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Introduction: Osteochondroma is the most common benign bone tumor (20-50%). It is located predominantly in the metaphysis of the long bones, and much less frequently, the proximal femur and acetabulum. Osteochondroma can eventually lead to hip osteoarthritis and limit patients' functional activities. Determining optimal treatment can be difficult due to the high risk of avascular necrosis in surgical resections. Case Report: A 44-year-old male from Sabinas Coahuila, Mexico, a priest by profession, who presents for consultation with right inguinal pain of 18 months' duration. The patient had been treated conservatively with rest, non-steroidal anti-inflammatory drugs, and physical therapy without showing improvement in his symptoms. The anteroposterior radiograph of the pelvis and axial tomography showed an oval bone excrescence with well-defined margins in the acetabular and intra-articular region of the hip, which caused a decrease in joint space but without soft tissue infiltration. Tumor resection and total hip replacement were the treatment options. The histopathological study concluded an osteochondroma. After 25 months of post-operative follow-up, radiographic studies show no evidence of lesion recurrence. The functional improvement is 98 points on the Harris scale; the patient typically performs his daily living and work activities. Conclusion: Treating intra-articular osteochondroma of the hip can be challenging for the orthopedic surgeon. For osteochondroma resulting in secondary osteoarthrosis of the hip joint, total hip replacement should be considered an effective method to restore function and assist in returning the patient to previous activities. Thorough pre-operative planning is mandatory to prevent intra- or immediate post-operative risk.

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Objective: This study aims to evaluate aspirin as a chemical prophylaxis (200 mg) in total hip arthroplasty. Methods: the study compared two groups and used ultrasonography (USG) to screen for low-deep venous thrombosis. Group 1 received 600 mg (control), and Group 2 received 200 mg of (intervention), associated with the use of elastic compression stockings and early walking. Results: fourteen patients were allocated to Group A (200mg), and 16 to Group B (600mg); in group A (200mg), 3 cases with thrombus below the popliteal vein were detected at the first USG examination. All of them are in the left lower limb (21.4%). In group B (600 mg), 5 cases were identified after the first exam (31.2%). All cases were asymptomatic and followed the protocol with prophylaxis only with Aspirin. Conclusion: In the statistical data, there were no differences in the presence of thrombus between the 200- and 600 mg groups, which is credited to using low-dose aspirin in low doses (200mg). Hematimetric levels returned to baseline levels and suggested there was no chronic or acute bleeding related to the use of aspirin. The manuscript was prepared according to the CONSORT guideline 2010. Level of Evidence I; Longitudinal Randomized Comparative Clinical Study.

Objetivo: Este estudo pretende avaliar a aspirina como profilaxia química (200 mg) na artroplastia total do quadril. Métodos: estudo comparando dois grupos com diferentes doses de aspirina e utilizando a ultrassonografia (USG) para rastreamento da trombose venosa profunda baixa. O grupo 1, 650 mg ao dia de aspirina (controle) e o grupo 2, 200 mg de aspirina ao dia na mesma posologia (intervenção) e associados ao uso de meias elásticas de compressão e deambulação precoce. Resultados: quatorze pacientes foram alocados no grupo A (200 mg) e 16 no grupo B (650 mg). No grupo A foram detectados 3 casos com trombos abaixo da veia poplítea ao USG sendo 21,4%. Já no grupo B, 5 casos foram identificados após o primeiro exame (31,2%). Todos assintomáticos e sem sinais de sangramento ativo ou queda da hematimetria no momento da detecção dos trombos. Conclusão: os dados sugerem não haver diferença na incidência de trombo em ambos os grupos, não sendo a profilaxia com a aspirina dose-dependente. Os níveis hematimétricos retornaram aos níveis iniciais o que sugere não ter havido sangramento crônico ou agudo relacionado ao uso. Nível de Evidência I; Estudo Clínico Randomizado Longitudinal Comparativo.

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ABSTRACT Objective: This study aims to evaluate aspirin as a chemical prophylaxis (200 mg) in total hip arthroplasty. Methods: the study compared two groups and used ultrasonography (USG) to screen for low-deep venous thrombosis. Group 1 received 600 mg (control), and Group 2 received 200 mg of (intervention), associated with the use of elastic compression stockings and early walking Results: fourteen patients were allocated to Group A (200mg), and 16 to Group B (600mg); in group A (200mg), 3 cases with thrombus below the popliteal vein were detected at the first USG examination. All of them are in the left lower limb (21.4%). In group B (600 mg), 5 cases were identified after the first exam (31.2%). All cases were asymptomatic and followed the protocol with prophylaxis only with Aspirin. Conclusion: In the statistical data, there were no differences in the presence of thrombus between the 200- and 600 mg groups, which is credited to using low-dose aspirin in low doses (200mg). Hematimetric levels returned to baseline levels and suggested there was no chronic or acute bleeding related to the use of aspirin. The manuscript was prepared according to the CONSORT guideline 2010. Level of Evidence I; Longitudinal Randomized Comparative Clinical Study.

RESUMO Objetivo: Este estudo pretende avaliar a aspirina como profilaxia química (200 mg) na artroplastia total do quadril. Métodos: estudo comparando dois grupos com diferentes doses de aspirina e utilizando a ultrassonografia (USG) para rastreamento da trombose venosa profunda baixa. O grupo 1, 650 mg ao dia de aspirina (controle) e o grupo 2, 200 mg de aspirina ao dia na mesma posologia (intervenção) e associados ao uso de meias elásticas de compressão e deambulação precoce. Resultados: quatorze pacientes foram alocados no grupo A (200 mg) e 16 no grupo B (650 mg). No grupo A foram detectados 3 casos com trombos abaixo da veia poplítea ao USG sendo 21,4%. Já no grupo B, 5 casos foram identificados após o primeiro exame (31,2%). Todos assintomáticos e sem sinais de sangramento ativo ou queda da hematimetria no momento da detecção dos trombos. Conclusão: os dados sugerem não haver diferença na incidência de trombo em ambos os grupos, não sendo a profilaxia com a aspirina dose-dependente. Os níveis hematimétricos retornaram aos níveis iniciais o que sugere não ter havido sangramento crônico ou agudo relacionado ao uso. Nível de Evidência I; Estudo Clínico Randomizado Longitudinal Comparativo.

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La displasia del desarrollo de cadera del adulto (D.D.C.) es una patología que sin un manejo adecuado temprano llega a una artrosis en tiempo corto, culminando en prótesis de cadera (P.T.C.) Revisar los parámetros radiográficos y funcionales pre y postquirúrgicos que presentan los pacientes con D.D.C. que fueron sometidos (P.T.C.) Se trata de un estudio descriptivo, retrospectivo y cohorte transversal de pacientes con antecedente de coxartrosis secundaria a (D.D.C.) sometido a tratamiento quirúrgico (P.T.C.), se encontraron 45 pacientes de los cuales 29 casos cumplieron con los criterios del estudio, se realizó medición de los parámetros radiográficos pre y postquirugicos, además de utilizar el Score Harris Hip modificado y la escala analógica visual de dolor EVA. Según el género encontramos 27 mujeres y 2 varones, media de edad de 51 años, no existió diferencia significativa en lado afectado, los grados que encontramos según clasificación Crowe fueron grado 1 y 2, y según Hartofilakidis en grados Tipo A, Tipo B1 y B2, de acuerdo a la mediciones radiográficas en preoperatorio la mayoría se encontraban alteradas y se aprecia la corrección en las mediciones radiográficas postoperatorias y se encontró datos favorables en Score Harris Hip modificado, como en el EVA. Los parámetros radiográficos y funciones son datos importantes en el pre y post-quirúrgico para una adecuada planificación quirúrgica y hacer un seguimiento adecuado nuestros resultados, llegando a corregir las deficiencias encontradas.

Developmental dysplasia of the hip in adults (D.D.C.) is a pathology that, without proper early management, leads to osteoarthritis in a short time, culminating in hip prostheses (P.T.C.) To review the pre- and post-surgical radiographic and functional parameters presented by patients with D.D.C. that were subjected (P.T.C.) This is a descriptive, retrospective and cross-sectional cohort study of all patients with a history of coxarthrosis secondary to (DDC) undergoing surgical treatment (PTC). Pre- and post-surgical radiographic parameters were measured, in addition to using the Harris Hip Score. modified visual analog scale of pain VAS.45 patients were found, of which 29 cases met the study criteria, 27 women and 2 men, mean age 51 years, there was no significant difference on the affected side, the grades found according to Crowe classification were grade 1 and 2, and according to Hartofilakidis in Type A, Type B1 and B2 grades, according to the preoperative radiographic measurements, most were altered and the correction in the postoperative radiographic measurements is appreciated, favorable data are found in the modified Harris Hip Score, as in VAS .Radiographic parameters and functions are important pre- and post-surgical data for proper surgical planning and adequate follow-up of our results, correcting the deficiencies found.

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Objective: Monitoring costs is critical in searching for a more effective healthcare system. This study aimed to comprehend the care pathway and measure the costs associated with hip replacement surgeries in different hospitals in Brazil. Methods: The time-driven activity-based costing method was applied for cost data collection and analyses. Data on 62 patients were retrieved from five public hospitals. A descriptive cost analysis was followed by a comprehensive analysis of the variability in each hospital's care process, leading to suggestions for cost-saving opportunities along with the surgical care pathway. As a final analysis, the cost of surgical treatment was contrasted with the national reimbursement fee. Results: The mean cost per patient of the total sample was $5,784 (MIN-MAX $2,525.9-$9,557.8). Pre- and post-surgery hospitalization periods demonstrated the highest variability in length of time and resource consumption among centers. Compared to the national best practice fee, the average cost per inpatient total hip arthroplasty (THA) pathway from all six hospitals was approximately 7x the national reimbursement. Conclusion: The application of the TDABC allowed us to identify differences in the surgical care pathway among hospitals, which could be explored in further studies aimed at designing a benchmark surgical pathway. Differences in how the treatment is delivered to patients also justified the high-cost variability among centers.

Objetivo: O custo do monitoramento é um elemento-chave na busca contínua por um sistema de saúde mais eficaz. O objetivo deste estudo foi compreender a trajetória assistencial e mensurar os custos associados às cirurgias de artroplastia do quadril em diferentes hospitais do Brasil. Métodos: O método de custeio baseado em atividades orientado pelo tempo foi aplicado para a coleta e análise de dados de custos. Os dados de 62 pacientes foram recuperados de cinco hospitais públicos. Uma análise descritiva de custos foi seguida por uma análise abrangente da variabilidade no processo de atendimento de cada hospital, levando a sugestões de oportunidades de redução de custos junto com a via de atendimento cirúrgico. Como análise final, o custo do tratamento cirúrgico foi contrastado com o valor de reembolso nacional. Resultados: O custo médio por paciente da amostra total foi de $ 5.784 (MIN-MAX $ 2.525,9-$ 9.557,8). Os períodos de internação pré e pós-operatórios demonstraram a maior variabilidade no tempo e no consumo de recursos entre os centros. Em comparação com o reembolso nacional de melhores práticas, o custo médio por cirurgia de prótese de quadril de paciente internado de todos os seis hospitais foi de aproximadamente 7x o reembolso nacional. Conclusão: A aplicação do TDABC nos permitiu identificar diferenças na via de atendimento cirúrgico entre hospitais, o que poderia ser explorado em estudos futuros que visem projetar uma via cirúrgica de referência. As diferenças na forma como o tratamento está sendo entregue aos pacientes também contribuíram para justificar a alta variabilidade dos custos entre os centros.

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INTRODUCTION AND HYPOTHESIS: Hip osteoarthritis (OA) compromises functioning. Total hip replacement (THR) is the indicated treatment and may improve urinary incontinence (UI) and symptoms of overactive bladder (OAB). OBJECTIVES: Assess UI, OAB symptoms, and quality of life (QoL) impact in preoperative and postoperative periods of women submitted to THR and investigate associated factors. METHODS: A prospective cohort was conducted with 183 women submitted to THR. The International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), International Consultation on Incontinence Questionnaire-Overactive Bladder (ICIQ-OAB) and SF-12 questionnaires were administered pre- and 3 and 6 months after surgery. RESULTS: Significant improvements were found in UI and QoL 3- and 6-month postoperatively in the overall sample and in the subgroup with preoperative UI. The multivariate regression revealed that the preoperative ICIQ-SF and ICIQ-OAB final scores were the best predictors of UI 6-month postoperatively. The factors the best predicted the occurrence of UI 6-month following THR were the preoperative ICIQ-OAB scores and preoperative UI. Each unit of increase in the ICIQ-OAB increases the chances of UI by 26.9% and preoperative UI increases the chances of postoperative UI by 18.7-fold. A weak but significant negative correlation was found between the ICIQ-SF score and the SF-12 score. CONCLUSION: Significant improvements in UI, OAB and QoL were found at 3- and 6-month postoperatively. Preoperative ICIQ-SF and ICIQ-OAB final scores were the best predictors of UI at 6 months after surgery. We found significant association between urinary symptoms and THR, but this association is partially explained by current literature.

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PURPOSE: The aim of this prospective study was to evaluate the clinical-radiological outcomes of the Alteon Neck Preserving Stem (ANPS) (Exactech, Gainesville, FL, USA) implanted in four different centres by five senior hip surgeons with a minimum of 5 years of follow-up. MATERIAL AND METHOD: We conducted a multicentre prospective study that analysed 155 consecutive total hip replacements during 2014. We performed clinical-radiological analysis measuring Harris Hip Score (HHS), subjective satisfaction evaluation, radiolucencies, position of components, limb length discrepancy, heterotopic ossification, medical and surgical complications and a survival analysis at 5 years follow-up. RESULTS: Thigh pain was reported in 5 cases (3.2%), 2 of which reported mild pain, 2 moderate, and 1 severe. In 2 cases, subsidences of 3 mm were detected in the first scheduled X-ray, both related to intraoperative fractures with no progression after 3 months. The overall complication rate was 5.8% and 6 of the 9 complications were in the first 30 cases. Mean HHS improved from 42.9 points (range 37.2-55.7 points) preoperatively to 94.9 on average (range 87-98) at the end of the follow-up (p <0.01). Subjective evaluation was excellent in 130 (83.87%) cases and good in 25 patients (16.13%). CONCLUSIONS: The clinical-radiographic results of ANPS THR are satisfactory. The mid-term results are promising. However, long-term follow-up studies are necessary to confirm the validity of the concept.

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Introducción: La luxación de la prótesis total de cadera puede afectar los resultados del implante, la calidad de vida del paciente, y el costo del proceso. Su etiología es multifactorial. Objetivos: Identificar posibles factores de riesgo relacionados con la aparición de luxación en prótesis total de cadera en una serie de casos. Métodos: En una serie de 2732 prótesis total de cadera, en la que hubo 92 luxaciones (3,4 por ciento), se compararon factores relacionados con el paciente, el implante, y la técnica quirúrgica uilizada en el Hospital La Paz-IDIPaz de Madrid entre los años 2000 y 2016. Se utilizó el análisis de regresión para la significación de dichos factores. Resultados: De las 92 luxaciones, 62 fueron tratadas de manera conservadora (67,4 por ciento) y 30 pacientes precisaron de cirugía de revisión (32,6 por ciento). El estudio multivariado mostró significación estadística en los siguientes factores de riesgo: estado de la columna lumbar (p < 0,001), y una pobre reconstrucción del centro de rotación de la cadera (p= 0,035), y cúpulas posicionadas fuera de las ventanas de Lewinnek (p < 0,001) y del mecanismo abductor (p < 0,001) en relación con la técnica quirúrgica. No hubo factores significativos en relación con el tipo de implante, diámetro de la cabeza femoral o par de fricción. Conclusiones: La patología lumbar aumenta el riesgo de luxación en la prótesis total de cadera. Una adecuada reconstrucción de la cadera, que incluya la posición de la cúpula y el centro de rotación de la cadera, así como del mecanismo abductor ayudaría a mejorar la tasa de inestabilidad(AU)

Introduction: The dislocation of the total hip replacement can affect the results of the implant, the quality of life of the patient, and the cost of the process. Its etiology is multifactorial. Objectives: To identify possible risk factors related to the appearance of dislocation in total hip replacement in a series of cases. Methods: In a series of 2732 total hip prostheses, in which there were 92 dislocations (3.4percent), factors related to the patient, the implant, and the surgical technique used at La Paz-IDIPaz Hospital in Madrid were compared, from 2000 to 2016. Regression analysis was used for the significance of these factors. Results: Out of 92 dislocations, 62 were treated conservatively (67.4 percent) and 30 patients required revision surgery (32.6 pecent). The multivariate study showed statistical significance in the following risk factors: state of the lumbar spine (p <0.001), and poor reconstruction of the center of rotation of the hip (p = 0.035), and domes positioned outside Lewinnek windows (p <0.001) and the abductor mechanism (p <0.001) in relation to the surgical technique. There were no significant factors in relation to the type of implant, diameter of the femoral head or friction torque. Conclusions: Lumbar pathology increases the risk of dislocation in total hip replacement. Proper hip reconstruction, including the position of the dome and the center of rotation of the hip, as well as the abductor mechanism, would help to improve the rate of instability(AU)

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BACKGROUND: When approaching a joint replacement procedure, pre-surgical planning is essential to predict an accurate estimation of implant size and position. There are currently two methods to achieve it, analog and digital. The present study aims to demonstrate how the hybrid technique is accurate and precise for pre-surgical planning in a non-cemented total hip replacement. METHODS: Concordance-type study is used against a gold standard, as well as inter- and intra-observer consistency evaluation of two orthopedic surgeons and two orthopedic surgery residents. Accuracy was calculated with the intra-class correlation coefficient (ICC). Afterwards, the same calculation was done considering a margin of error with one size more and one less. RESULTS: Thirty-eight patients were included in the study: 19 women and 19 men. Twenty-two prostheses (57.89%) were right-sided and 16 were left (42.11%). Twelve prostheses (31.57%) were Stryker and 26 Johnson & Johnson (68.43%). Acetabular cup correlation compared with the gold standard was moderate: ICC reported 0.45 (95% CI, 0.15-0.76). When adjusted by ± 1 size, ICC was 0.48 (95% CI, 0.18-0.79). On the other hand, results from the femoral stem reported ICC 0.85 (95% CI, 0.07-0.98). When adjusted by ± 1 size, ICC was 0.86 (95% CI, 0.06-0.99). CONCLUSIONS: Hybrid templating is a reliable substitute for analog or digital planning. It is quick, inexpensive, accurate, and better results are observed in the femoral component regardless the level of expertise of the evaluator. LEVEL OF EVIDENCE: Grade IV.

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The purpose of this study was to retrospectively assess patients treated with modular, non-cemented, tapered, fluted, distal fixation stems. We included patients with 24 months mínimum follow-up. Diagnosis that led to revisions were described. The radiographic analysis was made with preoperative, immediate postoperative and last control postoperative X-rays. Sixty-seven patients met inclusion criteria. We observed 59,7% (n=40) Osteointegration, 34,3% of Stable Fibrosis and 5,97% Unstable fibrosis. Stress Shielding was registered with 10,44% and Subsidence was observed in 34,3% of the patients. Modular, fluted, tapered, distal fixation stems have an excellent survival rates.

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INTRODUCTION: We hypothesised that a single preoperative intravenous dose of tranexamic acid (TXA) is effective in patients who undergo total hip arthroplasty (THA) and are at high risk of blood transfusion (preoperative haemoglobin level <13.0 g/dL). METHODS: A prospective, randomised controlled study of 308 patients who underwent primary THA was conducted. 256 participants remained in the study and were divided into 2 major groups: high-risk group comprising 116 patients with preoperative Hb < 13.0 g/dL (57 of whom were treated with a 15 mg/kg intravenous bolus of TXA, and 59 of whom did not receive the medication) and low-risk group comprising 140 patients with Hb ⩾ 13.0 g/dL (71 of whom received the same dose of TXA, and 69 of whom did not). Participants were followed up at 3 weeks, 3 months, 6 months, and 1 year after surgery. RESULTS: The use of TXA in both groups of patients significantly increased the levels of postoperative Hb and Ht. TXA protected high-risk patients from blood loss and from transfusion. In low-risk patients the use of TXA reduced blood loss but did not protect from blood transfusion. The median length of stay was significantly affected for high-risk patients. No thromboembolic event was recorded in either group. CONCLUSIONS: TXA reduces intra- and postoperative bleeding, transfusion rates, and the length of hospital stays in patients with low preoperative Hb. The use of TXA in patients with normal preoperative Hb reduces blood loss but does not affect the transfusion rate.ClinicalTrials.gov Identifier: NCT03019198.

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Introducción Existe una diferencia estadísticamente significativa del 1.2% en la tasa de revisión a 15 años a favor de cerámica- polietileno altamente entrecruzado (CP), demostrada en el registro nacional de artroplastia australiano. Nuestro objetivo es evaluar la costo-efectividad entre los pares: cerámica-polietileno altamente entrecruzado (CP) y metal- polietileno altamente entrecruzado (MP) para el pagador en Colombia. Materiales y métodos Se construyó un árbol de decisiones TreeAge Pro® comparando CP vs MP desde la perspectiva del Sistema de Salud Colombiano (SSC). Los parámetros se tomaron de la mejor evidencia disponible, para la efectividad se realizó una revisión sistemática de la literatura y para los costos se usaron tarifas del mercado local. Se determinó la relación de costo-efectividad incremental, asumiendo un horizonte temporal de 15 años y aplicando una tasa de descuento del 5% para costos y efectividad. La incertidumbre fue controlada por un análisis de sensibilidad determinístico y probabilístico. Resultados Para el SSC, con un umbral de 1 PIB per cápita por año de vida ganado ajustado por calidad (AVAC), en adultos llevados a RTC el uso de CP no es costo-efectiva, dado que la efectividad es similar (MP:11,32 AVAC vs CP: 11,36 AVAC) y el costo es tres veces mayor (MP $ 861.826 COP vs CP $ 2.298.090 COP). El análisis de sensibilidad determinístico demuestra que la variable más importante en el resultado es el costo de la cerámica. Discusión Para el SSC el uso rutinario de cabezas de cerámica en RTC no es una estrategia costo-efectiva.

Background There is a statistically significant difference of 1.2% in the revision rate in a 15 year follow in favour of the use of ceramic on highly cross-linked polyethylene (CP) recently described in the Australian National Joint Registry. The purpose of this study is to compare the cost-effectiveness of CP implants and metal-on-highly cross-linked polyethylene (MP) implants in patients undergoing total hip replacement (THR). Materials and methods A TreeAge Pro® decision tree was constructed in order to determine cost-effectiveness between two bearing surfaces: CP or MP from the perspective of the Colombian Health Care System (CHCS). The model parameters where taken from the best available evidence. For the effectiveness, a systematic review of the literature was performed, and costs were taken from local market rates. The incremental cost-effectiveness ratio was determined assuming a time horizon of 15 years, and a discount rate of 5% was used for costs and effectiveness. Cost-effectiveness uncertainty was controlled with deterministic and probabilistic sensitivity analysis. Results For the CHCS, with a 1PIB per capita threshold adjusted per QALY in adults undergoing (THR), the use of a CP implant is not cost-effective, given that the effectiveness is similar (11.32 QALY for MP vs 11.36 QALY for CP), and the cost is three times higher (MP $ 861.826 COP vs CP $ 2.298.090 COP). The deterministic sensitivity analysis showed that the most important variable in the results is the ceramic cost. Discussion for the CHCS the routine use of ceramic-highly cross-linked polyethylene bearing surface in a THR is not a cost-effective strategy.

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INTRODUCTION: The coxarthrosis has incidence of 88 cases per 100,000 people/year and symptomatic prevalence of 16% men and 6% women aged 65-74 years and increases with age. It is a growing public health disease. Total hip arthroplasty (THA) has become the most successful procedure to increase the quality of life of patients with coxarthrosis. Our objective was to determine the claudication, quality of life and functional results of THA through minimal invasive approach in patients with primary coxarthrosis. MATERIAL AND METHODS: Prospective longitudinal study in patients with unilateral primary coxarthrosis postop of THA with minimally invasive approach from March 2015-February 2016, each patient was analyzed with quality of Life instrument (WOMAC), Functional test for coxarthrosis (HHS) and functional test in patients with hip surgery (OHS) with follow-up of one year. RESULTS: We included 21 patients, 17 female and 4 males corresponding to 80.95% and 19.05% respectively, average age of 59.95 years (ED = 9.64), with excellent functional results to one year according to HHS and OHS, quality of life high in 100% of cases according to WOMAC, with claudication rate of 4.76%. DISCUSSION: The minimal invasive approach is a reproducible surgical technique, with excellent functional results, low claudication rate and high quality of life in postoperative patients of primary ATC at only one year of follow-up.

INTRODUCCIÓN: La coxartrosis tiene incidencia de 88 casos por 100,000 personas/año y prevalencia sintomática de 16% para hombres y 6% para mujeres en edades de 65-74 años e incrementa con la edad. Representa una enfermedad de salud pública que va en aumento, la mujer es quien presenta padecimiento más grave. La ATC (artroplastía total de cadera) se ha convertido en el procedimiento más exitoso para mejorar la calidad de vida de pacientes con coxartrosis. OBJETIVO: Determinar la claudicación, calidad de vida y resultados funcionales de la ATC mediante abordaje mínimo invasivo en pacientes con coxartrosis primaria. MATERIAL Y MÉTODOS: Estudio longitudinal y prospectivo en pacientes con coxartrosis primaria unilateral postoperados de ATC primaria con técnica mínimamente invasiva en el período comprendido de Marzo de 2015 a Febrero de 2016, se analizó a cada paciente con somatometría, calidad de vida (WOMAC), funcionalidad en pacientes con coxartrosis (HHS) y funcionalidad en pacientes con cirugía de cadera (OHS) de manera prequirúrgica y postquirúrgica con seguimiento a un año. RESULTADOS: Se incluyeron 21 pacientes, 17 femeninos y cuatro masculinos que corresponde a 80.95 y 19.05%, respectivamente, edad promedio de 59.95 años (DE = 9.64), con resultados funcionales excelentes a un año, según escalas de HHS y OHS, calidad de vida alta en 100% de los casos según WOMAC, con índice de claudicación bajo de 4.76%. DISCUSIÓN: El abordaje mínimo invasivo es una técnica quirúrgica reproducible con resultados funcionales excelentes, índice de claudicación baja y alta calidad de vida en pacientes postoperados de ATC primaria durante el primer año de seguimiento.

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Resumen: Introducción: La coxartrosis tiene incidencia de 88 casos por 100,000 personas/año y prevalencia sintomática de 16% para hombres y 6% para mujeres en edades de 65-74 años e incrementa con la edad. Representa una enfermedad de salud pública que va en aumento, la mujer es quien presenta padecimiento más grave. La ATC (artroplastía total de cadera) se ha convertido en el procedimiento más exitoso para mejorar la calidad de vida de pacientes con coxartrosis. Objetivo: Determinar la claudicación, calidad de vida y resultados funcionales de la ATC mediante abordaje mínimo invasivo en pacientes con coxartrosis primaria. Material y métodos: Estudio longitudinal y prospectivo en pacientes con coxartrosis primaria unilateral postoperados de ATC primaria con técnica mínimamente invasiva en el período comprendido de Marzo de 2015 a Febrero de 2016, se analizó a cada paciente con somatometría, calidad de vida (WOMAC), funcionalidad en pacientes con coxartrosis (HHS) y funcionalidad en pacientes con cirugía de cadera (OHS) de manera prequirúrgica y postquirúrgica con seguimiento a un año. Resultados: Se incluyeron 21 pacientes, 17 femeninos y cuatro masculinos que corresponde a 80.95 y 19.05%, respectivamente, edad promedio de 59.95 años (DE = 9.64), con resultados funcionales excelentes a un año, según escalas de HHS y OHS, calidad de vida alta en 100% de los casos según WOMAC, con índice de claudicación bajo de 4.76%. Discusión: El abordaje mínimo invasivo es una técnica quirúrgica reproducible con resultados funcionales excelentes, índice de claudicación baja y alta calidad de vida en pacientes postoperados de ATC primaria durante el primer año de seguimiento.

Abstract: Introduction: The coxarthrosis has incidence of 88 cases per 100,000 people/year and symptomatic prevalence of 16% men and 6% women aged 65-74 years and increases with age. It is a growing public health disease. Total hip arthroplasty (THA) has become the most successful procedure to increase the quality of life of patients with coxarthrosis. Our objective was to determine the claudication, quality of life and functional results of THA through minimal invasive approach in patients with primary coxarthrosis. Material and methods: Prospective longitudinal study in patients with unilateral primary coxarthrosis postop of THA with minimally invasive approach from March 2015-February 2016, each patient was analyzed with quality of Life instrument (WOMAC), Functional test for coxarthrosis (HHS) and functional test in patients with hip surgery (OHS) with follow-up of one year. Results: We included 21 patients, 17 female and 4 males corresponding to 80.95% and 19.05% respectively, average age of 59.95 years (ED = 9.64), with excellent functional results to one year according to HHS and OHS, quality of life high in 100% of cases according to WOMAC, with claudication rate of 4.76%. Discussion: The minimal invasive approach is a reproducible surgical technique, with excellent functional results, low claudication rate and high quality of life in postoperative patients of primary ATC at only one year of follow-up.

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Introduccion La tendencia creciente de uso de implantes no cementados y el desarrollo de tecnologías que buscan restablecer la anatomía y función articular con una mayor preservación ósea, ha incrementado el uso de vástagos cortos en el remplazo total de cadera (RTC). El objetivo de este estudio es describir resultados funcionales, restauración radiológica de la anatomía, tasa de complicaciones y reintervención de pacientes sometidos a RTC usando vástagos femorales cortos de fijación cervico metafisiaria con apoyo en cortical lateral. Materiales y Métodos Estudio descriptivo prospectivo, donde se incluyeron 45 caderas en pacientes con artrosis de cadera de cualquier etiología. El seguimiento fue de 18 meses. Las variables de desenlace evaluadas fueron: 1. Integración del implante, 2. Complicaciones dependientes del implante femoral, 3. Subsidencia y 4. Reintervención. Se evaluó adicionalmente el resultado funcional con escala WOMAC. Resultados Durante el periodo comprendido entre diciembre de 2011 a julio 2017, encontramos una mejoría en estado funcional en el 97% (n:44) de los pacientes, no hubo reintervenciones. Discusión En el 100% de los casos se encontró osteointegración del implante y los resultados son comparables con los reportes de la literatura. Consideramos que el uso de vástagos cortos en el Reemplazo total de Cadera es un procedimiento seguro, con buenos resultados, teniendo la ventaja de una adecuada integración ósea del implante y garantizar un mejor stock óseo en una próxima cirugía.

Background The growing trend in the use of non-cemented implants and the development of technologies that attempt to restore the anatomy and joint function with greater bone preservation has increased the use of short stems in the total hip replacement (THR). The objective of this study is to describe functional results, radiological restoration of the anatomy, complication and revision rate of patients undergoing THR using short femoral stems with metaphyseal cervical fixation with lateral cortical support. Materials and Methods A prospective descriptive study was performed that included 45 hips of patients with hip osteoarthritis of any origin. The follow-up was 18 months. The outcome variables evaluated were: 1. Integration of the implant, 2. Complications dependent on the femoral implant, 3. Subsidence, and 4. Re-intervention. The functional result was additionally evaluated using the Western Ontario and McMaster Universities Arthritis Index (WOMAC). Results During the period from December 2011 to July 2017, an improvement was observed in functional status in 97% (n: 44) of patients, with no reoperations. Discussion Bone integration of the implant was observed in 100% of the cases, making the results comparable with the reports in the literature. It is believed that the use of short stems in total hip replacement is a safe procedure, with good outcomes. It also has the advantage of an adequate bone integration of the implant, and guaranteeing a better bone stock in the next surgery.

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Introducción Las copas de doble movilidad son implantes en que se introduce una cabeza protésica en un núcleo de polietileno, el cual posteriormente se articula con una copa metálica implantada en el acetábulo. Este tipo de diseño desarrollado en Francia desde la década de 1970ha demostrado disminuir el riesgo de luxación en un remplazo total de cadera. Estas copas han sido utilizadas históricamente de forma no cementada. No obstante, actualmente se pueden utilizar copas cementadas. Los objetivos de este estudio son determinar la sobrevida de las copas de doble movilidad cementadas y medir la calidad de vida de los pacientes. Materiales y métodos Se realiza un estudio multicéntrico retrospectivo, cuya indicación para la cirugía sea fracturas (61,5%), artrosis (34,6%) o tumores (3,8%). El análisis se realizó con los pacientes operados entre los años 2011-2013 y se encontraron 82 caderas operadas con copas de doble movilidad cementadas con un promedio de edad de 76 años. Resultados Se revisó una copa de doble movilidad por infección; por tanto, se obtuvo una sobrevida del 97,6% con un promedio de tiempo de seguimiento de 33,7 (29,7-37,7) meses con un IC 95%, y un promedio en la escala de Oxford de 38,2 (34,8-41,7) con un IC 95%. Discusión Se pudo concluir que la tasa de sobrevida es óptima para el tiempo de seguimiento y el puntaje promedio en la escala de Oxford es bueno si se tienen en cuenta las comorbilidades y la media de edad de los pacientes. Nivel de evidencia clínica. Nivel IV.

Background The dual mobility cups are implants where a prosthetic head is introduced into a polyethylene core, which is subsequently articulated with a metal cup to be implanted in the acetabulum. This type of design developed in France since the seventies has shown to decrease the risk of dislocation in total hip replacement. These cups have been used historically cementless, however now can be use cemented. The objectives are to determine the survival of double cemented mobility cups and to measure the quality of life of patients. Materials and methods A retrospective multicenter study was made. Patients who underwent primary surgery and whose indication for surgery is fractures (61.5%), osteoarthritis (34.6%) or tumors (3.8%) were included. The analysis was performed with patients operated between 2011 and 2013. Results The study was based in 82 hips operated with dual mobility cemented cups with a patient's average age of 76 (13.4) years old. A dual mobility cup was checked for infection therefore obtaining a survival rate of 97.6% and an average follow up of 33.7 months with 95% CI (29,7-37,7) and an average in the Oxford scale of 38.2 with 95% CI (34,8-41,7) Discussion It was concluded that the survival rate is optimal taking into account the follow up time and the average score on Oxford scale were good considering comorbidities and the average age of patients. Evidence level. IV.

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Resumen: Introducción: Uno de los puntos más críticos en la planeación de las artroplastías de cadera es la selección del implante, puesto que su supervivencia impacta significativamente la salud de los pacientes. Sin embargo, hasta el momento no se ha definido cuál es la supervivencia ideal que debe demostrar un implante para ser seleccionado. El objetivo de este consenso es definir los estándares mínimos de desempeño para la selección de prótesis en reemplazo primario convencional de cadera. Material y métodos: El consenso se realizó mediante la metodología de «grupo nominal¼. Esto incluyó: 1. Revisión de la evidencia disponible y definición de los temas a evaluar, 2. Reunión para la votación y discusión y 3. Análisis estadístico cuantitativo con medianas (M) y rangos intercuartílicos (RIC) y cualitativo con proporciones de los resultados obtenidos para generar recomendaciones. Resultados: La fuente primaria de información para la selección de prótesis (M: 8; RIC: 7-9) y de elección en caso de evidencia contradictoria (M: 8; RIC: 7-9) o limitada en la literatura (M: 7; RIC: 4.75-825) son los registros nacionales. El mínimo seguimiento aceptable es 10 años (M: 9; RIC: 8-9) y el mínimo de supervivencia aceptable es 90% a 10 años (M: 8; RIC: 5-8.5). Discusión: De acuerdo con estos resultados, el consenso de expertos propone que la selección del implante en el reemplazo articular primario convencional de cadera se realice con base en la información publicada en los registros nacionales y que dicha prótesis tenga un seguimiento mínimo de 10 años y demuestre una supervivencia mínima de 90%.

Abstract: Background: One of the most critical points in the planning of hip replacement surgeries is the selection of the implant, since its survival significantly impacts the patients' health. However, the ideal survival time that an implant must prove to be selected has not been defined. The objective of this consensus is to define minimum performance standards for the selection of conventional primary hip replacement prosthesis. Material and methods: The consensus was carried out using the methodology of 'nominal group'. This included: 1. A review of the available evidence and the issues to be evaluated, 2. Meeting for the vote and discussion, 3. Quantitative statistical analysis with median (M) and interquartile range (IQR) and qualitative one with proportions of the results to generate recommendations. Results: The primary source of information for prosthesis selection (M: 8; IQR: 7-9), choice in the event of conflicting evidence (M: 8; IQR: 7-9), or limited evidence in the literature (M: 7; IQR: 4.75-825) should be national registries. The minimum acceptable follow-up is 10 years (M: 9; IQR: 8-9) and the minimum acceptable survival is 90% at 10 years (M: 8; IQR: 5-8.5). Discussion: According to these results, the consensus of experts proposed that the selection of the implant for conventional primary hip replacement must be based on the information published in the national registries and that the prosthesis must have a minimum follow-up of 10 years and show a minimum survival of 90%.

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INTRODUCTION: Rapidly destructive osteoarthritis is characterized by a severe destruction of the hip joint developing over short periods of time. However, to date, there is no agreement on the biological process that triggers this condition. The aim of this report is to present a case of rapidly destructive osteoarthritis. CASE REPORT: We report a case of a 76 year-old female who presented with hip pain of sudden onset and normal X-rays. Six weeks later she presented with increased pain intensity, functional limitation and evidence of a collapse of the femoral head in the X-rays. DISCUSSION: Rapidly destructive osteoarthritis of the hip is a complex entity that might be more frequent than previously described and which clinical course could vary between few weeks and several months. In order to make an accurate diagnosis, other causes of massive destruction of the joint should be excluded.

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BACKGROUND: One of the most critical points in the planning of hip replacement surgeries is the selection of the implant, since its survival significantly impacts the patients health. However, the ideal survival time that an implant must prove to be selected has not been defined. The objective of this consensus is to define minimum performance standards for the selection of conventional primary hip replacement prosthesis. MATERIAL AND METHODS: The consensus was carried out using the methodology of nominal group. This included: 1. A review of the available evidence and the issues to be evaluated, 2. Meeting for the vote and discussion, 3. Quantitative statistical analysis with median (M) and interquartile range (IQR) and qualitative one with proportions of the results to generate recommendations. RESULTS: The primary source of information for prosthesis selection (M: 8; IQR: 7-9), choice in the event of conflicting evidence (M: 8; IQR: 7-9), or limited evidence in the literature (M: 7; IQR: 4.75-825) should be national registries. The minimum acceptable follow-up is 10 years (M: 9; IQR: 8-9) and the minimum acceptable survival is 90% at 10 years (M: 8; IQR: 5-8.5). DISCUSSION: According to these results, the consensus of experts proposed that the selection of the implant for conventional primary hip replacement must be based on the information published in the national registries and that the prosthesis must have a minimum follow-up of 10 years and show a minimum survival of 90%.

INTRODUCCIÓN: Uno de los puntos más críticos en la planeación de las artroplastías de cadera es la selección del implante, puesto que su supervivencia impacta significativamente la salud de los pacientes. Sin embargo, hasta el momento no se ha definido cuál es la supervivencia ideal que debe demostrar un implante para ser seleccionado. El objetivo de este consenso es definir los estándares mínimos de desempeño para la selección de prótesis en reemplazo primario convencional de cadera. MATERIAL Y MÉTODOS: El consenso se realizó mediante la metodología de «grupo nominal¼. Esto incluyó: 1. Revisión de la evidencia disponible y definición de los temas a evaluar, 2. Reunión para la votación y discusión y 3. Análisis estadístico cuantitativo con medianas (M) y rangos intercuartílicos (RIC) y cualitativo con proporciones de los resultados obtenidos para generar recomendaciones. RESULTADOS: La fuente primaria de información para la selección de prótesis (M: 8; RIC: 7-9) y de elección en caso de evidencia contradictoria (M: 8; RIC: 7-9) o limitada en la literatura (M: 7; RIC: 4.75-825) son los registros nacionales. El mínimo seguimiento aceptable es 10 años (M: 9; RIC: 8-9) y el mínimo de supervivencia aceptable es 90% a 10 años (M: 8; RIC: 5-8.5). DISCUSIÓN: De acuerdo con estos resultados, el consenso de expertos propone que la selección del implante en el reemplazo articular primario convencional de cadera se realice con base en la información publicada en los registros nacionales y que dicha prótesis tenga un seguimiento mínimo de 10 años y demuestre una supervivencia mínima de 90%.

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Background: Osteosarcoma (OSA) is the most common primary bone tumor of the appendicular skeleton of dogs. Itmainly affects the metaphyseal region of long bones in large and giant breed dogs.The markedly aggressive and metastaticcharacter of the disease leads to an invariably poor to unfavorable prognosis.Although amputation is commonly performed,different surgical techniques may be used to preserve the limb. The most common methods of limb preserving surgeriesinvolve the use of endoprosthesis and allogeneic or autologous grafts. This report describes the successful use of total hipreplacement to treat a 3-year-old male dog, with OSA in the femoral head and neck.Case: This report describes the successful use of total hip replacement to treat a 3-year-old male dog, with OSA in thefemoral head and neck. The OSA stage IA located in the femoral head and neck was resected and treated through thelimb-sparing. The bone defect and joint function was reconstructed with total hip arthroplasty technique using a cementlesship prosthesis. The result of the histopathological analysis of the excised bone tissue showed a minimally productiveosteoblastic osteosarcoma. To date, the patient shows satisfactory movement rate and motion range, with no pain to palpationand without lameness in that limb. The radiographic follow-up after 24 months showed no local recurrence, metastasispulmonary or complications related to the implant. Total hip arthroplasty resulted in safe recovery of orthopedic signsassociated with osteosarcoma of the femoral head and neck [...]

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