Valenti-Nin, J.R. (Juan Ramón)
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- Banco de tejidos del sistema musculoesquelético. Aplicaciones clínicas(Universidad de Navarra, 1990) Cara, J.A. (José Antonio); Amillo, S. (Santiago); Valenti-Nin, J.R. (Juan Ramón)Desde Junio de 1987 hasta Junio de 1990 se han utilizado 310 aloinjertos del Banco de huesos y otros tejidos del sistema musculoesquelético del Departamento de Cirugía Ortopédica y Traumatología de la Clínica Universitaria de Navarra. De éstos, 219 se han utilizado en el Departamento correspondiendo a 142 aloinjertos de hueso esponjoso, 42 aloinjertos de hueso cortica], 24 a tendón rotuliano y 11 de fascia lata. Los otros 91 injertos se han remitido a otros centros hospitalarios de ámbito nacional. Se estudian retrospectivamente los pacientes que han sido sometidos a cirugía más aporte de aloinjerto. Se observan las diferencias entre los distintos tipos de aloinjerto y se compara con las técnicas convencionales. En las complicaciones sólo destaca el 10,52 % de infecciones por aloinjertos corticales en pacientes sometidos a tratamientos antineoplásicos y ninguna infección en los otros tipos de aloinjertos. Concluimos que el banco de huesos y otros tejidos del sistema musculoesquelético tiene una gran utilidad en diferentes técnicas quirúrgicas reconstructivas y de artrodesis que se utilizan con frecuencia en la cirugía ortopédica y traumatología, y es necesario disponer de un Banco para poder hacer y desarrollar la cirugía en esta especialidad médico-quirúrgica.
- Anterior cruciate ligament reconstruction with fresh-frozen patellar tendon allografts(Springer Verlag, 1994) Sala, D. (D.); Schweitzer, D. (D.); Valenti-Nin, J.R. (Juan Ramón)A prospective study was performed on 30 patients who underwent an anterior cruciate ligament reconstruction with fresh-frozen patellar tendon allograft. An arthroscopic technique alone was used in 10 patients, and in the other 20 patients this was combined with a miniarthrotomy. After a mean follow up of 35 months, the overall functional results were satisfactory in 85%. There were no cases of infection, disease transmission or tissue rejection. Fresh-frozen patellar tendon allografts are a good method of anterior cruciate reconstruction.
- Anterior cruciate ligament reconstruction: A multicenter prospective cohort study evaluating 3 different grafts using same bone drilling method(Lippincott, Williams & Wilkins, 2011) Tuneu, J. (Josep); Maestro, A. (Antonio); Alentorn-Geli, E. (Eduard); Leal-Blanquet, J. (Joan); Valenti-Nin, J.R. (Juan Ramón)To compare the clinical outcomes after anterior cruciate ligament (ACL) reconstruction with bone-patellar tendon-bone autograft (BPTBAu), BPTB allograft (BPTBAll), or hamstring (semitendinosus-gracilis) tendon autograft (HTAu), performing bone drilling with same methods in terms of transtibial drilling, orientation, positioning, and width of femoral and tibial tunnels. DESIGN: Multicenter prospective cohort study (level of evidence II). SETTING: Departments of Orthopedic Surgery of Centro Medico Teknon (Barcelona, Spain) Clinica Universitaria de Navarra (Navarra, Spain), and Clinica FREMAP (Gijon, Spain). PATIENTS: All patients with ACL tears attending 3 different institutions between January 2004 and June 2006 were approached for eligibility and those meeting inclusion criteria finally participated in this study. INTERVENTION: Each institution was assigned to perform a specific surgical technique. Patients were prospectively followed after undergoing ACL reconstruction with BPTBAu, BPTBAll, or HTAu, with a minimum follow-up of 24 months. MAIN OUTCOME MEASURES: Included knee laxity and International Knee Documentation Committee (IKDC) score. Knee laxity was assessed with the KT-1000 arthrometer (evaluated with neutral and external rotation positions) and both Lachman and pivot shift tests. Additional outcomes included main symptoms (anterior knee pain, swelling, crepitation, and instability), disturbance in knee sensation, visual analogue scale (VAS) for satisfaction with surgery, range of motion (ROM), and isokinetic knee strength. RESULTS: There were no significant differences among the 3 groups for any of the clinical outcomes, except for a slightly greater KT-1000-measured knee laxity in external rotation in the BPTBAu compared with the other groups. All patients demonstrated grade A or B of the IKDC. The mean VAS for satisfaction with surgery in all patients was 8.5. CONCLUSIONS: The selection of the surgical technique for ACL reconstruction may be based on the surgeon's preferences
- Hemostatic markers in surgery: a different fibrinolytic activity may be of pathophysiological significance in orthopedic versus abdominal surgery(Springer Verlag, 1997) Paramo, J.A. (José Antonio); Lopez, Y. (Yolanda); Pardo, F. (Fernando); Rocha, E. (Eduardo); Montes, R. (Ramón); Valenti-Nin, J.R. (Juan Ramón)Without prophylaxis, patients subjected to major abdominal surgery have a risk of deep vein thrombosis of approximately 30%, while the rate varies between 40% and 60% in orthopedic surgery. The reasons for this discrepancy are not completely understood. The present study was designed to compare the pre- and postoperative behavior of different coagulation and fibrinolysis parameters in patients undergoing both types of surgery, receiving low molecular weight heparin prophylaxis. Samples were taken before operation and on postoperative days 1, 3, and 7. The following parameters were assessed: prothrombin fragment 1 + 2, thrombin-antithrombin III complexes, fibrinopeptide A, tissue plasminogen activator, plasminogen activator inhibitor, plasmin-alpha 2-antiplasmin complexes, and fibrin degradation products. We found a significant increase in the clotting markers postoperatively compared with preoperative values (P < 0.05), both in abdominal and orthopedic surgery, indicating a marked hemostatic activation which remained until postoperative day 7. A significant increase in plasminogen activator inhibitor (P < 0.01) and a decrease in tissue plasminogen activator and plasmin-alpha 2-antiplasmin complexes was also observed early after operation. The plasminogen activator inhibitor activity decreased, while tissue plasminogen activator and plasmin-alpha 2-antiplasmin levels increased significantly on days 3 and 7 (P < 0.05). Fibrin degradation products significantly increased throughout the postoperative period (P < 0.01). Preoperatively, we found higher plasminogen activator inhibitor activity and lower tissue plasminogen activator and plasmin-alpha 2-antiplasmin complexes (P < 0.05) in patients undergoing hip replacement compared with abdominal surgery. Fibrin degradation products were also significantly lower on postoperative day 3 in patients undergoing hip replacement (P < 0.01). We suggest that the lower preoperative fibrinolytic activation observed in patients undergoing orthopedic surgery compared with abdominal surgery might have pathophysiological consequences. Our results also indicate that the hemostatic activation persists beyond the 7th postoperative day despite prophylaxis.
- Influencia de la edad en el resultado de la cirugía sustitutiva total de la cadera(Universidad de Navarra, 1983) Cañadell, J.M. (J. M.); Arenas, A. (A.); Imizcoz, J.L. (J. L.); Villas-Tome, C. (Carlos); Valenti-Nin, J.R. (Juan Ramón)A revision of the first 700 total hip prostheses (operated on in the period 1969-1980) is carried out with the purpose to establish the influence of the age on the evolution of the arthroplasty. The results are very satisfactory but it is younger patients that complications related to loosening are more frequent. This fact can be explained by a longer period of evolution and a major prosthetic stress in these patients. By this reason, we do not use actually cement to fix the implants in those patients younger than sixty.
- Long term evaluation of high tibial valgus osteotomy(Springer Verlag, 1990) Cañadell, J.M. (J. M.); Lopez, R. (R.); Calvo, R. (R.); Valenti-Nin, J.R. (Juan Ramón)We present a long term evaluation of 100 high valgus tibial osteotomies with a mean follow up of 11 years. Knees with slight or moderate osteoarthritis had the best results. Slight overcorrection was beneficial, but gross overcorrection was not. There were few complications and the overall long term results were goo
- Tratamiento de la necrosis isquémica de la cabeza femoral: conceptos actuales(Universidad de Navarra, 1991) Aguilella, L. (Luis); Valenti-Nin, J.R. (Juan Ramón)La necrosis isquémica de la cabeza femoral (NICF) ocupa un lugar importante dentro de la patología de la cadera, por su evolución espontánea hacia un grave deterioro articular, por su frecuente afectación bilateral y su mayor incidencia en varones alrededor de los cuarenta años, una etapa especialmente activa de la vida. En nuestro Departamento han sido tratados quirúrgicamente más de 300 pacientes afectos de NICF. La experiencia acumulada nos ha motivado a presentar los resultados de nuestra casuística y a contrastarla con los diversos tratamientos propuestos en la actualidad, que son analizados críticamente. Exponemos nuestro protocolo de tratamiento, en el que se incluyen los forages, la osteotomía intertrocantérea, la osteotomía de Sugioka y las prótesis totales de cadera.
- Levofloxacino. Experiencia clínica en tratamientos de larga duración de infecciones osteoarticulares(Servicio de Publicaciones de la Universidad de Navarra, 2002) Muñoz, M.J. (M. J.); Garcia-Quetglas, E. (Emilio); Azanza, J.R. (José Ramón); Cárdenas, E. (E.); Valenti-Nin, J.R. (Juan Ramón)Se ha realizado un estudio con el fin de evaluar la eficacia y la tolerancia de la administración de larga duración de levofloxacino en el tratamiento de infecciones osteoarticulares. Se incluyeron 50 pacientes con una previsión inicial de realizar tratamiento antibiótico de duración superior a cuatro semanas, durante los años 1999-2001. El 46% de los pacientes eran varones y recibieron tratamiento con levofloxacino durante una media de 122,8 días. En el 83,7% de los pacientes evaluables (41/49 pacientes) la evolución fue satisfac- toria, por la desaparición o mejoría de la infección. Se realizaron controles médicos y analíticos seriados, sin objetivarse en ellos alte- raciones significativas. Cinco de los pacientes estudiados presenta- ron un total de 7 efectos adversos: molestias digestivas (3), micosis oral (1), petequias (1), parestesias (1) y erupción pruriginosa(1). En tres de ellos se suspendió el tratamiento por este motivo. Se concluye que levofloxacino es un fármaco eficaz y bien tolerado, por ello puede ser utilizado en el tratamiento de infecciones que requieran terapia prolongada.
- Transient osteoporosis of the hip. Presentation of a case and literature review(Amb Acta Medica Belgica, 1996) Leyes, M. (Manuel); Arriola, F.J. (F.J.); Valenti-Nin, J.R. (Juan Ramón)We present a case of idiopathic transient osteoporosis of the hip in a 43 year-old male. The patient presented with pain in the hip and limb. Hip x ray showed osteoporosis and scintigraphy revealed a diffuse uptake in the femoral head. Magnetic resonance imaging showed decreased signal intensity on the T1 weighted images and increased signal intensity on T2 weighted images in the femoral head and neck. Blood tests were normal. Healing was achieved by restricting weight-bearing and administering calcitonin and calcium. Radiographic remineralization occurred simultaneously with clinical resolution
- The place of intertrochanteric osteotomy in the treatment of idiopathic necrosis of the head of the femur(Springer Verlag, 1986) Cañadell, J.M. (J. M.); Azcarate, J. (J.); Aguilella, R. (R.); Valenti-Nin, J.R. (Juan Ramón)The authors present their experience of the use of intertrochanteric osteotomy for the treatment of idiopathic necrosis of the head of the femur. The results obtained from 102 osteotomies performed on 81 patients with the disease are analysed. The mean follow-up is 4.2 years. The results show a statistically significant clinical improvement after operation. Patients presenting with Ficat and Arlet Stage II involvement fared much better than those with more severe changes. Better results were also seen in those with a necrosis angle of less than 200 degrees. No radiological improvement was seen although a high percentage showed no deterioration. The choice of treatment for the condition is discussed in the light of these results.