Lúcio Honório de Carvalho Júnior

Amplitude de movimento após artroplastia total do joelho

OBJECTIVE: To evaluate knee range of motion (ROM) after at least six months postoperatively in total knee arthroplasty, by comparing it to baseline value. MATERIALS AND METHODS: Ranges of motion of eighty arthroplasties were analyzed within an average follow-up of 21.9 months. RESULTS: No significant differences between pre- and postoperative averages for extension (p=0.09) and flexion (p=0.47) were found. By dividing the patients into two groups, a significant flexion improvement was seen in those with pre-op flexion equal or smaller than 90o (n=17) (p=0.000037). In the other group, a significant decrease in flexion was seen in those with pre-op flexion equal or greater than 120o (n=31) (p=0.000068). Four patients have been submitted to knee manipulations within an average of 2.1 months postoperatively. The mean flexion rate before manipulation and after six months was significantly different (p=0.0068). The mean pre-op flexion and after six months postoperatively was similar (p=0.28). CONCLUSION: Preoperative flexion significantly influences the post-op flexion in total knee arthroplasty. Its measurement provides the surgeon with a good parameter for previewing this.OBJECTIVE: To evaluate knee range of motion (ROM) after at least six months postoperatively in total knee arthroplasty, by comparing it to baseline value. MATERIALS AND METHODS: Ranges of motion of eighty arthroplasties were analyzed within an average follow-up of 21.9 months. RESULTS: No significant differences between pre- and postoperative averages for extension (p=0.09) and flexion (p=0.47) were found. By dividing the patients into two groups, a significant flexion improvement was seen in those with pre-op flexion equal or smaller than 90o (n=17) (p=0.000037). In the other group, a significant decrease in flexion was seen in those with pre-op flexion equal or greater than 120o (n=31) (p=0.000068). Four patients have been submitted to knee manipulations within an average of 2.1 months postoperatively. The mean flexion rate before manipulation and after six months was significantly different (p=0.0068). The mean pre-op flexion and after six months postoperatively was similar (p=0.28). CONCLUSION: Preoperative flexion significantly influences the post-op flexion in total knee arthroplasty. Its measurement provides the surgeon with a good parameter for previewing this.

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.

Reconstrução do ligamento patelofemoral medial para tratamento da luxação recidivante da patela

OBJECTIVE: To present a new technique for reconstruction of the medial patellofemoral ligament (MPFL) in patients with recurrent patellar dislocation and to evaluate the clinical findings from this. METHODS: Between January 2007 and January 2008, 23 patients underwent reconstruction of the MPFL with a free graft from the semitendinosus tendon. After a minimum of 244 months of follow-up, 22 patients were evaluated using the Kujala and Lysholm clinical protocols. RESULTS: The mean follow up was 26.2 months. According to the Lysholm protocol, the patients had a mean score of 53.72 points preoperatively and 93.36 points postoperatively (p = 0.000006). According to the Kujala protocol, the mean score was 59.81 points preoperatively and 83.54 points postoperatively (p = 0.002173). CONCLUSION: Reconstruction of the medial patellofemoral ligament using the proposed technique showed excellent results over the short term, when evaluated by means of clinical protocols.

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

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Reconstrução do ligamento cruzado anterior com o terço central do tendão do músculo quadríceps: análise de resultados após 10 anos

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.

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

OBJETIVO: Avaliar os resultados clinicos utilizando dois diferentes protocolos, 10 anos apos a cirurgia de reconstrucao do LCA (Ligamento Cruzado Anterior) com o terco central do tendao do musculo quadriceps (TQ). METODO: Entre novembro/1997 e abril/1998, 25 pacientes foram submetidos a 25 reconstrucoes do LCA com TQ pela tecnica transtibial. A parte ossea do enxerto foi fixada no tunel femoral com parafuso de interferencia e a parte tendinosa no tunel tibial, com parafuso em poste com arruela. Dois pacientes romperam o novo ligamento em entorses durante futebol. Seis nao foram encontrados para reavaliacao (24%). Foram avaliados 17 pacientes, sendo 15 homens e duas mulheres, com media de idade na cirurgia de 28,53 ± 6,64 anos. Todos foram examinados com seis meses, um ano e dez anos de cirurgia. A avaliacao clinica foi realizada com a escala de Lysholm e a do o joelho, com a do Hospital for Special Surgery. RESULTADOS: As lesoes foram operadas apos 9,87 ± 14,42 meses do acidente. Segundo a escala de Lysholm, os resultados ao fim do primeiro ano foram de 98,71 ± 2,47 e, ao fim de dez anos, de 97,35 ± 3,12. Usando a escala do Hospital for Special Surgery, a pontuacao foi de 95,07 ± 5,23 com um ano e de 94,87 ± 4,16 apos 10 anos. Todos os pacientes retornaram ao trabalho nas mesmas condicoes. Quinze (88,24%) retornaram ao mesmo esporte, um com modificacao na pratica e outro mudou de esporte. Nenhum paciente se queixou dor na area doadora do enxerto apos quatro semanas da cirurgia ate a ultima avaliacao. Quatro pacientes sofreram ruptura do LCA contralateral em atividades esportivas, sendo tres entorses no futebol e uma durante danca. CONCLUSAO: O enxerto do TQ e boa opcao para a reconstrucao do LCA, mesmo quando decorridos 10 anos do procedimento cirurgico. Nao houve dor na area doadora do enxerto a medio e longo prazo. A taxa de retorno ao esporte foi excelente e nao houve alteracao da articulacao femoropatelar.

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.

Femoral roll back in total knee arthroplasty: comparison between prostheses that preserve and sacrifice the posterior cruciate ligament

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.