Revista de la Asociación Argentina de Ortopedia y Traumatología

RAAOT-ACARO Issue

Gabriel Vindver — 2025-10-27

Dual mobility Cup in Patients Younger Than 70 Years: Preliminary Results of a Case series

María Florencia Molina — 2025-10-27

Objective: To evaluate the clinical and radiographic outcomes of patients younger than 70 years who underwent total hip arthro- plasty with a dual mobility acetabular cup system.

Materials and Methods: Retrospective descriptive study of 61 patients (mean age, 62 years) treated with cemented and uncemented dual mobility acetabular components between 2014 and 2019. Mean follow-up was 47 months (range, 36-86). Clinical evaluation included the Harris Hip Score and the Oxford Hip Score,
together with radiographic assessment of both hips.

Results: Indications for surgery were avascular necrosis of the hip (8 cases), femoral neck fracture (17 cases), and hip osteoarthritis (36 cases). During follow-up, no dislocations or component loosening were observed. One patient reported localized pain associated with trochanteric bursitis. The mean postoperative Harris Hip Score was 95 points, and the mean Oxford Hip Score was 45, which was a significant improvement.

Conclusions: The dual mobility cup is a valid option for patients younger than 70 years, regardless of the
underlying condition. Its use reduces the risk of prosthetic dislocation and provides good clinical outcomes, while also lowering hospitalization and reoperation costs.

One-Stage Revision for Periprosthetic Hip and Knee Infections: A Multicenter Experience

Walter Fabián Martínez — 2025-10-27

Introduction: Periprosthetic joint infection (PJI) is a devastating complication after hip or knee arthroplasty. Although two-stage revision is considered the treatment of choice for chronic infections, one-stage revision has emerged as an alternative that reduces morbidity.

Objective: To report the results and advantages of one-stage revision for chronic PJI of the hip and knee.

Materials and Methods: Twenty-four patients (16 knees and 8 hips) with PJI, without severe systemic or limb compromise according to McPherson’s classification, were included. All underwent one-stage revision and received intravenous antibiotics for at least 10 days, followed by oral therapy for a minimum of 3 months. Comorbidities, clinical outcomes, and infection control were assessed with a minimum follow-up of 1 year.

Results: Seventy-five percent of patients (18/24) were classified as McPherson host type A, and 91.6% (22/24) had good soft tissue conditions (type I). Infection was controlled in 22 cases (91.6%), while 2 patients had persistent infection. All patients showed improvement in mobility and satisfaction, particularly those treated for knee infections.

Conclusions: One-stage revision achieved good outcomes in most cases of chronic PJI, with a high infection control rate (91.6%). This strategy reduces the morbidity associated with two-stage revision, provided that patients are carefully selected, the causative pathogen is identified, and antibiotic susceptibility is known.

Dislocation of Bipolar Hip Hemiarthroplasty in the Elderly: Comparison of the Posterolateral and Anterolateral Approaches

Arturo Aguilar Maldonado — 2025-10-27

Objective: To compare the risk of bipolar hip hemiarthroplasty dislocation after femoral neck fracture using the posterolateral versus the anterolateral approach.

Materials and Methods: Patients older than 60 years who underwent bipolar hip hemiarthroplasty for femoral neck fracture between 2021 and 2022 were included. The number of dislocations following the posterolateral or anterolateral approach was recorded.

Results: Seventy-nine cases were included: 46 (58.8%) were treated with the posterolateral approach and 33 (41.8%) with the anterolateral approach. There were 3 dislocations in the posterolateral group and 2 in the anterolateral group; no significant differences were found (p = 0.655).

Conclusions: There were no differences in the risk of bipolar hemiarthroplasty dislocation between the posterolateral and anterolateral approaches in the treatment of femoral neck fractures in the elderly.

Impact of Patellar Thickness in Total Knee Arthroplasty: Clinical and Functional Outcomes and early Complications

Leonel Pérez Alamino — 2025-10-27

Introduction: Total knee arthroplasty (TKA) is effective in restoring function in patients with knee osteoarthritis. Restoration of the native patellar thickness is a critical aspect, but there is no consensus regarding the optimal thickness. The aim of this study was to evaluate the impact of patellar thickness on clinical and functional outcomes, radiological findings, complications, and revision rates in patients undergoing primary TKA.

Materials and Methods: We conducted a retrospective study of patients who under- went TKA for primary osteoarthritis, with patellar resurfacing, and a minimum follow-up of 24 months. Recorded data included age, sex, body mass index, alignment, preoperative and postoperative patellar thickness, anterior knee pain, Knee
Society Score (KSS), Visual Analog Scale (VAS) for pain, complication rates, and revision rates.

Results: The series included 44 patients (mean age, 70.4 ± 10.8 years), all treated with the same prosthesis model. KSS, VAS, and anterior knee pain scores improved signifi- cantly. No significant differences were found between preoperative and postoperative patellar thickness (22.6 ± 2.9 mm vs. 22.0 ± 1.5 mm; p = 0.09). Postoperatively, 15.9% of patients had the same thickness as before surgery, while differences of 1 mm, 2 mm, and 3 mm were observed in 45.5%, 29.5%, and 9.1% of patients, respectively.

Conclusion: Patellar thickness did not significantly influence clinical or functional scores, complication rates, or revision rates following primary TKA.

Intraosseous Vancomycin for Acute Periprosthetic Knee Infection: A Retrospective Study

Walter Fabián Martínez — 2025-10-27

Introduction: Periprosthetic joint infection (PJI) is an uncommon but serious complication after total knee arthroplasty (TKA), with significant clinical and healthcare implications. This study evaluated the effectiveness of the debridement, antibiotics, and implant retention (DAIR) protocol combined with intraosseous vancomycin administration and modular component exchange in controlling acute infection and improving functional outcomes.

Materials and Methods: We conducted a retrospective study across three institutions, including 12 patients (7 women, 5 men; mean age, 72.4 ± 6.3 years) with acute PJI treated with DAIR between February 2022 and June 2023. The mean interval between primary TKA and the DAIR procedure was 12.3 days. A standardized
protocol was applied, consisting of intraosseous vancomycin delivery, modular component exchange, and pathogen-directed antibiotic therapy.

Results: The mean surgical time was 95 ± 10 minutes. Infection control was achieved in 11 of 12 cases (91.6%), with one reinfection requiring two-stage revision. The Knee Society Score improved significantly from 42.5 ± 5.8 preoperatively to 88.6 ± 6.3 at 1 year (p < 0.001).

Conclusion: The DAIR protocol with intraosseous vancomycin and modular component exchange appears to be a promising strategy for managing acute periprosthetic knee infection. Larger studies are needed to confirm these preliminary results.

Location and Radiological Features of the Synovial Pit and Its Usefulness in Hip Arthroscopy

Agustín Oscar Perea — 2025-10-27

Introduction: The synovial pit is a cystic lesion or notch in the femoral neck, initially regarded as an incidental finding but more recently associated with femoroacetabular impingement (FAI). It is observed in approximately 5% of the general population, with a higher prevalence in men, and in up to 33% of patients with FAI. Its identification is clinically relevant given its association with labral and articular cartilage damage, although its origin may be related to both femoral (cam) and acetabular (pincer) morphological abnormalities, making it difficult to attribute to a single cause.

Materials and Methods: A total of 388 hip arthroscopies performed between 2018 and 2023 were included. Radiographs and complementary imaging studies were analyzed to classify morphological abnormalities and describe synovial pit characteristics. Measurements included the lateral center-edge angle, acetabular index, and alpha angle.

Results: In patients with predominantly femoral abnormalities, impingement tended to occur more proximally, and the synovial pit was located in that region; conversely, when acetabular abnormalities predominated, impingement occurred more distally. No other variables reached statistical significance.

Conclusion: The presence and features of the synovial pit in preoperative imaging, as well as its intraoperative identification during hip arthroscopy, may provide additional insight into the mechanisms of femoroacetabular impingement and its biomechanics.

Prophylactic Technique to Reduce the Risk of Interprosthetic Femoral Fractures

Belisario Segura — 2025-10-27

Introduction: With increasing life expectancy and patient longevity, the number of hip and knee arthroplasties has risen, leading to more ipsilateral joint replacements and, consequently, a higher risk of interprosthetic femoral fractures (IFF). The objectives of this study were to evaluate fracture-free survival in patients with ipsilateral hip and knee arthroplasties who had risk factors for IFF and to assess their functional outcomes.

Materials and Methods: Six patients with ipsilateral hip and knee arthroplasties were evalu- ated, all operated on by the same surgical team. The mean follow-up was 46.5 months. Risk factors for interprosthetic fractures included stemmed prostheses, advanced age, osteoporosis, distance between stems <8 cm, revision surgery, and obesity. At the time of arthroplasty, minimally invasive osteosynthesis with a locking plate was performed as a prophylactic measure.

Results: No cases of interprosthetic fracture, infection, loosening, or revision were observed. The rehabilitation protocol was not modified.

Conclusion: Although few studies have addressed interprosthetic fractures, and their results are heterogeneous, they consistently highlight the same risk factors. We believe that prophylactic osteosynthesis
entails low intraoperative morbidity and mortality and provides satisfactory short-term outcomes.

Impact of Total Hip Arthroplasty on Sexual Activity and Life Satisfaction: An Underexplored Aspect

Ezequiel Lulkin — 2025-10-27

Introduction: Sexual activity and life satisfaction are important outcomes for patients undergoing total hip arthroplasty (THA), yet they remain underexplored in routine assessments.

Materials and Methods: Retrospective study with paired pre- and postopera- tive evaluations in 40 adults (20
women, 20 men). Variables analyzed included sexual activity (yes/no), hip pain limiting sexual activity (yes/no), pain during sexual activity (frequency), and sexual satisfaction (5-point scale).

Results: The proportion of sexually active patients increased from 60% (24/40) to 75% (30/40), an absolute change of +15 percentage points. Patients reporting hip pain that limited sexual activity decreased from 12 (30%) to 6 (15%) (p = 0.031). Among the 30 patients who were sexually active postoperatively, 13.3% reported pain during sexual activity (“often”). High sexual satisfaction (scores 4–5) increased from 12.5% to 62.5%. Of the 10 patients (25%) who remained inactive after surgery, 7 attributed it to lack of desire or absence of a partner, and 3 to concern or fear.

Conclusions: Total hip arthroplasty was associated with increased sexual activity, reduced limiting pain, and a marked improvement in reported sexual satisfaction. Prospective studies are needed to confirm these findings.

Selective Arterial Embolization

Hernán G. Bertoni — 2025-10-27

Knee osteoarthritis is the most prevalent degenerative arthropathy and one of the leading causes of chronic pain and disability. Its pathophysiology involves chondral wear, synovial inflammation, pathological angiogenesis, and sensory neoinnervation. Treat- ment options range from conservative measures to arthroplasty; a subset of patients who are not yet surgical candidates would benefit from minimally invasive alternatives. Genicular artery embolization has emerged as a promising option by reducing neovascularization and, consequently, pain. Clinical improvements greater than 70% and a favorable safety profile have been reported. Its indications have also been extended to persistent pain after arthroplasty and to other chronic musculoskeletal entities (e.g., adhesive capsulitis), with encouraging results. Despite this promising early evidence, controlled trials and long-term follow-up are needed to define its role in the management of osteoarthritis and other musculoskeletal diseases and, in turn, to support its inclusion in treatment guidelines.

Traumatic Anterior Hip Dislocation in a 7-Year-Old Pediatric Patient

Gustavo E. Dávila-Godínez — 2025-10-27

Traumatic hip dislocation in children is extremely rare, and the anterior type is exceptional. It is considered an emergency due to the high risk of complications, the most serious being avascular necrosis of the femoral head. We report the case of a 7-year-old child who sustained a fall from a height of five meters, resulting in an anterior hip dislocation. The diagnosis was confirmed with computed tomography, and closed reduction was performed eight hours after the accident. Radiographic follow-up at three and six months showed no signs of avascular necrosis; however, given the risk of its occurrence, continued monitoring is warranted.

Medial Discoid Meniscus: A Rare Condition. Case Report and Treatment Considerations

Hugo Vasquez Diaz — 2025-10-27

Medial discoid meniscus is an extremely rare condition, with a reported incidence of 0.12 -0.3%. It results from early developmental abnormalities that produce a thickened meniscus, compromising function and stability and predisposing to injury. Magnetic resonance imaging (MRI) is the main diagnostic tool, while arthroscopy is considered the gold standard for confirmation. Treatment depends on clinical symptoms and associated injuries, and may be conservative or surgical, with an emphasis on preserving as much meniscal tissue as possible. We report the case of a 14-year-old patient with left knee pain. MRI findings confirmed the
diagnosis of medial discoid meniscus. The patient underwent arthroscopic saucerization with a favorable postoperative outcome.

Surgery in the Age of Artificial Intelligence: The Art That Only Human Hands Can Learn

Gabriel Vindver — 2025-10-27

In the age of artificial intelligence, orthopedic surgery faces the challenge of integrating technology without losing its human essence. This article reflects on the importance of practice, manual dexterity, and continuous surgical training as irreplaceable pillars of our specialty. Based on the experience of courses and workshops organized by ACARO and AAOT, it emphasizes that the surgeon’s precision and judgment remain the true driving forces of the surgical act.