Unicompartmental knee arthroplasty: current perspectives and trends in Brazil

OBJECTIVE: The aim of this study was to evaluate the approaches and procedures used by Brazilian orthopedic surgeons for treating osteoarthrosis by means of unicompartmental knee arthroplasty and high tibial osteotomy of the knee. METHODS: A questionnaire with 14 closed questions was developed and applied to Brazilian knee surgeons during the three days of the 43rd Brazilian Congress of Orthopedics and Traumatology. RESULTS: A total of 113 surgeons filled out the questionnaire completely and became part of the sample analyzed. In this study, the majority of the surgeons performed fewer than five unicompartmental knee arthroplasty procedures/year (61.1%) and between 5 and 15 high tibial osteotomy procedures/year (37.2%). Use of computerized navigation systems during surgery remains uncommon in our environment, since only 0.9% of the specialists were using it. 65.5% of the surgeons reported that they had chosen to use total knee arthroplasty rather than partial arthroplasty due to lack of familiarity with the surgical technique. When asked about the possibility that the number of unicompartmental prostheses used in Brazil would grow as surgeons in this country become increasingly familiar with the technique, 80.5% of the respondents believed in this hypothesis. In this sample, we found that the greater the surgeon's experience was, the greater the numbers of unicompartmental prostheses and tibial osteotomies performed annually were (r = 0.550 and r = 0.465, respectively; p < 0.05). CONCLUSIONS: There is a clear evolutional trend towards treatment of unicompartmental osteoarthritis using partial knee arthroplasty in Brazil. However, further prospective controlled studies are needed in order to evaluate the clinical and scientific benefits of these trends.OBJETIVO: O objetivo deste estudo é avaliar as condutas e procedimentos realizados pelos cirurgiões de joelho do Brasil no tratamento da osteoartrose com artroplastia unicompartimental e osteotomia tibial alta do joelho. MÉTODOS: Um questionário de 14 questões fechadas foi elaborado e aplicado a cirurgiões brasileiros de joelho durante os três dias do 43º Congresso Brasileiro de Ortopedia e Traumatologia. RESULTADOS: Um total de 113 cirurgiões de joelho preencheram completamente o questionário e fizeram parte da amostra analisada. Neste estudo, a maioria dos cirurgiões realizava menos de cinco artroplastias unicompartimentais do joelho/ano (61,1%) e entre cinco e 15 osteotomias tibiais altas/ano (37,2%). A utilização de navegação computadorizada no intraoperatório é ainda infrequente em nosso meio, sendo realizada por apenas 0,9% dos especialistas. A opção pelo uso da artroplastia total do joelho em detrimento da parcial devido à falta de familiaridade com a técnica cirúrgica foi relatada por 65,5% dos cirurgiões. Quando arguidos sobre a possibilidade de crescimento no número de próteses unicompartimentais no Brasil com o aumento da familiaridade com a técnica pelos cirurgiões do País, 80,5% dos entrevistados responderam que acreditam nesta hipótese. Nesta amostra, constatamos que quanto maior a experiência do cirurgião maior o número de próteses unicompartimentais e osteotomias tibiais realizadas anualmente (r = 0,550 e r = 0,465, respectivamente, e p < 0,05). CONCLUSÕES: Existem claras tendências em evolução no tratamento da osteoartrose unicompartimental com artroplastia parcial do joelho no Brasil. No entanto, mais estudos prospectivos controlados são necessários para avaliar o benefício clínico e científico destas tendências.Universidade Federal de São Paulo (UNIFESP) Departamento de Ortopedia e Traumatologia Centro de Traumatologia do EsporteUniversidade Federal de São Paulo (UNIFESP) Departamento de Ortopedia e TraumatologiaUNIFESP, Depto. de Ortopedia e Traumatologia Centro de Traumatologia do EsporteUNIFESP, Depto. de Ortopedia e TraumatologiaSciEL

Cross-evaluation of the therapeutical methods for idiopathic congenital clubfoot (talipes equinovarus): controversies regarding the tendocalcaneous tenotomy

OBJECTIVE: There has been a lot of discussion regarding the treatment of congenital clubfoot (talipes equinovarus,) and Posenti's methodology currently seems to be the most rational, offering high rates of satisfactory results when compared to Kite's approach that prevailed in orthopedics until the end of the 90s. With the recent change of concepts, this study purports to analyze the profile of orthopedists treating this infirmity in Brazil, through a questionnaire used at the 39th Brazilian Congress of Orthopaedics and Traumatology, since such data is unknown in the Brazilian literature. METHODS: An investigative questionnaire was prepared to ascertain the treatment method used, the characteristics of the population studied, the results acquired with treatment and, particularly, how they approached the Achilles tendon. RESULTS: Of the 5,329 registered orthopedists, we acquired 539 spontaneous participations. Of these, only 88 (16.30%) orthopedists perform the treatment for congenital clubfoot; 78 (88.60%) use the Ponseti method and 9 (10.20%) use Kite's; for 47.70%, conservative treatment is performed between 4 and 6 months and for 35.30%, between 1 and 3 months; 58 (66.00%) interviewees perform the Achilles tendon tenotomy in 80% to 100% of their patients and 59 (67.05%) perform it at a surgical center due to safety conditions, sterilized environment, anesthesia, ease of access, and patient monitoring; 32 (36.36%) orthopedists present 80% of good results or more, 54 (61.36%) present 50% to 80% good results and 46 (52.27%) present a 10% relapse rate. CONCLUSIONS: Although the Ponseti Method defines that the Achilles tendon tenotomy should be performed in an outpatient setting, most of the orthopedists (59 - 67.05%) perform it in the operating room.OBJETIVO: Há muita discussão em relação ao tratamento do pé torto congênito equino-cavo-varo e atualmente a sistemática proposta por Ponseti parece ser a mais racional oferecendo altas taxas de resultados satisfatórios em detrimento à metodologia de Kite que predominou no meio ortopédico até o final da década de 90. Com a recente mudança de conceitos, este trabalho tem o intuito de analisar, por meio de questionário aplicado no 39° Congresso Brasileiro de Ortopedia e Traumatologia, o perfil dos ortopedistas no Brasil frente a esta afecção, fato este desconhecido considerando a literatura nacional. MÉTODO: Um questionário para investigação foi elaborado para verificar o método de tratamento utilizado, as características da população estudada, os resultados obtidos com o tratamento e particularmente como abordam cirurgicamente o tendão calcâneo. RESULTADOS: Do total de 5.329 ortopedistas inscritos, obtivemos 539 participações espontâneas; destes, somente 88 (16,30%) indivíduos executam o tratamento para o pé torto congênito; 78 (88,60%) aplicam o método de Ponseti; e nove (10,20%) o de Kite. Para 47,70%, o tratamento conservador é realizado entre quatro e seis meses e para 35,20% entre um e três meses; 58 (66,00%) entrevistados efetuam a tenotomia do tendão calcâneo em 80% a 100% de seus pacientes e 59 (67,05%) a realizam no centro cirúrgico devido às condições de segurança, assepsia, anestesia, facilidade de acesso e monitorização do paciente; 32 (36,36%) ortopedistas apresentam 80% ou mais de bons resultados, 54 (61,36%) apresentam 50% a 80% de bons resultados e 46 (52,27%) apresentam taxa de recidiva de 10%. CONCLUSÃO: Embora o método de Ponseti defina que a tenotomia do tendão calcâneo seja realizada ambulatorialmente com anestesia local, a maioria 59 (67,05%) dos ortopedistas a realiza no centro cirúrgico.Universidade Federal de São Paulo (UNIFESP) Departamento de Ortopedia e TraumatologiaUniversidade Federal de São Paulo (UNIFESP) Departamento de Ortopedia e Traumatologia Ortopedia PediátricaUNIFESP, Depto. de Ortopedia e TraumatologiaUNIFESP, Depto. de Ortopedia e Traumatologia Ortopedia PediátricaSciEL

Microleakage of “bulk-fill” composite resin for class II restorations pretreated with CO2 laser in deciduous molars: an in vitro study

Introduction: Microleakage has been reported to cause dentin hypersensitivity because of the passage of bacteria and their products through the restoration-tooth interface and is one of the main reasons for replacement of restorations. CO2 laser can be used for treatment of dentin hypersensitivity. Thus, this study aimed to evaluate in vitro the microleakage in composite restorations following surface pretreatment with acid etching and CO2 laser.Methods: Twelve human caries-free primary molars were selected. Class II cavities were prepared on occlusal mesial and occlusal distal surfaces. Specimens were randomly divided into four groups (n = 6): Group 1 (G1) – 37% phosphoric acid gel etching + Beautiful-Bulk Restorative – Giomer (Shofu Inc); Group 2 (G2) – 37% phosphoric acid gel etching + SDR Bulk-Fill Flow (Dentsply); Group 3 (G3) – CO2 laser irradiation + Beautiful-Bulk Restorative – Giomer (Shofu Inc); Group 4 (G4) – CO2 laser irradiation + SDR Bulk-Fill Flow (Dentsply). Surfaces were restored with bonding agent (Natural Bond DE, DFL). Specimens were cut longitudinally and immersed in 0.5% methylene blue solution for 4 hours. Microleakage scores were assessed under a magnifying glass at x3,5 and qualitatively analyzed by scanning electron microscope (SEM). Data were analyzed using nonparametric Wilcoxon test (P &lt; 0.05).Results: Scores prevailed between 0 and 2, however, no statistically significant difference was found among the groups (P = 0.05).Conclusion: It could be concluded that all composite resins bulk fill did not show significant difference among them regarding microleakage using either CO2 laser or 37% phosphoric acid etching.  

Immediate Evaluation of the Effect of Infrared LED Photobiomodulation on Childhood Sleep Bruxism: A Randomized Clinical Trial.

peer reviewedThe gold standard for the management of sleep bruxism (SB) is the use of a rigid occlusal splint; however, there are limitations for its use in children and alternatives to the management of SB are needed. Photobiomodulation therapy has been used with positive results in temporomandibular disorders. This study aimed to evaluate the effects of photobiomodulation therapy with infrared LED in children with SB. Thirty children were divided into three groups: Group 1: control/absence of bruxism (n = 10); Group 2: SB treated with infrared LED (n = 10); Group 3: SB treated with occlusal splint (n = 10). Electromyographic evaluation of masseter, anterior temporalis, and upper trapezius, and salivary dopamine levels were assessed before and after treatments. Data were statistically analyzed using two-way mixed model ANOVA. An increase in the temporalis and right masseter EMG activity at rest was observed in Group 3, with large effect size (p < 0.05). Left masseter and temporalis EMG activity did not differ over time in the LED group, similar to the control group. Moreover, the EMG activity of masticatory muscles during chewing and upper trapezius muscle did not differ over time in all groups. The results also pointed to a difference in the levels of dopamine between children with and without SB, with Group 3 showing higher levels in the pre-treatment time compared to controls (p < 0.025). In conclusion, an increase in the masticatory muscles activity at rest was observed in children undergoing splint therapy. Moreover, a difference in the levels of salivary dopamine was found between children with and without SB.3. Good health and well-bein

PACIENTES GERIÁTRICOS: PERSPECTIVA GERAL SOBRE A COORDENAÇÃO DE CUIDADOS CONTÍNUOS E INTEGRADOS

One of the achievements of humanity was the extension of life span. Reaching old age was previously a privilege for a few and today it has become common even in poor countries, however, the aging of the population is not enough in itself, it is necessary that the increase in life expectancy is also associated with quality and comfort for old age. In addition to a greater occurrence of diseases, the elderly population can also face social, cognitive and functional problems, therefore, their need for health care is greater and they end up using a disproportionate amount of health resources. Bearing this in mind, the objective of this work is to analyze and identify the best strategies to effectively care for elderly patients from the point of view of the coordination of geriatric continuing care, carrying out an in-depth study based on the indicators of the Cuidar program, which currently receives 16010 patients, with an average age of 75 years, who are assisted by nurses who monitor their evolution. With this analysis, the aim is to map the situation of the elderly in the country and the scientific progress in this area, aiming to contribute to the advancement of the discussion about the model and its consolidation in supplementary health.Uma das conquistas da humanidade foi a ampliação do tempo de vida. Chegar à velhice antes era um privilégio para poucos e hoje passou a ser comum mesmo em países carentes, no entanto, o envelhecimento da população não basta por si só, é necessário que o aumento da expectativa de vida esteja associado também à qualidade e conforto para a velhice. Além de uma maior ocorrência de doenças, a população idosa também pode enfrentar problemas sociais, cognitivos e funcionais, por isso, sua necessidade de assistência à saúde é maior e acabam utilizando uma quantidade desproporcional de recursos de saúde. Tendo isso em mente, objetiva-se neste trabalho&nbsp; analisar e identificar as melhores estratégias para atender de forma eficaz os pacientes idosos a partir do olhar da coordenação de cuidados continuados geriátricos, realizando um estudo aprofundado com base nos indicadores do programa Cuidar+, que atualmente recebe 16010 pacientes, com média de 75 anos de idade, que são assistidos por enfermeiros que acompanham sua evolução. Com esta análise busca-se como resultado o mapeamento da situação do idoso no país e do avanço científico nesta área, visando contribuir para o avanço da discussão sobre o modelo e sua consolidação na saúde suplementar

Preparation and characterization of ramie-glass fiber reinforced polymer matrix hybrid composites

The use of ramie fibers as reinforcement in hybrid composites is justified considering their satisfactory mechanical properties if compared with other natural fibers. This study aims to verify changes in chemical composition and thermal stability of the ramie fibers after washing with distilled water. One additional goal is to study glass fiber and washed ramie fiber composites focusing on the effect of varying both the fiber length (25, 35, 45 and 55 mm) and the fiber composition. The overall fiber loading was maintained constant (21 vol.%). Based on the results obtained, the washed ramie fiber may be considered as an alternative for the production of these composites. The higher flexural strength presented being observed for 45 mm fiber length composite, although this difference is not significant for lower glass fiber volume fractions: (0:100) and (25:75). Also, by increasing the relative volume fraction of glass fiber until an upper limit of 75%, higher flexural and impact properties were obtained