Carlos Augusto Malheiros Luzo

Contrast-enhanced power Doppler imaging: comparison with scintigraphic phases of revascularization of the femoral head in Legg-Calvé-Perthes disease.

The authors evaluated the usefulness of an ultrasound contrast agent (SHU 508A) to help identify different scintigraphic phases of revascularization of the femoral head in children with Legg-Calvé-Perthes (LCP) disease. Eighteen unenhanced and contrast-enhanced power Doppler images and scintigrams of the pathologic hip in 18 children with LCP disease were compared. The scintigraphic stages of Conways classification for LCP disease (stage A, recanalization; stage B, neovascularization) were compared with the degree of vascularity and mean peak enhancement ratios obtained from analysis of Doppler sonograms. Qualitatively, the patients age (≤ or >7 years old) at the time of examination had a significant effect on the degree of vascularity visualized on postcontrast ultrasound images according to the scintigraphic stages. Quantitatively, there were no differences for overall mean peak enhancement ratios between stages A and B. Power Doppler ultrasound increased visualization of Doppler signals significantly but did not help in differentiating scintigraphic phases.

Total hip arthroplasty using a posterior minimally invasive approach - results after six years

Objective To evaluate the medium-term clinical–functional results (minimum follow-up of six years) from total uncemented hip arthroplasty performed by means of a posterior minimally invasive access, in comparison with the traditional right lateral access. Methods In a comparative prospective study, 224 adult patients underwent elective total hip arthroplasty due to a diagnosis of primary or secondary osteoarthrosis. A group of 103 patients with posterior minimally invasive access was compared with a group of 121 patients with the traditional right lateral access. The mean length of follow-up among the patients of this sample was 7.2 years. We evaluated the clinical–functional and radiographic results and occurrences of loosening, along with any complications that occurred, with a minimum follow-up of six years. Results The clinical–functional analyses before the surgical procedure and six years afterwards were similar in the two groups (p = 0.88 and p = 0.55). One patient in the minimally invasive group underwent revision of the acetabular component and two patients in the control group underwent the same procedure (p = 0.46). The Trendelenburg clinical test, which showed weakness of the hip abductor musculature, was present in five patients operated using the traditional lateral route and absent in all those who underwent the minimally invasive procedure (p = 0.06). There was no difference regarding the radiographic parameters obtained, either in acetabular or in femoral positioning (p = 0.32 and p = 0.58). Conclusions The medium-term clinical and radiographic results and the complication rates were similar between the patients who underwent total hip arthroplasty by means of the posterior minimally invasive access and those with the traditional lateral access.

Initial experience of use of an articulated external fixator in treating Legg-Calvé-Perthes disease by means of arthrodiastasis during the active phase of the disease

Objective To present the preliminary results from treating patients with Legg-Calvé-Perthes Disease (LCPD) by means of hip arthrodiastasis using a monolateral external fixator applied to the hip and to succinctly describe the surgical technique used, in a prospective study. Methods Prospective study on 18 patients with LCPD who underwent surgical treatment by means of the hip arthrodiastasis technique using a monolateral external fixator. There were 13 male and five female patients of mean age 8.5 years, ranging from five to 13 years. All the patients presented unilateral hip impairment: nine on the right side and nine on the left. The results were evaluated at maturity using clinical and radiological criteria. Results All the patients evolved with improvement of joint mobility, and pain relief was achieved in 88.9% of them. Reossification of the femoral epiphysis occurred within the first three months of the treatment. The hips operated at the necrosis stage of the disease did not passed through the fragmentation stage, thus shortening the evolution of the disease. The results were 77.8% satisfactory and 22.2% unsatisfactory. Conclusion Hip arthrodiastasis with a monolateral external fixator during the active phase of LCPD improved the degree of joint mobility. Use of the arthrodiastasis technique at the necrosis stage or at the fragmentation stage (active phase of the disease) presented satisfactory results from treatment of LCPD.

Artrodiastase para o tratamento da rigidez do quadril na artrite reumatoide juvenil (ARJ): resultados preliminares

OBJETIVO: Apresentar os resultados preliminares da utilizacao da artrodiastase do quadril em pacientes portadores de artrite reumatoide juvenil e com comprometimento da articulacao coxofemoral. METODOS: Estudo prospectivo de 12 pacientes (seis meninos e seis meninas) com idades entre oito e 18 anos (media de 10,5 anos). Foi utilizado um fixador externo monolateral que permite os movimentos de flexao e de extensao no quadril. O fixador externo foi mantido por um periodo que variou de 78 a 90 dias, com media de 86 dias. O controle radiografico foi realizado durante o ato operatorio e, semanalmente, durante o periodo de tracao e a cada quatro semanas, quando terminado este periodo. Na avaliacao clinica dos resultados, incluimos a graduacao da dor e o grau de movimentacao articular, com medidas e avaliacoes pre e pos-operatorias. O periodo de acompanhamento variou de 12 a 15 anos, com media de 13 anos. RESULTADOS: O valor medio da escala de dor foi de nove (9) antes da operacao e de quatro (4) no periodo pos-operatorio. Em dois pacientes nao ocorreu melhora da dor. O arco de movimento do quadril aumentou em todos os pacientes, com excecao de dois. Na avaliacao radiografica evidenciamos um aumento no espaco articular de 2mm, em media, e que se manteve no pos-operatorio. Nao foram observadas complicacoes com a utilizacao da tecnica. Apenas verificamos soltura dos pinos de Schanz da regiao do osso iliaco em dois pacientes. A tecnica operatoria nao ocasionou resultado satisfatorio. CONCLUSAO: O procedimento de artrodiastase esta bem indicado para a recuperacao da mobilidade em uma articulacao coxofemoral comprometida e rigida, como ocorre em pacientes com artrite reumatoide juvenil.