Aims The EURO-ENDO registry aimed to study the management and outcomes of patients with infective endocarditis (IE). Methods and results Prospective cohort of 3116 adult patients (2470 from Europe, 646 from non-ESC countries), admitted to 156 hospitals in 40 countries between January 2016 and March 2018 with a diagnosis of IE based on ESC 2015 diagnostic criteria. Clinical, biological, microbiological, and imaging [echocardiography, computed tomography (CT) scan, 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT)] data were collected. Infective endocarditis was native (NVE) in 1764 (56.6%) patients, prosthetic (PVIE) in 939 (30.1%), and device-related (CDRIE) in 308 (9.9%). Infective endocarditis was community-acquired in 2046 (65.66%) patients. Microorganisms involved were staphylococci in 1085 (44.1%) patients, oral streptococci in 304 (12.3%), enterococci in 390 (15.8%), and Streptococcus gallolyticus in 162 (6.6%). 18F-fluorodeoxyglucose positron emission tomography/computed tomography was performed in 518 (16.6%) patients and presented with cardiac uptake (major criterion) in 222 (42.9%) patients, with a better sensitivity in PVIE (66.8%) than in NVE (28.0%) and CDRIE (16.3%). Embolic events occurred in 20.6% of patients, and were significantly associated with tricuspid or pulmonary IE, presence of a vegetation and Staphylococcus aureus IE. According to ESC guidelines, cardiac surgery was indicated in 2160 (69.3%) patients, but finally performed in only 1596 (73.9%) of them. In-hospital death occurred in 532 (17.1%) patients and was more frequent in PVIE. Independent predictors of mortality were Charlson index, creatinine > 2 mg/dL, congestive heart failure, vegetation length > 10 mm, cerebral complications, abscess, and failure to undertake surgery when indicated. Conclusion Infective endocarditis is still a life-threatening disease with frequent lethal outcome despite profound changes in its clinical, microbiological, imaging, and therapeutic profiles.

A large series of split cord malformation (SCM). Over the last 22 years, we have operated more than 1500 patients of SD, of which over 450 are (SCM), and 300 are with various lipomatus malformations. About 55% type II and 45% type I SCM. A separate sub-classification of type I SCM (a,b,c and d), is presented which alter the surgical approach and influence the results. Overall improvement following surgery in patients with SCM was observed in 94%. Fifty percent patients improved and 44% remained stable. However, deterioration was noticed in 6%, mostly with composite type of SCM. A paradigm for management of SCM is provided taking into consideration also the author’s large experience.

Purpose High mortality and a limited performance of valvular surgery are typical features of infective endocarditis (IE) in octogenarians, even though surgical treatment is a major determinant of a successful outcome in IE. Methods Data from the prospective multicentre ESC EORP EURO-ENDO registry were used to assess the prognostic role of valvular surgery depending on age. Results As compared to < 80 yo patients, ≥ 80 yo had lower rates of theoretical indication for valvular surgery (49.1% vs. 60.3%, p < 0.001), of surgery performed (37.0% vs. 75.5%, p < 0.001), and a higher in-hospital (25.9% vs. 15.8%, p < 0.001) and 1-year mortality (41.3% vs. 22.2%, p < 0.001). By multivariable analysis, age per se was not predictive of 1-year mortality, but lack of surgical procedures when indicated was strongly predictive ). By propensity analysis, 304 ≥ 80 yo were matched to 608 < 80 yo patients. Propensity analysis confirmed the lower rate of indication for valvular surgery (51.3% vs. 57.2%, p = 0.031) and of surgery performed (35.3% vs. 68.4%, p < 0.0001) in ≥ 80 yo. Overall mortality remained higher in ≥ 80 yo (in-hospital: HR 1.50[1.06-2.13], p = 0.0210; 1-yr: HR 1.58[1.21-2.05], p = 0.0006), but was not different from that of < 80 yo among those who had surgery (in-hospital: 19.7% vs. 20.0%, p = 0.4236; 1-year: 27.3% vs. 25.5%, p = 0.7176). Conclusion Although mortality rates are consistently higher in ≥ 80 yo patients than in < 80 yo patients in the general population, mortality of surgery in ≥ 80 yo is similar to < 80 yo after matching patients. These results confirm the importance of a better recognition of surgical indication and of an increased performance of surgery in ≥ 80 yo patients.

RESUMENIntroducción: En los reemplazos totales de cadera la durabilidad de los componentes protésicos es, sin duda, uno de los principales temas de debate. En la evaluación del aflojamiento mecánico acetabular entran en juego varios aspectos, entre ellos, el cementado. Se realizó un análisis retrospectivo para predecir el aflojamiento, analizando la calidad del cementado en la radiografía posoperatoria inmediata, comparándola con los hallazgos radiográficos a mediano y largo plazo. Materiales y métodos: Se analizaron 180 reemplazos totales de cadera cementadas, con un promedio de seguimiento de 7,7 años y un promedio de edad de los pacientes de 66 años. Se analizó la interfase cemento-hueso de cada cótilo, comparando la radiografía posoperatoria inmediata con la del último control y se estableció un puntaje para las demarcaciones observadas en cada zona de De Lee Charnley para identificar y evaluar el aflojamiento. Resultados: De los 180 reemplazos totales de cadera, 149 cótilos se consideraron bien fijados (83%) y 31, mal fijados (17%). El promedio de aflojamiento radiográfico fue de 12,7% (23 de 180 caderas). El seguimiento promedio fue de 7,7 años. En los inicialmente bien fijados, se registraron 20 casos de aflojamiento radiográfico (11,1%), que no requirieron cirugía de revisión. Los cóti-los mal fijados tuvieron un porcentaje de aflojamiento cínico y radiográfico del 19,35% (6/31). Conclusiones: Consideramos que una correcta técnica de cementado del cótilo disminuye la probabilidad de aflojamiento clínico y radiográfico a largo plazo. Si bien es necesario un seguimiento más largo y un mayor número de pacientes, creemos que la calidad de la interdigitación del cemento en el hueso en la radiografía posoperatoria inmediata es predictiva de un aflojamiento mecánico acetabular futuro.PALABRAS CLAVE: Aflojamiento mecánico. Reemplazo total de cadera. Cótilo cementado. Técnica de cementado. Interfase cemento-hueso. Predicción. USE OF IMMEDIATE POSTOPERATIVE RADIOGRAPHS TO PREDICT MECHANICAL LOOSENING IN CEMENTED CUPSABSTRACT Background: the durability of prosthetic components in total hip arthroplasty (THA) is one of the main topics of discussion. In the evaluation of the acetabular mechanical loosening (AML) come into play several aspects, including the hardened. A retrospective analysis was performed to predict the AML, analyzing the quality of the cemented in immediate radiography (Rx) postoperative (PO), comparing it to the radiographic findings in the medium and long term. Methods: 180 cemented THA, with an average of 7.7 years follow-up and an average age of 66 years-old were analyzed. Interface bone-cement of each cup were analyzed, comparing the immediate PO Rx with the ultimate control, settling a score for boundaries observed in each area of Lee Charnley, capable of identifying and evaluating the AML. Results: of the 180 THA, 149 cups were considered well fixed (83%) and 31 badly fixed (17%). The radiographic AML averaged was 12.7% (23 of 180 hips). The median follow-up was 7.7 years. In the initially we...

ResumenIntroducción: El deseje en valgo es una deformidad compleja, con alteración ósea y de partes blandas. Se han descrito numerosas técnicas quirúrgicas que detallan la secuencia de liberación de las estructuras posterolaterales y la necesidad de utilizar implantes constreñidos. El reemplazo total de rodilla para el genu valgo es un desafío para el ortopedista. Los objetivos fueron evaluar nuestros resultados en el tratamiento quirúrgico del genu valgo severo y detallar la técnica quirúrgica empleada. Materiales y Métodos: Se estableció una clasificación clínico-radiológica y se discriminaron los casos con genu valgo severo. Se evaluaron 42 reemplazos totales de rodilla en 39 pacientes (seguimiento promedio 9.2 años). Se utilizó el Knee Society Score como parámetro de evaluación clínica. Para la evaluación radiográfica, se contó con la radiografía de mejor calidad del último control. El análisis de supervivencia contempló la necesidad de revisión por cualquier causa y por falla mecánica. Resultados: El Knee Society Score fue, en promedio, de 83,3, con franca mejoría en los parámetros dolor y rango de movilidad. Se utilizaron implantes constreñidos en el 16,7% de los casos. El ángulo posoperatorio promedio fue de 5,9°. Hubo dos revisiones, con una supervivencia protésica por falla mecánica del 97,6%. No hubo revisiones por causa infecciosa. Conclusiones: Se requiere de un minucioso examen físico y radiografías preoperatorias. La decisión de utilizar implante constreñido se toma durante la cirugía. Es importante la apropiada liberación de partes blandas. Al margen de la técnica quirúrgica empleada, el requerimiento de prótesis constreñida es bajo. Recomendamos nuestra técnica, pues se trata de un procedimiento poco demandante con resultados alentadores a mediano y largo plazo.Palabras clave: Genu valgum; grave; reemplazo total de rodilla; liberación; técnica quirúrgica. Nivel de Evidencia: IVTotal knee arthroplasty in severe genu valgum. Five to 14 years follow-up Abstract Introduction: Valgus malalignment is a complex, multiplanar deformity characterized by bone alterations and soft-tissue abnormalities. Several surgical techniques have been described for valgus knee, and the sequence of tight lateral structure release and the need of constrained prosthesis were addressed. Total knee arthroplasty in valgus deformity remains a surgical challenge for orthopaedic surgeons. The objectives of the study were to evaluate our mid-and long-term results in the surgical treatment of severe valgus disease, and to describe the applied surgical technique. Methods: A clinical-radiological classification was developed, and patients treated for severe genu valgum were discriminated. We retrospectively evaluated 42 total knee arthroplasties in 39 patients, with an average follow-up of 9.2 years. Knee Society Score was used for clinical evaluation, and the last control best quality radiograph was considered for radiographic evaluation. Survival analysis contemplated the need for revision for any reason and for mechanical failur...