Eduardo Frois Temponi

Infection after total knee replacement: diagnosis and treatment

Infection after total knee replacement (IATJ) is a rare complication. It is associated with increased morbidity and mortality increasing the final costs. Gram positive coccus and Staphylococcus coagulase-negative and Staphylococcus aureus are the most common isolated germs (>50% of the cases). Conditions related to the patient, to the surgical procedure and even to the post op have been identified as risk factors to IATJ. Many complementary methods together with clinical symptoms are useful to a proper diagnosis. Treatment for IATJ must be individualized but generally is a combination of systemic antibiotic therapy and surgical treatment. Prosthesis exchange in one or two stages is the first choice procedure. Debridement with prosthesis retention is an option in acute cases with stable implants and antibiotic sensible germs.

Infeccao em artroplastia total de joelho: diagnostico e tratamento

Infection after total knee replacement (IATJ) is a rare complication. It is associated with increased morbidity and mortality increasing the final costs. Gram positive coccus and Staphylococcus coagulase-negative and Staphylococcus aureus are the most common isolated germs (> 50% of the cases). Conditions related to the patient, to the surgical procedure and even to the post op have been identified as risk factors to IATJ. Many complementary methods together with clinical symptoms are useful to a proper diagnosis. Treatment for IATJ must be individualized but generally is a combination of systemic antibiotic therapy and Trabalho realizado no Hospital Madre Teresa, Belo Horizonte, MG, Brasil. ∗ Autor para correspondência: Hospital Madre Teresa, Av. Raja Gabaglia 1002, Gutierrez, Belo Horizonte, MG, Brasil. CEP 30430-142. E-mails: luciohcj@gmail.com, dufrois@hotmail.com (L.H. Carvalho Júnior). 0102-3616/

Partial tearing of the anterior cruciate ligament: diagnosis and treatment

– see front matter

Reducing the length of hospital stay after total knee arthroplasty: influence of femoral and sciatic nerve block

Partial tears of the anterior cruciate ligament (ACL) are common and represent 10–27% of the total. The main reasons for attending to cases of non-torn bundles are biomechanical, vascular and proprioceptive. Continued presence of the bundle also serves as protection during the healing process. There is controversy regarding the definition of these injuries, which is based on anatomy, clinical examination, translation measurements, imaging examinations and arthroscopy. The way in which it is treated will depend on the existing laxity and instability. Conservative treatment is optional for cases without instability, with a focus on motor rehabilitation. Surgical treatment is a challenge, since it requires correct positioning of the bone tunnels and conservation of the remnants of the torn bundle. The pivot shift test under anesthesia, the magnetic resonance findings, the previous level and type of sports activity and the arthroscopic appearance and mechanical properties of the remnants will aid the orthopedist in the decision-making process between conservative treatment, surgical treatment with strengthening of the native ACL (selective reconstruction) and classical (anatomical) reconstruction.

A Femoral Tunnel View Test During ACL Reconstruction

OBJECTIVE the aim of this study is to evaluate the change in length of hospital stay postoperatively for Total Knee Arthroplasty after using femoral and sciatic nerve block. MATERIALS AND METHODS the medical records of 287 patients were evaluated, taking into account the number of hours of admission, the percentage and the reason for re-hospitalization within 30 days, as well as associated complications. All patients were divided into two groups according or not to whether they were admitted to ICU or not. During the years 2009 and 2010, isolated spinal anesthesia was the method used in the procedure. From 2011 on, femoral and sciatic nerve blocking was introduced. RESULTS between the years 2009 and 2012, the average length of stay ranged from 74 hours in 2009 to 75.2 hours in 2010. The average length of stay in 2011 was 56.52 hours and 53.72 hours in 2012, all in the group of patients who did not remain in the ICU postoperatively. In the same period, among those in the group that needed ICU admission, the average length of stay was 138.7 hours in 2009, 90.25 hours in 2010, 79.8 hours in 2011, and 52.91 hours in 2012. During 2009 and 2010, the rate of re-hospitalization was 0%, while in 2011 and 2012, were 3.44% and 1%, respectively. CONCLUSION according to this study, the use of femoral and sciatic nerve blocking after total knee arthroplasty allowed significant reduction in hospital stay.

Reconstruction of chronic patellar tendon rupture using graft from contralateral patella graft together with reinforcement from flexor tendons. Case report

Despite technologic advances in the surgical techniques for anterior cruciate ligament (ACL) reconstruction, some patients continue to have violation of the femoral cortex, commonly referred to as wall blowout. These posterior or lateral cortical breaches lead to loss of graft containment and subsequent difficulty with graft fixation. If this intraoperative error is not promptly recognized and treated, the graft is at an increased risk of premature failure. Thus, in these situations, recognizing the complication and knowing strategies for alternative or salvage fixation are of importance. This article details a simple tunnel view test realized during ACL reconstruction that would enable determining the integrity and depth of the femoral tunnel. The femoral tunnel view test is a technically straightforward and quick test able to obtain a superior view of patient anatomy to facilitate accurate tunnel integrity evaluation during ACL reconstruction.

Diffuse pigmented villonodular synovitis in knee joint: diagnosis and treatment

Chronic patellar tendon rupture is a rare disabling injury that is technically difficult to repair. The true prevalence of this injury is unknown. Delayed reconstruction of chronic patellar tendon rupture has yielded suboptimal clinical and functional results. Many different surgical methods for reconstruction of chronic patellar tendon injury have been reported. In this report, we present a case with chronic patellar tendon injury that was addressed using a technique that had not previously been described in the literature, through combining procedures that had been described separately. The reconstruction method presented in this article has the advantages of being easy and reproducible, without a requirement of allografts.

Range of motion predictability after total knee arthroplasty with medial pivot prosthesis

Pigmented villonodular synovitis is a rare proliferative condition of the synovium. Although the condition can present in any joint, the knee is the most commonly affected site. Despite being a benign condition, pigmented villonodular synovitis is often aggressive, with marked extra-articular extension in some cases. Monoarticular involvement occurs in two forms: localized and diffuse. The latter is more common, with a high recurrence rate. There is no standard method of management of this lesion. Open surgery is a classical and effective method for treatment. Arthroscopic synovectomy, however, has gained popularity, and has several advantages over the open technique particularly in exclusively articular cases. The combined approach is suggested in cases with extra-articular involvement. Synovectomy through any approach may prevent secondary osteoarthritis and subsequent joint arthroplasty. Internal irradiation or external beam radiation as an adjuvant treatment to surgical synovectomy appears to decrease the rate of local recurrence in diffuse cases. The authors observed a great heterogeneity in reporting of functional results, and specific conclusions should not be drawn. Each patient should be managed in accordance with his/her particular condition.

Relationship between peri-incisional dysesthesia and the vertical and oblique incisions on the hamstrings harvest in anterior cruciate ligament reconstruction

Objective To assess whether there the final range of motion (ROM) results achieved by patients undergoing total knee arthroplasty (TKA) with prosthesis using Medial Pivot design are predictable. Methods Between January and August of 2014, 155 patients with primary osteoarthritis of knee who underwent TKA using the prosthesis ADVANCE® Medial Pivot were prospectively assessed. All ROM measures were made and recorded before, during, and after surgery. All patients were clinically assessed preoperatively and postoperatively (15, 45 days, three months, six months, one year, and annually thereafter after surgery); their functional status was assessed using the WOMAC questionnaire. Results Significant differences (p < 0.001) were observed between the means and medians of ROM in the preoperative when compared with those during the perioperative; the perioperative values, when compared with those after six months postoperative, were also different (p < 0.001). No significant differences were found between the means and medians ROM between the intraoperative period and at the 45-day assessment (ns) and between the means and medians ROM between the preoperative period and at the six-month evaluation (ns). Conclusion The final ROM achieved by patients that underwent TKA with medial pivot prosthesis can be predicted. The perioperative ROM correlates with that at 45 days after surgery. The final ROM is correlated with that of the pre-operative period.

Atypical femoral fracture due to chronic use of bisphosphonates: case report ☆

Objective To compare the incidence of peri-incisional dysesthesia according to the skin incision technique for hamstring tendon graft harvest in anterior cruciate ligament reconstruction. Methods Thirty-three patients with ACL rupture were separated in two groups: group 1, with 19 patients submitted to the oblique skin incision to access the hamstrings and group 2–14 patients operated by vertical skin incision technique. The selected patients were assessed after surgery. Demographic data and prevalence of dysesthesia was measured by digital pressure around the skin incision and classified according to the Highet scale. Results The total rate of dysesthesia was 42% (14 patients). Five patients (26%) on the oblique incision group reported dysesthesia symptoms. On the group submitted to the vertical incision technique, the involvement was 64% (nine patients). On the 33 knees evaluated, the superior lateral area was the most affected skin region, while the superior medial and inferior medial regions were affected in only one patient (7.1%). No statistical differences between both groups were observed regarding patients’ weight, age, and height¸ as well as skin incision length. Conclusion Patients who underwent reconstruction of the anterior cruciate ligament using the oblique access technique had five times lower incidence of peri-incisional dysesthesia when compared with those in whom the vertical access technique was used.