OBJECTIVES:Total hip arthroplasty (THA) is a highly effective procedure, with demand projected to increase significantly due to population ageing. Fast-track protocols aim to optimize perioperative management, enhance recovery, and reduce length of stay (LOS). However, LOS variability remains a concern. This study aimed to evaluate the influence of perioperative factors on LOS in patients undergoing primary THA at our institution. METHODS:This retrospective cohort study at a single tertiary-care center included a stratified random sample of 300 primary THAs performed between January 2018 and December 2022 (100 per surgical approach: direct lateral [DL], posterolateral [PL], direct anterior [DAA]). Collected variables were age, sex, BMI, ASA class, laterality, surgical approach, use of tranexamic acid, preoperative laboratory values (hemoglobin, hematocrit, albumin, glucose), chronic anticoagulation, and surgical timing. The primary outcome was length of stay (LOS); prolonged LOS was defined as >1 postoperative night. Continuous variables were compared using Student's t-test or the Mann-Whitney U test, and categorical variables using the Chi-square test. Statistical significance was set at p ≤ 0.05. The statistical analysis was primarily descriptive and exploratory, focusing on identifying associations between perioperative variables and prolonged length of stay. RESULTS:Among the 300 patients, 142 (47.3%) were discharged after an overnight stay, whereas 158 (52.7%) experienced prolonged LOS. Female sex (p = 0.003), lower preoperative hemoglobin and hematocrit levels (p < 0.001), and chronic anticoagulant therapy (p = 0.01) were significantly associated with prolonged LOS. Conversely, the DAA was associated with shorter LOS (p < 0.001). CONCLUSION:Prolonged LOS was associated with female sex, anemia, and chronic anticoagulant therapy. Likewise, the DAA was associated with a shorter LOS, although these findings should be interpreted with caution due to the retrospective and exploratory nature of the study. LEVEL OF EVIDENCE:III.

Accurate acetabular cup positioning is crucial in primary total hip arthroplasty (THA), as malposition is associated with instability and early failure. We hypothesized that acetabular cup orientation may differ according to the surgical approach used. The aim of this study was to assess whether acetabular anteversion and inclination vary according to surgical approach and whether these differences affect the proportion of acetabular cups positioned outside reference orientation zones. A retrospective single-centre comparative study was conducted including 300 primary THAs performed between 2018 and 2022. A stratified random sample of 100 hips per approach was selected: posterolateral (PLA), direct lateral (DLA), and direct anterior (DAA). Cup inclination and anteversion were measured on standardized postoperative radiographs using calibrated digital software. Positioning was analyzed according to the safe zones described by Lewinnek and Reina, as well as the zone corresponding to the lowest observed dislocation ratio reported by Esposito et al. Continuous and categorical variables were compared using appropriate statistical tests (p < 0.05). Mean inclination and anteversion for the overall cohort were 41.5° and 17.6°, respectively. Significant differences were observed between approaches for both inclination (p < 0.001) and anteversion (p = 0.011), with the DLA demonstrating lower mean anteversion compared with the PLA and DAA. No significant differences were observed in the proportion of cups positioned within the Lewinnek safe zone (p = 0.276). However, significant differences were observed in the proportion of cups within the Reina target zone (p = 0.0015) and within the zone centred on 48° inclination and 24° anteversion (± 10°) derived from Esposito et al. (p = 0.0004). Acetabular cup positioning appears to vary according to surgical approach in primary THA, particularly regarding anteversion, with the PLA demonstrating higher mean anteversion and the DLA lower values. However, these differences did not translate into clinically relevant differences in positioning within established reference orientation zones according to widely used criteria.

Introduction: Periprosthetic joint infection (PJI) after hip revision surgery shows variable failure rates, with the impact of osteomyelitis in the surrounding bone on outcomes remaining unclear. This study aims to examine bone osteomyelitis prevalence and its impact on hip PJI revision outcomes. Material and methods: This retrospective study reviewed 75 cases of chronic hip PJI patients undergoing hip revisions performed at a single center between January 2019 and June 2023. Only cases with peri-implant bone samples submitted for histology evaluation were included. Bone samples were assessed for osteomyelitis using histological criteria. Risk factors, including demographic data, preoperative infections, and previous revisions, were analyzed. Statistical significance was determined using Chi-square and Kaplan-Meier survival analysis ( p ≤ 0.05 ). Results: A total of 52 cases of chronic hip PJI were included for final analysis. Up to 30.8 % of the cases ( n = 16 ) presented histological signs of osteomyelitis. The success rate among those 36 cases where no signs of osteomyelitis were observed was 88.9 %, whereas, in the 16 cases where it was present, the rate dropped to 37.5 %. Histological signs of osteomyelitis were significantly associated with a prior history of multiple surgeries and unsuccessful antibiotic treatments ( p = 0.01 ), the presence of a sinus tract ( p = 0.01 ), and the need for additional debridement with spacer exchange after the first stage of a two-stage revision ( p = 0.001 ). Conclusion: Patients with signs of osteomyelitis demonstrated a higher failure rate. Histological evaluation of periprosthetic bone should ideally be performed during the first stage of revision surgery to guide second-stage management and to improve outcomes.

The strategy of debridement, antibiotics, and implant retention (DAIR) represents one of the main therapeutic modalities for acute periprosthetic joint infection (PJI). However, reported outcomes remain highly variable, with success rates ranging from 16 to 92

Anterior cruciate ligament (ACL) ruptures are prevalent, particularly among young athletes. Although ligament reconstruction is the gold standard treatment, the rehabilitation process is extensive and has high reinjury rates. Recovery is often hindered by muscle inhibition and psychological factors like kinesiophobia and associated fear of reinjury. Emerging evidence suggests that motor imagery and action observation could enhance rehabilitation outcomes. Immersive virtual reality (VR) offers a novel way to integrate these techniques, potentially accelerating recovery. In this parallel randomized controlled trial, patients undergoing ACL reconstruction were randomly assigned to receive either conventional rehabilitation alone or conventional rehabilitation plus VR training. Our VR content incorporated several novel elements, including embodiment in a virtual body, first-person perspective, and the performance of virtual exercises guided by a virtual physiotherapist. Another innovative feature was that patients conducted the daily VR training independently at home using a standalone head-mounted display. The VR group performed a 20-min daily VR rehabilitation program for 4 weeks post-surgery, visualizing, planning, and executing movements using an embodied virtual avatar. Self-reported disability (International Knee Documentation Committee score, IKDC), quadriceps strength limb symmetry, active knee extension range of motion (ROM) limb symmetry, and kinesiophobia (Tampa Scale of Kinesiophobia-short form, TSK-11) were measured at baseline, 4, 12, and 36 weeks. Forty-seven participants were randomized, with 44 completing treatment. IKDC scores were not statistically significantly different between groups, despite moderate effect sizes at 4 and 36 weeks (Cohen’s d = 0.559, and d = 0.722, respectively). The VR intervention group showed significantly lower kinesiophobia at 4 weeks post-surgery compared to controls (27.00 ± 6.58 vs. 33.35 ± 5.07, Cohen’s d = − 0.971, p = 0.045). Both groups demonstrated significant improvements in all outcomes over time (p < 0.001). No significant differences were found for range of motion or quadriceps strength limb symmetry. No adverse events were reported related to the intervention. Reducing kinesiophobia is crucial for timely and effective rehabilitation and return to sport, and for reducing reinjury risk. To our knowledge, this is the first clinical study to investigate the independent use of therapeutic VR at home during post-orthopedic surgery rehabilitation. Future research should explore different VR interventions, including more active exercises and personalized programs, to enhance adherence and optimize recovery. The study was pre-registered with the National Library of Medicine (NCT05080894; first registered 09/20/2021).

Introducción: La artroplastia total de cadera (ATC) es un procedimiento altamente eficaz, cuya demanda se prevé que aumente de forma significativa debido al envejecimiento poblacional. Los protocolos de recuperación optimizada tienen como objetivo mejorar el manejo perioperatorio, promover la rápida recuperación y reducir la estancia hospitalaria (EH). No obstante, persiste una variabilidad significativa en la EH, cuyos factores determinantes no están completamente definidos. El objetivo de este estudio fue evaluar la influencia de los factores perioperatorios sobre la EH en pacientes sometidos a ATC primaria en nuestro centro.Métodos: Estudio de cohorte retrospectivo realizado en un único centro terciario, que incluyó una muestra aleatoria estratificada de 300 ATC primarias efectuadas entre enero de 2018 y diciembre de 2022, distribuidas según el abordaje quirúrgico (100 por grupo: lateral directo [LD], posterolateral [PL] y anterior directo [AD]). Se recogieron variables demográficas y clínicas, incluyendo edad, sexo, índice de masa corporal (IMC), clasificación ASA, lateralidad, uso de ácido tranexámico, parámetros analíticos preoperatorios (hemoglobina, hematocrito, albúmina y glucosa), tratamiento anticoagulante crónico y momento de la cirugía. La variable principal fue la EH, definiéndose como prolongada cuando superaba una noche postoperatoria. Las variables continuas se analizaron mediante t de Student o la prueba de U de Mann-Whitney, y las categóricas mediante el test de Chi-cuadrado. Se consideró significación estadística un valor de p ≤ 0,05. El análisis estadístico fue principalmente descriptivo y exploratorio, orientado a identificar asociaciones entre variables perioperatorias y estancia hospitalaria prolongada.Resultados: De los 300 pacientes, 142 (47,3%) fueron dados de alta tras una noche de ingreso, mientras que 158 (52,7%) presentaron una EH prolongada. El sexo femenino (p = 0,003), niveles preoperatorios más bajos de hemoglobina y hematocrito (p < 0,001), y el tratamiento anticoagulante crónico (p = 0,01) se asociaron de forma significativa con una EH prolongada. Por el contrario, el abordaje AD se asoció con una menor EH (p < 0,001).Conclusión: El sexo femenino, la anemia preoperatoria y el tratamiento anticoagulante crónico se asociaron con una mayor probabilidad de EH prolongada. Asimismo, el abordaje AD se asoció con una menor estancia hospitalaria, si bien estos hallazgos deben interpretarse con cautela debido al carácter retrospectivo y exploratorio del estudio.Nivel de evidencia: III

Purpose Longus colli acute calcific tendinitis (LCCT) is a painful disease characterized by a triad of neck pain, neck stiffness and odynophagia. It is a relatively rare cause of neck pain, often unknown or underdiagnosed, but it is important to be aware of its existence as it can mimic other potentially more dangerous illnesses. Methods We present a short series of five cases in which we gathered demographic and clinical data including imaging studies and compared our findings to previous reports by other authors. The diagnosis of LCCT was made by the combination of a compatible clinical presentation and blood workup plus the identification of a calcific deposit in the proximal oblique fibers of the longus colli muscle and retropharyngeal edema via computed tomography. Results Five patients were analyzed. Mean age was 44 years, three female and two male. All patients initially presented neck pain and painful mobilization, while only 60% presented with odynophagia. There were no patients with radiculopathy nor fever. The mean values for ESR, CRP and White Blood Cell (WBC) were 23.2 mm/h, 2.97 mg/dl and 10.21 * 10^9/L respectively. On CT and/or MRI exploration all the patients presented a visible calcific deposit on the anteroinferior border of the anterior C1 arch and visible signs of retropharyngeal oedema. Conclusions LCCT is a self-limited pathology that is caused by a foreign-body type reaction in the retropharyngeal space secondary to the degradation and resorption of calcium hydroxyapatite deposits usually found at the anteroinferior border of the anterior C1 arch. It is necessary to create awareness of this pathology amongst physicians because it can mimic more serious illness like retropharyngeal abscess, meningitis and spondylodiscitis and this may lead to unnecessary expenditures and antibiotic usage.

Purpose Debridement, Antibiotic Treatment, and Implant Retention (DAIR) is considered the first-line treatment for early acute Prosthetic Joint Infection (PJI). This study aims to evaluate the five year success rates of early acute PJI managed with DAIR taking into consideration the time from the index surgery. Materials and methods A retrospective analysis of medical charts for 291 consecutive patients with acute PJI occurring within the first three months after primary or revision arthroplasty was conducted. Patients were stratified into two groups based on DAIR timing: Group (A) patients who underwent DAIR within the first four weeks post-arthroplasty; Group (B) patients who underwent DAIR between five and 12 weeks post- arthroplasty. Success rate was defined as implant in place, without signs of infection and not under suppressive antibiotic treatment. Results The overall five year success rate for the entire cohort at five years was 62.2%. The mortality rate during the study period was 8.2%. The five year success rate was 64.4% (141 of 219) for Group A and 55.6% (40 of 72) for Group B ( p = 0.21). Including deceased patients without signs of infection and retained implants as successful cases, the five year success rates increased to 69.9% for Group A (153 out of 219) and 69.4% for Group B (50 out of 72). The implant survival rate at five years was 73% for Group A and 71% for Group B. Conclusion Our findings indicate that there are no significant differences between patients who undergo a DAIR procedure within four weeks from those performed between week five and 12. Importantly, the overall success rate decreased from 75.6 to 62.2% in the last three years of follow-up.

Debridement, antibiotics, and implant retention (DAIR) is a commonly employed strategy for managing acute postoperative prosthetic joint infections (PJI) while preserving the prosthesis. However, the clinical value of an unplanned second DAIR - performed due to inadequate infection control - remains controversial and is often considered a potential treatment failure. This study aimed to compare the two year clinical outcomes of patients undergoing a single DAIR versus those requiring an unplanned second DAIR for acute postoperative PJI of the hip or knee. We retrospectively reviewed electronic medical records of patients treated with DAIR for acute postoperative PJI between January 1999 and December 2020. Patients were categorized into two groups: those managed with a single DAIR (DAIR-1 group) and those requiring an unplanned second DAIR within 12 weeks (DAIR-2 group). Treatment failure was defined as any of the following: further debridement beyond 12 weeks, revision surgery with prosthesis removal, initiation of long-term suppressive antibiotic therapy, or PJI-related mortality. Patients lost to follow-up before two years were excluded. A total of 318 patients were included, with 292 in the DAIR-1 group and 26 in the DAIR-2 group. Mean follow-up was 89.4 months. At two years, revision surgery was required in 19.2

PURPOSE:Rheumatoid arthritis (RA) is a systemic disorder that affects the cervical spine (CS). Synovial inflammation can disrupt spinal stability, leading to conditions such as atlantoaxial and/or subaxial subluxation, vertical settling, and combined instability. Although symptoms may appear in a minority of patients, they are commonly observed in those with advanced diseases. Myelopathy can develop in about 2.5% of patients with long-standing RA. Surgical treatment is indicated for the presence of myelopathy, progressive neurological deficit and/or chronic untreatable pain. The objective of this study is to evaluate the long-term outcomes following surgical treatment of CS involvement in patients with RA and to review the existing literature. MATERIALS AND METHODS:The present study is a retrospective and descriptive review of 17 patients with cervical involvement caused by RA who underwent surgery between 2000 and 2022. Collected data comprised the type of cervical lesion, the surgical approach and the pre-surgical, post-surgical and current neurological status. RESULTS:Most patients were women (70,58%) and the mean age at surgery was 51,17 years. Myelopathy was present in 12 patients at the time of surgery. Ten patients improved the post-surgical Ranawat score, while seven remained stable. One patient died from post-surgical complications (5,88% of fatal events), and four patients passed away during the follow-up period. DISCUSSION AND CONCLUSIONS:Surgical treatment of the cervical manifestation of RA provides benefits, improving quality of life and/or detaining the progression of the neurological damage. Even though the results are encouraging, surgery is not risk-free.

Virtual embodiment and virtual exercising are a promising adjunct to treatment for orthopedic patients, who face challenges from physical and psychological barriers during rehabilitation. This randomized controlled trial evaluated the impact of VR on post-surgical knee recovery. Patients (n=47) were assigned to either conventional rehabilitation or conventional plus daily 20-minute VR training, which utilized embodied avatars for movement visualization. The VR group demonstrated a substantial reduction in kinesiophobia scores at 4 weeks post-surgery (p=0.043). No significant differences were observed in quadriceps strength, knee range of motion, and disability scores. These findings support VR's potential for addressing psychological barriers in rehabilitation.

Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare and aggressive hematodermic neoplasm usually involving the skin. In this retrospective case series, 10 cases of BPDCN were identified, 90% of which had skin involvement and exhibited predominantly violaceous nodules and/or bruise-like plaques. Skin lesions showed diffuse or nodular dermal-based infiltrates of intermediate sized blasts with a grenz zone. Tumor immunophenotyping was CD4(+), CD56(+), CD123(+) and CD303(+). The most frequently mutated genes according to targeted next-generation sequencing were TET2 (3/7) and NRAS (2/7). Multiagent chemotherapy (CT) was administered as first-line therapy, and a total of 5 patients underwent allogenic hematopoietic stem cell transplantation (allo-HSCT). Better outcomes were observed in younger patients and those treated with acute lymphoblastic leukemia (ALL)-like CT followed by allo-HSCT. This study shows the clinical range of cutaneous lesions of BPDCN. Despite the absence of a gold standard therapy, patients treated with myeloablative intensive regimens and allo-HSCT seems to have a more favorable prognosis.

Antecedentes: El desarrollo del cáncer de piel está estrechamente relacionado con la alta exposición a la radiación UV. Los socorristas tienen un riesgo aumentado de exposición al sol.Objetivos: El objetivo principal de este estudio fue medir la exposición de los socorristas de las playas de Barcelona a la radiación UV.Métodos: Se tomaron mediciones en la silla de trabajo cada 30 minutos en un día típico de trabajo desde las 10:45 am hasta las 19:15 pm. Estas mediciones se realizaron en cuatro días diferentes. Estos datos se utilizaron para calcular las dosis eritematosas recibidas durante las horas de trabajo, así como las potencialmente recibidas a lo largo de la temporada estival. También se estimó la producción de vitamina D durante los cuatro días en que se midió la radiación recibida, y se calculó la cantidad generada durante toda la temporada estival.Resultados: La exposición a la radiación UV de los socorristas de Barcelona supera con creces los 68 límites de seguridad. En algunos lugares, la exposición a la radiación UVB es más de 16 veces superior a la dosis eritematosa mínima para pacientes con fototipo II.Limitaciones: Este estudio evaluó la radiación recibida durante sólo cuatro días. Sin embargo, es una cifra muy superior a la de la mayoría de los trabajos publicados.Conclusión: Aunque se conocen los riesgos para la salud de una exposición excesiva a la radiación UV, los socorristas de las playas de Barcelona no están suficientemente protegidos.

Background: acute radiation dermatitis (ARD) is the most widely reported radiotherapy-induced adverse event. Currently, there is no objective or reliable method to measure ARD.Objective: our main objective was to identify and quantify the effects of radiotherapy with a computational model using optical coherence tomography (OCT) skin scanning. Secondary objectives included determining the ARD impact of different radiotherapeutic schemes and adjuvant topical therapies.Methods: we conducted a prospective, single-center case series study in a tertiary referral center of patients with breast cancer who were eligible for whole breast radiotherapy (WBRT).Results: a total of 39 women were included and distributed according to the radiotherapeutic schemes (15, 20, and 25 fractions). A computational model was designed to quantitatively analyze OCT findings. After radiotherapy, OCT scanning was more sensitive revealing vascularization changes in 84.6% of the patients (vs 69.2% of the patients with ARD by clinical examination). OCT quantified an increased vascularization at the end of WBRT (P < .05) and a decrease after 3 months (P = .032). Erythematous skin changes by OCT were more pronounced in the 25-fraction regime.Conclusion: an OCT computational model allowed for the identification and quantification of vascularization changes on irradiated skin, even in the absence of clinical ARD. This may allow the design of standardized protocols for ARD beyond the skin color of the patients involved.

Background: The development of skin cancer is closely related to high exposure to UV radiation. Lifeguards are at an increased risk of excessive sun exposure. Objectives: The main objective of this study was to measure the exposure of Barcelona's beach lifeguards to UV radiation. Methods: Measurements in the work chair were taken every 30 min on a typical working day from 10:45 am to 19:15 pm. These measurements were carried out on four different days. These data were used to calculate the erythematous doses received during working hours, as well as those potentially received throughout the summer season. Vitamin D production was also estimated for the four days that the radiation received was measured, and the amount generated was calculated for the entire summer season. Results: Exposure to UV radiation among Barcelona lifeguards far exceeds safety limits. In some locations, the exposure to UVB radiation is more than 16 times the minimum erythematous dose for phototype II skin. Limitations: This study assessed the radiation received during only four days. However, is a much higher number than most of the published papers. Conclusion: Although the health risks of excessive exposure to UV radiation are known, Barcelona's beach lifeguards are insufficiently protected. (c) 2023 AEDV. Published by Elsevier Espan a, S.L.U. This is an open access article under the CC BY -NC -ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Femoral fractures are common in low and middle-income countries (LMIC), predominantly caused by high-energy trauma. The surgical implant generation network (SIGN®) program offers two different intramedullary nails in LMIC which are designed to be used without image intensifier free of charge for the patients: the SIGN standard nail (SSN®) and the SIGN Fin nail (SFN®). This study aimed to compare the results of the SSN® and the SFN® for the treatment of middle and distal shaft femoral fractures through a retrograde approach. This was a retrospective, descriptive, and non-experimental study including all consecutive patients who underwent surgical management of middle or distal shaft femoral fracture between January 2017 and May 2022 in an NGO hospital located in Freetown, Sierra Leone. The duration of surgery, type of reduction, complications like screw loosening, implant migration, anterior knee pain and non-union rate at six months of follow up were evaluated. A total of 122 patients were included in the study. Group A: 60 patients were managed with SSN® and Group B: 62 patients with SFN®. The mean operative time was 104 min with SSN® and 78 with SFN® (p < 0.001). Open reduction of the fracture was necessary in ten (16.7

Current treatment of cervical spine spondylodiscitis generally involves a radical surgical debridement and stable reconstruction together with antibiotic therapy until complete healing. But this classical approach could be difficult for patients who have been treated previously for an esophageal carcinoma and received radiotherapy.We present a case of a 75-year-old male who underwent an esophageal dilation procedure and developed afterward a spondylodiscitis with epidural abscess due to a neglected esophageal perforation. Blood cultures were positive for Peptostreptococcus. Cervical spondylodiscitis and epidural abscess are extremely rare complications of esophageal dilations. Successful treatment without debridement was achieved by performing a posterior fixation without decompression associated with antibiotic therapy for 8 weeks. The present case highlights that spondylodiscitis and epidural abscess may be treated in selected cases where the anterior neck is unapproachable and with a recognized pathogen by a posterior approach fixation without debridement, in association to specific antibiotic therapy.