Acta Ortopedica Brasileira最新文献

Objective: To document the effects of genicular nerve ablation in patients with severe knee osteoarthritis (OAJ) at 1 and 3 months.

Methods: Prospective, randomized, and controlled trial with 35 patients with grade IV knee osteoarthritis according to Kelgren & Lawrence, undergoing genicular nerve ablation with pulsed radiofrequency (PRF) or phenol. Outcomes were assessed at baseline, 1 month, and 3 months using the Numeric Rating Scale (NRS), the Knee Injury and Osteoarthritis Outcome Score (KOOS), the 30-Second Chair Stand Test (TSL30), and the Timed Up and Go (TUG) test.

Results: The groups were similar at baseline. Both groups improved similarly up to 3 months (p<0.001). NRS decreased by an average of 30% from baseline to all subsequent assessments (p<0.05). TUG decreased between baseline and one month post-procedure (p=0.001), while TSL30 increased from baseline to one and three months (p<0.05). The average behavior of patients was equal between groups over the evaluations for all scores (p Interaction > 0.05). None of the scores differed between groups, regardless of the evaluation period (p Group > 0.05).

Conclusions: Genicular nerve ablation in patients with severe OAJ can provide lasting improvements in pain, function, and quality of life. Both methods, phenol and radiofrequency, are effective. Level of Evidence I; Controlled Randomized Clinical Trial .

Objective: The objective of the article was to do a comparative study between Smith & Nephew ® prosthesis with constricted polyethylene against the standard in patients submitted to total knee arthroplasty surgery during a short-term follow-up. The aim was to analyze the survival of the related implants due to the range of movement and radiographic aspect.

Methods: The sample was divided into two different groups: constricted polyethylene and standard polyethylene. A clinical analysis of the patients was carried out, and it was verified whether implant loosening had occurred.

Results: This study evaluated 61 patients in a period of 2 years, 29 in the constricted polyethylene group. The pre-operative deformities were predominantly considered severe. In the postoperative, the tibial-femoral angle varied on average between 5 - 6° of valgus. The total range of movement in the post-operative was above 101° in both groups. One loosened implant in the constricted polyethylene group was observed.

Conclusion: The patients treated with constricted polyethylene had the same range of movement as the control group. There was no significant difference between both groups related to loosened implants in short-term follow-up. Level of evidence III; Retrospective study.

Introduction: There are few studies in Brazil evaluating the quality of life and costs of patients undergoing total hip arthroplasty (THA).

Purpose: (1) To describe the total cost, quality of life and functional scores of patients undergoing THA in a Brazilian private hospital; (2) to determine preoperative factors associated with quality of life and total cost; and (3) to evaluate the association between cost and quality of life.

Methods: Of the 1061 patients included, pre- and peri-operative data, total costs, pre- and post-operative functional scores (HOOS, WOMAC) and quality of life scores (EQ-5D) were collected over 2 years.

Results: EQ-5D, HOOS and WOMAC improved from 0.492, 54.5 and 45.2, respectively, to 0.888, 90 and 5.9 at 1-year follow-up, and 0.892, 90.4 and 4.0 at 2-year follow-up. The average cost was R$43,324.22±11,323. Associations were observed between EQ-5D variation and male sex (RM=1.058; p=0.03) as well as age (RM=0.996; p<0.001). No association was found between total cost and EQ-5D.

Conclusions: The average cost of patients undergoing THA was R$43,324.22. There was an improvement in quality of life and function, an association between quality of life and male sex and age, however no association was found between total cost and quality of life. Level of evidence IV; Case Series.

Introduction: Hip replacement in the elderly is challenging due to their unique clinical conditions. Choosing the prosthesis requires an evaluation of risks and benefits, considering the implant's durability, postoperative recovery, and patient longevity. Uncemented prostheses have emerged as a viable alternative, offering osseointegration, as well as mechanical and biological stability.

Methods: A retrospective observational study analyzed the medical records of patients aged 70 years or older who underwent total hip arthroplasty (THA) with an uncemented prosthesis between 2013 and 2022. Age, sex, diagnosis, procedures performed, and postoperative follow-up time were evaluated.

Results: Of the 231 patients analyzed, women predominated (62%), with an average age of 78.5 years for men and 79.1 for women. There was a consistent preference for the uncemented technique across all age groups, with less than 20% of cases requiring cerclage. Complications were minimal, with over 90% of cases being complication-free, highlighting the technique's efficacy.

Conclusion: The technique reduces complications, including inflammatory reactions and long-term bone loss. The low rate of surgical revision and return to recreational activities reinforce its efficacy. Although cemented prostheses have historically been preferred, uncemented prostheses offer advantages in the elderly population, as they preserve bone and facilitate revisions. Level of evidence III; Therapeutic Studies - Investigation of Treatment Outcomes.

Purpose: To evaluate the effect, in long-term postoperative follow-up (more than 15 years), of combined spinal fusion (anterior and posterior) and only posterior on the pulmonary function of patients with congenital scoliosis.

Methods: Case series with five patients, operated on from 03/1997 to 12/2009, groups: dual approach with anterior arthrodesis through thoracotomy versus only posterior arthrodesis. Data processed in SPSS 20.0. Comparison of means (Student's t-test and Anova, or Mann-Whitney and Kruskal-Wallis/Dunn) with p = 0.05.

Results: There was no difference in the absolute and predicted percentage values of pulmonary function FVC (Forced Vital Capacity) and FEV1 (Forced Expiratory Volume in 1 Second), Cobb of the main thoracic curve and thoracic kyphosis between the groups, in the preoperative and last follow-up (p>0.05).

Conclusion: There were no significant differences in preoperative and postoperative pulmonary function parameters between the groups, after an average follow-up of 17 years, and there were also no significant differences in relation to the radiographic variables evaluated. Level of evidence IV; Serie Cases.

Objective: To evaluate the healing of supraspinatus tendon lesions after arthroscopic repair, with analysis of intra- and inter-observer agreement by two experienced evaluators for the same lesions.

Materials and methods: A study was conducted with patients evaluated in the postoperative period of arthroscopic surgery to repair isolated supraspinatus tendon ruptures, with a minimum follow-up of one year. Tendon healing was evaluated using magnetic resonance imaging by two independent evaluators at two time points, with a seven-day interval between them. Categorical data were presented in absolute and relative frequencies, and mixed linear regression models were used to analyze intra- and inter-observer agreement, with a probability of rejecting the null hypothesis of 5%.

Results: Twenty-three patients (26 shoulders) were evaluated, with a mean age of 61.5 years. At both evaluation times, most patients presented a healing grade between I and III in the Sugaya classification for both observers. The interobserver agreement was good, and the intraobserver agreement was excellent.

Conclusion: The mean tendon healing rate for arthroscopic repair of isolated supraspinatus ruptures was 81.7%. Intra-observer agreement ratings were considered excellent, while inter-observer agreement was good, demonstrating reliability in the evaluations performed. Level of Evidence II; Cross-sectional study.

Objective: To analyze the evolution of patient/tumor characteristics and treatments for GCTB in the knee in Brazil over 30 years and assess changes in local recurrence rates.

Methods: Retrospective study of 335 patients (1989-2021) from 16 Brazilian centers. Data on patient/tumor characteristics, recurrence, metastasis, and treatment trends were evaluated.

Results: Campanacci grade 3 tumors, pulmonary metastasis, and local recurrence rates were 56.7%, 5.3%, and 15.8%, respectively. Recurrence was 21.4% for curettage and 9% for resection. Curettage with denosumab showed 23.8% recurrence, versus 21% for curettage alone. Overall, local recurrence decreased from 22.9% (1989-2005) to 15.1% (2006-2021), with a significant drop after en bloc resection (23% to 7.8%), while curettage-related recurrence remained stable.

Conclusions: Despite an increase in aggressive tumors, local recurrence decreased, especially after en bloc resection. These findings emphasize the challenges of managing rare diseases in emerging economies. Level of evidence: III; Retrospective Cohort Study.

Postoperative pain management remains a significant challenge in patient care, being particularly crucial in the context of arthroscopic or open rotator cuff repairs.

Objective: To compare the effectiveness of different medications in controlling pain after this surgical intervention.

Material and methods: A systematic review of the literature was carried out, conducting a data search in the Pubmed/Medline, Science Direct and Embase databases. Initially, 1,223 articles were identified where, after detailed analysis, eight studies were selected to compose this research. The total sample comprised 703 patients.

Results: We observed a predominance of male participants in most studies, and the age range of those involved varied, on average, from 50.0 to 59.9 years old. The studies included cover a variety of pain management strategies after arthroscopic rotator cuff repair, highlighting the diversity of approaches in the literature, including analgesics, anti-inflammatories, anticonvulsants and opioids.

Conclusion: In general, we showed that the interventions used were well tolerated. Some studies have demonstrated mild adverse effects, such as nausea, vomiting, dizziness, headache and other transient symptoms. This systematic review highlights that there is no well-established protocol for managing postoperative pain in arthroscopic rotator cuff repair, comparing the effectiveness of different medications. The diversity of approaches observed in the literature highlights the need for personalized strategies. Despite the good tolerance and positive results of the interventions, the choice of medication must consider the individuality of the patient and specific characteristics of the procedure. Level of Evidence II; Systematic Review.

Objective: To report the profile of patients diagnosed with systemic sclerosis and monitored in a four-year hospital in São Paulo.

Methods: Observational study with 51 patients, mostly composed of women. Descriptive statistics such as mean age, proportions (sex, ethnicity, form of the disease), and correlations between functional scores (HAQ, SHAQ, and Rodnan score) were extracted.

Results: The average age found was 49.96 ± 12.01 years. The time since diagnosis was 11.19 ± 10.16 years. When separated by sex, 25% of men presented the limited form, while 65.9% of women presented the localized form. There was a statistically significant correlation (p-value<0.01) between the Rodnan score and the HAQ score, with a value of 0.36 (CI: 0.09-0.58), as well as with the SHAQ score (value of 0.33; CI: 0.05-0.55, p-value=0.01). When evaluating the correlation between the Rodnan score and the Cochin functional scale, there was a statistically significant correlation (p-value<0.01), with a value of 0.38 (0.12-0.58).

Conclusion: According to the literature, this study showed the highest prevalence in women, and the predominant form is limited. Level of Evidence II; Cohort Study.

Objective: This research aims to promote the development of diagnosis and training of pediatricians using the simulated model "baby hips" and to evaluate the impact on the knowledge and skills of participants about the diagnosis.

Method: An ecological study was employed using the tool the International Institute of Hip Dysplasia provided.

Results: The World Health Organization considers developmental hip dysplasia (HD) a public health problem, and Brazil has no national policy for neonatal screening for HD. Delayed diagnosis impacts public resources with hospitalizations and surgeries, while early diagnosis promotes the opportunity for conservative treatment with good results and low cost. The pediatricians are essential for neonatal screening with Barlow and Ortolani tests, which have high specificity and sensitivity during this period of the child's life.

Conclusions: A positive impact on diagnostic competence was obtained, indicating the need to promote training programs for pediatricians and stimulate public health authorities to include HD in the neonatal screening practiced in Brazil. Level of evidence II; Analytic observational cross over study.