Bruno Gonçalves Schröder e Souza

Hip Arthroscopy for Femoroacetabular Impingement in Patients Aged 50 Years or Older

PURPOSEnThe purpose of this study was to investigate outcomes after hip arthroscopy in a consecutive series of patients aged 50 years or older and determine how long patients avoided total hip replacement.nnnMETHODSnBetween 2006 and 2008, prospectively collected data were retrieved from our database on 153 patients aged 50 years or older undergoing hip arthroscopy for femoroacetabular impingement. Data collected included range of motion, Modified Harris Hip Score (MHHS), Hip Outcome Score (HOS) for activities of daily living, HOS for sports, and Short Form 12 score. Survivors were defined as patients not requiring total hip replacement (THR). Survivorship was analyzed by use of the Kaplan-Meier method.nnnRESULTSnTHR was required after the arthroscopic treatment in 20% of patients (31 of 153). At 3 years (with data available in 64 patients), patients with greater than 2 mm of joint space had survivorship of 90% whereas those with 2 mm or less had survivorship of 57% (P = .001). In the patients who did not require THR, the MHHS improved from 58 to 84. The HOS for activities of daily living improved from 66 to 87 (P = .001), and the HOS for sports improved from 42 to 72 (P = .001). The physical component of the Short Form 12 improved from 38 to 49 (P = .001), whereas the mental component did not change (54 preoperatively v 53 postoperatively, P = .53). Median patient satisfaction was 9.nnnCONCLUSIONSnOn the basis of early results, patients with greater than 2 mm of joint space can expect improvement over preoperative status in pain and function after hip arthroscopy for femoroacetabular impingement. In patients aged 50 years or older with 2 mm of joint space or less and low preoperative MHHSs, early conversion to THR was seen.nnnLEVEL OF EVIDENCEnLevel IV, therapeutic case series.

Do complications in hip arthroscopy change with experience

PURPOSEnThe aim of this study was to evaluate the type and incidence of complications during the development of hip arthroscopic techniques.nnnMETHODSnA retrospective series of 194 files of patients treated with hip arthroscopy in a tertiary hospital from December 1999 to March 2008 was reviewed for complications. The incidence of complications was recorded consecutively for each group of 30 patients and in intervals of 2 years. A comparison between the complication rates was performed within the time frames and the set of cases. The type and severity of complications were also recorded.nnnRESULTSnThere were 12 complications (6.1%) in this series. Of these, 5 were neurologic (2.6%), 4 were musculoskeletal (2%), and 3 were vascular/ischemic (1.5%). According to severity, 2 were considered major complications (1%), 8 were intermediate (4.1%), and 2 were minor (1%). The incidence of complications did not change with time (P = .959) or with the number of cases performed (P = .771), but different types of complications occurred along the learning curve.nnnCONCLUSIONSnThe nature of complications changed with experience, but no significant variation in the incidence was observed over the 9-year period of experience with hip arthroscopy.nnnLEVEL OF EVIDENCEnLevel IV, therapeutic case series.

Tratamento artroscópico da osteocondromatose sinovial no quadril

OBJECTIVE: The objective of this study is to show the results achieved in the treatment of hip osteochondromatosis by arthroscopy. METHODS: Six patients submitted to hip arthroscopy for synovial osteochondromatosis have been assessed for pre- and postoperative function and pain. The time of preoperative complaint ranged from nine to 48 months, in an average of 28.2 months and the follow-up ranged from eight to 25 months (mean: 17.1 months). Mean age was 45.1 years, with four female patients (66.6%) and the right side affected in five cases (83.3%). RESULTS: Concerning the results according to Byrd-modified Harris criteria, the mean score evolved from 54.1 to 90.4, and the mean score on the face expressions scale for pain assessment ranged from 1.7 to 5.1. CONCLUSION: arthroscopy is a good alternative for hip osteochondromatosis treatment, although longer follow-up times are required to strictly stating this. The results found so far are encouraging, constituting a little-invasive procedure allowing good recovery.

Aspectos da distribuição de tecidos músculo-esqueléticos de um banco de tecidos

Objective: Is to evaluate the characteristics of the distribution of these grafts by a Tissue Bank in Brazil. Methods: Tissue Bank database from September 2006 to June 2008. The characteristics of the recipients were drawn up in the table form. The types of tissue processed were: femoral heads, metaphyseal-epiphyseal bone, cortical bone, flat or short bones and tendons. The intended purpose of the grafts was analyzed, and distribution frequencies were also obtained and analyzed. Results: Altogether, 734 units of fresh-frozen tissue were distributed and transplanted into 683 recipients. In terms of origin of the tissues, 97.9% came from multiple organ donors, and the remainder from living donors. A total of 489 units of cortical bone were transplanted, 137 of metaphyseal-epiphyseal bone, 44 of short or flat bones, 3 of tendon, 29 of particulate bone and 32 femoral heads. The mean age of the recipients was 50.3 years; 59.5% were women and 40.5% men. The tissues were used in orthopedic surgeries in 21.1% of the cases, and in oral and maxillofacial procedures in 78.9%. Conclusion: The Tissue Bank has increased the number of distributions in response to the growing demand for tissues, particularly for use in oral and maxillofacial procedures.

Complications and Revision Surgery in Hip Arthroscopy

The development of hip arthroscopy began in the early 1930s, with Burman [1], although it was given little attention until the 1980s, when new approaches, specific techniques, and instruments were developed. This delay can be partially attributed to the difficulties that the anatomical characteristics of the hip joint presented to the surgeon [2]. Many complications seen at that time were related to the evolving technique, inadequate instrumentation, and lack of understanding of hip joint anatomy. Initial results showed complication rates of up to 13% in reported cases [3].

ARTHROSCOPIC TREATMENT OF SYNOVIAL OSTEOCHONDROMATOSIS OF THE HIP

Objective: The objective of this study is to show the results achieved in the treatment of hip osteochondromatosis by arthroscopy. Methods: Six patients submitted to hip arthroscopy for synovial osteochondromatosis have been assessed for pre- and postoperative function and pain. The time of preoperative complaint ranged from nine to 48 months, in an average of 28.2 months and the follow-up ranged from eight to 25 months (mean: 17.1 months). Mean age was 45.1 years, with four female patients (66.6%) and the right side affected in five cases (83.3%). Results: Concerning the results according to Byrd-modified Harris criteria, the mean score evolved from 54.1 to 90.4, and the mean score on the face expressions scale for pain assessment ranged from 1.7 to 5.1. Conclusion: arthroscopy is a good alternative for hip osteochondromatosis treatment, although longer follow-up times are required to strictly stating this. The results found so far are encouraging, constituting a littleinvasive procedure allowing good recovery.