Publications by authors named "Fernando Comba"

47 Publications

Preliminary outcomes of the cementless UNITED hip system for primary total hip arthroplasty at a minimum 2-year follow-up.

Eur J Orthop Surg Traumatol 2021 Jun 12. Epub 2021 Jun 12.

Hip Surgery Unit, Institute of Orthopaedics "Carlos E. Ottolenghi", Italian Hospital of Buenos Aires, 4247 Potosí St., C1199ACK, Buenos Aires, Argentina.

Introduction: This study aimed to report the initial results of the cementless UNITED hip system in primary total hip arthroplasty (THA) with a minimum follow-up of 2 years.

Methods: We retrospectively studied a consecutive series of 203 cementless THAs in 180 patients operated between 2015-2017. We included 89 female and 91 male patients with a mean age of 67 (28 to 89) years. The mean follow-up was 40 (29 to 62) months. Clinical outcome scores and radiographs were measured. Survival was calculated defining failure as the need for any further femoral or acetabular revision, irrespective of the reason.

Results: No femoral component loosening was detected. One patient had a Vancouver-B1 intraoperative periprosthetic femoral fracture treated with implant retention and cerclage wires. Two acetabular components were revised for aseptic loosening. Three patients suffered an acute infection treated with debridement, antibiotics, and implant retention. The mean Merle d'Aubigné et Postel scores improved from 13 (4 to 16) points preoperatively to 17 (12 to 18) points at the latest follow-up (p < 0.001). At a mean time of 40 months of follow-up, the survival was 99% and 100% for the acetabular and the femoral components, respectively.

Conclusion: This cementless design showed excellent preliminary outcomes in terms of fixation and patient satisfaction, comparable to that of other well-known similar systems.
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http://dx.doi.org/10.1007/s00590-021-03038-5DOI Listing
June 2021

Are lateral view radiographs necessary to properly classify femoral neck fractures? Intra and interobserver analysis using Garden's classification system

Rev Fac Cien Med Univ Nac Cordoba 2021 03 29;78(1):41-44. Epub 2021 Mar 29.

Hospital Italiano de Buenos Aires.

Introduction: Femoral neck fractures have been historically diagnosed by anteroposterior (AP) and lateral (L) radiographic views. We analyzed the importance of the L view for management of femoral neck fractures, using the Garden's classification system.

Materials And Methods: Slides were elaborated with AP and L radiographic views of 100 patients with femoral neck fractures admitted to our emergency department. Three hip surgeons assessed independently AP views only and then AP and L views together using Garden's classification system.

Results: No statistically significant differences (Kruskal Wallis 0, p=1) were found while comparing categories among Garden's classification system, after assessing L views. There was an 81 % (p < 0.001) agreement of Garden category between AP and AP combined with L views. When analyzing patients with changing categories between displaced and non displaced after assessing L view images, we found a 5% (n=5, CI 95% 1-11%) of change. For comparing AP Garden with L view Garden, we used a quadratic weighted kappa method.

Conclusions: There is a high agreement in the Garden category when comparing AP with combined AP and L observations. Five patients would have received a different surgical treatment dependent on the hip surgeon who assessed the radiographs. This highlights the relevance of routinely L radiographs whenever a femoral neck fracture is suspected.
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March 2021

Patients with no recurrence of infection five years after two-stage revision hip arthroplasty may be classified as periprosthetic infection 'in remission'.

Bone Joint J 2021 Jan;103-B(1):79-86

'Sir John Charnley' Hip Surgery Unit, Institute of Orthopaedics 'Carlos E. Ottolenghi', Italian Hospital of Buenos Aires, Buenos Aires, Argentina.

Aims: We aimed to report the mid- to long-term rates of septic and aseptic failure after two-stage revision surgery for periprosthetic joint infection (PJI) following total hip arthroplasty (THA).

Methods: We retrospectively reviewed 96 cases which met the Musculoskeletal Infection Society criteria for PJI. The mean follow-up was 90 months (SD 32). Septic failure was assessed using a Delphi-based consensus definition. Any further surgery undertaken for aseptic mechanical causes was considered as aseptic failure. The cumulative incidence with competing risk analysis was used to predict the risk of septic failure. A regression model was used to evaluate factors associated with septic failure. The cumulative incidence of aseptic failure was also analyzed.

Results: There were 23 septic failures at final follow-up, with a cumulative incidence of 14% (95% confidence interval (CI) 8% to 22%) at one year, 18% (95% CI 11% to 27%) at two years, 22% (95% CI 14% to 31%) at five years, and 23% (95% CI 15% to 33%) at ten years. Having at least one positive culture (hazard ratio (HR) 2.38 (interquartile range (IQR) 1.19 to 4.74); p = 0.013), or a positive intraoperative frozen section (HR 2.55 (IQR 1.06 to 6.15); p = 0.037) was significantly associated with septic failure after reimplantation. With dislocation being the most common cause of aseptic revision (5.2%), the cumulative incidence of aseptic failure was 1% (95% CI 0% to 5%) at one year, 6% (95% CI 1% to 8%) at five years, and 8% (95%CI 3% to 17%) at ten years.

Conclusion: If there is no recurrent infection in the five years following reimplantation, the chances of further infection thereafter are remote. While the results of a frozen section may be a reliable guide to the timing of reimplantation, intraoperative culture has, currently, only prognostic value. Surgeons should be aware that instability remains a potential indication for further revision surgery. Cite this article: 2021;103-B(1):79-86.
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http://dx.doi.org/10.1302/0301-620X.103B1.BJJ-2020-0955.R1DOI Listing
January 2021

Who Restores Hip Biomechanics More Effectively after a Femoral Neck Fracture? Comparison of Total Hip Arthroplasties Performed by Either Hip Surgeons or Orthopaedic Residents.

Arthroplast Today 2020 Dec 29;6(4):736-741. Epub 2020 Aug 29.

Hip Surgery Unit, Institute of Orthopaedics "Carlos E. Ottolenghi", Italian Hospital of Buenos Aires, Buenos Aires, Argentina.

Background: This study aims to analyze the ability to restore hip biomechanics in patients who undergo total hip arthroplasty for displaced femoral neck fractures operated by either hip surgeons (HSs) or orthopaedic residents (ORs).

Methods: We retrospectively compared 95 patients treated by HSs (group A) with 110 patients treated by ORs (group B). Leg-length discrepancy, femoral offset (FO), center of rotation (COR), acetabular inclination, and acetabular anteversion were evaluated on postoperative radiographs using the healthy contralateral hip as control.

Results: The median leg-length discrepancy was 2 mm for both groups ( = .74). The leg length was increased in 54% of the HS group and 57% of the OR group ( = .13). The median FO difference of groups A and B were 7 mm and 5.5 mm, respectively ( = .14). FO was increased in 80% of the HS group and 69% of the OR group ( = .19). Median discrepancies of the horizontal and vertical CORs were not statistically relevant, with -values of .69 and .14, respectively. The horizontal COR was slightly medialized in 58% of the HS group and 53% of the OR group ( = .003). The vertical COR was slightly proximal in 66% of the HS group and 76% of the OR group ( = .28). The median acetabular inclination angles of groups A and B were 41° and 40°, respectively ( = .62). The median anteversion angle was 19° for both groups ( = .89).

Conclusions: The horizontal COR was the only measurement with statistical significance. To conclude, ORs under supervision are as reliable as HSs to properly restore hip biomechanics in patients who undergo total hip arthroplasty for displaced femoral neck fractures.
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http://dx.doi.org/10.1016/j.artd.2020.07.027DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7475170PMC
December 2020

Prolonged social lockdown during COVID-19 pandemic and hip fracture epidemiology.

Int Orthop 2020 10 8;44(10):1887-1895. Epub 2020 Aug 8.

'Sir John Charnley' Hip Surgery Unit, Institute of Orthopaedics 'Carlos E. Ottolenghi', Italian Hospital of Buenos Aires, 4190 Peron St., C1199ABH, Buenos Aires, Argentina.

Purpose: To analyse the impact of prolonged mandatory lockdown due to COVID-19 on hip fracture epidemiology.

Methods: Retrospective case-control study of 160 hip fractures operated upon between December 2019 and May 2020. Based on the date of declaration of national lockdown, the cohort was separated into two groups: 'pre-COVID time' (PCT), including 86 patients, and 'COVID time' (CT), consisting of 74 patients. All CT patients tested negative for SARS-CoV-2. Patients were stratified based on demographic characteristics. Outcome measures were 30-day complications, readmissions and mortality. A logistic regression model was run to evaluate factors associated with mortality.

Results: Age, female/male ratio, body mass index and American Society of Anaesthesia score were similar between both groups (p > 0.05). CT patients had a higher percentage of Charlson ≥ 5 and Rockwood Frailty Index ≥ 5 scores (p < 0.05) as well as lower UCLA and Instrumental Activities of Daily Living scores (p < 0.05). This translated into a higher hemiarthroplasty/total hip arthroplasty ratio during CT (p = 0.04). Thromboembolic disease was higher during CT (p = 0.02). Readmissions (all negative for SARS-CoV-2) were similar between both groups (p = 0.34). Eight (10.8%) casualties were detected in the CT group, whereas no deaths were seen in the control group. Logistic regression showed that frailer (p = 0.006, OR 10.46, 95%CI 8.95-16.1), less active (p = 0.018, OR 2.45, 95%CI 1.45-2.72) and those with a thromboembolic event (p = 0.005, OR 30, 95%CI 11-42) had a higher risk of mortality.

Conclusion: Despite testing negative for SARS-CoV-2, CT patients were less active and frailer than PCT patients, depicting an epidemiological shift that was associated with higher mortality rate.
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http://dx.doi.org/10.1007/s00264-020-04769-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7414899PMC
October 2020

Simultaneous Bilateral Femoral Neck Fracture Due to a Tonic-Clonic Seizure and High-Dose Steroid Therapy.

Arthroplast Today 2020 Sep 14;6(3):513-516. Epub 2020 Jul 14.

Institute of Orthopaedics "Carlos E. Ottolenghi" Italian Hospital of Buenos Aires, Buenos Aires, Argentina.

Simultaneous bilateral femoral neck fractures (FNFs) are extremely rare and usually associated with an underlying condition affecting the bone quality and mineralization. Convulsions have also been described as a possible cause, mostly as a consequence of epilepsy, hyponatremia, and hypocalcemia. We present a 52-year-old female patient, with bilateral displaced FNFs due to a tonic-clonic seizure and high-dose steroid therapy related to a frontal lobe anaplastic oligodendroglioma brain tumor resection. Two days after admission, bilateral one-stage uncemented total hip arthroplasty (THA) under general anesthesia and through a posterolateral approach was performed using a metal-on-polyethylene bearing surface. Several risk factors can be identified in this unique case, such as the high-dose steroid therapy, the low-demand activity of the patient due to her functional sequelae, and finally, the convulsive episode. Surgeons should be aware of this uncommon injury to ensure early diagnosis and treatment in all patients with a previous history of seizures, chronic steroid use, severe hip pain, and inability to walk. For bone metabolic diseases, preventive measures should be indicated to avoid these complications. Bilateral one-stage uncemented THA represents an effective procedure with a low complication rate allowing early rehabilitation.
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http://dx.doi.org/10.1016/j.artd.2020.05.013DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7364048PMC
September 2020

4- to 8-year complication analysis of 2 'partial collum' femoral stems in primary THA.

Hip Int 2021 Jan 26;31(1):75-82. Epub 2019 Sep 26.

Hip Surgery Unit, Institute of Orthopaedics "Carlos E. Ottolenghi", Italian Hospital of Buenos Aires, Buenos Aires, Argentina.

Objectives: Compare the clinical and radiological outcome of CFP stem with the MiniHip design in a prospective series, with special interest in intraoperative periprosthetic fracture (IPPF).

Methods: We prospectively followed 101 cases treated with the MiniHip stem (Group 1) and 89 with the CFP stem (Group 2) operated between 2010 and 2014. No significant demographic differences were observed between both groups. Median follow-up was 72 months. Average stem length was 41% shorter in the MiniHip group (  0.001). Radiological parameters were measured and a logistcic regression model was created to evaluate factors associated with IPPF.

Results: Mean mHHS improved from 54 to 95 in the MiniHip group (  0.001) and from 64 to 98 in the CFP group (  0.001). No significant differences were observed in terms of loosening, infection or instability. We observed 7 IPPFs (3.68%), 3 in group 1 and 4 in group 2. After adjusting for confounders, CFP was not associated with a greater risk of IPPF (OR 3.23; 95% CI, 0.250-42.034,   0.368), however, a more complex fracture pattern was observed with this stem design. Prior acetabular fractures were associated with IPPF (OR 66.85; 95% CI, 1.142-3911,   0.043). Compared to Dorr A femurs, type Dorr B appeared protective against IPPF (OR 0.039; 95% CI, 0.001-1.109,   0.058). Valgus alignment tended to increase the risk of IPPF (OR 20.59; 95% CI 0.870-487.221,   0.061).

Conclusions: MiniHip showed similar radiological outcomes to CFP at short- to mid-term follow-up without increasing IPPFs with a shorter stem length. Given that CFP produced a more complex IPPF pattern, surgeons should be cautious with alignment of this particular design, especially in Dorr A femur.
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http://dx.doi.org/10.1177/1120700019879360DOI Listing
January 2021

Unaddressed arterial injuries in revision total hip arthroplasty: mortality outcomes of a low-prevalence complication.

Int Orthop 2020 01 20;44(1):23-29. Epub 2019 Jun 20.

Hip Surgery Unit, Institute of Orthopaedics "Carlos E. Ottolenghi", Italian Hospital of Buenos Aires, ACK1199, 4247 Potosi St, Buenos Aires, Argentina.

Purpose: Peri-operative major arterial haemorrhage after revision total hip arthroplasty (RTHA) is an odd but limb- and life-threatening complication. In this retrospective analysis, we sought to determine the prevalence of such injuries requiring selective catheter embolization or bypass after RTHA and to evaluate the associated mortality rate.

Methods: Between 1995 and 2016, 2524 RTHAs were performed at a high-volume centre (1031 one-stage revisions, 1370 two-stage revisions and 123 resection arthroplasties). Throughout this period, nine patients presented with signs of persistent bleeding unaddressed during index surgery (9/2524; 0.35%), causing haemodynamic instability. All patients underwent angiographic exploration within the first 24 post-operative hours. Angiography evidenced four cases of bleeding pseudoaneurysms (three of them related to the common femoral artery and one to the medial circumflex femoral artery) and five cases of direct lacerations (one case in the inferior epigastric artery, one in the hypogastric artery, one in the external iliac artery, one in the popliteal artery and another in the superior gluteal artery).

Results: Six cases underwent selective percutaneous angiographic embolization with gelatin microspheres, obtaining immediate haemodynamic stabilization; whereas three cases required a further bypass surgery with synthetic graft. Of the former group, four patients had an uneventful evolution, while two died at a mean of 49 days after surgery due to multi-organ failure (MOF). Two cases of the bypass group died because of MOF at a mean of 22 days. Overall mortality rate was 44%.

Conclusions: The overall risk of arterial injury associated with RTHA was low. However, recognition of such a complication is imperative since it was associated with a high mortality rate.
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http://dx.doi.org/10.1007/s00264-019-04358-2DOI Listing
January 2020

Impaction Bone Grafting or Uncemented Modular Stems for the Treatment of Type B3 Periprosthetic Femoral Fractures? A Complication Rate Analysis.

J Arthroplasty 2019 Sep 14;34(9):2051-2057. Epub 2019 May 14.

Hip centre "Sir John Charnley", Institute of Orthopaedics "Carlos E. Ottolenghi" Italian Hospital of Buenos Aires, Buenos Aires, Argentina.

Background: Because the gold standard for the treatment of Vancouver type-B3 periprosthetic femoral fractures (PFFs) is yet to be defined, we sought to analyze the complication rate between the impaction bone grafting (IBG) technique with a cemented stem and reconstruction with an uncemented distally-fixed modular stem (DFMS).

Methods: We retrospectively studied 54 B3 PFFs operated between 2000 and 2016, comparing the complication rate of 33 patients treated with the IBG technique (group A) with 21 patients treated with a DFMS (group B). Median follow-up of groups A and B were 75 months (interquartile range [IQR], 36-111 months) and 55 months (IQR, 32-73 months), respectively (P = .008). Median age of groups A and B were 78 years (IQR, 74-83 years) and 81 years (IQR, 74-86 years), respectively (P = .30). Median grade of Endo-Klink femoral bone defect was 3 (IQR, 3-3) for both groups (P = .11). We performed a multiple regression analysis to determine risk factors for complications including the following variables: age, initial diagnosis, and surgical technique.

Results: As for infection outcomes, 2-stage revision surgery was more frequent in group A than in group B (4 vs 0, P = .003). Group A presented more implant failures than group B (5 vs 1, P = .195). We found 4 dislocations in group B and 2 in group A (P = .192). Multiple regression analysis showed a significant association between surgical technique and complication rate (P = .01). The IBG technique presented an odds risk for complications of 4.77 (P = .016; IQR, 1.33-17.21).

Conclusion: Femoral reconstruction with the IBG technique evidenced an ostensibly higher complication rate than that of DFMS for the treatment of B3 PFF.
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http://dx.doi.org/10.1016/j.arth.2019.04.047DOI Listing
September 2019

Aggressive granulomatosis of the hip: a forgotten mode of aseptic failure.

Int Orthop 2019 06 30;43(6):1321-1328. Epub 2018 Nov 30.

Hip Surgery Unit, Italian Hospital of Buenos Aires, Institute of Orthopaedics "Carlos E. Ottolenghi", 4247 Potosí St, C1199ACK, Buenos Aires, Argentina.

Purpose: It has been acknowledged that implant wear correlates with the risk for periprosthetic osteolysis, being aggressive granulomatosis the worst expression of bone resorption. We sought to determine the clinical, radiological, and histological features of aggressive granulomatosis after primary total hip arthroplasty (THA).

Methods: We included nine cases with aggressive granulomatosis of the hip around cemented stems. Indications for revision THA consisted of progressive signs of extensive bone resorption or implant loosening. Mean follow-up since revision THA was 143 months (SD ± 59.4). We analysed clinical outcomes, component loosening and gross as well as histological characteristics of the granulomatous lesions.

Results: Overall mean time between primary THA and revision surgery was 81 months (SD ± 20.8). All of the cases evidenced multiple ovoid tumour-like lesions around the stem with extensive bone loss. Only one case reported thigh pain before revision surgery, with radiological evidence of stem loosening; the remaining cases were asymptomatic with well-fixed implants. Gross anatomy findings revealed metallosis in the femoral canal and inside the cystic lesions. Pathology analysis showed monocyte-macrophage-dominated adverse foreign-body-type tissue reaction with fibroblastic reactive zones and granulomatous inflammation.

Conclusions: We found a prevalence of 1% of this aseptic mode of implant failure. Since most of the retrieved stems were not loose, we did not find any alarming clinical symptoms anticipating implant failure. In this scenario, surgeons should be aware of the rapidly progressive nature of this entity and propose a revision THA in a timely fashion.
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http://dx.doi.org/10.1007/s00264-018-4252-9DOI Listing
June 2019

State-of-the-art diagnosis and surgical treatment of acute peri-prosthetic joint infection following primary total hip arthroplasty.

EFORT Open Rev 2018 Jul 17;3(7):434-441. Epub 2018 Jul 17.

Hip Surgery Unit, Italian Hospital of Buenos Aires, Argentina.

Acute peri-prosthetic joint infection (PJI) following total hip arthroplasty (THA) is a potentially devastating and undesired complication, with a prevalence of 0.3% to 2.9%. Its suspicion begins with a meticulous physical examination and anamnesis. Diagnosis should be made on the basis of the Musculoskeletal Infection Society criteria. Serum and synovial biomarkers are very useful tools when major criteria are absent.Although sometimes not possible due to medical conditions, surgery is usually the first line of treatment. Although its outcome is highly correlated with the isolated microorganism, irrigation and debridement with implant retention (DAIR) is the gold standard for treatment. Ideally, the prior approach should be proximally and distally extended to augment the field of view and remove all of the prosthetic modular components, that is, femoral head and acetabular insert.Given DAIR's unclear control of infection, with successful outcomes in the range of 30% to 95%, one- or two-stage revision protocols may play a role in certain cases of acute infections; nonetheless, further prospective, randomized studies are necessary to compare long-term outcomes between DAIR and revision surgeries.Following surgical treatment, length of antibiotherapy is in the range of six weeks to six months, without any difference in outcomes between short and long protocols. Treatment should be adjusted to the isolated bacteria and controlled further with post-operative serum biomarker levels. Cite this article: 2018;3:434-441. DOI: 10.1302/2058-5241.3.170032.
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http://dx.doi.org/10.1302/2058-5241.3.170032DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6129958PMC
July 2018

Periprosthetic stress fracture around a well-fixed type 2B short uncemented stem.

SICOT J 2018 30;4:33. Epub 2018 Jul 30.

Hip Surgery Unit, Institute of Orthopaedics "Carlos E. Ottolenghi", Italian Hospital of Buenos Aires, Buenos Aires, Argentina.

Despite the theoretical advantages of uncemented short stems, postoperative thigh pain is still matter of concern and can be attributed to different causes. We report a peculiar case of a stress fracture around a short cementless stem with cervico-metaphyseal fixation in an otherwise healthy patient. We implanted a MiniHip stem in a 43 year-old male professional golf player for the treatment of primary osteoarthritis using a ceramic on ceramic bearing. Against medical advice, the patient started to play soccer at the 4th postoperative month and was completely asymptomatic to that extent; but at 8 months follow-up and without a history of trauma he started complaining about progressive hip pain. After ruling out infection and loosening, histological analysis from a bone biopsy confirmed the diagnosis of stress fracture. Although revision surgery was initially scheduled, pain started to decrease gradually with protected weight-bearing (crutches) and disappeared around the first postoperative year, remaining the patient asymptomatic at 2 and half years of follow-up, with radiographs depicting a healed fracture with a hypertrophic callus. We encourage surgeons to be aware of the existence of periprosthetic stress fractures as a source of thigh pain (sometimes intractable), and despite being infrequent, they should always be contemplated, providing that these cases can be managed conservatively with rest and limited weight-bearing. After this uncommon case, we suggest to align the stem in order to equally distribute loads onto the medial calcar and the lateral femoral cortical.
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http://dx.doi.org/10.1051/sicotj/2018031DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6065269PMC
July 2018

Transfusion rate using intravenous tranexamic acid in hip revision surgery.

Hip Int 2018 Mar;28(2):194-199

Hip Surgery Centre "Sir John Charnley", Italian Hospital of Buenos Aires, Buenos Aires - Argentina.

Introduction: Hip revision surgery is associated with a high probability of the necessity for a blood transfusion. Different studies support the use of tranexamic acid (TXA) to decrease the rate of transfusions in primary hip surgery. Nevertheless, the use of this drug in hip revision surgery has not yet been widely accepted. The aim of our study was to establish the rate of blood transfusion with and without TXA in hip revision surgery.

Methods: We retrospectively studied 125 hip revision surgery patients operated on between 2011 and 2014. We divided our series into 2 groups: the TXA group with 61 patients (in which a 1000 mg dose of TXA was used before the skin incision and a second identical dose after skin closure) and a control group with 64 patients. We analysed the red blood cell (RBC) transfusion rates and their odds risk as well as the presence of collateral complications.

Results: Average RBC transfusion was 2.7 units/patient (range 0-6) in the control group compared to 1.6 units/patient (range 0-6) in the TXA group. A 90.11% (odds ratio [OR] 0.098; confidence interval [CI] 0.02-0.04; p<0.0029) odds risk reduction for transfusion of at least 1 unit of erythrocyte blood cell was observed in the TXA group. Complications associated with the TXA were similar in both groups.

Interpretation: The benefits of TXA have been shown in elective hip replacement. In this study, TXA proved to be safe and efficacious in reducing the need for transfusions following revision total hip arthroplasty.
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http://dx.doi.org/10.1177/1120700018768655DOI Listing
March 2018

Re-admissions treble the risk of late mortality after primary total hip arthroplasty.

Int Orthop 2018 09 10;42(9):2015-2023. Epub 2018 Mar 10.

Hip Surgery Unit, 'Carlos E. Ottolenghi' Institute of Orthopaedics, Italian Hospital of Buenos Aires, 4247 Potosi St, ACK1199, Buenos Aires, Argentina.

Background: Following a total hip arthroplasty (THA), early hospital re-admission rates of 3-11% are considered as 'acceptable' in terms of medical care cost policies. Surprisingly, the impact of re-admissions on mortality has not been priorly portrayed. Therefore, we sought to determine the mortality rate after 90-day re-admissions following a THA in a series of patients from a captive medical care program.

Patients And Methods: We prospectively analysed 90-day readmissions of 815 unilateral, elective THA patients operated upon between 2010 and 2014 whose medical care was the one offered by our institution. We stratified our sample into readmitted and non-readmitted cohorts. Through a Cox proportional hazards model, we compared demographic characteristics, clinical comorbidities, surgical outcomes and laboratory values between both groups in order to determine association with early and late mortality.

Results: We found 37 (4.53%) re-admissions at a median time of 40.44 days (IQR 17.46-60.69). Factors associated with re-admission were hospital stay (p = 0.00); surgical time (p = 0.01); chronic renal insufficiency (p = 0.03); ASA class 4 (p = 0.00); morbid obesity (p = 0.006); diabetes (p = 0.04) and a high Charlson index (p = 0.00). Overall mortality rate of the series was 3.31% (27/815). Median time to mortality was 455.5 days (IQR 297.58-1170.65). One-third (11/37) of the re-admitted patients died, being sepsis non-related to the THA the most common cause of death. After adjusting for confounders, 90-day re-admissions remained associated with mortality with an adjusted HR of 3.14 (CI95% 1.05-9.36, p = 0.04).

Conclusions: Unplanned re-admissions were an independent risk factor for future mortality, increasing three times the risk of mortality.
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http://dx.doi.org/10.1007/s00264-018-3876-0DOI Listing
September 2018

Is a short stem suitable for patients with hip dysplasia? A report on technical problems encountered during femoral reconstruction.

Hip Int 2018 May 14;28(3):315-323. Epub 2017 Oct 14.

Hip Surgery Unit, Institute of Orthopaedics "Carlos E. Ottolenghi", Italian Hospital of Buenos Aires, Buenos Aires - Argentina.

Introduction: A wide variety of stems have been used for the treatment of osteoarthritis secondary to advanced hip dysplasia. Since evidence for using short stems in dysplastic hips is limited, we planned to analyse the technical problems encountered when reconstructing the proximal femur of patients with osteoarthritis secondary to congenital dysplasia of the hip treated with total hip arthroplasty (THA) using a type 2B short stem.

Methods: We prospectively analysed 17 patients (22 hips) treated with primary THA performed with a single-branded short uncemented stem with metaphyseal fixation (MiniHip™; Corin). We excluded cases in which other type of stems were used, or in which retrospective data was only available. Mean follow-up was 41.22 months (minimum 24). We analysed clinical outcome using the modified Harris Hip Score (mHHS) and pain using the visual analogue scale (VAS). Radiographs were examined in order to determine causes of complications and revision surgery.

Results: All patients showed statistically significant improvement when preoperative and postoperative values for mHHS (54.19 vs. 94.57; p = 0.0001) and for pain VAS (8.71 vs. 0.71; p = 0.0003) were compared. No cases of thigh pain, instability or infection were found. 1 case of acetabular cup loosening and 1 case of periprosthetic fracture were diagnosed at 8 months and 45 days, respectively. Overall survival was 84.7% at 5 years (CI 95%, 64.4-105.3) with revision for any reason as an end point. When stem performance was separately evaluated, it showed a survival rate of 100% at 5 years with revision for aseptic loosening as an end point.

Conclusions: THA with a type 2B short stem for the treatment of dysplastic osteoarthritis showed very few technical intraoperative problems, being a useful alternative for femoral reconstruction.
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http://dx.doi.org/10.5301/hipint.5000562DOI Listing
May 2018

THA conversion rate comparing decompression alone, with autologous bone graft or stem cells in osteonecrosis.

Hip Int 2018 03 10;28(2):189-193. Epub 2017 Sep 10.

"Sir John Charnley" Hip centre, "Carlos E. Ottolenghi" Orthopaedic and Traumatology Institute, Italian Hospital of Buenos Aires, Buenos Aires - Argentina.

Introduction: Core decompression (CD) with or without the addition of autologous bone graft (CDBG) is currently the most widely accepted treatment for hip osteonecrosis in stages of pre-collapse. The use of bone marrow mesenchymal stem cells (CDSC) is emerging as a promising biological alternative. We sought to determine the total hip arthroplasty (THA) conversion rate for patients treated with CD, CDBG or CDSC.

Material And Methods: Between 1996 and 2012, 97 cases were evaluated in 72 patients: 47 CD cases, 34 CDGB cases and 16 CDSC cases. The mean age was 39 (20-63) years, 25 bilateral, 19 female and 53 male, 14 Ficat 1 and 83 Ficat 2. Bilateral cases with asymmetric stage and equal treatment were excluded.

Results: Conversion rate to THA was 44% for the CD group (21/47) at an average of 77 (24-324) months; 50% for the CDBG group (17/34) at an average of 34 (24-240) months and 50% for the CDSC group (8/16) at an average of 48 (24-72) months (p = 0.619). Log Rank test for survivorship analysis was not significant (p = 0.2011). Immunodeficiency or corticosteroid treatment history was associated with 16/47 of the CD group, 7/34 in the CDBG group and 1/16 in the CDSC group. Trauma was associated with 2/47 of the CD group, 5/34 of the CDBG group and none of the CDSC group. Hazard ratio considering risk factors was not significant (p = 0.252).

Conclusions: In these series of cases including patients with pre-collapse osteonecrosis, we observed non-significant results regarding rate of conversion to THA with CD, CDBG or CDSC at an average of 5.5 years.
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http://dx.doi.org/10.5301/hipint.5000552DOI Listing
March 2018

Transfusion rate using intravenous tranexamic acid in hip revision surgery.

Hip Int 2017 Oct 12. Epub 2017 Oct 12.

Hip Surgery Centre "Sir John Charnley", Italian Hospital of Buenos Aires, Buenos Aires - Argentina.

Introduction: Hip revision surgery is associated with a high probability of the necessity for a blood transfusion. Different studies support the use of tranexamic acid (TXA) to decrease the rate of transfusions in primary hip surgery. Nevertheless, the use of this drug in hip revision surgery has not yet been widely accepted. The aim of our study was to establish the rate of blood transfusion with and without TXA in hip revision surgery.

Methods: We retrospectively studied 125 hip revision surgery patients operated on between 2011 and 2014. We divided our series into 2 groups: the TXA group with 61 patients (in which a 1000 mg dose of TXA was used before the skin incision and a second identical dose after skin closure) and a control group with 64 patients. We analysed the red blood cell (RBC) transfusion rates and their odds risk as well as the presence of collateral complications.

Results: Average RBC transfusion was 2.7 units/patient (range 0-6) in the control group compared to 1.6 units/patient (range 0-6) in the TXA group. A 90.11% (odds ratio [OR] 0.098; confidence interval [CI] 0.02-0.04; p<0.0029) odds risk reduction for transfusion of at least 1 unit of erythrocyte blood cell was observed in the TXA group. Complications associated with the TXA were similar in both groups.

Interpretation: The benefits of TXA have been shown in elective hip replacement. In this study, TXA proved to be safe and efficacious in reducing the need for transfusions following revision total hip arthroplasty.
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http://dx.doi.org/10.5301/hipint.5000555DOI Listing
October 2017

Three cases of type-1 complex regional pain syndrome after elective total hip replacement.

SICOT J 2017 5;3:52. Epub 2017 Sep 5.

Hip Surgery Unit, Institute of Orthopaedics "Carlos E. Ottolenghi", Italian Hospital of Buenos Aires, 4247 Potosí St., C1199ACK Buenos Aires, Argentina.

Complex regional pain syndrome (CRPS) constitutes an atypical cause of pain after orthopaedic procedures. To our knowledge, there is a paucity of literature reporting this syndrome after total hip arthroplasty (THR), since only two case reports have been published. We thenceforth describe the clinical outcome of three cases of type-1 CRPS developed after elective THR, two of them initially diagnosed with secondary osteoarthritis whereas the remaining one presented a sequel of a failed osteosynthesis that required conversion to THR. Remission of disease was found at an average seven months (range: 4-9). Medical treatment involved a combined therapy of pain management, bisphosphonates and intense physical therapy. One patient was additionally treated with a corticosteroid blockade of his right sympathetic lumbar ganglia. None of the patients required surgical treatment. At final follow-up, physical examinations and imaging were negative for disease.
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http://dx.doi.org/10.1051/sicotj/2017038DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5579881PMC
September 2017

Arthroscopic acetabuloplasty without labral detachment for focal pincer-type impingement: a minimum 2-year follow-up.

J Hip Preserv Surg 2017 Jul 12;4(2):145-152. Epub 2017 Apr 12.

Hip Surgery Unit, Carlos E. Ottolenghi, Institute of Orthopaedics, Italian Hospital of Buenos Aires, 4247 Potosi St., Buenos Aires 1199, Argentina.

In order to access and resect the acetabular rim, arthroscopic acetabuloplasty was described with labral detachment. When the chondrolabral junction remains intact, acetabuloplasty and labral refixation can be performed maintaining an unharmed labrum. We aimed to evaluate the outcome of a group of patients treated with arthroscopic acetabuloplasty without labral detachment. During the study period, we retrospectively analysed 44 patients with pincer-type o combined impingement and an intact chondroblabral junction, with an average follow-up of 32 months (range: 27-38). We excluded patients with isolated CAM-type impingement and previous hip pathology. Radiographs were analysed to define impingement and classify grade of osteoarthritis. Clinical evaluation consisted of pre-operative and post-operative modified Harris hip score (mHHS) and WOMAC as well as post-operative visual analogue scale (VAS) of pain and satisfaction. Reoperations were considered surgical failures for purposes of survival analysis. Mean mHHS changed from 51.06 (SD 4.81) pre-operatively to 84.97 (SD 12.79) post-operatively. Pre-operative WOMAC was 29.18 (SD 8) and post-operative, 13.10 (SD 11). Post-operative VAS was 7.5 and 2.27 for satisfaction and pain, respectively. When comparing patients with Tönnis 0 to those with Tönnis 1, the former showed better results regarding post-operative mHHS (89.9 s versus 77.85,  = 0.03), pain VAS (1.5 versus 6.3,  = 0.03) and satisfaction VAS (8.2 versus 6.3,  = 0.01). Survival was 100% at 24 months and 76% at 40 months (95% CI: 35-98%). Arthroscopic acetabuloplasty without labral detachment achieved good clinical outcomes. Slight degenerative changes on radiographs correlated with poorer clinical outcomes.
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http://dx.doi.org/10.1093/jhps/hnx015DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5467423PMC
July 2017

Joint preservation after hip arthroscopy in patients with FAI. Prospective analysis with a minimum follow-up of seven years.

Muscles Ligaments Tendons J 2016 Jul-Sep;6(3):317-323. Epub 2016 Dec 21.

Hip Surgery Unit, Institute of Orthopaedics "Carlos E. Ottolenghi", Hospital Italiano de Buenos Aires, Argentina.

Background: The purpose of this study is to evaluate the clinical outcomes, radiological degenerative progression and the joint preservation rate in a series of patients with Femoroacetabular Impingement (FAI) treated with hip arthroscopy at a minimum follow-up of 7 years. The predictive factors for total hip arthroplasty (THA) requirement were analyzed.

Materials And Methods: Between February 2008 and February 2009, 42 consecutive patients treated with hip arthroscopy due to FAI syndrome were included. There were 15 women and 27 men with an average age of 38 years (range 23 to 56 years). The surgery involved joint damage stabilization (labral tears and/or chondrolabral injuries) and correction of associated bony deformities (cam and/or pincer lesions). A prospective clinical follow-up was made with no patient lost. We specifically addressed the need for THA. Predictive factors for THA were also analyzed.

Results: At final follow up, joint preservation rate was 83.33% (CI 95% 68,64%-93,03%). Probability of evolving to a THA in patients with radiographic preoperative Tonnis grades 0 and I was of 0% (CI 95%: 0-12.77). Probability of evolving to a THA in patients with preoperative Tonnis grades II and III was 46,67% (CI 95%21.27%-73,41%). A statistically significant difference was present between both groups (p= 0.002). Patients older than 45 years at the time of hip arthroscopy were at significant risk of evolving to a THA (p=0.0012). Excluding those patients who undergone a THA: modified HHS was 88.25 points (80-96) and radiographic analysis addressed a 14,29% (IC95% 4,81%-30,26%) of progressive degenerative changes without affecting clinical results.

Conclusions: Hip arthroscopy for the treatment of patients with FAI syndrome showed favorable results regarding joint preservation. Patients with preoperative radiographic evidence of advanced-stage osteoarthritis and those older than 45 years at the time of surgery have higher risk of requiring THA.

Level Of Evidence: IV.
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http://dx.doi.org/10.11138/mltj/2016.6.3.317DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5193521PMC
December 2016

Long-term Outcome of Unconstrained Primary Total Hip Arthroplasty in Ipsilateral Residual Poliomyelitis.

Orthopedics 2017 Mar 14;40(2):e255-e261. Epub 2016 Nov 14.

Incapacitating articular sequelae in the hip joint have been described for patients with late effects of poliomyelitis. In these patients, total hip arthroplasty (THA) has been associated with a substantial rate of dislocation. This study was conducted to evaluate the long-term clinical and radiologic outcomes of unconstrained THA in this specific group of patients. The study included 6 patients with ipsilateral polio who underwent primary THA between 1985 and 2006. Patients with polio who underwent THA on the nonparalytic limb were excluded. Mean follow-up was 119.5 months (minimum, 84 months). Clinical outcomes were evaluated with the modified Harris Hip Score (mHHS) and the visual analog scale (VAS) pain score. Radiographs were examined to identify the cause of complications and determine the need for revision surgery. All patients showed significantly better functional results when preoperative and postoperative mHHS (67.58 vs 87.33, respectively; P=.002) and VAS pain score (7.66 vs 2, respectively; P=.0003) were compared. Although 2 cases of instability were diagnosed, only 1 patient needed acetabular revision as a result of component malpositioning. None of the patients had component loosening, osteolysis, or infection. Unconstrained THA in the affected limb of patients with poliomyelitis showed favorable long-term clinical results, with improved function and pain relief. Nevertheless, instability may be a more frequent complication in this group of patients compared with the general population. [Orthopedics. 2017; 40(2):e255-e261.].
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http://dx.doi.org/10.3928/01477447-20161108-03DOI Listing
March 2017

Endoscopic Extra-articular Surgical Removal of Heterotopic Ossification of the Rectus Femoris Tendon in a Series of Athletes.

Orthop J Sports Med 2016 Sep 8;4(9):2325967116664686. Epub 2016 Sep 8.

Institute of Orthopedics "Carlos E. Ottolenghi," Italian Hospital of Buenos Aires, Buenos Aires, Argentina.

Background: Calcific deposits in tendon, muscles, and periarticular areas are very common. Heterotopic ossification of the rectus femoris (HORF) is a rare condition, and several theories exist regarding the etiopathogenesis, which appears to be multifactorial with traumatic, genetic, and local metabolic factors involved. Although HORF typically responds to nonoperative treatment, when this approach fails, endoscopic treatment is a minimally invasive technique to address the pathology.

Purpose: To report the clinical and radiological outcomes of 9 athletes with HORF who underwent endoscopic resection.

Study Design: Case series; Level of evidence, 4.

Methods: Nine male athletes were treated with endoscopic extra-articular resection of HORF after failure of a 6-month course of nonoperative treatment. All patients were studied with radiographs, computed tomography, and magnetic resonance imaging. Outcomes were assessed clinically using the modified Harris Hip Score (mHHS), a visual analog scale for sport activity-related pain (VAS-SRP), patient satisfaction, and ability and time to return to the preoperative sport level. Radiographic assessment was performed to determine recurrence.

Results: The mean age of the patients was 32 years (range, 23-47 years). Mean follow-up was 44 months (range, 14-73 months). All patients had improved mHHS scores from a mean preoperative of 65.6 (SD, 8.2) to 93.9 (SD, 3.6). Pain decreased from a mean 8.2 preoperatively (SD, 0.9) to 0.4 (SD, 0.7) at last follow-up. There were no complications, and all patients were able to return to their previous sports at the same level except for 1 recreational athlete. There was only 1 radiological recurrence at last follow-up in an asymptomatic patient.

Conclusion: To our knowledge, this is the largest case series of athletes with HORF treated with endoscopic resection. We found this extra-articular endoscopic technique to be safe and effective, showing clinical outcome improvement and 90% chance of return to full activity. We also found 10% recurrence rate of asymptomatic heterotopic ossification.
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http://dx.doi.org/10.1177/2325967116664686DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5019195PMC
September 2016

Primary Total Hip Arthroplasty With Fourth-Generation Ceramic-on-Ceramic: Analysis of Complications in 939 Consecutive Cases Followed for 2-10 Years.

J Arthroplasty 2017 02 10;32(2):480-486. Epub 2016 Aug 10.

The Hip Surgery Unit, Institute of Orthopaedics "Carlos E. Ottolenghi", Italian Hospital of Buenos Aires, Buenos Aires, Argentina.

Background: Delta ceramics may be the bearing of choice for younger and active patients due to its improved toughness and wear characteristics, provided there is no risk of fracture. However, ceramic fracture is the most serious complication related to this type of bearing. Although millions of Delta ceramics have been implanted worldwide, short to midterm results have been scarcely reported in the literature. The purpose of this study was to report the complication rate at short to midterm follow-up associated with the bearing surface used in a series of primary total hip arthroplasties with Delta ceramic-on-ceramic bearings performed in a single institution.

Methods: A total of 939 cases (880 patients) undergoing primary total hip arthroplasty with fourth-generation Delta ceramic-on-ceramic bearings were retrospectively reviewed. They were followed for an average of 5.3 years (2-10 years).

Results: One hip experienced a liner fracture, 2 cups presented early loosening due to friction between the acetabular screw and the backside of the liner, one femoral ball head had a fracture; one case of squeaking was reported, which is impending revision. Considering revision or impending revision in relationship with the bearing surface as the end point, the mean survival rate was 99.3% (confidence interval 95%, 98.3%-99.7%) at 2-10 years.

Conclusion: This study showed a low rate of ceramic fracture compared with others; however, it was much higher than the complication rate presented by the manufacturers. The complications observed were directly related to technical errors that surgeons should avoid when using this type of surface.
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http://dx.doi.org/10.1016/j.arth.2016.07.032DOI Listing
February 2017

Endoscopic Surgical Removal of Calcific Tendinitis of the Rectus Femoris: Surgical Technique.

Arthrosc Tech 2015 Aug 17;4(4):e365-9. Epub 2015 Aug 17.

Institute of Orthopedics "Carlos E. Ottolenghi," Italian Hospital of Buenos Aires, Buenos Aires, Argentina.

Calcific tendinitis of the rectus femoris (CTRF) is an under-recognized condition and, because of its self-limiting nature, is usually managed conservatively. Nevertheless, when nonsurgical therapy fails, further invasive alternatives are required. At this point, arthroscopic resection provides a minimally invasive and interesting alternative to open surgery. The aim of this work is to report the surgical technique of endoscopic surgical removal in patients with CTRF at the periarticular region of the hip joint. Endoscopic surgical removal of CTRF was performed without traction following anatomic landmarks for hip arthroscopy portal placement. We used the anterolateral portal and the proximal accessory portal to obtain access to the lesion. A shaver and radiofrequency device are useful tools to depict the calcific lesion while the whole resection is performed with a 5-mm round burr. Intraoperative fluoroscopy control during the entire procedure is essential. Endoscopic treatment of calcific tendinitis of the hip is a valuable technique in the treatment of patients who do not respond to conservative treatment.
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http://dx.doi.org/10.1016/j.eats.2015.03.022DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4680952PMC
August 2015

Hip arthroscopy in osteoarthritis: a systematic review of the literature.

Hip Int 2016 Jan-Feb;26(1):8-14. Epub 2015 Sep 14.

The Institute of Orthopaedics "Carlos E. Ottolenghi", Italian Hospital of Buenos Aires, Buenos Aires - Argentina.

Background: Hip arthroscopy treatment in patients with osteoarthritis is controversial.

Hypothesis/purpose: To systematically review the clinical outcome of patients with hip osteoarthritis (OA) treated with arthroscopy and what proportion of these patients subsequently underwent total hip arthroplasty (THA).

Study Design: Systematic review.

Methods: PubMed, Cochrane library and LILACS were searched from January 1990 through December 2013 for eligible studies. The methodological quality of the collected data (applied to each study) was performed with a modified version of the Coleman methodology score (mCMS).

Results: 11 studies were included in this review. Most of the studies included reported clinical improvements. The overall conversion rate to THA ranged from 9.5% to 50%. Mean time between arthroscopy and THA was 13.5 months.

Conclusions: The quality of studies is low. We have found inconclusive evidence to make categorical indications for hip arthroscopy in the treatment of OA, although we have found that there is some postoperative clinical outcome improvement of pain and function in a short-term evaluation. Increasingly worse outcomes were seen as the severity of OA increased.
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http://dx.doi.org/10.5301/hipint.5000299DOI Listing
January 2017

Skin staples versus intradermal wound closure following primary hip arthroplasty: a prospective, randomised trial including 231 cases.

Hip Int 2015 Nov-Dec;25(6):563-7. Epub 2015 Jun 27.

The Hip Surgery Unit, Institute of Orthopaedics "Carlos E. Ottolenghi", Italian Hospital of Buenos Aires, Buenos Aires - Argentina.

Intradermal wound closure is controversial in primary total hip arthroplasty. Randomised, controlled trials in wound closure following a total hip arthroplasty (THA) are scarce. Our hypothesis was that skin staples closure would be related to a similar complication rate and operative time as intradermal closure with polypropylene. From September 2011 to May 2012, 231 THAs in 219 patients with an average age of 62 years old (range: 21-91) were performed. No differences were observed in both groups according to sex, age, BMI and comorbidities (p = 0,82). Cases were divided into 3 groups according to medical factors that influence wound healing: group 1 (no medical history, 70.5%), group 2 (diabetes, tobacco smokers, obesity, corticosteroids, rheumatoid disease, 25%) and group 3 (organ transplantation, neoplastic patients or 2 or factors of group 2, 4.5%). Once randomised using a computer-generated method, all patients remained within the group to which they were allocated to wound closure with skin staples (Leukosan® SkinStapler PTW-35, BSN, Germany) that were used in 112 THAs in 105 patients (48%), or continuous 3.0 intradermal non-absorbable polypropylene suture (Prolene™ 0, Ethicon Inc. Somerville, New Jersey, USA) in 119 THA´s in 115 patients (52%). A 3.8% wound complication rate was observed in this series, with a 2.1% complication rate for the group that was closed with skin staples and a 1.7% rate for the group with intradermal suture (p = 0.7). All the complications were treated conservatively except for one acute deep infection (0.4%) that was successfully treated with debridement, component retention and intravenous antibiotics. There were no differences in both groups related to operative time or wound length.In these series of primary elective THAs, skin staples were associated with a similar complication rate to an intradermal closure technique.
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http://dx.doi.org/10.5301/hipint.5000278DOI Listing
October 2016

Intraoperative synovial C-reactive protein is as useful as frozen section to detect periprosthetic hip infection.

Clin Orthop Relat Res 2015 Dec;473(12):3876-81

Hip Surgery Unit, Institute of Orthopaedics "Carlos E. Ottolenghi", Italian Hospital of Buenos Aires, Potosí 4247, C1199ACK, Buenos Aires, Argentina.

Background: Synovial quantification of C-reactive protein (SCRP) has been recently published with high sensitivity and specificity in the diagnosis of periprosthetic joint infection. However, to our knowledge, no studies have compared the use of this test with intraoperative frozen section, which is considered by many to be the best intraoperative test now available.

Questions/purposes: We asked whether intraoperative SCRP could lead to comparable sensitivity, specificity, and predictive values as intraoperative frozen section in revision total hip arthroplasty.

Methods: A prospective study was performed including 76 patients who underwent hip revision for any cause. SCRP quantification (using 9.5 mg/L as denoting infection) and the analysis of frozen section of intraoperative samples (five or more polymorphonuclear leukocytes under high magnification in 10 fields) were performed in all the patients. The definitive diagnosis of an infection was determined according to the Musculoskeletal Infection Society (MSIS). In this group, 30% of the patients were diagnosed with infection using the MSIS criteria (23 of 76 patients).

Results: With the numbers available, there were no differences between SCRP and frozen section in terms of their ability to diagnose infection. The sensitivity of SCRP was 90% (95% confidence interval [CI], 70.8%-98.6%), the specificity was 94% (95% CI, 84.5%-98.7%), the positive predictive value was 87% (95% CI, 66.3%-97%), and the negative predictive value was 96% (95% CI, 87%-99.4%); the sensitivity, specificity, positive predictive value, and negative predictive value were the same using frozen sections to diagnose infection. The positive likelihood ratio was 16.36 (95% CI, 5.4-49.5), indicating a low probability of an individual without the condition having a positive test, and the negative likelihood ratio was 0.10 (95% CI, 0.03-0.36), indicating low probability of an individual without the condition having a negative test.

Conclusions: We found that quantitative SCRP had similar diagnostic value as intraoperative frozen section with comparable sensitivity, specificity, and predictive value in a group of patients undergoing revision total hip arthroplasty. In our institution, SCRP is easier to obtain, less expensive, and less dependent on the technique of obtaining and interpreting a frozen section. If our findings are confirmed by other groups, we suggest that quantitative SCRP be considered as a viable alternative to frozen section.

Level Of Evidence: Level I, diagnostic study.
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http://dx.doi.org/10.1007/s11999-015-4340-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4626517PMC
December 2015

Fracture of the C-Stem cemented femoral component in revision hip surgery using bone impaction grafting technique: report of 9 cases.

Hip Int 2015 Mar-Apr;25(2):184-7. Epub 2015 Feb 3.

The Hip Surgery Unit, Institute of Orthopaedics "Carlos E. Ottolenghi", Italian Hospital of Buenos Aires, Buenos Aires - Argentina.

We present a series of 9 fractures of a C-Stem femoral component (6 long stems and 3 conventional stems) that had been implanted with the use of impaction bone grafting (IBG). The length of the long fractured stems was 240 mm in 4 cases and 200 mm in 2. The patients presented had an average BMI of 26.5 and an average of 2.7 previous hip surgeries (range 2-5 surgeries) before the stem fracture. A total of 5 cases presented with a metal mesh fracture in addition to the fractured stem. Bending of the stems or stem defects was not observed in any case. Typical fracture waves consistent with fatigue failure were clearly visible on all the cut surfaces, starting anterolaterally and propagating to the medial side. Although fatigue fracture of a modern cemented tapered polished femoral stem is a rare event, stress due to the absence of proximal femoral bone support could be sufficient to put this stem at a higher risk for fatigue fracture in non-obese patients.
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http://dx.doi.org/10.5301/hipint.5000210DOI Listing
January 2016

Total hip arthroplasty using a short-stemmed femoral component in the presence of a long dynamic condylar screw osteosynthesis plate.

Case Rep Orthop 2014 30;2014:725403. Epub 2014 Sep 30.

The Hip Surgery Unit, Institute of Orthopaedics "Carlos E. Ottolenghi", Italian Hospital of Buenos Aires, Potosí 4247, C1199ACK Buenos Aires, Argentina.

We present a potential indication of a short-stemmed femoral component in a patient with multiple comorbidities presenting with hip posttraumatic osteoarthritis and a long dynamic condylar screw osteosynthesis plate. Removal of the plate and implantation of a long stem would have been related to a much longer operative time and potential local or systemic complications.
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http://dx.doi.org/10.1155/2014/725403DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4199077PMC
October 2014