Introduction: Patellar resurfacing (pr) in total knee arthroplasty (TKA) is still controversial. Outerbridge classification of cartilage defects in the patella is the most commonly used one in the literature. The purpose of this study is to determine when PR should be done depending on the degree of cartilage involvement of the patella according to Outerbridge classification.

Materials and Methods: Between 1995 and 2000 we performed a prospective randomised study of 500 TKAs. We performed PR or not depending on the Outerbridge classification of the patella at the time of surgery. Patients with grades I, II and III of Outerbridge formed group A, while patients with grade IV formed group B. Within each group resurfacing was completed on one half of the patients. Group A was formed by 328 patients (164 with PR, 164 without PR). In group B there were 172 patients (86 with PR and 86 without PR). In both groups we always used the same prosthetic design. The average follow-up was 7.8 years for both Group A and Group B. At the end of follow-up we assessed the number of patients in each group that required a secondary resurfacing because of patellofemoral pain.

Results: In group A only one patient required a secondary PR (1.2% rate), while in group B ten patients needed PR (9.8% rate).

Conclusions: The findings of this study make us recommend PR in Outerbridge grade IV patellae, but not in grades I, II and III.

Introduction: The current gold standard for the treatment of the infected total knee arthroplasty is a two-stage revision. The purpose of this study is to present our results with two-stage revision arthroplasty in a series of 48 infected TKAs.

Materials and Methods: Over a 10-year period (1996–2005) we have performed 2140 TKAs. Of them 48 (48 patients) were infected and required a two-stage revision arthroplasty (2.2% infection rate). In 43 patients of these patients we used LCCK prostheses (Zimmer, USA) and in 5 (with severe instability) a rotating hinge prosthesis (Waldemar Link, Germany). In 26 occasions antibiotics-loaded cement (Palacos with gentamicine) was used and in 22 we used articulated spacers. The average age of patients was 67 years (range, 59–82) and the average follow-up was 5.5 years (range: 1–10). The results were assessed according to the Knee Society scores.

Results: Four knees were re-infected. Results were excellent in 28 knees, good in 13, fair in 3 and poor in 4 (the four re-infected prostheses). The four infected prostheses had been treated by static spacers. The survival rate taking as end-point removal of components for infection is 91.6% (results at average of 5.5 years).

Conclusion: Our results confirm that two-stage revision TKA is a reproducible procedure in the infected primary TKA. Also that articulated antibiotic-loaded spacers seem to be better than static spacers.

Introduction: Althoug the advantages of partial revision in hip replacement are well-documented, the effectiveness of this treatment strategy has not been established in revision TKA. The purpose of this study is compare the results of tibial component versus full–component (Miller-Galante II-MG II to Constrained Condylar Knee-CCK) revision TKA for wear-related problems.

Materials and Methods: A retrospective review was used to identify who had partial revision TKA. Over a 10-year period, 55 revision TKAs were completed. All the primary arthroplasties were MG II hybrid primary arthroplasties (uncemented femoral component, cemented tibial component, cemented patellar resurfacing). Twenty-five partial revisions (tibial component and polyethylene exchange) and 30 full-component revision TKAs were done. The average follow-up was 5.2 years. Knee Society clinical scores were used to compare patients who had tibial revision with patients who had full-component revision.

Results: The average Knee Society score for full component revisions was 85 compared to 63 for partial revisions (significant difference).

Discussion and Conclusion: We recommend caution in doing isolated tibial revisions in which retaining the femoral component limits the surgeon options to properly balance the knee. Full revision should be done if there is any question regarding ligamentous balancing or equalization of flexion and extension gaps.

Purpose: To understand the epidemiology and risk factors of an osteoporotic hip fracture in a non-elderly patient.

Methods: Retrospective study covering the period 1999–2004, assessing individual and family history, fracture type, hospital stay, time until surgery, type of treatment and possible study or treatment of bone fragility.

Results: 38 cases. 23 patients (60.5%) presented some risk factor related to osteoporosis: enolism 7, liver pathology 3, neuromuscular disease 13, steroid treatment 4 and anticonvulsant 3. Seven patients (18.4%) presented some type of psychiatric disorder. Mean hospitalisation time: 13 days. Time until surgery: 3 days. Fracture type: 20 (52.6%) pertrochanteric and 16 (42.10%) subcapital. Treatment: cannulated screws in 11 cases (29%), screw and plate in 21 (55.2%). We found no diagnosis of osteoporosis or related indications in the admission reports except in one patient. Patients over 50: hip fracture incidence 161.21/100,000 inhabitants, pertrochanteric in 54.9% and subcapital in 45.1%*.

*

A Torrijos, C Ojeda. Area 5 hip study group, La Paz Hospital

Conclusions:

Hip fractures resulting from low-energy trauma are uncommon in the population under the age of 50.