pablo sanz ruiz - Profile on Academia.edu (original) (raw)

Papers by pablo sanz ruiz

Journal of Orthopaedic Surgery and Research, Mar 4, 2022

The appropriate degree of constraint in knee prosthetic revision is unknown, necessitating the us... more 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. 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 survival rates than rotating hinge implants (p = 0.005), due to a higher aseptic loosening rate (p = 0.031). Using a specific RHK design with less rotational constraint has better clinical and survival outcomes than implants with greater rotational constraint, such as one specific CCK.

Case Reports in Orthopedics

Introduction. Reconstruction of acetabular bone defects by the combination of trabecular metal au... more Introduction. Reconstruction of acetabular bone defects by the combination of trabecular metal augments and porous cups can be complex when extensive bone loss and poor-quality bone exists. The onset of porous cups with an interlocking mechanism may simplify surgical technique due to its superior initial mechanical stability. We endorse the possibility for a change in the classical order of setting of the augments and the cup. Methods. We present a technical modification and a series of cases of three patients with Paprosky IIB and IIIA acetabular defects operated with a combination of porous metal augments and a porous cup. In all the three patients, the setting of the cup was done first and secured with locked screws, and then the augments were set in place as a wedge and fixed with screws in a standard fashion. Results. The postoperative X-ray showed good position of implants with restoration of the center of rotation, and the patients had good recovery. Radiological evaluation i...

Journal of Orthopaedic Research, 2020

The real degree of constriction of rotating hinge knee (RHK) and condylar constrained prostheses ... more The real degree of constriction of rotating hinge knee (RHK) and condylar constrained prostheses (CCK) is a matter of discussion in revision knee arthroplasty. The objectives of this study are to compare the tibial rotation of both implants and validate the use of inertial sensors with optical tracking system as movement measurement tools. A total of 16 cadaver knees were used. Eight knees were replaced using a RHK (Endomodel LINK), and the remaining eight received a CCK prosthesis (LCCK, Zimmer). Tibial rotation range of motion was measured in full extension and at 30°, 60°, and 90° of flexion, with four continuous waveforms for each measurement. Measurements were made using two inertial sensors with specific software and compared with measurements obtained using the gold standard technique ‐ the motion capture camera. The comparison of the accuracy of both measurement methods showed no statistically significant differences between inertial sensors and motion capture cameras, with ...

Journal of Orthopaedic Surgery and Research, 2021

BackgroundThis study aims to analyze the clinical outcome of a new ultrasound-guided surgery for ... more BackgroundThis study aims to analyze the clinical outcome of a new ultrasound-guided surgery for partial plantar fasciotomy performed with a needle for treatment of plantar fasciitis.MethodsWe performed a retrospective review of 107 patients diagnosed with plantar fasciitis who underwent ultrasound-guided release of the plantar fascia.The series included 62 males (57.9%) and 45 females (42.1%) treated between April 2014 and February 2018, with a mean follow-up of 21.05 ± 10.96 months (7–66) and a minimum follow-up of 24 months. The mean age was 48.10 ± 10.27 years (27–72).Clinical assessments and ultrasound examination were carried out before treatment, after 1 week, and then after 1, 3, 12, and 24 months. The clinical assessment was based on a visual analog scale and the Foot and Ankle Disability Index.ResultsHeel pain improved in 92.5% (99) of patients, but not in 7.4% (8 patients). In the group of patients whose heel pain improved, 9 experienced overload on the lateral column and...

EFORT Open Reviews, 2019

Because of the risk of bacterial biofilm infections, prophylactic use of antibiotics in orthopaed... more Because of the risk of bacterial biofilm infections, prophylactic use of antibiotics in orthopaedic procedures involving the implantation of large prosthesis systems is considered mandatory. A strategy based on the rationale that local antibiotics released from bone cement or other carriers establish a second antibacterial frontline in and around the prosthesis is considered complementary to the administration of systemic antibiotics. Although less common as a consequence of the initially very high drug concentrations of local antibiotics in the tissues, a selection process of previous high resistance bacteria may occur, leading to antibiotic resistance. The use of antibiotic combinations in bone cement is generally accepted to improve antibiotic efficacy and minimizes the treatment failure risk due to antibiotic resistance. This is important in septic revisions and/or in patients at particularly high risk of infection. On an individual basis, the benefit of a lower infection probab...

Reports of Practical Oncology & Radiotherapy, 2013

Introduction. Conservative surgery (CS) and postoperative radiotherapy (EBRT) is a well-establish... more Introduction. Conservative surgery (CS) and postoperative radiotherapy (EBRT) is a well-established treatment for primary soft tissue sarcomas (pSTS). Radiation dose effect has been described as improved factor in control disease. Intraoperative radiotherapy allowed deliver high radiation dose selectively. Purpose. To evaluate the patterns of failure and toxicity of CS and Intraoperative Electron Beam Radiotherapy (IOERT) or Perioperative High Dose-Rate Brachytherapy (PHDRB) in pSTS of the extremities and trunk. Methods and materials. Patients were treated with CS combined IOERT or PHDRB plus EBRT. Adjuvant chemotherapy was given in high-grade tumours. Results. 103 patients were retrospectively analysed. Patients received either IOERT (n = 35, 34%) or PHDRB (n = 68, 66%) plus EBRT. The median size was 7.5 cm. Location were in extremities 80 (77.7%) and trunk 23 (22.3%). AJCC stage I-IIA were documented in 33 (32%) and IIB-III in 69 (67%). Margins was free or close in 80 (77.7%) and affected in 23 (22.3%). Mayor complications acute or late (Toxicity Grade 3-5) was documented in 30 patients (29.1%) 15 out of 35 (42%) in IOERT and 15 out of 68 (22%) in HDRBT patients. After a median follow-up of 75.7 months the 5-year rates of DFS, LRC, DC and OS were 62%, 80%, 73% and 90%, respectively. Univariate analysis of LRC, DFS, DC and OS showed for free margins compared with affected an significance improved 5-year control rates (88% vs. 49%), (70% vs. 27%), (79% vs. 52%) and (84% vs. 64) respectively. Univariate analysis of DC and OS showed for tumour lower than 9.5 cm compared with higher an improved 5-year control rates (80% vs. 55%, p = 0.02) and (95% vs. 80%, p = 0.04) respectively. No differences in 5-year LRC rates between IOERT and PHDRB were observed. Conclusions. Margins and tumour size are the most important prognostic factor in pSTS treated with CS and intra-operative radiotherapy plus EBRT.

BMC Musculoskeletal Disorders, Feb 25, 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.

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.

Journal of Orthopaedic Surgery and Research, Mar 4, 2022

The appropriate degree of constraint in knee prosthetic revision is unknown, necessitating the us... more 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. 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 survival rates than rotating hinge implants (p = 0.005), due to a higher aseptic loosening rate (p = 0.031). Using a specific RHK design with less rotational constraint has better clinical and survival outcomes than implants with greater rotational constraint, such as one specific CCK.

Case Reports in Orthopedics

Introduction. Reconstruction of acetabular bone defects by the combination of trabecular metal au... more Introduction. Reconstruction of acetabular bone defects by the combination of trabecular metal augments and porous cups can be complex when extensive bone loss and poor-quality bone exists. The onset of porous cups with an interlocking mechanism may simplify surgical technique due to its superior initial mechanical stability. We endorse the possibility for a change in the classical order of setting of the augments and the cup. Methods. We present a technical modification and a series of cases of three patients with Paprosky IIB and IIIA acetabular defects operated with a combination of porous metal augments and a porous cup. In all the three patients, the setting of the cup was done first and secured with locked screws, and then the augments were set in place as a wedge and fixed with screws in a standard fashion. Results. The postoperative X-ray showed good position of implants with restoration of the center of rotation, and the patients had good recovery. Radiological evaluation i...

Journal of Orthopaedic Research, 2020

The real degree of constriction of rotating hinge knee (RHK) and condylar constrained prostheses ... more The real degree of constriction of rotating hinge knee (RHK) and condylar constrained prostheses (CCK) is a matter of discussion in revision knee arthroplasty. The objectives of this study are to compare the tibial rotation of both implants and validate the use of inertial sensors with optical tracking system as movement measurement tools. A total of 16 cadaver knees were used. Eight knees were replaced using a RHK (Endomodel LINK), and the remaining eight received a CCK prosthesis (LCCK, Zimmer). Tibial rotation range of motion was measured in full extension and at 30°, 60°, and 90° of flexion, with four continuous waveforms for each measurement. Measurements were made using two inertial sensors with specific software and compared with measurements obtained using the gold standard technique ‐ the motion capture camera. The comparison of the accuracy of both measurement methods showed no statistically significant differences between inertial sensors and motion capture cameras, with ...

Journal of Orthopaedic Surgery and Research, 2021

BackgroundThis study aims to analyze the clinical outcome of a new ultrasound-guided surgery for ... more BackgroundThis study aims to analyze the clinical outcome of a new ultrasound-guided surgery for partial plantar fasciotomy performed with a needle for treatment of plantar fasciitis.MethodsWe performed a retrospective review of 107 patients diagnosed with plantar fasciitis who underwent ultrasound-guided release of the plantar fascia.The series included 62 males (57.9%) and 45 females (42.1%) treated between April 2014 and February 2018, with a mean follow-up of 21.05 ± 10.96 months (7–66) and a minimum follow-up of 24 months. The mean age was 48.10 ± 10.27 years (27–72).Clinical assessments and ultrasound examination were carried out before treatment, after 1 week, and then after 1, 3, 12, and 24 months. The clinical assessment was based on a visual analog scale and the Foot and Ankle Disability Index.ResultsHeel pain improved in 92.5% (99) of patients, but not in 7.4% (8 patients). In the group of patients whose heel pain improved, 9 experienced overload on the lateral column and...

EFORT Open Reviews, 2019

Because of the risk of bacterial biofilm infections, prophylactic use of antibiotics in orthopaed... more Because of the risk of bacterial biofilm infections, prophylactic use of antibiotics in orthopaedic procedures involving the implantation of large prosthesis systems is considered mandatory. A strategy based on the rationale that local antibiotics released from bone cement or other carriers establish a second antibacterial frontline in and around the prosthesis is considered complementary to the administration of systemic antibiotics. Although less common as a consequence of the initially very high drug concentrations of local antibiotics in the tissues, a selection process of previous high resistance bacteria may occur, leading to antibiotic resistance. The use of antibiotic combinations in bone cement is generally accepted to improve antibiotic efficacy and minimizes the treatment failure risk due to antibiotic resistance. This is important in septic revisions and/or in patients at particularly high risk of infection. On an individual basis, the benefit of a lower infection probab...

Reports of Practical Oncology & Radiotherapy, 2013

Introduction. Conservative surgery (CS) and postoperative radiotherapy (EBRT) is a well-establish... more Introduction. Conservative surgery (CS) and postoperative radiotherapy (EBRT) is a well-established treatment for primary soft tissue sarcomas (pSTS). Radiation dose effect has been described as improved factor in control disease. Intraoperative radiotherapy allowed deliver high radiation dose selectively. Purpose. To evaluate the patterns of failure and toxicity of CS and Intraoperative Electron Beam Radiotherapy (IOERT) or Perioperative High Dose-Rate Brachytherapy (PHDRB) in pSTS of the extremities and trunk. Methods and materials. Patients were treated with CS combined IOERT or PHDRB plus EBRT. Adjuvant chemotherapy was given in high-grade tumours. Results. 103 patients were retrospectively analysed. Patients received either IOERT (n = 35, 34%) or PHDRB (n = 68, 66%) plus EBRT. The median size was 7.5 cm. Location were in extremities 80 (77.7%) and trunk 23 (22.3%). AJCC stage I-IIA were documented in 33 (32%) and IIB-III in 69 (67%). Margins was free or close in 80 (77.7%) and affected in 23 (22.3%). Mayor complications acute or late (Toxicity Grade 3-5) was documented in 30 patients (29.1%) 15 out of 35 (42%) in IOERT and 15 out of 68 (22%) in HDRBT patients. After a median follow-up of 75.7 months the 5-year rates of DFS, LRC, DC and OS were 62%, 80%, 73% and 90%, respectively. Univariate analysis of LRC, DFS, DC and OS showed for free margins compared with affected an significance improved 5-year control rates (88% vs. 49%), (70% vs. 27%), (79% vs. 52%) and (84% vs. 64) respectively. Univariate analysis of DC and OS showed for tumour lower than 9.5 cm compared with higher an improved 5-year control rates (80% vs. 55%, p = 0.02) and (95% vs. 80%, p = 0.04) respectively. No differences in 5-year LRC rates between IOERT and PHDRB were observed. Conclusions. Margins and tumour size are the most important prognostic factor in pSTS treated with CS and intra-operative radiotherapy plus EBRT.

BMC Musculoskeletal Disorders, Feb 25, 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.

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.