Revista Brasileira de Ortopedia最新文献

Throughout the last few decades, the evolution of the surgical treatment of meniscal injuries has been remarkable, especially since a deeper understanding of the meniscus functions has come to light. This evolution resulted in a trend towards more conservative surgical approaches, focusing on preserving the meniscal anatomy as close as possible to the native status. Such a trend has led to a preference for meniscal repair procedures, which represents a significant change from previous practices. This transformation reflects the ongoing commitment to optimize the clinical and functional outcomes for patients with meniscal injuries.

Objective: To evaluate the anatomical conformity of 25 total knee arthroplasty (TKA) implants to the knee morphology of the Brazilian female and male population.

Methods: We analyzed 500 magnetic resonance imaging (MRI) scans of knees from 250 women and 250 men. We collected data on anteroposterior (AP) and mediolateral (ML) measurements of femurs, tibias, and implants to assess their morphological correspondence.

Results: The mean AP versus ML divergence between joint morphologies and the implants was as follows: 4.48 mm for female femurs; 4.89 mm for male femurs; 3.63 mm for female tibias; and 6.11 mm for male tibias. The implants with the best AP versus ML adaptation were: Medacta Sphere for female femurs; Stryker Triathlon for male femurs; Smith & Nephew Legion for female tibias; and Zimmer Persona for male tibias. When comparing the best femoral and tibial implant ratios for female subjects, the United Orthopedic U2 presented the best statistical score, followed by the Aesculap Columbus and Smith &Nephew Legion implants. For male patients, the implants with the highest scores were the Zimmer Persona, the Microport Advance, and the Smith & Nephew Legion. The worst ratios were found in the Peter Brehm BPK-S for female individuals and the Orthovasive Indus for male subjects.

Conclusion: The implants studied presented satisfactory results for bone coverage of the knees of Brazilian subjects of both genders undergoing TKA. However, we also found differences higher than 10 mm in most implants. This finding highlights that surgeons must carefully plan the TKA during implant selection. Imported implants proved to be more customizable than Brazilian ones in this population.

Objective: To assess the perceptions and expectations of Brazilian patients regarding robotic orthopedic knee surgery, addressing their prior knowledge, technique-related concerns, economic impact, and acceptance of the technology.

Methods: The present quantitative, observational, cross-sectional study employed a structured questionnaire administered to 218 orthopedic patients undergoing knee arthroplasty at a specialized outpatient clinic. The study evaluated sociodemographic variables, information sources and levels, expectations regarding benefits, concerns related to robotic surgery, and the economic impact on decision-making. Data analysis used descriptive and inferential statistics (Chi-squared test and logistic regression), with significance set at p  < 0.05.

Results: Most patients (75%) had superficial knowledge about robotic surgery. Their chief sources of information were the attending physicians (40%) and the internet/social media (35%). In total, 60% of the patients had a positive attitude about robotic surgery, with expectations regarding greater precision (70%) and implant durability (55%). However, concerns about high costs (50%) and lack of human control (30%) were common. Willingness to pay for the procedure out of pocket was low (30%), mainly due to its high cost and lack of health insurance coverage.

Conclusion: Patients showed high interest in robotic surgery, but they remained hesitant due to economic concerns and the lack of adequate information. Educational strategies and more accessible financing models can significantly increase the acceptance and adoption of this technology in Brazil.

Objective: To evaluate the anatomical conformity of 25 total knee arthroplasty (TKA) implants to the knee morphology of the Brazilian female and male population.

Methods: We analyzed 500 magnetic resonance imaging (MRI) scans of knees from 250 women and 250 men. We collected data on anteroposterior (AP) and mediolateral (ML) measurements of femurs, tibias, and implants to assess their morphological correspondence.

Results: The mean AP versus ML divergence between joint morphologies and the implants was as follows: 4.48 mm for female femurs; 4.89 mm for male femurs; 3.63 mm for female tibias; and 6.11 mm for male tibias. The implants with the best AP versus ML adaptation were: Medacta Sphere for female femurs; Stryker Triathlon for male femurs; Smith & Nephew Legion for female tibias; and Zimmer Persona for male tibias. When comparing the best femoral and tibial implant ratios for female subjects, the United Orthopedic U2 presented the best statistical score, followed by the Aesculap Columbus and Smith &Nephew Legion implants. For male patients, the implants with the highest scores were the Zimmer Persona, the Microport Advance, and the Smith & Nephew Legion. The worst ratios were found in the Peter Brehm BPK-S for female individuals and the Orthovasive Indus for male subjects.

Conclusion: The implants studied presented satisfactory results for bone coverage of the knees of Brazilian subjects of both genders undergoing TKA. However, we also found differences higher than 10 mm in most implants. This finding highlights that surgeons must carefully plan the TKA during implant selection. Imported implants proved to be more customizable than Brazilian ones in this population.

Objective: To evaluate the outcomes of phrenic nerve transfer in total traumatic brachial plexus injury, focusing on elbow flexion and respiratory function.

Methods: The present is a case series of 16 patients undergoing phrenic nerve transfer between 2014 and 2021. Patients over 18 years old, operated on for more than 6 months, and without other orthopedic conditions of the upper limb were included. Elbow flexion strength was assessed by Medical Research Council (MRC) scale and an isokinetic dynamometer, along with an electromyograph. Respiratory function was assessed by spirometry.

Results: The patients were mainly young men affected by motorcycle accidents. Level III on the MRC was achieved by 37.5% of patients, with 43.8% reaching level IV. On average, elbow flexion strength was of 9.1% compared with that of the unaffected arm. The study identified inconsistent deficits in respiratory function, with no severe impairment in forced vital capacity and forced expiratory volume. Respiratory symptoms were not reported. Involuntary activation of the biceps brachii during forced respiratory cycles was observed, peaking after an initial recovery period.

Conclusion: Phrenic nerve transfer effectively restored elbow flexion in most patients. We found signs of neuroplasticity that enhanced the motor control of the arm over time. We found no evidence of severe pulmonary impairment in these patients.

Throughout the last few decades, the evolution of the surgical treatment of meniscal injuries has been remarkable, especially since a deeper understanding of the meniscus functions has come to light. This evolution resulted in a trend towards more conservative surgical approaches, focusing on preserving the meniscal anatomy as close as possible to the native status. Such a trend has led to a preference for meniscal repair procedures, which represents a significant change from previous practices. This transformation reflects the ongoing commitment to optimize the clinical and functional outcomes for patients with meniscal injuries.

Objective: To assess the perceptions and expectations of Brazilian patients regarding robotic orthopedic knee surgery, addressing their prior knowledge, technique-related concerns, economic impact, and acceptance of the technology.

Methods: The present quantitative, observational, cross-sectional study employed a structured questionnaire administered to 218 orthopedic patients undergoing knee arthroplasty at a specialized outpatient clinic. The study evaluated sociodemographic variables, information sources and levels, expectations regarding benefits, concerns related to robotic surgery, and the economic impact on decision-making. Data analysis used descriptive and inferential statistics (Chi-squared test and logistic regression), with significance set at p  < 0.05.

Results: Most patients (75%) had superficial knowledge about robotic surgery. Their chief sources of information were the attending physicians (40%) and the internet/social media (35%). In total, 60% of the patients had a positive attitude about robotic surgery, with expectations regarding greater precision (70%) and implant durability (55%). However, concerns about high costs (50%) and lack of human control (30%) were common. Willingness to pay for the procedure out of pocket was low (30%), mainly due to its high cost and lack of health insurance coverage.

Conclusion: Patients showed high interest in robotic surgery, but they remained hesitant due to economic concerns and the lack of adequate information. Educational strategies and more accessible financing models can significantly increase the acceptance and adoption of this technology in Brazil.

Objective: To evaluate the outcomes of phrenic nerve transfer in total traumatic brachial plexus injury, focusing on elbow flexion and respiratory function.

Methods: The present is a case series of 16 patients undergoing phrenic nerve transfer between 2014 and 2021. Patients over 18 years old, operated on for more than 6 months, and without other orthopedic conditions of the upper limb were included. Elbow flexion strength was assessed by Medical Research Council (MRC) scale and an isokinetic dynamometer, along with an electromyograph. Respiratory function was assessed by spirometry.

Results: The patients were mainly young men affected by motorcycle accidents. Level III on the MRC was achieved by 37.5% of patients, with 43.8% reaching level IV. On average, elbow flexion strength was of 9.1% compared with that of the unaffected arm. The study identified inconsistent deficits in respiratory function, with no severe impairment in forced vital capacity and forced expiratory volume. Respiratory symptoms were not reported. Involuntary activation of the biceps brachii during forced respiratory cycles was observed, peaking after an initial recovery period.

Conclusion: Phrenic nerve transfer effectively restored elbow flexion in most patients. We found signs of neuroplasticity that enhanced the motor control of the arm over time. We found no evidence of severe pulmonary impairment in these patients.

Objective: To compare the biomechanical characteristics of olecranon osteotomy fixation using transcortical (TC) or intramedullary (IM) screws.

Methods: We sectioned synthetic polyurethane ulnas to simulate a Chevron osteotomy. Osteotomy fixations were performed using TC ( n  = 11) or IM screws ( n  = 11). After fixation, we assembled the specimens on a positioning device in the testing machine to subject them to a preload of 10 N, followed by 100 loading cycles ranging from 10 to 500 N. At the end of the 100 cycles, we maintained the 500-N load and assessed the opening of the fracture focus (gap) in the osteotomy region. Then, we applied monotonic tensile loading until fixation failure and measured the maximum resistance force, system stiffness, and failure mode.

Results: No group presented failure after the application of load cycles ranging from 10 to 500 N, with no difference in gap values ( p  = 0.9420). The maximum failure force in the IM group was 1.27 times greater than in the TC group ( p  = 0.0459). The stiffness of the 2 systems was similar ( p  = 0.670).

Conclusion: Both techniques were effective alternatives in terms of stability and rigidity. Fixation with IM screws resulted in better load-bearing capacity before failure, suggesting a potential advantage in mechanical strength. The results of the present study may help the interpretation of the clinical implications of the two techniques in investigations on fixation methods for olecranon osteotomy.

Objective: To investigate the correlation between the score on the modified Japanese Orthopaedic Association (mJOA) scale and the dynamic magnetic resonance (DMR) findings in patients diagnosed with degenerative cervical myelopathy (DCM).

Methods: We conducted a retrospective cohort study. All patients underwent a DMR examination of the cervical spine using the same device. The anatomic parameters evaluated were the spinal canal diameter (SCD) and the spinal canal width (SCW). The SCD was measured as the distance between the midpoint of the posterior portion of the intervertebral disc and the anterior margin of the yellow ligament. The SCW was measured as the distance between the anterior and posterior margins of the spinal cord at the exact point used to assess the SCD. The mJOA scale was chosen to assess the functional status. The intra and interobserver reliability of the morphometric parameters of the magnetic resonance imaging (MRI) were calculated using the intraclass correlation coefficient (ICC), and values of p  < 0.05 were considered statistically significant.

Results: Regarding the intraobserver evaluation of the SCD, an almost perfect agreement was achieved, and the SCW's interobserver evaluation presented a strong agreement. The mJOA score ranged from 6 to 18, and there was a weak, non-statistically significant correlation between the SCD and SCW parameters.

Conclusion: We could not identify a correlation involving the cervical spinal canal measurements obtained from DMR exams and the clinical severity of patients with DCM measured using the mJOA score. Due to the small sample size, these findings should be interpreted with caution.