Biomedical subjects

E García-Cimbrelo

Publications and source records attributed to E García-Cimbrelo.

6 recordsLinked to original sources

PubMed2002

The intramedullary elongation nail for femoral lengthening.

We have analysed the results of 24 femoral lengthenings in 23 patients operated on between 1993 and 2000, using a gradual elongation intramedullary nail (Albizzia). Of the 23 patients, 22 had femoral deficiency and one was of short stature. Their mean age was 16.9 years. Technical difficulties encountered during the procedure were mild or moderate in 18 femora and severe in six femora. Distraction was obtained by 15 ratchetings per day (1 mm/day). There were 18 excellent results although in two patients this was achieved after the development of a pseudarthrosis which required further surgery. There were four good and two fair results in which the lengthening obtained was at least 3 cm less than had been projected. The consolidation index was 35.2 days/cm. No patient had associated long-term stiffness of the knee. Femoral lengthening using an elongation nail gives good results and is a comfortable procedure.

Adolescent↗

PubMed1997

Progression of radiolucent lines adjacent to the acetabular component and factors influencing migration after Charnley low-friction total hip arthroplasty.

We analyzed the progression of radiolucent lines around the acetabular cup after 452 Charnley low-friction arthroplasties that had been performed in 392 patients between 1971 and 1976. The average duration of follow-up was twenty years (range, eleven to twenty-five years) for the 442 hips (382 patients) that had the original component in place at ten years. The demarcation of the bone-cement interface was classified according to the system of Hodgkinson et al. We sought to determine if there was a relationship between the progression of the radiolucent line and the age, gender, and weight of the patient; the level of activity; the preoperative diagnosis; or the amount of wear of the acetabular cup. The demarcation increased over time in 138 (31 per cent) of the 452 hips. Radiographs made at the time of the latest follow-up showed migration of eleven (5 per cent) of the 233 acetabular cups with no demarcation on the initial postoperative radiograph, eighteen (11 per cent) of the 167 cups with type-1 demarcation, twelve (35 per cent) of the thirty-four cups with type-2 demarcation, and thirteen of the eighteen cups with type-3 demarcation. Preoperative acetabular protrusion, inflammatory arthritis, and severe acetabular dysplasia as well as a previous operation were associated with the extent of the radiolucent line on the most recent radiograph (p < or = 0.05 for all). A high level of activity and more than two millimeters of wear of the acetabular cup also were related to the progression of the radiolucent line (p = 0.0004 and p < 0.0001, respectively). Kaplan-Meier survivorship analysis demonstrated that the greater the demarcation on the initial postoperative radiograph, the greater the risk of migration (p < 0.0001, Mantel-Cox test). Our data suggest that, after a Charnley low-friction arthroplasty, any cemented cup, even one with the least amount of demarcation (types 0 and 1), can migrate. As the type of the initial postoperative demarcation increases, so does the risk of migration of the cup, particularly when there is loss of the acetabular bone stock.

Acetabulum↗

PubMed1993

Low-friction arthroplasty in severe acetabular dysplasia.

Eighty consecutive low-friction arthroplasties in 64 patients with secondary arthritis due to severe acetabular dysplasia (Crowe grades III and IV) are analyzed. Two groups of patients were considered. In group 1 over 20% of the cup was not covered by the acetabulum and was reconstructed with a femoral head graft (32 cases; in group 2) a femoral head graft was not used because the cup was adequately covered (48 cases). The mean follow-up period was 9.4 years (range, 3-17 years) for group 1 and 8.8 years (range, 3-18 years) for group 2. Early complications were frequent (19%). To study long-term results only 78 hips were assessed since two patients were excluded due to deep infection. In these 78 hips, group 1 patients showed "better" results after 16 years (69.6% good results) than group 2 (nongraft procedures) (52.2%), but these differences were not significant (P > or = .05). Early cup loosening was more frequent in group 2 than in group 1, and good coverage was obtained in 91% of the group 1 cups and in 71% of the group 2 cups (P > or = .05). Acetabular cup loosening was not correlated with acetabular cup position. Bone-grafts appeared consolidated in all cases, but resorption areas were frequently observed. Radiographic stem aseptic loosening appeared in 10 cases, cortical hypertrophy in 7 cases, and endosteal osteolysis in 3 cases. Although limb discrepancy was frequent in both groups (75%), the average discrepancy was 1.7 cm.

Adult↗

PubMed1992

Dislocation in low-friction arthroplasty.

In a series of 2,050 low-friction arthroplasties, 61 cases (2.97%) of dislocation were analyzed. The mechanism of production was malposition of the components (group 1, 33%), deficiency of the abductor mechanism (group 2, 34%), or the association of both (group 3, 26%). Failure to find a cause was even more rare (group 4, 7%). The best treatment is prevention by careful surgical technique, since good results with different procedures have only been attained in 51% of dislocated hips.

Adult↗

PubMed1992

Ilizarov technique. Results and difficulties.

Of 100 cases treated by the Ilizarov method, 91 patients were reviewed from February 1985 to March 1990. There were 32 tibial fractures (29 open) and 21 nonunions (nine infected). There were 47 cases of limb lengthening (28 tibia and 19 femur). The results were as follows: good, 83%; fair, 13%; and poor, 4%. Slight and intermittent pain in some wire of the device was frequent (69%). Average bone healing time in tibial fractures was 4.95 months and 5.83 months in tibial nonunions. In bone-lengthening operations, the average lengthening index in the tibia was 1.02 months/cm (lengthenings ranged from 3 cm to 10 cm, with a mean of 5.71 cm), whereas in the femur, the average lengthening index was 1.14 months/cm (lengthenings ranged from 3 cm to 7 cm, with a mean of 5.34 cm). Manually-tensed wires produced frequent problems (24.5%), whereas wire tensed by the dynamometric tensioner produced problems in only 7.8% of the cases. Despite good results, the Ilizarov technique requires adequate training to reduce an overall complication rate (approximately 30%).

Adolescent↗

PubMed1992

Early and late loosening of the acetabular cup after low-friction arthroplasty.

Between 1971 and 1979, 680 low-friction arthroplasties of the hip were performed in 598 patients. The average duration of follow-up was twelve years and eight months. Sixty-one acetabular cups had loosening as seen on roentgenograms eighteen years postoperatively, resulting in a total cumulative probability of loosening of 19 per cent, according to survivorship analysis. In twenty-nine cups, the loosening appeared within ten years after the operation (early loosening) and in thirty-two, more than ten years after the operation (late loosening). Early loosening was associated with deficient structure of the bone of the acetabulum, a previous congenital dislocation of the hip, acetabular fracture, or acetabular protrusion in all instances (p < 0.01). Late loosening was associated with the depth of acetabular wear. Of the thirty-two cups that had more than two millimeters of wear, eighteen (56 per cent) had loosening on the roentgenograms (p < 0.001). In hips that had early loosening, migration was the most frequent finding, and its rate of progression was higher than in hips that had late loosening (p < 0.001). In late loosening, a complete bone-cement radiolucency of more than two millimeters was the most frequent finding. Clinical failure was seen in twenty-two (76 per cent) of the twenty-nine cups that loosened early and in nine (28 per cent) of the thirty-two cups that loosened late. The probability of extensive resorption of bone necessitates close observation of patients who have early loosening, while a reasonable period of observation is possible for those who have late loosening.

Acetabulum↗