Journal Information
Vol. 14. Issue 5.
Pages 371-377 (September - October 2000)
Vol. 14. Issue 5.
Pages 371-377 (September - October 2000)
Open Access
Uso apropiado de los mecanismos de fijación en la prótesis de cadera
Visits
5500
A. Escobar1,
Corresponding author
aescobar@hbas.osakidetza.net

Antonio Escobar Martínez. Unidad de Investigación. Hospital de Basurto. Av. de Montevideo 18. 48013 Bilbao.
, J.M. Quintana2, I. Aróstegul2, J. Azkárate3, J.I. Güenaga4
1 Unidad de Investigación. Hospital de Basurto
2 Unidad de Investigación. Hospital de Galdakao
3 Servicio de Traumatología. Hospital del Alto Deba
4 Servicio de Traumatología. Hospital de Santiago
This item has received

Under a Creative Commons license
Article information
Resumen
Objetivo

Evaluar el uso apropiado de los mecanismos de fijación de la prótesis de cadera en pacientes con diagnóstico de osteoartrosis o recambio de prótesis, usando criterios explícitos.

Método

Siguiendo el método de uso apropiado de RAND, se realizó una revisión de la bibliografía y se creó una lista de 12 indicaciones para la osteoartrosis y de 32 para los recambios. Un panel de 27 expertos, todos ellos traumatólogos, puntuó el grado de uso apropiado para cada indicación en una escala de 1 (totalmente inapropiado) hasta 9 (totalmente apropiado). Según la mediana de las puntuaciones y el nivel de acuerdo, cada indicación se clasificó como apropiada, dudosa o inapropiada. Posteriormente se recogieron los datos de diez hospitales públicos, de medio y gran tamaño, de la red de Osakidetza-Servicio Vasco de Salud y se aplicaron los criterios desarrollados por el panel de expertos a las intervenciones evaluadas.

Resultados

Se evaluaron un total de 831 intervenciones de osteoartrosis y 349 recambios. De las 136 intervenciones en las que se utilizó la prótesis cementada, en dos tercios se consideró apropiada su utilización. La prótesis no cementada se uso más frecuentemente (77%) y en la mayoría de los casos (94%) se consideró apropiada de acuerdo a los criterios del panel. De las 68 revisiónes acetabulares en que se emplearon prótesis cementadas, en el 85% de ellas se recomendaba el uso de un mecanismo no cementado. Sin embargo, de las 134 intervenciones que usaron prótesis no cementadas el panel estaba de acuerdo en un 94%. Resultados similares ocurrieron con el recambio femoral.

Conclusiones

El estudio ofrece unas recomendaciones sobre el uso de las prótesis cementadas y no cementadas basadas en el trabajo de un panel de expertos. Una vez aplicados los criterios del panel se observa un cierto nivel de uso dudoso.

Palabras clave:
Uso apropiado
Variabilidad
Prótesis de cadera
Mecanismos de fijación
Summary
Objective

To evaluate the appropriateness of the use of fixation mechanisms for hip replacement in patients with osteoartrhitis or prosthesis revision, using explicit criteria.

Methods

Following the RAND appropriateness method, it was carried out a revision of the bibliography and was created a list of 12 indications for osteoartrhitis and 32 for the revision. A panel of 27 experts, all of them traumatologists, punctuated the degree of appropriateness for each indication in a scale of 1 (completely inappropriate) up to 9 (completely appropriate). According to the median of the punctuations and the agreement level, each indication was classified as appropriate, uncertain or inappropriate.The data of ten public hospitals of medium and big size of the Basque Service of Health-Osakidetza, were picked up and the developed criteria were applied to the evaluated interventions.

Results

831 osteoartrhitis interventions and 349 revisions were evaluated. Of the 136 interventions in which the prosthesis used was cemented, in two thirds its use was considered appropriate. The cementless prosthesis was used more frequently (77%) and in most of the cases (94%) it was considered appropriate according to the criteria of the panel. Of the 68 acetabular revisions in which cemented prosthesis was used, in 85% of them the use of cementless mechanism was recommended. However, of the 134 interventions that used cementless, the panel agreed on 94%. Similar results happened with the femoral revision.

Conclusions

The study offers some recommendations on the use of the cemented and cementless prosthesis, based on the work of a panel of experts. Once applied, the criteria of the panel a certain level of uncertain use is observed.

Key words:
Appropriateness
Variability
Hip prosthesis
Fixation mechanisms
Full text is only aviable in PDF
Bibliografía
[1.]
R. Madhok, D.G. Lewallen, S.L. Wallrichs, D.M. Ilstrup, R.L. Kurland, L.J. Melton III.
Trends in the utilization of primary total hip arthroplasty, 1969 through 1990: a population-based study in Olmsted County, Minnesota.
Mayo Clin Proc, 68 (1993), pp. 11-18
[2.]
W.G. Boettcher.
Total hip arthroplasties in the elderly. Morbidity, mortality, and cost effectiveness.
Clin Orthop, (1992), pp. 30-34
[3.]
A. Laupacis, R. Bourne, C. Rorabeck, D. Feeny, C. Wong, P. Tugwell, et al.
The effect of elective total hip replacement on health-related quality of life.
J Bone Joint Surg Am, 75 (1993), pp. 1619-1626
[4.]
C.H. Rorabeck, R.B. Bourne, A. Laupacis, D. Feeny, C. Wong, P. Tugwell, et al.
A double-blind study of 250 cases comparing cemented with cementless total hip arthroplasty. Cost-effectiveness and its impact on health-related quality of life.
Clin Orthop, (1994), pp. 156-164
[5.]
M.R. Chassin, R.H. Brook, R.E. Park, J. Keesey, A. Fink, J. Kosecoff, et al.
Variations in the use of medical and surgical services by the Medicare population.
N Engl J Med, 314 (1986), pp. 285-290
[6.]
M.G. Peterson, J.P. Hollenberg, T.P. Szatrowski, N.A. Johanson, C.A. Mancuso, M.E. Charlson.
Geographic variations in the rates of elective total hip and knee arthroplasties among Medicare beneficiaries in the United States.
J Bone Joint Surg Am, 74 (1992), pp. 1530-1539
[7.]
A. Faulkner, L.G. Kennedy, K. Baxter, J. Donovan, M. Wilkinson, G. Bevan.
Effectiveness of hip prostheses in primary total hip replacement: a critical review of evidence and an economic model.
Health Technol Assess, 2 (1998), pp. 1-133
[8.]
P. Lázaro, K. Fitch, Y. Martín.
Estándares para el uso apropiado de la angioplastia coronariatransluminal percutánea y cirugía aortocoronaria.
Rev Esp Cardiol, 51 (1998), pp. 689-715
[9.]
R.H. Brook, M.R. Chassin, A. Fink, D.H. Solomon, J. Kosecoff, R.E. Park.
A method for the detailed assessment of the appropriateness of medical technologies.
Int J Technol Assess Health Care, 2 (1986), pp. 53-63
[10.]
M. Singh, A.R. Nagrath, P.S. Maini.
Changes in trabecular pattern of the upper end of the femur as an index of osteoporosis.
J Bone Joint Surg [Am], 52 (1970), pp. 457-467
[11.]
W.G. Paprosky, M.S. Bradford, T.I. Younger.
Classification of bone defects in failed prostheses.
Chir Organi Mov, 79 (1994), pp. 285-291
[12.]
C.H. Rorabeck, R.B. Bourne, B.D. Mulliken, N. Nayak, A. Laupacis, P. Tugwell, et al.
The Nicolas Andry award: comparative results of cemented and cementless total hip arthroplasty.
Clin Orthop, (1996), pp. 330-344
[13.]
S.P. Godsiff, R.J. Emery, M.B. Heywood-Waddington, T.L. Thomas.
Cemented versus uncemented femoral components in the ring hip prosthesis.
J Bone Joint Surg Br, 74 (1992), pp. 822-824
[14.]
W.J. Hozack, R.H. Rothman, R.E. Booth Jr., R.A. Balderston.
Cemented versus cementless total hip arthroplasty. A comparative study of equivalent patient populations.
Clin Orthop, (1993), pp. 161-165
[15.]
NIH consensus conference: Total hip replacement.
NIH Consensus Development Panel on Total Hip Replacement.
JAMA, 273 (1995), pp. 1950-1956
[16.]
O. Robertsson, K. Knutson, S. Lewold, S. Goodman, L. Lidgren.
Knee arthroplasty in rheumatoid arthritis. A report from the Swedish Knee Arthroplasty Register on 4,381 primary operations 1985-1995.
Acta Orthop Scand, 68 (1997), pp. 545-553
[17.]
B.C. Burkart, R.B. Bourne, C.H. Rorabeck, P.G. Kirk.
Thigh pain in cementless total hip arthroplasty. A comparison of two systems at 2 years’ follow-up.
Orthop Clin North Am, 24 (1993), pp. 645-653
[18.]
L.L. Leape, R.E. Park, J.P. Kahan, R.H. Brook.
Group judgments of appropriateness: the effect of panel composition.
Qual Assur Health Care, 4 (1992), pp. 151-159
[19.]
C.E. Phelps.
The methodologic foundations of studies of the appropriateness of medical care.
N Engl J Med, 329 (1993), pp. 1241-1245
[20.]
J.M.V. Pons, J. Martí Valls, A. Granados.
Agència d’Avaluació de Tecnologia i Recerca Mèdiques. La efectividad y la eficiencia en la cirugía protésica de cadera: elementos para su mejora. Breus.
BR99, (1999),
Copyright © 2000. Sociedad Española de Salud Pública y Administración Sanitaria
Idiomas
Gaceta Sanitaria
Article options
Tools
es en

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?