Development, manufacturing and evaluation of effects and safety of a hip orthosis prototype used in the functional rehabilitation of a patient undergoing Girdlestone arthroplasty

A Artroplastia de Ressecção tipo Girdlestone (ARG) é um procedimento que altera o estilo de vida do indivíduo gerando fadiga precoce, instabilidade articular, distúrbio da marcha e discrepância de membros. Como medida auxiliar no processo de reabilitação podem ser utilizadas órteses. Contudo, não há no mercado nacional dispositivos adequados, sendo necessária a importação com custo elevado. Assim, este estudo desenvolveu e avaliou os efeitos e a segurança de um protótipo de órtese de quadril em uma paciente feminina submetida à ARG. O modelo proposto melhorou o desempenho físico e a funcionalidade e promoveu o alívio de dores osteomusculares.Girdlestone resection arthroplasty (GRA) is a procedure that changes one’s lifestyle, leading to early fatigue, joint instability, gait disorder and limb discrepancy. Orthoses can be used as an aid in the rehabilitation process. However, there are no adequate devices available in Brazil and the imported ones are high-cost. Thus, this study developed and evaluated the effects and safety of a hip orthosis prototype in a woman who underwent GRA. The proposed model improved physical performance and functionality and provided relief of musculoskeletal pain

Biology of Bone Graft and the Use of Bovine Bone for Revision of Total Hip Arthroplasty with Acetabular Reconstruction

The use of bone graft in orthopaedic surgeries has become essential in many situations in which there is a bone defect. This includes bone tumour procedures, fracture operations where there was a loss of bone tissue and revision arthroplasty surgeries. In this chapter, we will introduce aspects related to history of bone transplantation, the biological and mechanical aspects, as well sterilization, transmission of infectious diseases and biological safety, and concluding, the functioning of tissue banks and screening of musculoskeletal tissue donors

Baixos níveis séricos de vitamina D aumentam significativamente o risco de morte em idosos com fraturas de quadril : coorte prospectiva

Objective: to evaluate the relationship between 25(OH)D3 levels and fatal outcome in patients over 60 years of age undergoing surgical repair of hip fractures. Methods: prospective cohort of patients undergoing surgical repair of hip fractures. At admission, 25(OH)D3 levels were measured, among other parameters. Patients were followed for at least 1 year, and incident mortality was recorded. Results: 209 patients were included in the study, with a mean age of 79.5 ± 7.6 years among survivors and 80.7 ± 8.2 years among those who died in the first postoperative year (p=0.346). The 25(OH)D3 levels of survivors were significantly higher than those of patients who died (p=0.003). After adjusting for confounding variables, 25(OH)D3 levels below 12.5ng/mL were significant risk factors regardless of mortality (adjusted OR: 7.6; 95% CI: 2.35 to 24.56). Conclusions: our data show that serum 25(OH)D3 levels below 12.5ng/mL significantly and independently increased the risk of mortality in the first year after surgical repair of low-energy hip fracture in patients over 60 years of age in the geographic region where this study was conducted. Low albumin also showed a significant association with mortality in these patients. All other factors had no significant associations.Métodos: coorte prospectiva de pacientes submetidos a correção cirúrgica de fraturas de quadril. À admissão, foram medidos os níveis de 25(OH)D3, entre outros parâmetros. Os pacientes foram acompanhados por, pelo menos, um ano e a mortalidade foi registrada. Resultados: foram incluídos 209 pacientes no estudo, com média de idade de 79,5 ± 7,6 anos entre os sobreviventes e 80,7 ± 8,2 anos entre os que morreram no primeiro ano de pós-operatório (p=0,346). Os níveis de 25(OH)D3 dos sobreviventes foram significativamente maiores do que os dos pacientes que morreram (p=0,003). Após o ajuste para variáveis de confusão, níveis de 25(OH)D3 abaixo de 12,5ng/mL foram fator de risco significativo, independentemente da mortalidade (OR ajustado 7,6; IC 95% 2,35 24,56). Conclusões: níveis séricos de 25(OH)D3 abaixo de 12,5ng/mL aumentaram significativa e independentemente o risco de morte no primeiro ano após o reparo cirúrgico de fratura de quadril de baixa energia em pacientes com mais de 60 anos de idade na região geográfica onde este estudo foi realizado. A albumina baixa também teve associação significativa com a mortalidade nesses pacientes. Todos os outros fatores não tiveram associações significativas

Hip Arthroplasty

Hip replacement is one of the most performed surgical procedures in orthopedic hip surgery. Through this surgery, the patient returns to most of his normal life and a life without pain. The primary indication for a hip arthroplasty remains osteoarthritis (OA). OA is a degenerative disease that affects synovial joints. A successful surgery is always preceded by good planning. The planning in turn takes into account the analysis of the patient and his physical examination and the radiological image. But also, the surgical planning must take into account another important factor, the choice of the surgical approach. In this chapter, the authors script a revision on the history of hip arthroplasty, total hip arthroplasty approaches, implant types, complications associated with hip arthroplasty, outcomes, and perspectives to the future. We wish you a good reading

In Vitro and In Vivo Evaluation of Lyophilized Bovine Bone Biocompatibility

INTRODUCTION: The use of bone grafts in orthopedic, maxillofacial and dental surgery has been growing. Nevertheless, both fresh autografts and frozen allografts have limitations, and therefore, alternative synthetic or natural biomaterials, such as processed and lyophilized bovine bone graft have been developed. OBJECTIVE: To evaluate in vitro and in vivo biocompatibility of lyophilized bovine bone manufactured in a semi-industrial scale, according to a modifical protocol developed by the authors. METHODS: Samples of bovine cancellous bone were processed according to a protocol developed by Kakiuchi et al., and modified to process samples of bovine cancellous bone. The following trials were performed: in vitro cytotoxicity, in vivo acute systemic toxicity, in vivo oral irritation potential, in vitro pyrogenic reaction, and bioburden. RESULTS: The in vitro evaluation of lyophilized bovine cancellous bone revealed an absence of cytotoxicity in 100% of the samples. Regarding in vivo evaluation of acute systemic toxicity, neither macroscopic abnormalities nor deaths were noted in the animals. Pyrogenicity was not greater than 0.125 UE/ml in any of the samples. The bioburden revealed negative results for microbial growth before sterilization. Regarding the oral irritation potential, in vivo evaluation at 24 and 72 hours showed that the animals had no edema or erythema on the oral mucosa. CONCLUSION: The protocol changes established by the authors to prepare lyophilized bovine cancellous bone at a semi-industrial scale is reproducible and yielded a product with excellent biocompatibility

Total hip arthroplasty with Biomec : 20-year follow-up

Objetivo: Avaliar o desfecho clínico e radiográfico da artroplastia total de quadril (ATQ) com prótese Biomec em um período de 20 anos (1988 a 2008). Métodos: Os pacientes foram avaliados clinicamente segundo a classificação funcional de Merle d’Aubigné e Postel e submetidos à radiografia de bacia em anteroposterior (AP) e da articulação operada em perfil. As variáveis avaliadas foram osteólise acetabular e femoral, desgaste do polietileno, migração da haste, seguimento e desfecho clínico. Resultados: O seguimento médio foi de 10,6 anos (4 a 20 anos); a amostra foi de 84 pacientes, sendo 32 do sexo masculino e 52, do feminino; a idade média no pré-operatório foi de 47 anos; obtivemos 88% de resultados bons e muito bons na avaliação clínica. Com relação aos achados radiográficos obtivemos 92,5% de bons resultados. O desgaste médio do polietileno foi de 1,4mm. Conclusão: A utilização da prótese Biomec nesta coorte apresentou bons resultados clínicos e radiográficos.Objective: To analyze the clinical and radiological outcomes of total hip arthroplasty with Biomec prosthesis over a 20-year period (1988 to 2009). Methods: The patients were evaluated clinically according to the Merle d’Aubigné and Postel functional classification, and submitted to anteroposterior (AP) radiography of the spleen and operated joint in profile. The variables evaluated were acetabular and femoral osteopenia, polyethylene wear, stem migration, follow-up and clinical outcomes. Results: The mean follow-up was 10.6 years (4 to 21years), the sample consisted of 84 patients; 32 male and 52 female; the mean preoperative age was 47 years; we obtained 88% good or excellent results in the clinical evaluation. In relation to the radiological findings, we obtained 92.5% good results. The mean polyethylene wear was 1.4 mm. Conclusion: The use of the Biomec prosthesis in this cohort showed good clinical and radiographic results

Reabilitação acelerada versus reabilitação convencional na artroplastia total do quadril (ARTHA) : um ensaio clínico randomizado, duplo cego

Objectives: compare an accelerated physiotherapeutic protocol to a conventional physiotherapeutic protocol in total hip arthroplasty patients. Methods: a randomized double blinded clinical trial performed from August 2013 to November 2014. Forty-eight patients diagnosed with hip osteoarthritis submitted to a total hip arthroplasty surgery. An accelerated rehabilitation physiotherapy applied three times a day and start gait training on the first day or standard physiotherapy applied once a day and start gait training on the second or third day of hospitalization. The Merle dAubigné and Postel score (mobility, pain and gait), muscle strength force, range of motion, in hospital stay and time to start of gait training, were the outcomes. Results: the mean age was 64.46 years (10.37 years standard deviation). No differences were observed in age in different genders, and the two randomization groups were homogeneous. In hospital stay was lower in the intervention group compared to the control group, 3 (3-4) days [median (interquartile range)] versus 4 (4-5) days. Time to the start of gait training was early in the intervention group compared to the control group, 1 (1-1) days versus 2 (2-2) days. Higher muscle strength values were observed in the postoperative results in the intervention group compared to the control group for internal rotation, external rotation and abduction. Conclusions: an accelerated physiotherapeutic protocol should be encouraged, because it shows favourable results in gait, muscle strength and length of hospital stay, even upon hospital discharge.Objetivos: comparar um protocolo fisioterapêutico acelerado com um protocolo fisioterapêutico convencional em pacientes submetidos a artroplastia total do quadril. Métodos: ensaio clínico randomizado, duplo-cego, realizado de agosto/2013 a novembro/2014. Quarenta e oito pacientes diagnosticados com coxartrose submetidos a cirurgia de artroplastia total do quadril. Fisioterapia de reabilitação acelerada aplicada três vezes ao dia com início de marcha no primeiro dia ou fisioterapia convencional aplicada uma vez ao dia e início de marcha no segundo ou terceiro dia de hospitalização. Os escores de Merle dAubigné e Postel (mobilidade, dor e marcha), força muscular, amplitude de movimento, internação hospitalar e tempo para o início de marcha foram os desfechos. Resultados: a idade média foi 64,46 anos (desvio padrão 10,37 anos). Não foram observadas diferenças na idade nos diferentes sexos, e os grupos de randomização foram homogêneos. O tempo de internação hospitalar foi menor no grupo intervenção em comparação ao grupo controle, 3 (3-4) dias [mediana (intervalo interquartil)] versus 4 (4-5) dias. O tempo para início da marcha foi precoce no grupo de intervenção em comparação ao grupo controle, 1 (1-1) dias versus 2 (2-2) dias. Maiores valores de força muscular foram observados nos resultados pós-operatórios no grupo intervenção em comparação ao grupo controle para rotação interna, rotação externa e abdução. Conclusões: um protocolo fisioterapêutico acelerado deve ser incentivado, pois apresenta resultados favoráveis na marcha, força muscular e tempo de internação, mesmo após a alta hospitalar