Rodrigo Pereira Guimarães

Do complications in hip arthroscopy change with experience

PURPOSE The aim of this study was to evaluate the type and incidence of complications during the development of hip arthroscopic techniques. METHODS A retrospective series of 194 files of patients treated with hip arthroscopy in a tertiary hospital from December 1999 to March 2008 was reviewed for complications. The incidence of complications was recorded consecutively for each group of 30 patients and in intervals of 2 years. A comparison between the complication rates was performed within the time frames and the set of cases. The type and severity of complications were also recorded. RESULTS There were 12 complications (6.1%) in this series. Of these, 5 were neurologic (2.6%), 4 were musculoskeletal (2%), and 3 were vascular/ischemic (1.5%). According to severity, 2 were considered major complications (1%), 8 were intermediate (4.1%), and 2 were minor (1%). The incidence of complications did not change with time (P = .959) or with the number of cases performed (P = .771), but different types of complications occurred along the learning curve. CONCLUSIONS The nature of complications changed with experience, but no significant variation in the incidence was observed over the 9-year period of experience with hip arthroscopy. LEVEL OF EVIDENCE Level IV, therapeutic case series.

Tradução e adaptação transcultural do instrumento de avaliação do quadril "Harris Hip Score"

OBJECTIVE: The Harris Hip Score is a specific evaluation tool, originally developed to assess the results of hip arthroplasty. The objective of this study was to translate and cross-culturally adapt the Harris Hip Score for the Portuguese language. METHOD: The method of translating and culturally adapting the Harris Hip Score involved four steps: 1 - initial translation, 2 - back-translation, 3 - evaluation of the pre-final versions with the development of a consensus version, 4 - commented pre-test with development of the final version. RESULTS: The consensus version was applied to thirty patients with hip disorders. Some difficulties were identified in understanding some expressions, which were replaced by more commonly-used expressions. When the questionnaire was re-applied, it was understood by 100% of the patients, in relation to the semantic, idiomatic and conceptual meanings. CONCLUSION: The Brazilian version of the Harris Hip Score provides another important tool for assessing quality of life of patients with hip disorders. A further study is currently underway to evaluate the reliability and validity of the culturally adapted version.

Arthroscopic treatment of femoroacetabular impingement: minimum five-year follow-up

Purpose To evaluate the clinical outcomes of an arthroscopic treatment of femoroacetabular impingement at a minimum of a five-year follow-up. Methods A case series with 24 subjects (26 hips) was conducted. Subjects that were submitted to an arthroscopic procedure for the treatment of femoroacetabular impingement, at a minimum of five years, were evaluated. Subjects completed the modified Harris Hip Score (mHHS), the pain numeric rating scale and a general questionnaire accessing sports practice and satisfaction. Results Twenty-one of the 24 subjects (87.5%) were male and the average age at the time of surgery was 34.6 ± 9.5 years old (range 13-51). Of the 27 subjects submitted to hip arthroscopy, three (11.1%) could not be contacted. Follow-up was 6.1 ± 0.8 years, and at this time the average mHHS was 90.6 ± 11.6. Pain numeric rating scale was 2.6 ± 1.9 and 11 hips (42.3%) reported no pain. Of the 14 subjects that complained of hip pain during sports activities prior to surgery, 10 (71.4%) returned to normal sports activities while four (28.6%) subjects could not return to preoperative activities. Three patients had to be submitted to a new surgical procedure. All 24 subjects were satisfied with their procedure and would repeat it if necessary. Conclusions Arthroscopic treatment of femoroacetabular impingement, at five years follow-up, revealed good results in terms of improved function, pain relief and satisfaction.

Proposta de padronização do estudo radiográfico do quadril e da pelve

Diagnoses of hip and pelvis disorders are based on the detailed medical history, physical examination and laboratory tests, as appropriate for each condition. Plain radiography is still the initial examination of choice and, because of its importance, there is a need to standardize radiographic studies, both in relation to execution and in radiographic series, according to the different pathological conditions. The aim of this paper was to propose standardization for the main radiographic views of the hip and pelvis, and with regard to performing specific series for different pathological conditions, and to provide technical guidance for achieving these aims.

Epidemiology of fractures of the proximal third of the femur in elderly patients

Objective This was an epidemiological study on fractures of the proximal third of the femur in elderly patients who were treated at a teaching hospital in the central region of São Paulo. Methods The subjects were patients over the age of 60 years who were attended over a 1-year period. A questionnaire seeking basic sociodemographic data and information on comorbidities presented and medications used was drawn up. The circumstances of the fractures and their characteristics, the treatment instituted and the intra-hospital mortality rate were evaluated. Results The 113 patients included in the study presented a mean age of 79 years. The ratio between the sexes was three women to each man. Only 30.4% of the patients reported having osteoporosis and only 0.9% had had treatment for the disease. Low-energy trauma was the cause of 92.9% of the fractures. Femoral neck fractures accounted for 42.5% of the fractures and trochanteric fractures, 57.5%. Five patients did not undergo operations; 39 underwent joint replacement; and 69 underwent osteosynthesis. The mean length of hospital stay was 13.5 days and the mean length of waiting time until surgery was 7 days. The intra-hospital mortality rate was 7.1%. Conclusion The patients attended at this institution presented an epidemiological profile similar to what is found in the Brazilian literature. Chronic kidney failure is a significant factor with regard to intra-hospital mortality. Preventive measures such as early diagnosis and treatment of osteoporosis and regular physical activity practices were not implemented.

Artroscopia do quadril em atletas

OBJETIVO: Confirmar a importância terapeutica da artroscopia do quadril em atletas cuja dor impede a funcao desportiva da articulacao do quadril, sendo capaz de minimiza-la a ponto de ajudar o retorno a atividade esportiva em niveis satisfatorios. METODOS: Foram analisados 49 pacientes que praticam esporte (51 quadris), submetidos a artroscopia do quadril que apresentavam dor e incapacidade para a pratica esportiva. O seguimento minimo foi de 12 meses e o maximo de 74 meses (media de 39,0 meses). No periodo pre-operatorio avaliou-se a localizacao da dor, sua intensidade segundo a Escala de Expressao Facial (EEF) e o grau de incapacidade utilizando-se o criterio de Harris Hip Score modificado (HHS). Anotaram-se diferentes diagnosticos que levaram a indicacao da artroscopia, como impacto femoroacetabular, lesao do labio acetabular nao secundaria ao impacto femoroacetabular e outros. No periodo pos-operatorio, os pacientes foram avaliados pelos mesmos metodos do periodo pre-operatorio e pela analise subjetiva de retorno ao esporte. RESULTADOS: Baseando-se no HHS e EEF pre e pos-operatorios, a analise estatistica mostrou significância entre os valores. Observou-se alguma melhora em todos os casos e retorno ao esporte, de forma satisfatoria, na maioria deles. CONCLUSAO: Diante do que foi estudado, confirmamos que a artroscopia em atletas com lesoes localizadas no quadril e tecnica eficaz, capaz de promover o retorno a pratica esportiva na maioria dos casos, sem dor e com funcao articular efetiva, desde que bem indicada.

Hip arthroscopy in athletes

To confirm the therapeutic importance of hip arthroplasty in athletes whose pain precludes sportive function of the hip joint, being able to minimize it to the extent of helping on the return of sports practice at satisfactory levels. Methods: 49 athlete patients (51 hips) submitted to hip arthroscopy complaining of pain and inability to practice sports were assessed. Follow-up time ranged from 12 to 74 months (mean: 39.0 months). Preoperatively, pain site, severity according to Facial Expression Scale (FES) and the degree of disability using the modified Harris Hip Score (HHS) were assessed. Different diagnoses were provided, which led to the indication of arthroscopy, such as femoralacetabular impact, acetabular lip injury not secondary to femoral-acetabular impact, etc. Postoperatively, the patients were assessed by using the same methods as used at baseline and by the subjective analysis of return to sports activities. Results: Based on pre-and postoperative HHS and FES, the statistical analysis showed significance between values. We found some improvement in all cases and return to sports activities at a satisfactory level in most of the cases. Conclusion: As a result of our study, we confirm that arthroscopy in athletes with local hip injuries is an effective technique, able to promote the return to sports practice in most of the cases, without pain, and with an effective joint function, provided well indicated.

Tratamento cirúrgico para impacto femoroacetabular em um grupo que realiza agachamento

OBJETIVO: Relatar os resultados do tratamento cirurgico artroscopico de um grupo de pacientes que desenvolveram sintomas apos atividades fisicas repetitivas, movimentando o quadril em uma posicao de hiperflexao, como leg press e agachamento. METODOS: O grupo do estudo compreendeu 47 individuos (48 quadris) que desenvolveram o inicio dos sintomas dolorosos associados a exercicios de hiperflexao de quadril (leg press ou agachamento) e submetidos a tratamento artroscopico. Os pacientes foram avaliados radiografica e clinicamente segundo o Harris Hip Score modificado por Byrd (MHHS), nos periodos pre e pos-operatorio, questionados sobre seu retorno as atividades esportivas e os achados cirurgicos. RESULTADOS: A media do MHHS nos periodos pre e pos-operatorio foi, respectivamente, 60 pontos (DP 11,0, faixa 38,5-92,4) e 95,9 pontos (DP 7,7, faixa 63,8-100), aumento de 35,9 pontos (P < 0,001). Em relacao a atividade fisica, 30 individuos (71,5%) retomaram as atividades esportivas apos a cirurgia, 25 (83,4%) destes com o mesmo nivel anterior, seis individuos (12,8%) nao retornaram devido a dor persistente. Na artroscopia, 48 quadris (100%) apresentaram lesoes do labio acetabular e 41 quadris (85,4%), lesoes condrais acetabulares. CONCLUSAO: Os pacientes com sintomas dolorosos apos os exercicios de hiperflexao do quadril associados ao impacto femoroacetabular apresentaram melhora apos o tratamento artroscopico.

Tratamento artroscópico do impacto femoroacetabular

Objective: The purpose of this study is to evaluate the short- term follow-up results of arthroscopic treatment of femoro- acetabular impingement. Our hypothesis is that arthroscopic treatment results are favorable. Methods: Between August 2003 and August 2007, 28 hips had femoroacetabular im- pingement treated by hip arthroscopy. The mean age was 34 years, with mean follow-up period of 27 months. Clini- cal results were graded with the modified Harris hip score, which was measured pre- and postoperatively. Patients had also their internal rotation analyzed. These parameters were calculated by using Wilcoxons t test for analysis of nonpara- metric paired samples performed. Results: The mean preop- erative Harris Hip Score was 54.2, improving to 94.8 post- operatively (p<0,001). The mean increase was 37.5 points. We had 4 good results (15%) and 24 excellent results (85%). Preoperatively, the patients had a mean internal rotation of 17°, and, postoperatively, 36°. The average internal rotation increase was 19° (p<0,001).Conclusions: The arthroscopic treatment of femoroacetabular impingement presents satis- factory results.

Effects of ionizing radiation on proteins in lyophilized or frozen demineralized human bone

Objective The aim was to study the effects of application of ionizing radiation (gamma and electrons) as sterilizing agents at doses of 15 kGy, 25 kGy and 50 kGy, on lyophilized or frozen demineralized bone tissue for use in transplants. Methods Five human femoral diaphyses from different donors of musculoskeletal tissue were demineralized and preserved as lyophilized or frozen at −80 °C. The samples were divided into two groups: non-irradiated (control) and irradiated by means of gamma rays or an electron beam. The bone proteins were extracted and used to determine the concentrations of total protein and BMP 2 and 7. Results Decreases in total protein and BMP 2 and 7 concentrations were observed. The decreases in total protein concentrations, in comparison with the respective control groups, were significant in the lyophilized and frozen samples that were irradiated at a dose of 50 kGy of gamma radiation and electron beam, with reductions of more than 30%. Significant decreases in the levels of BMP 2 and 7 were also observed at higher doses and especially through use of the electron beam. Conclusion The reductions in the concentrations of total proteins and osteoinductive proteins (BMP 2 and 7) were related to the radiation dose, i.e. they increased with higher doses of ionizing radiation type and the type of bone preservation. The largest reductions in concentrations were observed in the bones irradiated by means of an electron beam and at a dose of 50 kGy. However, this type of radiation and this high dose are not usual practices for sterilization of bone tissue.