medigraphic.com
ISSN 2992-8036 (Digital)
ISSN 2306-4102 (Impreso)
Órgano Oficial del Colegio Mexicano de Ortopedia y Traumatología

2013, Número 2

<< Anterior Siguiente >>

Acta Ortop Mex 2013; 27 (2)


Utilización del metal trabecular en artroplastía total de rodilla en pacientes obesos graves y mórbidos (IMC >35 kg/m2)

Núñez FA, Argüelles AA, Lozano LL, Popescu D, Maculé F, Suso V-S

Idioma: Español
Referencias bibliográficas: 31
Paginas: 97-102
Archivo PDF: 89.67 Kb.


RESUMEN

El empleo del metal trabecular en la superficie tibial podría aumentar la supervivencia de las prótesis dentro de la población que presenta obesidad grave o mórbida (IMC > 35 kg/ m2). Se realizó un estudio prospectivo, descriptivo, con prótesis total de rodilla de componente de metal trabecular a pacientes con IMC > 35 kg/m2, con un seguimiento mínimo de dos años, análisis estadístico mediante la prueba T Student a las escalas Knee Society Score y Western Ontario and Mc- Master Universities prequirúrgico y postquirúrgico. Prueba χ2 a valores de índice de masa corporal relacionándolos con mayor o menor imágenes de radiolucencias. En 39 pacientes, de los cuales se eliminaron tres pacientes por no contar con el seguimiento radiográfico, seguimiento promedio de 34 meses (25-43), 35 fueron del sexo femenino, edad promedio de 69.4 años (57-81), índice de masa corporal promedio de 39.43 kg/m2 (35-55), todos con artrosis tricompartimental grado 3 y 4. KSS(R y F) y WOMAC, con un 95% de intervalo de confianza, mostraron mejoría con significación estadística a la evaluación de los resultados prequirúrgicos y al final del seguimiento. Existen escasos estudios que midan la supervivencia de los implantes a largo plazo. La mayoría de autores definen la supervivencia como ausencia de necesidad de revisión de los implantes protésicos, siendo el punto final de la supervivencia la extracción o el recambio de los componentes protésicos. Actualmente el metal trabecular se utiliza en cirugía ortopédica y cada vez se están aumentando sus aplicaciones clínicas con buenos resultados.


REFERENCIAS (EN ESTE ARTÍCULO)

  1. Stickles B, Philips L, Brox WT, Owens B, Lanzer WL: Defi ning the Relationship Between Obesity and Total Joint Arthroplasty. Obes Res 2001; 9: 219-23.

  2. Vaishnav Rajgopal, Bourne R, Chesworth B, MacDonald SJ, McCalden RW, Rorabeck CH: The Impact of Morbid Obesity on Patient Outcomes After Total Knee Arthroplasty. Journal Arthroplasty 2008; 23: 795-800.

  3. Foran JRH, Mont M, Etienne G, Jones LC, Hungerford S: The Outcome of Total Knee Arthroplasty in Obese Patients. J Bone Joint Surg 2004; 86A: 1609-15.

  4. Foran JRH, Mont MA, Rajadhyaksha AD, Jones LC, Etienne G, Hungerford S: Total Knee Arthroplasty in Obese Group. J Arthroplasty 2004; 19: 817-24.

  5. Unger AS, Duggan JP: Midterm results of a porous tantalum monoblock tibia components clinical and radiographic results of 108 knees J Arthroplasty 2011; 26(6): 855-60.

  6. Bobyn D, et al: Clinical Validation of a Structural Porous Tantalum Biomaterial for Adult Reconstruction. The Journal of Bone and Joint Surgery 2004; 86: 123-9.

  7. Minoda Y, et al: Comparison of Bone Mineral Density Between porous Tantalum and Cementd tibial Total knee Arthroplasty Components. The Journal of Bone and Joint Surgery 2010; 92: 700-6.

  8. Powell A, Teichtahl AJ, Wluka AE, Cicuttini FM: Obesity: a preventable risk factor for large joint osteoarthritis which may act through biomechanical factors. Br J Sports Med 2005; 39: 4-5.

  9. Nevitt MC: Obesity outcomes in disease management: Clinical outcomes for osteoarthritis. Obes Res 2002; 10: 33-7.

  10. Felson DT, Anderson JJ, Maunmark A, Walker AM, Meenan RF: Obesity and knee osteoarthritis. The Framingham study. Ann Intern Med 1988; 109: 18-24.

  11. Spector TD, Hart DJ, Doyle DV: Incidence and progression of osteoarthritis in women with unilateral knee disease in the general population: the effect of obesity. Ann Rheum Disease 1994; 53: 565-8.

  12. Abbate LM, Stevens J, Schwartz TA, Renner JB, Helmick CG, Jordan JM: Anthropometric Measures, Body composition, Body fat distribution, and knee osteoarthritis in women. Obesity 2006; 4: 1274-81.

  13. Lachiewics PF: Cement versus cementless total knee replacement: is there a place for cementless fi xation in 2001? Curr Opin Orthop 2001; 12: 33.

  14. Dodd CA, Hungerford DS, Krackow KA: Total knee aerthroplasty fi xation. Comparison of the early results of paried cemented versus uncemented porous coated anatomic knee prostheses. Clin Orthop Relat Res 1990; 260: 66-70.

  15. Dumbar MJ, et al: Fixation of a trabecular metal knee Arthroplasty Component. A prospective Randomized Study. J Bone Joint Surg Am 2009; 91: 1578-86.

  16. Henricson A, Linder L, Nilsson KG: Trabecular metal tibial component in patients younger than 60 years. A prospective RSA study. J Bone Joint Surg [Br] 2008; 90-B: 1585-93.

  17. Winiarsky R, Barth P, Lotke P: Total knee arthroplasty in morbidly obese patients. J Bone Joint Surg Am 1998; 80(12): 1770-4.

  18. Cataldo MA, et al: Prosthetic Joint Infection: Recent Developments in Diagnosis y management. Journal of Infection 2010; 61: 443-8.

  19. Namba R, et al: Obesity and Perioperative Morbidity in Total Hip and Total Knee Arthroplasty Patients. The Journal of Arthroplasty 2005; 20(7 Suppl 3): 46-50.

  20. Malinzak RA, et al: Morbidly obese, diabetic, younger, and unilateral joint arthroplasty patients have elevated total joint arthroplasty infection rates. J Arthroplasty 2009; 24(6 Suppl): 84-8.

  21. Dowsey MM, Choong PF: Obese diabetic patients are at substantial risk for deep infection after primary TKA. Clin Orthop Relat Res 2009; 467(6): 1577-81.

  22. Spicer DD, et al: Body Mass Index as a Predictor of Outcome in total Knee Replacement. Int Orthop 2001; 25: 246.

  23. Núñez M, Lozano L, Núñez E, Sastre S, Luis Del Val J, Suso S: Good Quality of Life in Severely Obeses Total knee Replacement Patients A Case-Control Study. Obes Surg 2011; 21(8): 1203-8.

  24. Nuñez M, Lozano L, Nuñez E, Segur JM, Sastre S: Factors Infl uencing Health-related Quality of Life after TKA in Patients who are Obese. Clin Orthop Relat Res 2011; 469(4): 1148-53.

  25. Vazquez-Vela J, Worland RL, Keenan J, Norambuena N: Patient demographics as a predictor of the ten-year survival rate in primary total knee replacement. J Bone Joint Surg Br 2003; 85(1): 52-6.

  26. Nilsson KG, Kärrholm J, Ekelund L, Magnusson P: Evaluation of micromotion in cemented vs uncemented knee arthroplasty in osteoarthritis and rheumatoid arthritis: randomized study using roentgen stereophotogrammetric analysis. J Arthroplasty 1991; 6: 265-78.

  27. Nilsson KG, Kärrholm J: Increased varus-valgus tilting of screw fi xated knee prostheses: stereoradiographic study of uncemented versus cemented tibial components. J Arthroplasty 1993; 8: 529-40.

  28. Önsten I, Nordqvist A, Carlsson ÅS, Besjakov J, Shott S: Hydroxyapatite augmentation of the porous coating improves fi xation of tibial components: a randomized RSA study in 116 patients. J Bone Joint Surg [Br] 1998; 80-B: 417-25.

  29. Nilsson KG, Kärrholm J, Carlsson L, Dalén T: Hydroxyapatite coating versus cemented fi xation of the tibial component in total knee arthroplasty: prospective randomized comparison of hydroxyapatite-coated and cemented tibial components with 5-year follow-up using radiostereometry. J Arthroplasty 1999; 14: 9-20.

  30. Carlson Å, Bjorkman A, Besjakov J, Önsten I: Cemented tibial component fi xation performs better than cementless fi xation: a randomized study comparing porous-coated, hydroxyapatite-coated and cemented tibial components over 5 years. Acta Orthop Scand 2005; 76: 362-9.

  31. Nilsson KG, Henricson A, Norgren B, Dalén T: Uncemented HA-coated implant is the optimum fi xation for TKA in the young patient. Clin Orthop 2006; 448: 129-38.




2020     |     www.medigraphic.com