<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>2306-4102</journal-id>
<journal-title><![CDATA[Acta ortopédica mexicana]]></journal-title>
<abbrev-journal-title><![CDATA[Acta ortop. mex]]></abbrev-journal-title>
<issn>2306-4102</issn>
<publisher>
<publisher-name><![CDATA[Colegio Mexicano de Ortopedia y Traumatología A.C.]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S2306-41022024000500291</article-id>
<article-id pub-id-type="doi">10.35366/117377</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[Minimizando riesgos: evaluación de la relación entre el aflojamiento de vástagos femorales y el riesgo de presentar fractura periprotésica de cadera]]></article-title>
<article-title xml:lang="en"><![CDATA[Minimizing risk: evaluation of the relationship between femoral stem loosening and the risk of presenting with peri-prosthetic hip fracture]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Flores-Gallardo]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
<xref ref-type="aff" rid="Aaf"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Sánchez-Pérez]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Vaquero]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
<xref ref-type="aff" rid="Aaf"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Hospital General Universitario Gregorio Marañón Servicio de Cirugía Ortopédica y Traumatología ]]></institution>
<addr-line><![CDATA[Madrid ]]></addr-line>
<country>Spain</country>
</aff>
<aff id="Af2">
<institution><![CDATA[,Universidad Complutense de Madrid Facultad de Medicina ]]></institution>
<addr-line><![CDATA[Madrid ]]></addr-line>
<country>Spain</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>10</month>
<year>2024</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>10</month>
<year>2024</year>
</pub-date>
<volume>38</volume>
<numero>5</numero>
<fpage>291</fpage>
<lpage>297</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_arttext&amp;pid=S2306-41022024000500291&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_abstract&amp;pid=S2306-41022024000500291&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_pdf&amp;pid=S2306-41022024000500291&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[Resumen:  Introducción:  evaluación de factores predictores de fractura periprotésica en vástagos femorales aflojados.  Material y métodos:  estudio de casos y controles retrospectivo, comparando vástagos aflojados asépticos en dos grupos. Casos: pacientes que experimentaron fractura periprotésica femoral antes de poder efectuar recambio (n = 9). Controles: experimentaron recambio protésico, sin llegar a producirse fractura (n = 19).  Resultados:  la intensidad del dolor (EVA) fue el aspecto más importante (p = 0.01), predominando en los controles. Los parámetros radiológicos simples no mostraron hallazgos predictores de fractura periprotésica de manera estadísticamente significativa (número de zonas de Gruen, suma de las mismas en milímetros, stress shielding, pedestal, desgaste del polietileno, hundimiento del vástago). El papel de las pruebas complementarias (TAC y gammagrafía) para el diagnóstico definitivo del aflojamiento sí fue relevante, pero sin significación. El tipo de implante no mostró diferencias. La supervivencia total del implante fue mayor en los casos respecto a los controles (p = 0.016). Esta diferencia continúa al comparar cada vástago aflojado hasta la fractura o recambio (p = 0.024).  Conclusión:  el principal factor protector de fractura es el propio recambio de un vástago con diagnóstico clínico y radiológico de aflojamiento. En esto juega un papel determinante un adecuado seguimiento del paciente, sobre todo al considerar la mayor intensidad del dolor en los controles, que orientaba antes a los cirujanos a realizar recambios antes de ocurrir la fractura. Esto se refuerza si tenemos en cuenta que hasta un tercio de los casos no tenían revisiones regladas y por lo tanto no tuvieron oportunidad de recambio previo a la fractura. Resulta también muy importante el papel de las pruebas complementarias (TAC y gammagrafía) al tener en cuenta la baja rentabilidad diagnóstica extraída de las radiografías simples.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[Abstract:  Introduction:  evaluation of predictors of periprosthetic fracture in loosened femoral stems.  Material and methods:  retrospective case-control study comparing aseptic loosened stems in two groups: cases: patients who experienced periprosthetic femoral fracture before replacement could be performed (n = 9). Controls: experienced prosthetic replacement without fracture (n = 19).  Results:  pain intensity (VAS) was the most important aspect (p = 0.01), predominating in the controls. The simple radiological parameters did not show statistically significant findings predictive of peri-prosthetic fracture (number of Gruen zones, sum of them in mm, stress shielding, pedestal, polyethylene wear, stem subsidence). The role of complementary tests (CT and scintigraphy) for the definitive diagnosis of loosening was relevant, but not significant. The type of implant showed no differences. Overall implant survival was higher in cases than in controls (p = 0.016). This difference continues when comparing each loosened stem until fracture or replacement (p = 0.024).  Conclusion:  the main factor protecting against fracture is the replacement of a stem with clinical and radiological diagnosis of loosening. Adequate follow-up of the patient plays a determining role in this, especially when considering the greater intensity of pain in the controls, which used to guide surgeons to perform replacements before the fracture occurred. This is reinforced if we take into account that up to one third of the cases did not have regular check-ups, and therefore did not have the opportunity for replacement prior to the fracture. The role of complementary tests (CT and scintigraphy) is also very important, taking into account the low diagnostic yield obtained from simple X-rays.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[aflojamiento aséptico]]></kwd>
<kwd lng="es"><![CDATA[fractura periprotésica]]></kwd>
<kwd lng="es"><![CDATA[reemplazo de cadera]]></kwd>
<kwd lng="es"><![CDATA[artroplastía de revisión]]></kwd>
<kwd lng="en"><![CDATA[aseptic loosening]]></kwd>
<kwd lng="en"><![CDATA[periprosthetic fracture]]></kwd>
<kwd lng="en"><![CDATA[hip replacement]]></kwd>
<kwd lng="en"><![CDATA[revision arthroplasty]]></kwd>
</kwd-group>
</article-meta>
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