Guilherme Moreira de Abreu e Silva

Avaliação prospectiva dos pacientes submetidos à artroplastia total do joelho com e sem colocação de dreno de sucção

OBJECTIVE: Our aim is to prospectively evaluate the standard evolution and post-operative complications related to the use of suction drainage devices when compared to not using these devices in TKA. METHODS: Forty-two patients from a clinic referred to knee surgery were included. Fifteen patients did not receive suction drainage postoperatively and 27 received suction drainage. The parameters evaluated were the range of movement, hematometric indices, knee circumference, and complications for each group. Patients were observed for six months after the surgical procedure. RESULTS: There were no statistically significant differences in knee circumference, hemoglobin, hematocrit, transfusion rate, and infection index. The analysis of the range of movement did not reveal statistically significant differences between the groups preoperatively (p=0.126), during the first postoperative day (p=0.583), fifth to seventh postoperative day (p=0.076) and at six months follow-up (p=0.848). There was a statistically significant difference between groups in the comparison during the 14th and 28th postoperative days (p=0.025). CONCLUSION: In conclusion, there is no benefit to using closed suction drains beyond six months after TKA. However, the range of movement at the end of the first month is superior in patients that received suction drainage.

Complicações precoces no tratamento ortopédico das metástases ósseas

OBJETIVO: Avaliar as complicacoes precoces do tratamento ortopedico de lesoes osseas metastaticas e os fatores associados a essas complicacoes. METODOS: Foram avaliados retrospectivamente 64 pacientes submetidos a tratamento cirurgico de metastases osseas, analisando as complicacoes ocorridas no peroperatorio e pos-operatorio precoce e associando-as com a origem do tumor, o tipo de procedimento realizado, a necessidade de reposicao de sangue no peroperatorio, necessidade de novos procedimentos cirurgicos e a mortalidade em decorrencia das complicacoes. RESULTADOS: Complicacoes precoces do tratamento foram observadas em 17 (26,6%); seis (35,2%) evoluiram para obito em decorrencia dessa complicacao. De acordo com o tipo, em 15 (23,8%) casos foram complicacoes cirurgicas, em quatro (6,3%), clinicas e tres (4,7%) pacientes apresentaram tanto complicacoes clinicas quanto cirurgicas. Nao houve diferenca significativa na frequencia das complicacoes ou mortalidade quando avaliados o tipo de reconstrucao ou o local acometido. Os tumores de origem renal necessitaram de maior reposicao sanguinea e tiveram maior frequencia de complicacoes (p = 0,0001). CONCLUSAO: As complicacoes ocorreram em 26,6%. As complicacoes nao estao associadas ao tipo de tratamento realizado, nem ao local acometido. Os tumores de origem renal apresentaram risco aumentado de hemorragia.

Six month follow-up of patients submitted to total knee arthroplasty with and without placement of suction drainage devices

Objective: The aim of this study was to prospectively evaluate the evolution and postoperative complication patterns relating to the use of suction drains, in comparison with not using these devices in total knee arthroplasty (TKA) procedures. Methods: Forty-two patients at a knee surgery referral clinic were included. Fifteen patients did not receive suction drainage postoperatively and 27 received suction drainage. The parameters evaluated were the range of motion, hematological indices, knee circumference and complication rate. The observation period was for six months after the surgical procedure. Results: There were no statistically significant differences between the groups regarding knee circumference, hemoglobin, hematocrit, transfusion rate or infection index. Regarding range of motion, there was no statistically significant difference between the groups with and without drains preoperatively (p = 0.126), during the first postoperative day (p = 0.583), on the fifth to seventh postoperative day (p = 0.076) or at the six-month follow-up (p = 0.848). There was a statistically significant difference between the groups in the evaluation performed between the 14th and 28th postoperative days (p = 0.025). Conclusion: From this study, it was concluded that there was no benefit from using closed suction drains in TKA cases beyond six months after the operation. However, the range of movement at the end of the first month was greater in the patients that received suction drainage.

DISTAL FEMORAL VARUSING FOR OSTEOARTHRITIS OF VALGUS KNEE: A LONG-TERM FOLLOW-UP.

Objective: Assess the long-term results of distal femoral varusing osteotomy and try to establish predictive criteria that could help on selecting patients to be submitted to this technique. Methods: Fifteen patients with lateral compartment osteoarthritis and valgus deformity of the knee were submitted to distal femoral “V” varusing osteotomy fixated with lateral plate, pursuing knee alignment at 0° on the anatomical axis. The mean follow-up period was 81.4 months, ranging from 43 to 132 months. The Knee Society Rating System protocol was employed. Additional assessed variables were the following: patient age, follow-up time, and postoperative anatomical angle. Results: 11 results were regarded as excellent or good (73%) and four as fair or poor (27%). Conclusion: Distal femoral “V” varusing osteotomy constitutes a good treatment alternative for patients with lateral compartment osteoarthritis and valgus knee. The following variables have not been confirmed: patient age at the time of surgery, follow-up time, and postoperative anatomical angle as predictive factors for the results.

Tibial tubercle fracture associated with distal rupture of the patellar tendon: case report

Avulsion of the tibial tubercle is an uncommon injury that occurs in the young athlete, resulting from an eccentric contraction of the extensor mechanism with the leg fixed to the ground. Concomitant injuries to the patellar tendon are very rare, with few cases reported in the literature. The authors present a case of a 15-year-old basketball player who suffered an avulsion of the tibial tubercle associated with complete distal rupture of the patellar tendon while training. It was treated with open reduction of the tibial fragment and reconstruction of the patellar tendon with mini-anchors and cannulated screws, as well as hamstring autograft tendon reinforcement. The patient showed excellent results and returned to sports after 12 months of follow-up.

A functional and roentgenographic preliminary comparative study using metal-backed and all-polyethylene tibial components in total knee arthroplasty

Objective: To describe and clinically and radiographically compare patients who underwent total knee arthroplasty (TKA) with all-polyethylene (ALP) and metal-backed (MTB) tibial implants. Methods: Patients who underwent TKA between January 1988 and December 2004 were grouped according to the type of implant received: all-polyethylene or metal-backed. Sixty patients came for evaluations, totaling 82 operated knees. Among these, 22 patients had undergone TKA only with ALP (12 unilateral and 10 bilateral cases), 33 patients only with MTB (26 unilateral and 7 bilateral cases) and five patients underwent TKA with ALP in one knee and MTB in the other. The knees were divided thus: group 1, 37 knees with ALP; and group 2, 45 knees with MTB. Results: There were no differences in clinical or functional evaluations between the groups. The mean radiolucency in the femur was 0.838 mm for the patients in group 1 and 0.356 mm for the patients in group 2 (p = 0.049). For the tibia, in the AP view, there was a mean value of 2.703 mm for group 1 and 0.733 mm for group 2 (p = 0.000). In the lateral view, the mean values for osteolysis was 0.405 mm for group 1 and 0.200 mm for group 2 (p = 0.074). Conclusions: There were no differences between the groups in the functional and clinical evaluations. However, greater radiolucency was observed in the arthroplasties with ALP, both in the femur in the lateral view and in the tibia in the AP view. Level of evidence IV – case series study.

Estudo comparativo funcional e radiográfico preliminar da artroplastia total do joelho com componente tibial metal-backed e all-polyethylene

OBJECTIVE: To evaluate and clinically and roentgenographically compare two populations who had undergone total knee arthroplasty (TKA) with all-polyethylene (ALP) and metal-backed (MTB) tibial components. METHODS: Two groups of 40 patients underwent TKA between January 1988 and December 2004. Sixty patients showed up for evaluation, totaling 82 operated knees. From these, 22 patients had undergone TKA with only ALP (12 unilateral and 10 bilateral), 33 patients with only MTB (26 unilateral and 7 bilateral) and 5 patients had undergone both implants. The 82 operated knees were divided into two groups according to the type of tibial implant: Group 1 - 37 knees with ALP and Group 2 - 45 knees with MTB. RESULTS: There was no clinical or functional difference in outcome between the studied groups. The measurement of radioluscent line in the femoral component averaged 0.838 mm in Group 1 and 0.356 mm in Group 2 (p=0.049). For the tibial component, in the AP view radioluscent line measurement averaged 2.703 mm in Group 1 and 0.733 mm in Group 2 (p=0.000); and in the lateral view, the average values were 0.405 mm in Group 1 and 0.200 mm in Group 2 (p=0.074). CONCLUSIONS: There was no difference in the functional or clinical outcomes between the groups. However, radioluscent line was observed more frequently in the ALP arthroplasty group, in the lateral view in the femoral component as well as the AP view of the tibial component. Level of evidence IV - case series study.

Surgical treatment of patellofemoral instability

Objective: To describe functional outcomes following surgical treatment of patients with patellofemoral instability submitted to patellar realignment. Methods: This was a retrospective study evaluating 34 operated knees for patellofemoral instability between 1989 and 2004. The patients were evaluated in the late postoperative period when a functional questionnaire was applied. Results: After a mean follow-up time of 6 years and 5 months, the mean score was 82.94 in the surgical group (p=0.00037). The results of this investigation showed pain relief in 97.05% and low rate of recurrent dislocation (5.88%), although lower scores were seen in intense articular activities (squatting, running and jumping). No patient developed osteoarthritis while being followed up. Conclusion: The procedure for joint described in this paper was shown to be effective for treating patients with recurrent patellofemoral instability.

EARLY COMPLICATIONS IN THE ORTHOPEDIC TREATMENT OF BONE METASTASES.

Objective: To assess the early complications in the orthopedic treatment of metastatic bone lesions and the factors associated with these complications. Method: There were assessed, retrospectively, 64 patients that underwent surgical treatment for bone metastases, analyzing the complications that occurred in the pre-operative and early post- operative period and associating them with the tumor origin, type of procedure done, the need of blood reposition before the surgery, the need of new surgical procedures and the mortality due to the complications. Results: Early complications in the treatment were observed in 17 (26.6%) patients, of which six (35.2%) ended up dying due to these complications. Regarding the type, 15 (23.8%) cases were due to surgical complications, four (6.3%) clinical and three (4.7%) patients showed clinical and surgical complications. There was no significant difference in the frequency of complications or mortality when assessed the type of reconstruction or affected region. The tumors with a renal origin needed more blood reposition and showed a bigger frequency of complications. Conclusion: The complications occurred in 26.6%. The complications are not related to the kind of treatment performed or to the region affected. The renal origin tumors showed a higher risk of hemorrhage.

Tratamento cirúrgico da instabilidade fêmoro-patelar

OBJECTIVE: To describe functional outcomes following surgical treatment of patients with patellofemoral instability submitted to patellar realignment. METHODS: This was a retrospective study evaluating 34 operated knees for patellofemoral instability between 1989 and 2004. The patients were evaluated in the late postoperative period when a functional questionnaire was applied. RESULTS: After a mean follow-up time of 6 years and 5 months, the mean score was 82.94 in the surgical group (p=0.00037). The results of this investigation showed pain relief in 97.05% and low rate of recurrent dislocation (5.88%), although lower scores were seen in intense articular activities (squatting, running and jumping). No patient deve-loped osteoarthritis while being followed up. CONCLUSION: The procedure for joint described in this paper was shown to be effective for treating patients with recurrent patellofemoral instability.