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Total knee arthroplasty consists of the artificial replacement of the knee joint in its three compartments. One of its main challenges is the anatomical restoration of the joint line. The relief of inappropriate postoperative pain can lengthen the recovery time and increase the days of intrahospital stay and readmission. Total Navigated Knee Arthroplasty is considered one of the most innovative procedures in the treatment of knee osteoarthritis. It was introduced in the late 90s and there is currently good evidence, that navigation has greater precision in the position of the prosthetic components, compared to a manual instrumentation, especially the reduction of the atypical alignment values of the mechanical axis. The supporters of (TNKA) have argued that this technique can improve the score of functional scales, the alignment of the prosthetic components, revision rates and survival, because it reduces the percentage of atypical radiographic values in the alignment of the coronal and sagittal plane, greater precision in axial rotation of the components, improvement of the flexion gap and the extension gap and the soft tissue balance. In general, experience is gained, learning curves are improved and the complication rate is decreased with acceptable costs.

La artroplastía total de rodilla consiste en el reemplazo artificial de la articulación de la rodilla en sus tres compartimientos. Uno de sus principales desafíos es la restauración anatómica de la línea articular. El alivio de dolor postoperatorio inadecuado puede alargar el tiempo de recuperación y aumentar los días de hospitalización y reingreso. La artroplastía total de rodilla navegada (ATRN) es considerada uno de los procedimientos más novedosos en el tratamiento de la artrosis de rodilla. Se introdujo a finales de los años 90 y actualmente existe una buena evidencia de que la navegación tiene mayor precisión en la colocación de los componentes protésicos, en comparación con la instrumentación manual, especialmente en la reducción de los valores atípicos de alineación del eje mecánico. Los defensores de ATRN han argumentado que esta técnica puede mejorar la puntuación de escalas funcionales, la alineación de los componentes, tasas de revisión y supervivencia, debido a que reduce el porcentaje de valores atípicos radiográficos en la alineación del plano coronal y sagital, mayor precisión en rotación axial de los componentes, mejora de la brecha en flexión y extensión y el balance de ligamentos. Se gana experiencia, se mejoran las curvas de aprendizaje y se disminuyen la tasa de complicaciones, con costos aceptables.

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BACKGROUND: Elaborate an updated guideline of recommendations for the safe return to elective orthopedic surgery post COVID-19 pandemic. METHODS: Bibliographic review of relevant global literature. RESULTS: Recommendation guidelines with appropriate definitions of orthopedic elective surgery, correct contagion risk stratification for COVID-19, considerations for specific risk groups, hospital adaptations and anesthetic, intraoperative and postoperative special care for a safe restart of orthopedic elective surgery post COVID-19 pandemic. CONCLUSIONS: The safe restart of orthopedic elective surgery is possible as long as we take into consideration the appropriate recommendations, which we have summarized in this review.

JUSTIFICACIÓN: Proporcionar recomendaciones actuales que nos permitan retomar la cirugía ortopédica electiva posterior a la pandemia COVID-19 en condiciones adecuadas de seguridad para el personal de salud, pacientes y familiares para el tratamiento perioperatorio de acuerdo a la situación en nuestro país. MÉTODOS: Revisión bibliográfica de literatura actual mundial relevante. RESULTADOS: Una guía de recomendaciones con la adecuada definición de procedimientos ortopédicos electivos, la correcta estratificación de riesgo de contagio por COVID-19, las consideraciones especiales en selección de pacientes según su grupo de riesgo, las adecuaciones hospitalarias a implementar y los cuidados anestésicos, intraoperatorios y postoperatorios especiales ante el reinicio de cirugía electiva posterior a la pandemia COVID-19. CONCLUSIONES: El reinicio seguro de cirugía ortopédica electiva posterior a la pandemia COVID-19 en México es posible tomando en cuenta las recomendaciones especiales preoperatorias, intraoperatorias y postoperatorias.

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Introducción: Las fracturas del cuello del fémur, constituyen un capítulo muy importante en la práctica de la Traumatología, debido a su alta incidencia principalmente en los pacientes mayores de 65 años, suponiendo cerca de 65% de las intervenciones en Traumatología. Es de vital importancia la funcionalidad temprana de un paciente con fractura del cuello de la cadera, ya que la supervivencia disminuye en los primeros 12 meses. El objetivo de este trabajo fue comparar la evolución trans- y postquirúrgica de los pacientes sometidos a cirugía articular primaria de cadera con el abordaje lateral de Hardinge y el posterolateral de Moore. Material y métodos: Se seleccionaron 79 pacientes mayores de 65 años, con fracturas del cuello del fémur y se dividieron en dos grupos según el estudio. Representando al abordaje lateral de Hardinge (32 pacientes) y abordaje posterolateral de Moore (47 pacientes) en el período de Marzo de 2011 a Abril 2013. Resultados: Tomando en consideración las variables estudiadas se observó una diferencia estadísticamente significativa (p < 0.005) en el número de paquetes transfundidos por pacientes manejados mediante el abordaje lateral directo de Hardinge. Conclusiones: Coincidimos con la literatura en que hay diferencia significativa en la evolución trans- y postquirúrgica de los pacientes con fracturas del cuello del fémur manejado mediante abordaje lateral de Hardinge. Se demostró una diferencia estadísticamente significativa en el número de paquetes transfundidos por paciente, lo cual en nuestro medio representa una mejor utilización de los recursos.

Introduction: Femoral neck fractures represent an important chapter in the practice of Traumatology, due to their high incidence, mainly among patients over 65 years of age; they account for around 65% of surgeries in Traumatology. Early function of patients who sustained a femoral neck fracture is of the utmost importance, as survival decreases within the first 12 months. The purpose of this paper is to compare the intra- and postoperative course of patients who underwent primary hip surgery using Hardinge's direct lateral approach versus Moore's posterolateral approach. Material and methods: 79 patients over 65 years of age with femur fractures were selected and divided into 2 groups according to the approach used. Hardinge's direct lateral approach was used in 32 patients and Moore's posterolateral approach in 47 patients, from March 2011 to April 2013. Results: Considering the variables studied, a statistically significant difference (p < 0.005) was seen in the number of blood units transfused to patients in whom Hardinge's direct lateral approach was used. Conclusions: We agree with the literature in that there is a significant difference in the intra- and post-operative course of patients with femur neck fractures managed using Hardinge's direct lateral approach. A statistically significant difference was seen in the number of blood units transfused per patient, something that in our setting represents better resource utilization.

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INTRODUCTION: Femoral neck fractures represent an important chapter in the practice of Traumatology, due to their high incidence, mainly among patients over 65 years of age; they account for around 65% of surgeries in Traumatology. Early function of patients who sustained a femoral neck fracture is of the utmost importance, as survival decreases within the first 12 months. The purpose of this paper is to compare the intra- and postoperative course of patients who underwent primary hip surgery using Hardinge's direct lateral approach versus Moore's posterolateral approach. MATERIAL AND METHODS: 79 patients over 65 years of age with femur fractures were selected and divided into 2 groups according to the approach used. Hardinge's direct lateral approach was used in 32 patients and Moore's posterolateral approach in 47 patients, from March 2011 to April 2013. RESULTS: Considering the variables studied, a statistically significant difference (p < 0.005) was seen in the number of blood units transfused to patients in whom Hardinge's direct lateral approach was used. CONCLUSIONS: We agree with the literature in that there is a significant difference in the intra- and post-operative course of patients with femur neck fractures managed using Hardinge's direct lateral approach. A statistically significant difference was seen in the number of blood units transfused per patient, something that in our setting represents better resource utilization.

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INTRODUCTION: Carpal tunnel syndrome is the most prevalent compressive neuropathy and its medical costs in the United States exceed one billion dollars per year. Occurrence increases with age; prevalence is 0.6% in males and as much as 5.8% in females, in ages between 45 and 54 years. Besides a thorough case history, there are other more reliable diagnostic methods such as electrophysiological tests that include electromyography and conduction velocity tests. MATERIAL AND METHODS: A prospective, longitudinal analysis was conducted of patients with a diagnosis of Carpal tunnel syndrome confirmed with electromyography and evoked potentials. They were treated at Hospital Español de México in 2008-2009. RESULTS: Forty-seven patients were detected, representing 60 cases of carpal tunnel syndrome; 36 females, 11 males. In forty-seven percent of patients the right hand was involved; in 15% the left hand; 38% of patients had bilateral involvement. They underwent medical treatment and the results of the electrodiagnostic tests were good (61%), moderate (33%), and poor (6%). DISCUSSION: Isolated electromyography does not measure the true magnitude of the damage; however, motor conduction velocity becomes a relevant diagnostic method as it detects almost 50% of the patients at the time diagnosis. Patients with motor abnormalities had very favorable postoperative results compared to those with sensory abnormalities.

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OBJECTIVE: To evaluate the experience acquired in hallux valgus correction with percutaneous distal metatarsal osteotomy. MATERIAL AND METHODS: Retrospective study including patients who underwent percutaneous distal metatarsal osteotomy between May 2005 and May 2007. The age, sex, and number of feet operated on were recorded. The clinical evaluation of results 6 months after surgery using the AOFAS scale, the intermetatarsal angle and the hallux valgus angle were also recorded. RESULTS: A total of 40 patients were included; 38 females and 2 males; mean age was 49 years (28-73 years). Fifty-eight osteotomies were performed. According to the AOFAS scale, 28 patients (41/58 feet) had no pain. The mean functional capacity score was 41 points, and an excellent alignment was achieved in 74% of cases. The mean intermetatarsal angle was 7.5 degrees. Complications occurred in 2 patients (2 feet). CONCLUSIONS: The appropriate treatment for the correction of hallux valgus consists of minimally invasive procedures, except for the cases in which the metatarsophalangeal joint shows signs of arthrosis.

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