Robson Rocha da Silva

Quality of life after total knee arthroplasty: systematic review,

Objective To review the literature on quality of life among patients who underwent total knee arthroplasty (TKA) and assess the impact of various associated factors. Methods this was a systematic review of the literature in the Medline, Embase, Lilacs and SciELO databases, using the terms: TKA (total knee arthroplasty); TKR (total knee replacement); quality of life; and outcomes. There were no restrictions regarding study design. Results 31 articles addressing this topic using various quality-of-life evaluation protocols were selected. SF-36/SF-12, WOMAC and Oxford were the ones most frequently used. The studies made it possible to define that TKA is capable of making an overall improvement in patients’ quality of life. Pain and function are among the most important predictors of improvement in quality of life, even when function remains inferior to that of healthy patients. Conclusion The factors associated negatively were obesity, advanced age, comorbidities, persistence of pain after the procedure and a lengthy wait for surgery.

Sports Activity After Total Knee Arthroplasty

BACKGROUND Osteoarthritis of the knee is a degenerative disease which affects the functional status and qua-lity of life of patients. The treatment of choice in advanced stages is total knee arthroplasty (TKA). Although the procedure consistently yields good results, functional limitations may persist after surgery. The aim of the study was to evaluate the impact of TKA on the practice of sport and how this relates to factors such as demographic and clinical data. MATERIAL AND METHODS This is a cross-sectional cohort study of operated vs. unoperated patients. A standar-diz-ed instrument for data collection was employed. Information collected comprised personal, socio-demographic and clinical data. Patients were asked about their current practice of physical exercise. We also recorded group-specific data; for the operated group, we recorded data about the surgery and, for the unoperated group, we recorded data about the disease. RESULTS Patients who had undergone TKA practiced sport twice as much as those who had not been opera-ted on yet (33.8% versus 15.5%). The prevalence of the practice of sports was significantly higher in older patients with lower levels of pain, p < 0.001 and p < 0.001, respectively. CONCLUSIONS 1.The findings of our study support the conclusion that patients are significantly more active after total knee arthroplasty. 2. Low and medium intensity sports modalities were more prevalent in operated patients. 3.We also identified that active patents tend to be older, with lower level of pain, have better functional class, and a higher level of education.

Tomographic Study of Femoral Positioning in Anterior Cruciate Ligament Reconstruction Using the Transtibial Technique

Purpose To analyze the location of the femoral tunnel by three-dimensional computed tomography (3D CT) of the lateral condyle in patients who underwent arthroscopic single-bundle anterior cruciate ligament (ACL) reconstruction, performed using a modified transtibial technique, and to compare the results with data from the literature. Materials and Methods Seventeen patients with ACL lesions underwent modified transtibial ACL reconstruction. Postoperatively, 3D CT examinations were performed and the images were analyzed by the quadrant system described by Bernard and Hertel to define the femoral tunnel coordinates. Results The mean value of femoral tunnel location coordinates was 37.1±5.9 in the horizontal plane and 23.9±7.5 in the vertical plane. Compared with other studies using the transtibial or transportal technique, femoral positioning was improved in the vertical plane. The outside-in technique provided the best results both in the vertical and horizontal planes. Conclusions The modified transtibial technique was not effective for systematically anatomic femoral tunnel positioning; however, it was relatively better than the conventional transtibial technique.

Severe valgus deformity of the knee: description of new surgical technique for its correction

Varus supracondylar osteotomy of the femur is the established procedure for treating painful knees that present lateral arthrosis and valgus deformity. In descriptions of the conventional surgical techniques, there are divergences regarding the location, access route, correction level, fixation type and area for synthesis insertion. This is most evident in cases of severe valgus with angles greater than 30° and distal femoral deformation, in association with hypoplasia of the lateral condyle. The authors describe a new surgical technique for distal femoral osteotomy, based on anatomical and geometrical criteria, which was developed in their clinic for treating severe valgus cases, and they present one of the cases treated. In the new technique, the wedge to be surgically resected has an oblique direction and the format of an isosceles triangle. This new proposal thus seeks to resolve problems that have been presented in such cases, through enabling valgus correction without causing any new deformity of the distal femur. Good cortical bone contact is promoted, and application of a stable synthesis system is made easier. However, the age limits for such patients and the degree of knee arthrosis that might contraindicate this procedure remain unknown. Hence, a larger sample and longer follow-up for operated cases are required.

COMPARATIVE STUDY OF SPINAL AND LOCAL ANESTHESIA WITH PROPOFOL INFUSION FOR KNEE ARTHROSCOPY.

Spinal anesthesia for knee arthroscopy is a well-documented and safe procedure. However, some complications and higher costs have been reported. Also, many orthopaedic surgeons are reluctant to use local anesthesia for fear of having to convert to general anesthesia due to inadequate pain control. The purpose of this study is to compare local with spinal anesthesia in two groups of patients submitted to knee arthroscopy. Sixty-five patients were divided in two groups; based on the anesthesia method used, and submitted to the same surgical routine and postoperative analgesia protocol. They were evaluated for analgesia, level of postoperative pain, and level of satisfaction with the type of anesthetic. The two groups did not present any significant differences in relation to perioperative analgesia and pain on the first postoperative day, neither was there any difference in relation to emotional state. However, there was a significant difference in terms of acceptance of the procedure; 100% said they would accept the procedure again in the local anesthesia group, compared with 60.5% in the spinal anesthesia group; also, 100% in the local anesthesia group said they felt encouraged by the type of anesthesia, compared with 67.7% in the spinal anesthesia group. We can conclude that local anesthesia is similar to spinal anesthesia in almost all the aspects investigated, except in terms of acceptance and patients’ level of satisfaction with the procedure. Local anesthesia can be a good alternative to spinal anesthesia, especially in outpatient departments, or when patients have restrictions to traditional models of anesthesia.

Deformidade acentuada em valgo do joelho: descrição de nova técnica cirúrgica para correção

A osteotomia supracondilar varizante do femur e o procedimento estabelecido para tratamento do joelho doloroso com artrose lateral e deformidade em valgo. Na descricao das tecnicas cirurgicas convencionais, ha divergencia com respeito ao local, via de acesso, grau de correcao, tipo de fixacao e regiao para colocacao da sintese, sendo mais evidente nos casos graves de valgo com angulacoes acima de 30˚e deformacao do femur distal associada a hipoplasia do condilo lateral. Os autores descrevem uma nova tecnica cirurgica de osteotomia femoral distal, baseada em criterios anatomicos e geometricos, desenvolvida no proprio servico para o tratamento de casos graves de valgo, apresentando um dos casos tratados. A nova tecnica consiste em que a cunha a ser ressecada no ato operatorio tem direcao obliqua e formato de um triângulo isosceles. A nova proposta para estes casos pretende, entao, resolver os problemas apresentados, trazendo a correcao do valgo sem causar uma nova deformidade do femur distal. E promovido um bom contato osseo cortical, alem de facilitar a aplicacao de um sistema estavel de sintese. Entretanto, ainda nao se tem ideia dos limites de idade do paciente e do grau de artrose do joelho que possam contraindicar esta cirurgia, necessitando, portanto, de maior casuistica e tempo de acompanhamento dos casos operados.