-and pathogen-related factors... more There is growing body of evidence that important patient-, procedure-and pathogen-related factors are linked to higher risks for prosthetic joint infections (PJI) following arthroplasty surgeries. The prior identification and optimization of such risk factors is considered paramount to minimize the incidence of these infections. Without any doubt, antibiotic prophylaxis remains one of the cornerstones among all preventive measures. However, the ideal antibiotic prophylaxis is still in debate and discussions have emerged, whether certain situations deserve adjustments or variations of the standard protocol taking into account antibiotic resistance surveillance data and patient risk factors for infections. This review aims to provide the reader with an overview of possible antibiotic prophylaxis strategies in response to these risks and discusses the clinical experiences so far obtained. We further present preliminary evidence that the use of a reinforced local antibiotic prophylaxis regimen with high-dose dual antibiotic-loaded bone cement may be an effective and easy-to-apply option in patients at high infection risks.
Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine, Jan 4, 2017
High-resolution ultrasonography (US) can play an important role in studying nerves, as it has sev... more High-resolution ultrasonography (US) can play an important role in studying nerves, as it has several advantages. Entrapments of distal tibial nerve branches can be mapped out or diagnosed with selective anesthetic blocks, and US can guide therapeutic procedures, such as radiofrequency ablation and selective infiltrations of specific nerve branches. The aim of this study was to verify that US is an effective method for accurately locating the posterior tibial nerve and its terminal branches, such as the medial calcaneal branch, the first calcaneal branch, and the medial and lateral plantar nerves. In this study, we analyzed the correlation between US mapping and real anatomy after cadaveric dissection, assessing the distribution and variability of the tibial nerve and its terminal branches. We used 12 fresh anatomic specimens of the foot and ankle, including the calf. A high-resolution US study of the tibial nerve and its branches was performed. The results of the US studies of the ...
Arthroplasty Today, 2017
Bone cement spacers loaded with antibiotic are the gold standard in septic revision. However, the... more Bone cement spacers loaded with antibiotic are the gold standard in septic revision. However, the management of massive bone defects constitutes a surgical challenge, requiring the use of different nails, expensive long stems, or cement-coated tumor prostheses for preparing the spacer. In most cases, the knee joint must be sacrificed. We describe a novel technique for preparing a biarticular total femur spacer with the help of a trochanteric nail coated with antibiotic loaded cement, allowing mobility of the hip and knee joints and assisted partial loading until second step surgery. This technique is helpful to maintain the length of the leg, prevent soft tissue contracture, and help eradicate the infection preserving the patient comfort and autonomy while waiting to receive total femoral replacement.
Arthroplasty Today, 2017
Osteogenesis imperfecta (OI) is a rare congenital disease characterized by alterations in bone qu... more Osteogenesis imperfecta (OI) is a rare congenital disease characterized by alterations in bone quality, with susceptibility to fractures, instability, deformities, and osteoarthrosis. Prosthetic surgery in these patients is associated with an abnormally high rate of implant failures. On the other hand, abnormal bone fragility adds to the complexity of revision surgery in such individualsdthus representing a genuine challenge for the orthopaedic surgeon. We present a case of femoral reconstruction in a patient with OI and prosthetic loosening after reconstruction secondary to femoral septic pseudoarthrosis. Intramedullary total femoral reconstruction was carried out after exceeding the biological reconstruction limits. This is the first reported instance of the use of an intramedullary total femur arthroplasty as salvage technique in an OI patient. This technique should be considered when we have exceeded biological limits for femoral fixation.
BMC musculoskeletal disorders, Oct 3, 2016
Isolated gastrocnemius contracture is thought to lead to numerous conditions. Although many techn... more Isolated gastrocnemius contracture is thought to lead to numerous conditions. Although many techniques have been described for gastrocnemius recession, potential anesthetic, cosmetic, and wound-related complications can lead to patient dissatisfaction. Open and endoscopic recession techniques require epidural anesthesia, lower limb ischemia, and stitches and may lead to damage of the sural nerve, which is not under the complete control of the surgeon at all stages of the procedure. The purpose of this study was to evaluate the safety and efficacy of a new technique based on ultrasound-guided ultra-minimally invasive gastrocnemius recession. We performed a pilot study with 22 cadavers to ensure that the technique was effective and safe. In the second phase, we prospectively performed gastrocnemius recession in 23 patients (25 cases) with chronic non-insertional Achilles tendinopathy, equinus foot, and other indications. In the clinical study, we evaluated the range of dorsiflexion be...
Revista Latinoamericana de Cirugía Ortopédica, 2016
La impresión 3D posibilita la traslación de una planificación virtual a modelos tangibles. El uso... more La impresión 3D posibilita la traslación de una planificación virtual a modelos tangibles. El uso hospitalario de las impresoras 3D comercializadas para uso doméstico facilita la obtención de forma autónoma (do it yourself) de reproducciones realistas al mínimo coste. Objetivo: Exponer nuestra metodología para la traslación clínica de la impresión 3D doméstica al campo de la Cirugía Ortopédica y Traumatología, definir sus indicaciones y aplicaciones específicas de acuerdo con la experiencia clínica. Material y métodos: Estudio analítico observacional prospectivo de 63 casos intervenidos en nuestro servicio desde el año 2014, mometo desde el que la impresión 3D doméstica está incluida en el proceso asistencial. Variables como el grado de satisfacción percibida por los pacientes, la precisión, el tiempo o la exposición a radiaciones ionizantes durante la intervención son analizadas. Resultados: Se define un flujo de trabajo hasta la obtención del modelo impreso en 3D mediante el uso de programas de libre acceso e impresoras 3D domésticas, con una mejoría en todas las variables incluidas en el estudio. Conclusiones: La impresión 3D doméstica tiene numerosas aplicaciones en Cirugía Ortopédica y Traumatología. La experiencia clínica ha permitido definir un flujo de trabajo con unos resultados clínicos satisfactorios.
![Research paper thumbnail of [Individualized molds for alignment of primary knee arthroplasty]](https://attachments.academia-assets.com/99353910/thumbnails/1.jpg)
](Acta ortopédica mexicana
Patient-specific cutting blocks (PSCB) have been proposed as an interesting option to achieve app... more Patient-specific cutting blocks (PSCB) have been proposed as an interesting option to achieve appropriate alignment in knee arthroplasty. However, there is no information as to which of the available planning methods is the right one. A prospective study was designed to compare two, PSCB systems using different planning methods (Signature with CAT scan + teleradiography; Visionaire with MRI) with the standard alignment method. Radiographic and functional pre- and postoperative parameters were analyzed, together with hospital stay, blood transfusion needs, operative time and associated complications. A total of 10 patients per group were operated on. No statistically significant differences were observed between both of the patient-specific alignment systems and the standard system (p > 0.05). However, greater precision was achieved with the former systems and the Signature system was slightly more accurate. Operative time was shorter in patients in whom PSCBs were used, and it wa...
BMC Musculoskeletal Disorders, 2015
Background: The increasing number of revision knee arthroplasty result in the more frequently use... more Background: The increasing number of revision knee arthroplasty result in the more frequently use of a constraint implant but results from previous reports are difficult to interpret. The purpose of this study was to compare the long-term outcomes of superficial cemented versus metaphyseal cemented in revision total knee arthroplasty with a condylar constrained arthroplasty. Methods: The study was a retrospective analysis of clinical and radiographic outcomes in a series of revision total knee arthroplasties performed with a constrained condylar knee prosthesis and press-fit modular stems. We hypothesized that the clinical and radiographic outcome of surface cementation would be inferior to that of metaphyseal cementation. Fifty-two consecutive revision cases were followed for a median of 8.2 years (range, 6 to 10 years). Results: Substantial improvements in range of motion and Knee Society score were achieved in all patients, although these were not significant between groups. Significantly more radiolucent lines were visible on the tibial component with surface cementation than with metaphyseal cementation, although the clinical differences were not relevant. Conclusions: Radiologic outcome was better in revision total knee arthroplasty using metaphyseal cemented revision and components with press-fit cementless stems than in the surface cementation-based approach; however, the difference was not clinically relevant.
European Orthopaedics and Traumatology, 2013
We report 2 cases of pseudoaneurysm of the geniculate artery after a total knee arthroplasty (TKA... more We report 2 cases of pseudoaneurysm of the geniculate artery after a total knee arthroplasty (TKA). The first one was located in the superomedial geniculate artery and resolved after compression dressing and warfarin cessation. The second one was located in the superolateral geniculate artery and was successfully treated with transarterial embolisation. There was no recurrence in both cases. The rare occurrence and delayed presentation of pseudoaneurysms pose a diagnostic challenge. A high index of suspicion is required to make the diagnosis. Early duplex Doppler ultrasonography is recommended when patients present with atypical knee pain and prolonged swelling after a TKA.
The Journal of Arthroplasty, 2014
Antibiotic cement has been recommended in the treatment of prosthetic infections. The purpose of ... more Antibiotic cement has been recommended in the treatment of prosthetic infections. The purpose of this study was to investigate the mechanical behavioral changes in cement loaded with two antibiotics, vancomycin and cefazolin, in dry and liquid medium. Six groups and four study conditions were established according to the doses of antibiotic used and the ageing (immersion in phosphate buffered saline) of the samples. Properties evaluated were friction coefficient and wear. Samples in dry medium showed higher wears than in liquid. Antibiotic selection did not influence wear properties tested in dry conditions, however, in liquid medium, there were higher frictional coefficients and wear for cefazolin loaded cement after one week and for vancomycin and cefazolin after one month. The results suggest that antibiotic cements behave differently in liquid and that the molecular characteristics of antibiotics are essential for determining this influence.
Tabla 27: Datos del grupo 6 en las diferentes condiciones en el ensayo de desgaste
Revista Latinoamericana de Cirugía Ortopédica, 2016
Introducción: La prótesis de rodilla de plataforma móvil se diseñó con el objetivo de reducir el ... more Introducción: La prótesis de rodilla de plataforma móvil se diseñó con el objetivo de reducir el desgaste de los implantes y así conseguir mayor supervivencia que la prótesis de plataforma fija. Objetivo: Mostrar los resultados clínicos de pacientes intervenidos de artroplastia total de rodilla con plataforma móvil y un seguimiento medio de 94 meses. Material y método: Estudio retrospectivo de 75 artroplastias totales de rodilla intervenidas entre 2003 y 2010 mediante el sistema Low Contact Stress (LCS ®). El seguimiento medio fue de 94 (rango: 60-118) meses. Preoperatoriamente 64 rodillas presentaban deformidad en varo (media: 169 •) y 11 rodillas deformidad en valgo (media: 187,8 •). Los pacientes, con gonartrosis, fueron evaluados con la escala del Hospital for Special Surgery (HSS) preoperatoriamente y a 1, 12, 36 y 60 meses de la cirugía. Resultados: Durante la cirugía se produjeron 2 avulsiones parciales del tendón rotuliano (2,6%). Se diagnosticaron 6 casos de aflojamiento del componente tibial (8%), de los cuales 4 requirieron revisión protésica (5,3%). Fueron diagnosticadas 2 infecciones crónicas (2,6%), recambiando la prótesis en 2 tiempos. No se observó ningún caso de luxación del polietileno (spin-out). La puntuación media preoperatoria del HSS fue de 44,6, mejorando a 86,9 puntos al final del seguimiento (p < 0,001). Conclusión: Nuestro estudio mostró que una prótesis de rodilla con plataforma móvil ofrece buenos resultados en cuanto a función y supervivencia, con un seguimiento medio de 94 meses, similares a los implantes de plataforma fija.
Journal of Orthopaedic Research, 2017
Two-stage exchange with antibiotic-loaded bone cement spacers remains the gold standard for chron... more Two-stage exchange with antibiotic-loaded bone cement spacers remains the gold standard for chronic periprosthetic joint infection (PJI). Rifampicin is highly efficient on stationary-phase staphylococci in biofilm; however, its addition to PMMA to manufacture spacers prevents polymerization and reduces mechanical properties. Isolation of rifampicin during polymerization by microencapsulation could allow manufacturing rifampicin-loaded bone cement maintaining elution and mechanical properties. Microcapsules of rifampicin with alginate, polyhydroxybutyratehydroxyvalerate (PHBV), ethylcellulose and stearic acid (SA) were synthesized. Alginate and PHBV microcapsules were added to bone cement and elution, compression, bending, hardness, setting time and microbiological tests were performed. Repeated measures ANOVA and Bonferroni post-hoc test were performed, considering a p < 0.05 as statistical significance. Bone cement specimens containing alginate microcapsules eluted more rifampicin than PHBV microcapsules or non-encapsulated rifampicin over time (p < 0.012). Microencapsulation of rifampicin allowed PMMA to preserve mechanical properties in compression and bending tests. Cement with alginate microcapsules showed similar behavior in hardness tests to control cement over the study period (73 AE 1.68H D). PMMA with alginate microcapsules exhibited the largest zones of inhibition in microbiological tests. Statistically significant differences in mean diameters of zones of inhibition between PMMA loaded with alginate-rifampicin (p ¼ 0.0001) and alginate-PHBV microcapsules (p ¼ 0.0001) were detected. Rifampicin microencapsulation with alginate is the best choice to introduce rifampicin in PMMA preserving mechanical properties, setting time, elution, and antimicrobial properties. The main applicability of this study is the opportunity for obtaining rifampicin-loaded PMMA by microencapsulation of rifampicin in alginate microparticles, achieving high doses of rifampicin in infected tissues, increasing the successful of PJI treatment.
Arthroplasty
Prosthetic joint infection (PJI) is one of the most devastating complications of orthopedic surge... more Prosthetic joint infection (PJI) is one of the most devastating complications of orthopedic surgery. However, not all patients are equally at the risk of severe infection. The incidences of PJI vary with the host and surgery-related risk factors. It is now generally accepted that some important medical comorbidities may predispose the patients to a high risk of PJI. Time-consuming and invasive surgical procedures, such as revision arthroplasties, are also associated with a high incidence of PJI, presumably due to the increased risk of surgical site contamination. Effective infection-preventing strategies should begin with identifying and optimizing the patients at a high risk of infection prior to surgery. Optimizing the operating room environment and antibiotic prophylaxis are also essential strategies that help minimize the overall incidence of infection in orthopedic surgery. The ideal antibiotic prophylaxis is still under debate, and discussions have emerged about whether variat...
Journal of Orthopaedic Surgery and Research, 2022
Background The appropriate degree of constraint in knee prosthetic revision is unknown, necessita... more Background The appropriate degree of constraint in knee prosthetic revision is unknown, necessitating the use of the lowest possible constraint. This study aimed to compare the long-term clinical and survival results of revision with rotation hinge knee (RHK) VS constrained condylar constrained knee (CCK) implants. Methods Overall, 117 revision case were prospectively reviewed and dividing into two groups based on the degree of constraint used, using only one prosthetic model in each group (61 CCK vs 56 RHK). All implants were evaluated for a minimum of 10 years. Survival of both implants at the end of follow-up, free from revision for any cause, aseptic loosening, and septic cause was compared. Results Better results were seen with use of the RHK in joint ranges of (p = 0.023), KSCS (p = 0.015), KSFS (p = 0.043), and KOOS (p = 0.031). About 22.2% of the cases required repeat surgery (11.7% RHK vs 29.6% CCK, p = 0.023). Constrained condylar implants had a significantly lower surviva...
International Orthopaedics, 2022
Purpose Microencapsulation techniques have allowed the addition of rifampicin to bone cement, but... more Purpose Microencapsulation techniques have allowed the addition of rifampicin to bone cement, but its in vivo efficacy has not been proven. The aim of our study is to determine the superiority of cement containing gentamicin and rifampicin microcapsules in the treatment of PJI versus cement exclusively containing gentamicin. Methods An S. aureus PJI was induced in 15 NZW rabbits. A week after inoculation, the first stage of replacement was carried out, and the animals were divided into two groups: group R received a spacer containing gentamicin and rifampicin microcapsules, and group C received a spacer containing gentamicin. Intra-articular release curve of rifampicin and infection and toxicity markers were monitored for four weeks post-operatively, when microbiological analysis was performed. Results The microbiological cultures showed a significantly lower growth of S. aureus in soft tissue (2.3·104 vs 0; p = 0.01) and bone (5.7·102 vs 0; p = 0.03) in the group with rifampicin mi...
Journal of Orthopaedic Surgery and Research, 2021
Background Greater trochanteric pain syndrome encompasses a range of causes of lateral hip pain i... more Background Greater trochanteric pain syndrome encompasses a range of causes of lateral hip pain including greater trochanteric bursitis, tendinopathy and tears of the gluteus minimus and medius, and lateral snapping hip (LSH). Surgical options for LSH range from open surgery to endoscopic surgery, including a diamond-shaped cut or a simple transversal release to gluteus maximus tendon release. Resection of an area of proximal iliotibial band (ITB) and step-cut or z-plasty lengthening have not proven superior to transverse release of the ITB. Therefore, making a complete and effective transverse cut guided by ultrasound may represent a potential advance over endoscopic surgery. Purpose In this case series study, we describe how to perform proximal release of the ITB guided by ultrasound. Methods The surgical technique—either z-plasty or transverse section of the ITB—was first validated on 10 cadaver specimens and then used in clinical practice. Fourteen patients (5 males and 9 female...
La artroplastia de cadera es una alternativa a la artroplastia convencional, que esta indicada en... more La artroplastia de cadera es una alternativa a la artroplastia convencional, que esta indicada en pacientes jovenes y activos. Los buenos resultados y la prevencion de complicaciones dependen de una minuciosa tecnica quirurgica asi como de una correcta seleccion de pacientes. Presentamos un caso de un paciente de 43 anos que tras ser sometido a una sustitucion de cadera bilateral con protesis de recubrimiento sufrio una fractura en ambos cuellos femorales de manera no simultanea, por necrosis avascular, que tuvo que ser tratada mediante la colocacion de un vastago de anclaje metafisario. Las radiografias postoperatorias mostraron una buena colocacion del implante sin muescas en el cuello («notching» femoral), con discreta alineacion de 7o valgo del componente femoral. La movilidad pasiva y activa era dolorosa. El estudio radiografico mostro una fractura cervical del femur derecho. (La cabeza femoral estaba unida al implante no encontrando metalosis ni aflojamiento de los componentes...
Los sistemas de bloque de corte especificos (BCE) se han presentado como una interesante medida p... more Los sistemas de bloque de corte especificos (BCE) se han presentado como una interesante medida para obtener una correcta alineacion en la artroplastia de rodilla, aunque se desconoce cual de todos los metodos existentes para realizar la planificacion es el adecuado. Material y metodos: Se ha disenado un estudio prospectivo comparando dos sistemas de BCE con planificaciones diferentes (Signature con TAC + teleradiografia; Visionaire con RMN) con el sistema convencional de alineacion. Se analizaron parametros radiograficos, funcionales preoperatorios y postoperatorios, estancia hospitalaria, necesidad de transfusion, tiempo quirurgico y complicaciones asociadas. Resultados: Un total de 10 pacientes fueron intervenidos por cada grupo. No se observaron diferencias estadisticamente significativas entre los dos sistemas de alineamiento especificos y el sistema convencional (p > 0.05), aunque se objetivo una mayor precision con estos sistemas, siendo discretamente superior en el sistem...
BMC Musculoskeletal Disorders, 2021
Background 3D printing technology in hospitals facilitates production models such as point-of-car... more Background 3D printing technology in hospitals facilitates production models such as point-of-care manufacturing. Orthopedic Surgery and Traumatology is the specialty that can most benefit from the advantages of these tools. The purpose of this study is to present the results of the integration of 3D printing technology in a Department of Orthopedic Surgery and Traumatology and to identify the productive model of the point-of-care manufacturing as a paradigm of personalized medicine. Methods Observational, descriptive, retrospective and monocentric study of a total of 623 additive manufacturing processes carried out in a Department of Orthopedic Surgery and Traumatology from November 2015 to March 2020. Variables such as product type, utility, time or materials for manufacture were analyzed. Results The areas of expertise that have performed more processes are Traumatology, Reconstructive and Orthopedic Oncology. Pre-operative planning is their primary use. Working and 3D printing h...
Orthopedic Research and Reviews, 2020
There is growing body of evidence that important patient-, procedure-and pathogen-related factors... more There is growing body of evidence that important patient-, procedure-and pathogen-related factors are linked to higher risks for prosthetic joint infections (PJI) following arthroplasty surgeries. The prior identification and optimization of such risk factors is considered paramount to minimize the incidence of these infections. Without any doubt, antibiotic prophylaxis remains one of the cornerstones among all preventive measures. However, the ideal antibiotic prophylaxis is still in debate and discussions have emerged, whether certain situations deserve adjustments or variations of the standard protocol taking into account antibiotic resistance surveillance data and patient risk factors for infections. This review aims to provide the reader with an overview of possible antibiotic prophylaxis strategies in response to these risks and discusses the clinical experiences so far obtained. We further present preliminary evidence that the use of a reinforced local antibiotic prophylaxis regimen with high-dose dual antibiotic-loaded bone cement may be an effective and easy-to-apply option in patients at high infection risks.
Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine, Jan 4, 2017
High-resolution ultrasonography (US) can play an important role in studying nerves, as it has sev... more High-resolution ultrasonography (US) can play an important role in studying nerves, as it has several advantages. Entrapments of distal tibial nerve branches can be mapped out or diagnosed with selective anesthetic blocks, and US can guide therapeutic procedures, such as radiofrequency ablation and selective infiltrations of specific nerve branches. The aim of this study was to verify that US is an effective method for accurately locating the posterior tibial nerve and its terminal branches, such as the medial calcaneal branch, the first calcaneal branch, and the medial and lateral plantar nerves. In this study, we analyzed the correlation between US mapping and real anatomy after cadaveric dissection, assessing the distribution and variability of the tibial nerve and its terminal branches. We used 12 fresh anatomic specimens of the foot and ankle, including the calf. A high-resolution US study of the tibial nerve and its branches was performed. The results of the US studies of the ...
Arthroplasty Today, 2017
Bone cement spacers loaded with antibiotic are the gold standard in septic revision. However, the... more Bone cement spacers loaded with antibiotic are the gold standard in septic revision. However, the management of massive bone defects constitutes a surgical challenge, requiring the use of different nails, expensive long stems, or cement-coated tumor prostheses for preparing the spacer. In most cases, the knee joint must be sacrificed. We describe a novel technique for preparing a biarticular total femur spacer with the help of a trochanteric nail coated with antibiotic loaded cement, allowing mobility of the hip and knee joints and assisted partial loading until second step surgery. This technique is helpful to maintain the length of the leg, prevent soft tissue contracture, and help eradicate the infection preserving the patient comfort and autonomy while waiting to receive total femoral replacement.
Arthroplasty Today, 2017
Osteogenesis imperfecta (OI) is a rare congenital disease characterized by alterations in bone qu... more Osteogenesis imperfecta (OI) is a rare congenital disease characterized by alterations in bone quality, with susceptibility to fractures, instability, deformities, and osteoarthrosis. Prosthetic surgery in these patients is associated with an abnormally high rate of implant failures. On the other hand, abnormal bone fragility adds to the complexity of revision surgery in such individualsdthus representing a genuine challenge for the orthopaedic surgeon. We present a case of femoral reconstruction in a patient with OI and prosthetic loosening after reconstruction secondary to femoral septic pseudoarthrosis. Intramedullary total femoral reconstruction was carried out after exceeding the biological reconstruction limits. This is the first reported instance of the use of an intramedullary total femur arthroplasty as salvage technique in an OI patient. This technique should be considered when we have exceeded biological limits for femoral fixation.
BMC musculoskeletal disorders, Oct 3, 2016
Isolated gastrocnemius contracture is thought to lead to numerous conditions. Although many techn... more Isolated gastrocnemius contracture is thought to lead to numerous conditions. Although many techniques have been described for gastrocnemius recession, potential anesthetic, cosmetic, and wound-related complications can lead to patient dissatisfaction. Open and endoscopic recession techniques require epidural anesthesia, lower limb ischemia, and stitches and may lead to damage of the sural nerve, which is not under the complete control of the surgeon at all stages of the procedure. The purpose of this study was to evaluate the safety and efficacy of a new technique based on ultrasound-guided ultra-minimally invasive gastrocnemius recession. We performed a pilot study with 22 cadavers to ensure that the technique was effective and safe. In the second phase, we prospectively performed gastrocnemius recession in 23 patients (25 cases) with chronic non-insertional Achilles tendinopathy, equinus foot, and other indications. In the clinical study, we evaluated the range of dorsiflexion be...
Revista Latinoamericana de Cirugía Ortopédica, 2016
La impresión 3D posibilita la traslación de una planificación virtual a modelos tangibles. El uso... more La impresión 3D posibilita la traslación de una planificación virtual a modelos tangibles. El uso hospitalario de las impresoras 3D comercializadas para uso doméstico facilita la obtención de forma autónoma (do it yourself) de reproducciones realistas al mínimo coste. Objetivo: Exponer nuestra metodología para la traslación clínica de la impresión 3D doméstica al campo de la Cirugía Ortopédica y Traumatología, definir sus indicaciones y aplicaciones específicas de acuerdo con la experiencia clínica. Material y métodos: Estudio analítico observacional prospectivo de 63 casos intervenidos en nuestro servicio desde el año 2014, mometo desde el que la impresión 3D doméstica está incluida en el proceso asistencial. Variables como el grado de satisfacción percibida por los pacientes, la precisión, el tiempo o la exposición a radiaciones ionizantes durante la intervención son analizadas. Resultados: Se define un flujo de trabajo hasta la obtención del modelo impreso en 3D mediante el uso de programas de libre acceso e impresoras 3D domésticas, con una mejoría en todas las variables incluidas en el estudio. Conclusiones: La impresión 3D doméstica tiene numerosas aplicaciones en Cirugía Ortopédica y Traumatología. La experiencia clínica ha permitido definir un flujo de trabajo con unos resultados clínicos satisfactorios.
Acta ortopédica mexicana
Patient-specific cutting blocks (PSCB) have been proposed as an interesting option to achieve app... more Patient-specific cutting blocks (PSCB) have been proposed as an interesting option to achieve appropriate alignment in knee arthroplasty. However, there is no information as to which of the available planning methods is the right one. A prospective study was designed to compare two, PSCB systems using different planning methods (Signature with CAT scan + teleradiography; Visionaire with MRI) with the standard alignment method. Radiographic and functional pre- and postoperative parameters were analyzed, together with hospital stay, blood transfusion needs, operative time and associated complications. A total of 10 patients per group were operated on. No statistically significant differences were observed between both of the patient-specific alignment systems and the standard system (p > 0.05). However, greater precision was achieved with the former systems and the Signature system was slightly more accurate. Operative time was shorter in patients in whom PSCBs were used, and it wa...
BMC Musculoskeletal Disorders, 2015
Background: The increasing number of revision knee arthroplasty result in the more frequently use... more Background: The increasing number of revision knee arthroplasty result in the more frequently use of a constraint implant but results from previous reports are difficult to interpret. The purpose of this study was to compare the long-term outcomes of superficial cemented versus metaphyseal cemented in revision total knee arthroplasty with a condylar constrained arthroplasty. Methods: The study was a retrospective analysis of clinical and radiographic outcomes in a series of revision total knee arthroplasties performed with a constrained condylar knee prosthesis and press-fit modular stems. We hypothesized that the clinical and radiographic outcome of surface cementation would be inferior to that of metaphyseal cementation. Fifty-two consecutive revision cases were followed for a median of 8.2 years (range, 6 to 10 years). Results: Substantial improvements in range of motion and Knee Society score were achieved in all patients, although these were not significant between groups. Significantly more radiolucent lines were visible on the tibial component with surface cementation than with metaphyseal cementation, although the clinical differences were not relevant. Conclusions: Radiologic outcome was better in revision total knee arthroplasty using metaphyseal cemented revision and components with press-fit cementless stems than in the surface cementation-based approach; however, the difference was not clinically relevant.
European Orthopaedics and Traumatology, 2013
We report 2 cases of pseudoaneurysm of the geniculate artery after a total knee arthroplasty (TKA... more We report 2 cases of pseudoaneurysm of the geniculate artery after a total knee arthroplasty (TKA). The first one was located in the superomedial geniculate artery and resolved after compression dressing and warfarin cessation. The second one was located in the superolateral geniculate artery and was successfully treated with transarterial embolisation. There was no recurrence in both cases. The rare occurrence and delayed presentation of pseudoaneurysms pose a diagnostic challenge. A high index of suspicion is required to make the diagnosis. Early duplex Doppler ultrasonography is recommended when patients present with atypical knee pain and prolonged swelling after a TKA.
The Journal of Arthroplasty, 2014
Antibiotic cement has been recommended in the treatment of prosthetic infections. The purpose of ... more Antibiotic cement has been recommended in the treatment of prosthetic infections. The purpose of this study was to investigate the mechanical behavioral changes in cement loaded with two antibiotics, vancomycin and cefazolin, in dry and liquid medium. Six groups and four study conditions were established according to the doses of antibiotic used and the ageing (immersion in phosphate buffered saline) of the samples. Properties evaluated were friction coefficient and wear. Samples in dry medium showed higher wears than in liquid. Antibiotic selection did not influence wear properties tested in dry conditions, however, in liquid medium, there were higher frictional coefficients and wear for cefazolin loaded cement after one week and for vancomycin and cefazolin after one month. The results suggest that antibiotic cements behave differently in liquid and that the molecular characteristics of antibiotics are essential for determining this influence.
Tabla 27: Datos del grupo 6 en las diferentes condiciones en el ensayo de desgaste
Revista Latinoamericana de Cirugía Ortopédica, 2016
Introducción: La prótesis de rodilla de plataforma móvil se diseñó con el objetivo de reducir el ... more Introducción: La prótesis de rodilla de plataforma móvil se diseñó con el objetivo de reducir el desgaste de los implantes y así conseguir mayor supervivencia que la prótesis de plataforma fija. Objetivo: Mostrar los resultados clínicos de pacientes intervenidos de artroplastia total de rodilla con plataforma móvil y un seguimiento medio de 94 meses. Material y método: Estudio retrospectivo de 75 artroplastias totales de rodilla intervenidas entre 2003 y 2010 mediante el sistema Low Contact Stress (LCS ®). El seguimiento medio fue de 94 (rango: 60-118) meses. Preoperatoriamente 64 rodillas presentaban deformidad en varo (media: 169 •) y 11 rodillas deformidad en valgo (media: 187,8 •). Los pacientes, con gonartrosis, fueron evaluados con la escala del Hospital for Special Surgery (HSS) preoperatoriamente y a 1, 12, 36 y 60 meses de la cirugía. Resultados: Durante la cirugía se produjeron 2 avulsiones parciales del tendón rotuliano (2,6%). Se diagnosticaron 6 casos de aflojamiento del componente tibial (8%), de los cuales 4 requirieron revisión protésica (5,3%). Fueron diagnosticadas 2 infecciones crónicas (2,6%), recambiando la prótesis en 2 tiempos. No se observó ningún caso de luxación del polietileno (spin-out). La puntuación media preoperatoria del HSS fue de 44,6, mejorando a 86,9 puntos al final del seguimiento (p < 0,001). Conclusión: Nuestro estudio mostró que una prótesis de rodilla con plataforma móvil ofrece buenos resultados en cuanto a función y supervivencia, con un seguimiento medio de 94 meses, similares a los implantes de plataforma fija.
Journal of Orthopaedic Research, 2017
Two-stage exchange with antibiotic-loaded bone cement spacers remains the gold standard for chron... more Two-stage exchange with antibiotic-loaded bone cement spacers remains the gold standard for chronic periprosthetic joint infection (PJI). Rifampicin is highly efficient on stationary-phase staphylococci in biofilm; however, its addition to PMMA to manufacture spacers prevents polymerization and reduces mechanical properties. Isolation of rifampicin during polymerization by microencapsulation could allow manufacturing rifampicin-loaded bone cement maintaining elution and mechanical properties. Microcapsules of rifampicin with alginate, polyhydroxybutyratehydroxyvalerate (PHBV), ethylcellulose and stearic acid (SA) were synthesized. Alginate and PHBV microcapsules were added to bone cement and elution, compression, bending, hardness, setting time and microbiological tests were performed. Repeated measures ANOVA and Bonferroni post-hoc test were performed, considering a p < 0.05 as statistical significance. Bone cement specimens containing alginate microcapsules eluted more rifampicin than PHBV microcapsules or non-encapsulated rifampicin over time (p < 0.012). Microencapsulation of rifampicin allowed PMMA to preserve mechanical properties in compression and bending tests. Cement with alginate microcapsules showed similar behavior in hardness tests to control cement over the study period (73 AE 1.68H D). PMMA with alginate microcapsules exhibited the largest zones of inhibition in microbiological tests. Statistically significant differences in mean diameters of zones of inhibition between PMMA loaded with alginate-rifampicin (p ¼ 0.0001) and alginate-PHBV microcapsules (p ¼ 0.0001) were detected. Rifampicin microencapsulation with alginate is the best choice to introduce rifampicin in PMMA preserving mechanical properties, setting time, elution, and antimicrobial properties. The main applicability of this study is the opportunity for obtaining rifampicin-loaded PMMA by microencapsulation of rifampicin in alginate microparticles, achieving high doses of rifampicin in infected tissues, increasing the successful of PJI treatment.