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INTRODUCTION: anterior cruciate ligament injuries (ACL) continue increasing in frecuency in the general population and sportmen who practice soccer and american football where we can locate 53% of the total of cases, the annual incidence is 70 per 100,000 persons. The incidence of this injuries has being increasing in women probably of the increase of the participation in such sports. OBJECTIVE: to document the causes of anterior cruciate ligament (ACL) plasty failure, as well as the diagnosis, surgical technique, and postoperative care of a revision ACL plasty surgery. MATERIAL AND METHODS: a search for relevant information, original research articles, clinical trials, and reviews in indexed journals was performed. RESULTS: anterior cruciate ligament injuries continue to increase among the general population and athletes who play soccer and American soccer mainly, in this population group we found 53% of the total cases. The gold standard for treatment is arthroscopic reconstruction of the ligament. ACL reconstruction surgery has good results, with an estimated 75-90% success rate. Long-term failures of anterior cruciate ligament repair represent 5-25%. Among the factors associated with this failure are technical errors, traumatic antecedents, biological factors, among others. CONCLUSIONS: in ACL revision surgery good results can be achieved with respect to graft stability, return to play and functional stability of the knee, but the results are generally inferior to those of primary ACL reconstruction.

INTRODUCCIÓN: las lesiones del ligamento cruzado anterior (LCA) continúan en aumento entre la población general y deportistas que practican fútbol soccer y americano en donde se encuentra 53% del total de los casos; la incidencia anual es de 70 por cada 100,000 personas. La incidencia de estas lesiones ha ido en aumento en mujeres, probablemente por el incremento de la participación deportiva. OBJETIVO: documentar las causas de fracaso de plastía de ligamento cruzado anterior (LCA), así como el diagnóstico, técnica quirúrgica, cuidado postquirúrgico de una cirugía de revisión de plastía LCA. MATERIAL Y MÉTODOS: se ha realizado una búsqueda de información relevante, artículos de investigación originales, ensayos clínicos y revisiones en revistas indexadas. RESULTADOS: las lesiones del ligamento cruzado anterior continúan en aumento entre la población general y deportistas que practican futbol soccer y americano principalmente; en este grupo de la población encontramos 53% del total de los casos. El estándar de oro para su tratamiento es la reconstrucción del ligamento por vía artroscópica. La cirugía de reconstrucción de LCA presentan buenos resultados, se estima 75-90% de éxito. Los fracasos a largo plazo de la reparación de ligamento cruzado anterior representan de 5-25%. Dentro de los factores asociados a este fracaso encontramos errores técnicos, antecedentes traumáticos, factores biológicos, entre otros. CONCLUSIONES: en la cirugía de revisión de LCA se pueden lograr buenos resultados con respecto a la estabilidad del injerto, regreso al juego y estabilidad funcional de la rodilla, pero los resultados son generalmente inferiores a los de la reconstrucción primaria del LCA.

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INTRODUCTION: revision total knee arthroplasty (TKA) is a challenging procedure that requires proper alignment, restoration of bone loss, and prevention of instability. Modern revision systems offer progressive implant constriction with multiple options for offset, augmentation, and fixation stems. OBJECTIVE: to evaluate the clinical outcomes of a modular implant with hybrid fixation in revision TKA with a minimum follow-up of two years. MATERIAL AND METHODS: we retrospectively included all revision TKA surgeries performed between September 2018 and September 2019, using the same implant. Patient demographics, comorbidities, and data on bone defects were recorded. Clinical outcomes were assessed using subjective roles and Maudsley scores and the Knee Society Score (KSS). Complications during follow-up were also documented. RESULTS: a total of 23 patients were analyzed, comprising 65% females and 35% males, with a median age of 71.1 years. Bone defects following implant removal were classified as F2.T2 in 39.13% of cases, F1.T2 in 8.69%, and F1.T1 in the remaining 52.17%. There were significant improvements in the KSS score (preoperative: 53 points, postoperative: 79 points; p < 0.001). Three (13%) complications were reported, two of which were directly related to the surgery, and two patients required subsequent revision surgery. The 2-year survival rate was 91.3%. CONCLUSION: the use of a modular implant with hybrid fixation in revision TKA demonstrated a high 2-year survival rate, significant improvements in clinical scores, and a low incidence of short-term complications. These findings support the efficacy and safety of this approach, providing favorable clinical outcomes and high patient satisfaction.

INTRODUCCIÓN: la artroplastía total de rodilla (ATR) de revisión es un procedimiento desafiante que requiere alineación adecuada, restauración ósea y estabilidad. Los sistemas modernos de revisión ofrecen opciones de implantes modulares con fijación híbrida. OBJETIVO: evaluar los resultados clínicos de un implante modular de fijación híbrida con seguimiento mínimo de dos años. MATERIAL Y MÉTODOS: se incluyeron retrospectivamente cirugías de revisión de ATR realizadas entre Septiembre de 2018 y Septiembre de 2019 con el mismo implante. Se registraron datos demográficos, comorbilidades y se evaluaron los resultados clínicos utilizando puntuaciones subjetivas y la Knee Society Score (KSS). RESULTADOS: se analizaron 23 pacientes (65% mujeres, 35% hombres; edad mediana: 71.1 años). Los defectos óseos posteriores a la extracción del implante se clasificaron como F2.T2 en 39.13% de los casos, F1.T2 en 8.69%, y F1.T1 en 52.17%. Se observaron mejoras significativas en la puntuación de la KSS (preoperatoria: 53 puntos, postoperatoria: 79 puntos; p < 0.001). Se registraron tres (13%) complicaciones totales, dos relacionadas directamente con la cirugía, y dos casos requirieron una nueva cirugía de revisión. La tasa de supervivencia a los dos años fue de 91.3%. CONCLUSIÓN: el uso del implante modular con fijación híbrida en la revisión de ATR mostró una alta tasa de supervivencia a dos años, mejoras significativas en las puntuaciones clínicas y baja incidencia de complicaciones a corto plazo. Estos resultados respaldan la eficacia y seguridad de este enfoque, proporcionando resultados clínicos favorables y alta satisfacción del paciente.

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Stenotrophomonas maltophilia, a well-established opportunistic bacterium, primarily impacts healthcare settings. Infection of the musculoskeletal system with this bacterium is rare. We report on the first known case of hip periprosthetic joint infection (PJI) caused by S. maltophilia. The potential for development of a PJI caused by this pathogen should be considered by orthopaedic surgeons, particularly in patients with multiple severe comorbidities.

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Resumen: Introducción: la artroplastía total de rodilla (ATR) de revisión es un procedimiento desafiante que requiere alineación adecuada, restauración ósea y estabilidad. Los sistemas modernos de revisión ofrecen opciones de implantes modulares con fijación híbrida. Objetivo: evaluar los resultados clínicos de un implante modular de fijación híbrida con seguimiento mínimo de dos años. Material y métodos: se incluyeron retrospectivamente cirugías de revisión de ATR realizadas entre Septiembre de 2018 y Septiembre de 2019 con el mismo implante. Se registraron datos demográficos, comorbilidades y se evaluaron los resultados clínicos utilizando puntuaciones subjetivas y la Knee Society Score (KSS). Resultados: se analizaron 23 pacientes (65% mujeres, 35% hombres; edad mediana: 71.1 años). Los defectos óseos posteriores a la extracción del implante se clasificaron como F2.T2 en 39.13% de los casos, F1.T2 en 8.69%, y F1.T1 en 52.17%. Se observaron mejoras significativas en la puntuación de la KSS (preoperatoria: 53 puntos, postoperatoria: 79 puntos; p < 0.001). Se registraron tres (13%) complicaciones totales, dos relacionadas directamente con la cirugía, y dos casos requirieron una nueva cirugía de revisión. La tasa de supervivencia a los dos años fue de 91.3%. Conclusión: el uso del implante modular con fijación híbrida en la revisión de ATR mostró una alta tasa de supervivencia a dos años, mejoras significativas en las puntuaciones clínicas y baja incidencia de complicaciones a corto plazo. Estos resultados respaldan la eficacia y seguridad de este enfoque, proporcionando resultados clínicos favorables y alta satisfacción del paciente.

Abstract: Introduction: revision total knee arthroplasty (TKA) is a challenging procedure that requires proper alignment, restoration of bone loss, and prevention of instability. Modern revision systems offer progressive implant constriction with multiple options for offset, augmentation, and fixation stems. Objective: to evaluate the clinical outcomes of a modular implant with hybrid fixation in revision TKA with a minimum follow-up of two years. Material and methods: we retrospectively included all revision TKA surgeries performed between September 2018 and September 2019, using the same implant. Patient demographics, comorbidities, and data on bone defects were recorded. Clinical outcomes were assessed using subjective roles and Maudsley scores and the Knee Society Score (KSS). Complications during follow-up were also documented. Results: a total of 23 patients were analyzed, comprising 65% females and 35% males, with a median age of 71.1 years. Bone defects following implant removal were classified as F2.T2 in 39.13% of cases, F1.T2 in 8.69%, and F1.T1 in the remaining 52.17%. There were significant improvements in the KSS score (preoperative: 53 points, postoperative: 79 points; p < 0.001). Three (13%) complications were reported, two of which were directly related to the surgery, and two patients required subsequent revision surgery. The 2-year survival rate was 91.3%. Conclusion: the use of a modular implant with hybrid fixation in revision TKA demonstrated a high 2-year survival rate, significant improvements in clinical scores, and a low incidence of short-term complications. These findings support the efficacy and safety of this approach, providing favorable clinical outcomes and high patient satisfaction.

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We aimed to discuss the weight loss success of the revision of RYGB to sleeve gastrectomy (SG). Between January 2019 and June 2020, four patients' files were analyzed retrospectively. Post-RYGB mean minimal BMI was 27.4 ± 9.47 kg/m², before SG the mean BMI was 43.41 ± 4.16 kg/m2. Post-operative gastric fistula developed in two patients. The mean follow-up time after revision surgery was 17.25 ± 6.89 months, mean excess weight loss (EWL) was 74.77 ± 8.94%, and mean BMI was 32.65 ± 2.9 kg/m2. Despite high rate of major complications, revision of RYGB to SG is successful in weight loss and resolving certain complications of RYGB.

Nuestro objetivo era discutir el éxito en la pérdida de peso de la revisión de BGYR a gastrectomía en manga (SG). Entre enero de 2019 y junio de 2020, se analizaron retrospectivamente los archivos de cuatro pacientes. El IMC mínimo medio post BGYR fue 27.4 ± 9.47 kg/m², antes de SG el IMC medio fue 43.41 ± 4.16 kg/m2. En dos pacientes se desarrolló una fístula gástrica posoperatoria. El tiempo medio de seguimiento después de la cirugía de revisión fue de 17.25 ± 6.89 meses, la pérdida media de exceso de peso (PEP) fue de 74.77 ± 8.94% y el IMC medio fue de 32.65 ± 2.9 kg/m2. A pesar de la alta tasa de complicaciones mayores, la revisión de BGYR a SG tiene éxito en la pérdida de peso y la resolución de ciertas complicaciones de BGYR.

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INTRODUCTION: Gastro-gastric fistula is a rare complication after divided Roux-en-Y gastric by-pass. VIDEO CONTENT: 52-year-old male with a BMI over 49 who underwent divided Roux-en-Y gastric by-pass presented with weight regain 2 years later and a type 2 gastro-gastric fistula. Laparoscopic revision, excision of the fistula with re-do of gastrojejunal anastomosis and remnant gastrectomy, was performed CONCLUSION: Laparoscopic resolution is a technical challenge in this case due to the local inflammatory environment.

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INTRODUCTION: Closed reduction and fixation using a cephalomedullary nail represents the accepted management of unstable intertrochanteric fractures. Cut-through has been described as a complication associated with the treatment. Although a hip arthroplasty may be the most predictable revision method, a non-prosthetic option can lead to similar results. The objective is to describe a non-prosthetic revision procedure in cases of cut-through. METHOD: We performed a retrospective analysis of our Institutional Registry for Hip Fractures in elderly patients (RIAFC) from January 2010 to June 2018 searching for cut-through as a failure after unstable intertrochanteric fracture treatment. REVISION PROCEDURE: (A) Helical blade removal, introduction of structural bone graft (autologous or allograft) as a plug to obliterate the communication to the joint and a new blade insertion. (B) Same as in A but augmenting the blade/head purchase with poly(methyl methacrylate) (PMMA). Before the cement insertion, a radio-opaque solution was instilled to assure lack of joint leakage. RESULTS: We evaluated 1616 patients. Sixteen of them presented a cut-through complication (1%). Ten of them were females with an average age for all of 84 years. One patient denied an implant revision and opted for a total joint replacement. In four of the patients, the procedure A was done, 2 of them had a new failure, and an joint arthroplasty was performed. In the B group, only one patient needed a revision to a total hip. The other 10 patients healed uneventfully and did not need any further intervention. CONCLUSION: Cut-through revision after fixation of unstable intertrochanteric fractures treated with cephalomedullary nail by blocking of the joint communication and augmenting the head blade purchase with PMMA is a safe and minimal invasive procedure, generates low blood loss and rate of complications and allows bone healing preserving the native joint. LEVEL OF EVIDENCE IV: Nil.

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BACKGROUND: Revisional surgery is technically demanding and is usually associated with higher intraoperative and perioperative risks than primary procedures. The objective of this study is to compare outcomes of patients who had gastric bypass procedures performed as a rescue procedure for failed gastric banding, with those who had a primary gastric bypass. MATERIALS AND METHODS: The group of patients undergoing revisional gastric bypass for failed gastric band was matched in a 1:2 ratio with control patients who underwent a primary RYGB, based on gender, score, preoperative body mass index, and comorbidities. Data were retrospectively retrieved. RESULTS: Thirty one (33.3%) patients underwent band removal and gastric bypass (group A) and 62 (66.6%) only primary gastric bypass (group B). Nonsignificant differences were seen in operative time, operative bleeding, or length of stay. Complications were more frequent in group A. Postoperative weight at 12-month follow-up was greater in group A, however, not statistically significant. Changes in weight, both absolute, and percentage were not different between groups. This observation was also true for BMI, in which no significant differences were seen. Overall, mean follow-up was 16 ± 3.2 months. CONCLUSION: Gastric bypass can be performed as revisional bariatric surgery, with low complication rates and acceptable outcomes, though not with the same safety as a primary procedure. Gastric bypass is a satisfactory option for patients with a failed gastric band.

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INTRODUCTION: Total femoral replacement (TFR), it is an uncommon surgery in non-oncological patients. Our main objective is to review our total femur replacement surgeries and analyze functional and clinical outcomes. MATERIAL AND METHODS: We retrospectively review our series of seven non-oncological patients treated at our center with a TFR from 2011 to 2014. After excluding patients (Oncological patients or non-follow up) we revised four patients. Paprosky bone loos classification and different values were studied: number and time of surgeries, complications, revision surgeries, functional scales, and follow-up. RESULTS: Mean age of 78.5 years. According to Paprosky classification of femur bone loss: 1 IIIA, 2 were IIIB, 1 IV. On the other side acetabular loss: 2 I, 1 IIA, 1 IIB. Surgical time for TFR was 110 minutes on average. Three patients were need revision surgery due to instability. And every single patient suffered from chronic infection. Mean range of motion was 85 flexion, 0o extension. Comparing preoperative and postoperative Harris Hip Score for hip function was 54.9 points and Enneking score was an average of 14.25 points better in our patients with TFR. Visual analogue pain score was on average less than two points. Mean follow-up is almost seven and a half years. CONCLUSIONS: TFP has not a standardized surgical protocol yet. Infection is always present in our series and acetabular constrained components in TFR avoid instability complications. TFP should be implanted only in selected patients.

INTRODUCCIÓN: Las prótesis totales de fémur (PTF) son un procedimiento muy excepcional y más aún en pacientes no oncológicos. El objetivo es analizar una serie de casos de prótesis total de fémur, su seguimiento y resultados a largo plazo. MATERIAL Y MÉTODOS: Estudio retrospectivo en el que se incluyeron siete pacientes, intervenidos desde 2011 hasta 2014. Tras aplicar los criterios de exclusión (seguimiento y pacientes oncológicos), se analizaron cuatro pacientes. Se utilizó la clasificación de Paprosky para medir el defecto óseo y se valoraron diferentes parámetros: número de cirugías previas, duración de la cirugía, complicaciones, cirugías de revisión, escala de valoración funcional y seguimiento clínico radiológico. RESULTADOS: Edad media de 78.5 años al implante de la prótesis total de fémur (PTF). El defecto óseo en el fémur (1-IIIA, 2-IIIB y 1-IV) fue más importante que en el acetábulo (2-I, 1-IIA y 1-IIB). El tiempo medio de la cirugía fue de 110 minutos. El motivo de la cirugía de revisión más frecuente fue el recambio del componente acetabular en tres pacientes debido a inestabilidad. La complicación más frecuente fue la infección. Flexión media de cadera de 85 grados y extensión de 0. La diferencia entre la valoración funcional Harris Hip Score pre- y post- es de 54.9 puntos, en la escala de Enneking fue de 14.25 puntos de media y la escala de dolor (VAS) medio es inferior a 2. El seguimiento promedio es de aproximadamente siete años y medio. CONCLUSIONES: La PTF es una cirugía sin protocolo estandarizado al día de hoy. La infección en nuestra serie está siempre presente y el componente acetabular constreñido evitaría inestabilidades. Por lo que el implante de PTF debe ser a pacientes muy bien seleccionados.

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AIMS: There is a paucity of long-term studies analyzing risk factors for failure after single-stage revision for periprosthetic joint infection (PJI) following total hip arthroplasty (THA). We report the mid- to long-term septic and non-septic failure rate of single-stage revision for PJI after THA. METHODS: We retrospectively reviewed 88 cases which met the Musculoskeletal Infection Society (MSIS) criteria for PJI. Mean follow-up was seven years (1 to 14). Septic failure was diagnosed with a Delphi-based consensus definition. Any reoperation for mechanical causes in the absence of evidence of infection was considered as non-septic failure. A competing risk regression model was used to evaluate factors associated with septic and non-septic failures. A Kaplan-Meier estimate was used to analyze mortality. RESULTS: The cumulative incidence of septic failure was 8% (95% confidence interval (CI) 3.5 to 15) at one year, 13.8% (95% CI 7.6 to 22) at two years, and 19.7% (95% CI 12 to 28.6) at five and ten years of follow-up. A femoral bone defect worse than Paprosky IIIA (hazard ratio (HR) 13.58 (95% CI 4.86 to 37.93); p < 0.001) and obesity (BMI ≥ 30 kg/m2; HR 3.88 (95% CI 1.49 to 10.09); p = 0.005) were significantly associated with septic failure. Instability and periprosthetic fracture were the most common reasons for mechanical failure (5.7% and 4.5%, respectively). The cumulative incidence of aseptic failure was 2% (95% CI 0.4 to 7) at two years, 9% (95% CI 4 to 17) at five years, and 12% (95% CI 5 to 22) at ten years. A previous revision to treat PJI was significantly associated with non-septic failure (HR 9.93 (95% CI 1.77 to 55.46); p = 0.009). At the five-year timepoint, 93% of the patients were alive (95% CI 84% to 96%), which fell to 86% (95% CI 75% to 92%) at ten-year follow-up. CONCLUSION: Massive femoral bone loss was associated with greater chances of developing a further septic failure. All septic failures occurred within the first five years following the one-stage exchange. Surgeons should be aware of instability and periprosthetic fracture being potential causes of further aseptic revision surgery. Cite this article: Bone Joint J 2021;103-B(7):1247-1253.

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