Caio Oliveira D'Elia

Tratamento das infecções pós artroplastia total de joelho: resultados com 2 anos de seguimento

OBJECTIVE: The objective of this study is to analyze and standardize the treatment protocol of infections following total knee arthroplasty proposed by the Knee Group and the Infectology Group of IOT-HC-FMUSP. MATERIALS AND METHODS: Between 2003 and 2004, twenty-nine patients (19 women and 10 men, mean age: 67 years) diagnosed with infection after total primary knee arthroplasty were hospitalized at IOT-HC FMUSP (Institute of Orthopedics and Traumatology of Hospital das Clinicas, Medical College, University of Sao Paulo, SP, Brazil) and subjected to a treatment protocol. The mean follow-up time was 20 months. Nine cases had superficial infections, three had acute deep infections and eighteen had chronic deep infections. The classification is based on local clinical criteria and on the time of symptoms onset. RESULTS: Eight patients with superficial infection and three patients with acute deep infection were treated, showing good outcomes and no recurrence cases. Eighteen patients with chronic deep infection were treated and cured, 14 of whom with no recurrence during the follow-up period. CONCLUSION: We regard our outcomes and treatment protocol as appropriate and consistent with literature.

Infecção pós-artoplastia total do joelho: considerações e protocolo de tratamento

Total knee arthroplasty results have markedly improved during the last decades due to diffusion of accurate surgical techniques and development of high-technology implant materials. However, complications still develop, infection being that of most difficult resolution. Risk factors for infection, classification of infections, clinical and surgical conditions, as well as diagnostic methods are discussed in the present article. Therapeutic options include suppression by antibiotic therapy, maintenance of the prosthesis, immediate or two-step replacement of prosthetic, and salvage procedures. In addition, the authors describe the treatment protocol used by the Arthroplasty Group in the Institute of Orthopedics and Traumatology (I.O.T.) of the Clinics Hospital of the Medical School of the Sao Paulo University.

Osteoarticular complications related to HIV infection and highly active antiretroviral therapy

With the significant increase in life expectancy for HIV-infected patients in the era of high potency antiretroviral therapy, major metabolic changes have been observed due to the prolonged period of the viral infection and the treatment itself. Osteoarticular changes resulting from these processes are mainly reported in long term HIV-infected patients receiving high potency antiretroviral therapy and include osteopenia/osteoporosis, osteonecrosis, carpal tunnel syndrome and adhesive capsulitis of the shoulder.

Aseptic Loosening of Total Hip Arthroplasty: Preliminary Genetic Investigation

Femoral and acetabular loosening can be attributed different factors, but the causes and mechanism of early failure are still obscure. The objective of this study was to investigate the relationship between gene polymorphisms and early implant failure. Fifty-eight patients older than 50 years was recruited for analysis of MMP-1 promoter polymorphisms in early osseointegrated implant failure. The results showed in control group a frequency of 20.97% of 2G allele and 67.74% the genotype 1G/1G whereas, in the test group, a frequency of 83.33% of 2G allele and 66.66% the genotype 2G/2G. These results indicate that the polymorphism in the promoter of the MMP-1 gene could be a risk factor for early implant failure of total hip arthroplasty.

RANDOMIZED PROSPECTIVE STUDY ON TRAUMATIC PATELLAR DISLOCATION: CONSERVATIVE TREATMENT VERSUS RECONSTRUCTION OF THE MEDIAL PATELLOFEMORAL LIGAMENT USING THE PATELLAR TENDON, WITH A MINIMUM OF TWO YEARS OF FOLLOW-UP

Objective: The aim of this study was to compare the surgical results from reconstruction of the medial patellofemoral ligament (MPFL) with non-operative treatment of primary patellar dislocation. Methods: Thirty-nine patients (41 knees) with patellar dislocation were randomized into two groups. One group was treated conservatively (immobilization and physiotherapy) and other was treated surgically with reconstruction of the MPFL, and the results were evaluated with a minimum follow-up of two years. The Kujala questionnaire was applied to assess pain and quality of life, and recurrences were evaluated. Pearsons chi-square test and Fishers exact test were used in the statistical evaluation. Results: The statistical analysis showed that the mean Kujala score was significantly lower in the conservative group (70.8), compared with the mean value in the surgical group (88.9), with p = 0.001. The surgical group presented a higher percentage of “good/excellent” Kujala score results (71.43%) than in the conservative group (25.0%), with p = 0.003. The conservative group presented a greater number of recurrences (35% of the cases), while in the surgical group there were no reports of recurrences and/or subluxation. Conclusions: Treatment with reconstruction of the medial patellofemoral ligament using the patellar tendon produced better results, based on the analysis of post-treatment recurrences and the better final results from the Kujala questionnaire after a minimum follow-up period of two years.

Revisão da artroplastia total de joelho em dois tempos: o valor da cultura obtida por biópsia artroscópica

OBJETIVO: O tratamento mais utilizado para o tratamento das infeccoes profundas nas artroplastias totais do joelho tem sido a revisao em dois tempos. Mesmo seguindo os passos preconizados neste tipo de tratamento, ainda existe a duvida do periodo certo para realizar o segundo tempo da revisao sem o risco de colocacao de um novo implante em uma area ainda infectada. Nosso trabalho tem como objetivo determinar o valor da cultura obtida por biopsia artroscopica, a fim de determinar o momento adequado para a realizacao do segundo tempo da revisao e tambem o tempo adequado para manter o espacador. MATERIAL E METODOS: Doze pacientes com o diagnostico de infeccao profunda pos-artroplastia total de joelho primaria foram submetidos ao protocolo de revisao em dois tempos, e apos seis semanas da colocacao do espacador e da antibioticoterapia, o paciente foi submetido a biopsia artroscopica no joelho infectado e atraves dela foram colhidas amostras para cultura a fim de verificar se o momento era adequado para a realizacao do segundo tempo da revisao. RESULTADOS: Os resultados das culturas de todos os pacientes submetidos a biopsia artroscopica foram negativos, sendo todos submetidos ao segundo tempo da revisao. Das culturas colhidas durante o implante da nova protese, onze confirmaram a inexistencia de processo infeccioso ativo no sitio cirurgico; uma cultura foi positiva, sendo isolado neste paciente Staphyloccocus aureus sensivel a oxacilina. CONCLUSAO: Apesar do pequeno numero de casos, concluimos que a cultura obtida pela biopsia artroscopica tem valor e mostrou que seis semanas e o tempo adequado para manutencao do espacador.

Comparação funcional entre revisão de artroplastia de joelho séptica e asséptica

INTRODUCAO: A artroplastia total de joelho (ATJ) nao e um procedimento isento de riscos. A infeccao na ATJ nao e a complicacao mais comum, porem e uma das mais graves. A revisao em 2 tempos e a escolha nos casos de infeccao profunda da protese de joelho. Por outro lado, a soltura asseptica chega a quase metade das indicacoes de revisao de artroplastias primarias. A queda do nivel de satisfacao do paciente pode cair nas revisoes. OBJETIVO: O objetivo do presente estudo foi comparar atraves dos resultados obtidos nos escores funcionais e de qualidade de vida entre cirurgia de revisao de ATJ por soltura septica e asseptica. METODO: Realizamos escores HSS e SF-36 para avaliar a qualidade de vida e o resultado funcional entre pacientes submetidos a cirurgia de revisao da ATJ entre dois grupos, um que realizou a substituicao da protese em dois tempos (septica) e outro no qual a substituicao ocorreu em tempo unico (asseptica). RESULTADOS: A analise dos dados obtidos mostra melhor desempenho do segundo grupo na pontuacao do HSS e em 06 dos 08 dominios do SF-36. Conclusao: A revisao de ATJ em tempo unico apresenta melhores resultados funcionais.

Bioabsorbable Suture Anchor Migration to the Acromioclavicular Joint: How Far Can These Implants Go?

Few complications regarding the use of bioabsorbable suture anchors in the shoulder have been reported. What motivated this case report was the unusual location of the anchor, found in the acromioclavicular joint which, to our knowledge, has never been reported so far. A 53-year old male with previous rotator cuff (RC) repair using bioabsorbable suture anchors presented with pain and weakness after 2 years of surgery. A suspicion of retear of the RC led to request of a magnetic resonance image, in which the implant was found located in the acromioclavicular joint. The complications reported with the use of metallic implants around the shoulder led to the development of bioabsorbable anchors. Advantages are their absorption over time, minimizing the risk of migration or interference with revision surgery, less artifacts with magnetic resonance imaging, and tendon-to-bone repair strength similar to metallic anchors. Since the use of bioabsorbable suture anchors is increasing, it is important to know the possible complications associated with these devices.

Acute Calcaneus Tendon Rupture Associated with Ipsilateral Malleolar Fracture: Case Report and Literature Review

Malleolar fractures are rarely associated with lesions of the adjacent tendons or neurovascular structures. The association of ankle fractures with Achilles tendon rupture is even more infrequent, although both of these injuries are very common in and of themselves. To our knowledge, fracture of the lateral malleolus in association with an acute rupture of the ipsilateral calcaneus tendon has not been previously described. In this article, we describe a female patient who sustained an acute rupture of the Achilles tendon in conjunction with fracture of the ipsilateral lateral malleolus.

Neurapraxia do femoral pelo uso do garrote: relato de caso

The authors describe the case of a 27 year-old female patient submitted to knee surgery for patellar realignment with the use of a pneumatic tourniquet, who developed femoral neurapraxia. They make a brief literature review about the advantages and disadvantages of using a tourniquet in knee surgeries, and discuss the need for tourniquet indication considering the complications entailed by the incorrect use of the tourniquet.