Total ankle replacement: Brazilian experience with the HINTEGRA prosthesis

A artrose do tornozelo vem se tornando mais comum a cada dia. A busca por soluções que preservem a função articular fez surgir uma nova geração de próteses com três componentes e maior liberdade de movimento. Neste trabalho, apresentam-se os resultados obtidos em 10 pacientes tratados com a prótese HINTEGRA (Integra, New Deal), em ação conjunta dos Grupos do Tornozelo e Pé do DOT da Unifesp-Escola Paulista de Medicina e IOT da Faculdade de Medicina da USP-Universidade de São Paulo. Os 10 pacientes (seis mulheres e quatro homens), com idade variando de 29 a 66 anos, foram submetidos ao tratamento cirúrgico segundo a técnica de Hinterman entre janeiro e junho de 2005. Foram avaliados em intervalos predeterminados e os dados foram submetidos à análise estatística. A mobilidade do tornozelo apresentou melhora significante com a cirurgia realizada. Radiologicamente, não foram detectados sinais de soltura ou falhas nos componentes prostéticos de nenhum dos pacientes estudados. A taxa de complicações nessa amostra foi alta, mas equivalente às de outros autores e representa diretamente a curva de aprendizado relacionada com esse tipo de procedimento. Ao final de quatro anos, observaram-se significativa redução da dor e melhora do padrão funcional dos pacientes com os escores da AOFAS e de Hinterman, apontando para 20% de excelentes, 70% de bons e 10% de maus resultados. O tratamento da artrose do tornozelo através da artroplastia total com o modelo HINTEGRA, foi capaz de oferecer bons resultados no tempo médio de observação de quatro anos.Ankle arthritis is becoming more and more common. The search for solutions that preserve joint function has led to a new generation of prosthesis with three components and more degrees of freedom. This paper presents the results achieved in ten patients treated with the HINTEGRA Prosthesis (Integra, New Deal), a joint action of the Foot and Ankle Teams of DOT of Unifesp - Escola Paulista de Medicina and the School of Medicine of USP - Universidade de São Paulo. The ten patients (six women and four men), aged between 29 and 66 years, underwent a surgical procedure according to Hinterman's technique, from January to June 2005. They were evaluated at pre-arranged intervals, and the data were submitted to statistical analysis. The surgery led to a significant improvement in ankle mobility. Radiological studies showed no signs of loosening or failure in the prosthetic components in any of the patients studied. Although the rate of complications in our sample was high, it was equivalent to those of other authors, and directly represents the long, steep learning curve associate with this kind of procedure. At the end of four years, there was a significant reduction in the pain, and an improvement in functional pattern of the patients, with AOFAS and Hinterman scores indicating 20% excellent, 70% good, and 10% poor results. Despite the drawbacks, treatment of ankle arthritis through total arthroplasty with the HINTEGRA prosthesis proved to be capable of giving good results over an average observation period of four years

Predictive factors of gait in neuropathic and non-neurophatic diabetic patients

OBJETIVO: Analisar a amplitude de movimento do tornozelo e as forças de reação vertical do solo envolvidas na marcha de pacientes portadores de diabetes com e sem neuropatia periférica. CASUÍSTICA E MÉTODO: 36 indivíduos divididos em três grupos: Controle - GC: 10 indivíduos sem diabetes, Diabetes - GD: 10 indivíduos portadores de diabetes sem neuropatia periférica e Neuropatia - GDN: 16 indivíduos portadores de diabetes e neuropatia diabética periférica. Foi realizada análise da marcha - AMTI® OR6/6, e da amplitude de movimento articular tíbio-társica - Sistema Vicom 640® - de todos os participantes. RESULTADOS: O primeiro e segundo pico de força vertical de reação do solo são maiores no grupo Neuropatia e a amplitude de movimento articular do tornozelo é menor nos grupos Diabetes e Neuropatia. CONCLUSÃO: A amplitude de movimento da articulação tíbio-társica está diminuida nos diabetéticos, independente da presença ou ausência de neuropatia periférica, e os diabéticos com neuropatia periférica, apresentaram aumento no primeiro e no segundo pico da força de reação vertical do solo durante a marcha.OBJECTIVE: The purpose of this study was to analyze the range of movement of the ankle and the vertical ground reaction force involved in gait among diabetic patients with and without peripheral neuropathy. SAMPLE AND METHOD: 36 individuals were divided into three groups: Control group - CG: 10 individuals without diabetes, Diabetic group - DG: 10 individuals with diabetes without peripheral neuropathy and Neuropathy, and Diabetic neuropathic group - DNG: 16 individuals with diabetes and peripheral diabetic neuropathy. Gait - AMTI® OR6/6m and range of tibiotarsal joint movement - System Vicom 640® was carried out in all the participants. RESULTS: The first and second vertical ground reaction force peaks were statistically higher in the neuropathy group, and the range of ankle motion was lower in the Diabetes and Neuropathy groups. CONCLUSION: The range of movement of the tibiotarsal joint is lower in diabetics, regardless of the presence or absence of peripheral neuropathy, and diabetics with peripheral neuropathy show an increase in the first and second vertical ground reaction force peaks during walking

PLANTAR THROMBOPHLEBITIS: MAGNETIC RESONANCE IMAGING FINDINGS

ABSTRACTObjective: Demonstrate the magnetic resonance imaging (MRI) findings in plantar thrombophlebitis. Methods: Retrospective review of twenty patients with pain in the plantar region of the foot, in which the MRI findings indicated plantar thrombophlebitis. Results: A total of fourteen men and six women, mean age 46.7 years were evaluated. Eight of these patients also underwent Doppler ultrasonography, which confirmed the thrombophlebitis. The magnetic resonance images were evaluated in consensus by two radiologists with experience in musculoskeletal radiology (more than 10 years each), showing perivascular edema in all twenty patients (100%) and muscle edema in nineteen of the twenty patients (95%). All twenty patients had intraluminal intermediate signal intensity on T2-weighted (100%) and venous ectasia was present in seventeen of the twenty cases (85%). Collateral veins were visualized in one of the twenty patients (5%). All fourteen cases (100%), in which intravenous contrast was administered, showed perivenular tissues enhancement and intraluminal filling defect. Venous ectasia, loss of compressibility and no flow on Doppler ultrasound were also observed in all eight cases examined by the method. Conclusion: MRI is a sensitive in the evaluation of plant thrombophlebitis in patients with plantar foot pain

Dor nos membros inferiores

Lower limb pains are very commom. Many muscle-skeletal, neuropathic, vascular and visceral abnormalities may be responsible for pain in the lower limbs. The analysis of the clinical history, the medical evaluation and, when necessary, thecomplementary exams allows the precise diagnosis in majority of the cases. The treatment is based in the elimination of the causal condictions and, when necessary, in the use of analgesics, psychotropics, physical medicine, psychotherapy and functionalneurosurgical procedures.Dor é fenômeno comum nos membros inferiores. Várias são as razões de sua ocorrência. Afecções músculo-esqueléticas,dermatológicas, vasculares, neuropáticas ou viscerais abdominais. Destacam-se as músculo-esqueléticas, especialmente as síndromes dolorosas miofasciais. Os dados de história e de exame clínico e, quando necessário, os exames subsidiários possibilitam diagnóstico preciso na maioria dos casos. O tratamento da condição primária e o uso de medidas analgésicas especialmente de medicamentos antiinflamatórios ou opióides, psicotrópicos, medicina física, psicoterapia e, quando necessário, intervenções neurocirúrgicas funcionais aliviam a dor na maioria dos casos

Biomechanical evaluation in runners with Achilles tendinopathy

OBJECTIVES: To evaluate the clinical characteristics, ground reaction force (GRF), and function of the plantar muscles and dorsiflexors of the ankle in runners with and without Achilles tendinopathy (AT) and in nonrunners. METHODS: Seventy-two participants (42 men, 30 women; mean age: 37.3±9.9 years) were enrolled in this crosssectional study and divided into three groups: AT group (ATG, n=24), healthy runners’ group (HRG, n=24), and non-runners’ group (NRG, n=24). Both ankles were evaluated in each group. The American Orthopedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale was used for clinical and functional evaluation. GRF was evaluated using force plates and muscle strength was evaluated using an isokinetic dynamometer. RESULTS: The AOFAS scores were lower in the ATG. The strike impulse was higher in the ATG than in the HRG and NRG. However, GRF was similar among the groups. The ATG exhibited lower total work at 120o /s speed than the HRG. The peak torque in concentric dorsiflexion was lower in the NRG than in the ATG and HRG. The peak torque and total work in concentric plantar flexion were lower in the NRG than in the ATG. The peak torque and total work in eccentric plantar flexion were lower in the NRG than in the ATG and HRG. CONCLUSION: Runners with AT showed higher strike impulse, lower muscle strength of the plantar flexors, and higher clinical and functional damage