Proposta de um novo teste clínico para o diagnóstico do ressalto lateral do quadril

ResumoO ressalto lateral do quadril é uma entidade nosológica muitas vezes desconhecida pela maioria dos ortopedistas e até mesmo por alguns especialistas em cirurgia do quadril. Trata‐se da presença de um estalido palpável e/ou audível na face lateral do quadril, por vezes doloroso, causado pelo atrito musculotendíneo sobre o grande trocanter durante a flexão e a extensão da articulação coxofemoral. Descreveremos a seguir um novo teste para o diagnóstico do ressalto lateral do quadril, que é eminentemente clínico.AbstractLateral hip snapping is a nosological entity that is often unknown to many orthopedists and even to some hip surgery specialists. It comprises palpable and/or audible snapping on the lateral face of the hip that is sometimes painful, caused by muscle‐tendon friction on the greater trochanter during flexion and extension of the coxofemoral joint. In the following, we describe a new test for diagnosing lateral hip snapping, which is eminently clinical

Relationship of the Pelvic-Trochanteric Index with greater trochanteric pain syndrome

OBJECTIVES: This study aimed to correlate a higher Pelvic-Trochanteric Index (PTI) with an increased varus of the femoral neck with greater trochanteric pain syndrome (GTPS). The secondary objective was to check whether the pelvic width changes with age. METHODS: A prospective study was conducted to compare female patients diagnosed with GTPS (case group) with asymptomatic female participants (control group) from March 2011 to June 2017. On an anteroposterior pelvic radiograph, lines were drawn by two radiologists, and the PTI (ratio of the distance between the greater trochanters and distance between the iliac crests) was defined and the femoral neck-shaft angle was measured. RESULTS: Data collected based on radiographs of 182 female patients (cases) and 150 female participants (controls) showed that the mean PTI was 1.09 (SD=0.01) in the case group and 1.07 (SD=0.01) in the control group (p<0.05), regardless of age. The distance between iliac crests increased with age (p<0.05) in symptomatic and asymptomatic individuals. It was also found that the mean femoral neck-shaft angle was 130.6° (SD=0.59) and progression of the varus angulation occurred with age in both groups, with a significance level of 5%. CONCLUSIONS: The PTI was higher in patients with GTPS. The femoral neck-shaft angle does not differ between individuals with and without GTPS; however, it does decrease with age. The pelvic width tends to increase with aging in symptomatic or asymptomatic individuals; therefore, the increase in the pelvic width and decrease in the femoral neck-shaft angle can be interpreted as normal in aging women, which could alter the biomechanics of the hips and pelvis

Avascular necrosis of the femoral head in HIV-infected patients: preliminary results from surgical treatment for ceramic-ceramic joint replacement

OBJETIVOS: Avaliar os resultados funcionais iniciais e o índice de complicações precoces das artroplastias totais do quadril cerâmica-cerâmica em pacientes que convivem com o HIV e apresentam osteonecrose da cabeça femoral. MÉTODO: Doze pacientes HIV+ com diagnóstico de osteonecrose da cabeça do fêmur incongruente foram avaliados através de critérios clínicos, laboratoriais, pela escala funcional WOMAC antes e após o tratamento com substituição articular. RESULTADOS: Observamos que 83,3% dos indivíduos faziam uso de inibidores de protease, 75% apresentavam dislipidemia e 66,6% síndrome lipodistrófica, a melhora na evolução no escore WOMAC foi estatisticamente significativa para seis e 12 meses de pós-operatório em comparação com o escore pré-operatório e não observamos complicações secundárias a esse procedimento. CONCLUSÃO: A artroplastia total do quadril com implante de cerâmica-cerâmica para o tratamento da necrose avascular do quadril nessa parcela da população é opção cirúrgica adequada, apresenta melhora funcional inicial significativa e baixo índice de complicação precoce

Acetabular component positioning in total hip arthroplasty with and without a computer-assisted system: a prospective, randomised and controlled study

Em um estudo prospectivo e randomizado sobre o posicionamento do componente acetabular na artroplastia total do quadril, 20 quadris foram operados com o auxílio da navegação livre de métodos de imagem e 20 quadris foram operados através do método convencional. Todas as cirurgias foram realizadas pelo mesmo cirurgião com o paciente em decúbito lateral. A avaliação do posicionamento foi feita através da medição tomográfica pós-operatória dos ângulos de anteversão e inclinação cirúrgicos e análise da zona de segurança. Os resultados obtidos foram similares em todas as comparações: anteversão média de 17,4o no grupo navegado e 14,5o no grupo convencional (p=0,215), inclinação média de 41,7o no grupo navegado e 42,2o no grupo convencional (p=0,633), desvio médio do objetivo da anteversão (15o) de 5,5o no grupo navegado e 6,6o no grupo convencional (p=0,429), desvio médio do objetivo da inclinação (40o) de 3o no grupo navegado e 3,2o no grupo convencional (p=0,783) e localização dentro da zona de segurança de 90% no grupo navegado e 80% no grupo convencional (p=0,661). A avaliação tomográfica pós-operatória do posicionamento acetabular na artroplastia total de quadril realizada com o paciente em decúbito lateral foi semelhante ao se comparar a técnica navegada com a técnica convencionalIn a prospective and randomised study of the acetabular component position in total hip arthroplasty, 20 hips were operated using imageless navigation and 20 hips were operated using the conventional method. The same surgeon performed all the operations with the patient in the lateral position. The correct position of the acetabular component was evaluated with computed tomography performed after the surgeries, measuring the operative anteversion angle and the operative inclination angle and determining the cases inside the safe zone. The results were similar in all the analyses: a mean anteversion of 17.4o in the navigated group and 14.5o in the conventional group (p=0.215), a mean inclination of 41.7o in the navigated group and 42.2o in the conventional group (p=0.633), a mean deviation from the desired anteversion (15o) of 5.5o in the navigated group and 6.6o in the conventional group (p=0.429), a mean deviation from the desired inclination (40o) of 3o in the navigated group and 3.2o in the conventional group (p=0.783), and location inside the safe zone of 90% in the navigated group and 80% in the conventional group (p=0.661). The acetabular component positions tomography analyses in total hip arthroplasty, performed with the patient in the lateral position, were similar whether using imageless navigation or performing it conventionall

Hip arthroscopy

Hip arthroscopy is a safe method for treating a variety of pathological conditions that were unknown until a decade ago. Femoroacetabular impingement is the commonest of these pathological conditions and the one with the best results when treated early on. The instruments and surgical technique for hip arthroscopy continue to evolve. New indications for hip arthroscopy has been studied as the ligamentum teres injuries, capsular repair in instabilities, dissection of the sciatic nerve and repair of gluteal muscles tears (injuries to the hip rotator cuff), although still with debatable reproducibility. The complication rate is low, and ever-better results with fewer complications should be expected with the progression of the learning curve

Diacereína x glicosamina no modelo de artrose em ratos

OBJETIVO: O trabalho foi realizado com o objetivo de comparar o efeito condroprotetor da diacereína em relação ao da glicosamina quanto às alterações degenerativas e à rigidez articular num modelo experimental de artrose. MÉTODOS: Vinte ratos foram submetidos à meniscectomia medial do joelho direito. Dez animais receberam diacereína, e dez glicosamina, todos do primeiro dia ao terceiro mês pós-operatório, quando foram sacrificados. Foram realizadas análise histológica e funcional (medida da extensão máxima) dos joelhos. RESULTADOS: Todos os joelhos operados apresentaram amplitude de extensão mais limitada e maiores alterações degenerativas, em relação ao lado contra-lateral não operado. Ao compararmos as duas drogas, a rigidez articular foi significantemente menor com a diacereína, e as alterações degenerativas foram semelhantes. CONCLUSÕES: 1- O uso profilático da diacereína leva à menor rigidez articular em relação a glicosamina. 2- O efeito condroprotetor profilático da diacereína é semelhante, histologicamente, ao da glicosamina.PURPOSE: The purpose of this study was to compare the chondroprotective effect of diacerein and glucosamine regarding degenerative changes and articular stiffness in an experimental model of arthritis. METHODS: Twenty rats underwent medial meniscectomy on the right knee. Ten animals were given diacerhein, and 10 were given glucosamine, from day 1 to the third month postoperatively, when all of them were killed. Histological and functional analysis of the knees were performed (measurement of maximum extension). RESULTS: All operated knees showed more limited extension values and more degenerative changes as compared to nonoperated contralateral sides. A comparison of the two drugs showed that the degree of articular stiffness was significantly lower with diacerein, although degenerative changes were similar. CONCLUSIONS: 1) Prophylactic use of diacerein leads to lower degree of articular stiffness when compared to glucosamine; 2) The prophylactic chondroprotective effects of diacerein and glucosamine are histologically similar

Reproducibility of Digital Planning in Cementless Total Hip Arthroplasty Among Experienced and Novice Surgeons

Abstract Objective The present study aims to assess the reproducibility of digital planning for cementless total hip arthroplasty (THA) among surgeons with different levels of experience. In addition, it attempts to determine the degree of planning reliability based on a contralateral THA or on a spherical marker positioned at the greater trochanter for calibration. Methods Two evaluators with different experience levels (A1 and A2) performed independently the retrospective digital surgical planning of 64 cementless THAs. Next, we compared the planning with the implants used in the surgery. The reproducibility was excellent when planning and implants were identical; proper in case of a single-unit variation; and inappropriate if there was variation in two or more units. The present analysis also determined the calibration accuracy between the contralateral THA and the spherical marker at the greater trochanter level. Results The present study demonstrated greater success when the most experienced evaluator performed the planning and greater accuracy for the contralateral THA. When splitting the analysis per parameter (contralateral THA or spherical marker), there was a statistical difference only for the planning of A1 and the implants used in the surgery. This difference occurred in the excellent category, with 67.3% for contralateral THA compared with 30.6% for a spherical marker (p < 0.001), and in the inappropriate category, with 7.1% for contralateral THA compared with 30.6% for a spherical marker (p < 0.001). Conclusions Digital planning is more accurate when performed by an experienced evaluator. The contralateral prosthesis head was a better reference than a marker on the greater trochanter

Use of closed suction drainage after primary total hip arthroplasty: a prospective randomized controlled trial

ABSTRACT Objective: This study aimed to investigate drain use in a controlled population of patients with hip osteoarthritis undergoing primary total hip arthroplasty. Methods: This prospective controlled trial evaluated 93 patients randomized into two groups: a group that received drains and a group that did not. The patients who were randomized to the drain group used a 3.2 mm drain placed under the fascia that was kept in place for 24 h. Postoperative evaluations were performed after 24 h and then three, six, and 12 weeks after total hip arthroplasty. The primary outcome was perioperative blood loss in both groups 24 h after total hip arthroplasty. The other parameters that were evaluated included mid-thigh circumference, the rate of blood transfusion, hematocrit, inflammatory serum levels, and the Harris Hip Score. Results: The clinical and laboratory data revealed no differences between the study groups with respect to blood loss and need for blood transfusion, duration of hospital stay, reoperation rate, complications, inflammatory serum markers, and the Harris Hip Score. Patients without closed suction drainage reported higher pain levels after 24 h (VAS score 1 vs. 2, p < 0.01). Conclusion: Similar clinical and laboratory outcomes were found in both cohorts

What is the role of core decompression in the early stages of osteonecrosis of the femoral head? Evaluation of the surgical result by functional score and radiological follow-up

ABSTRACT Objectives: This study is aimed at evaluating whether core decompression of the femoral head in the early stages of femoral head osteonecrosis improves patients' subjective perception of pain and avoids the progression of the disease to a femoral head collapse and a final indication of total hip arthroplasty. Methods: Eighteen patients (30 hips) in the early stages of the disease (Ficat and Arlet 1 and 2A) were evaluated through clinical, radiological, risk factor maintenance, and by the functional Merle D'Aubigné, and Postel score before and after core decompression of the femoral head. Results: There was an improvement of symptoms up to the sixth month in 83.3% of the hips evaluated through the Merle D'Aubigné and Postel score. However, 73.3% of the cases evolved with femoral head collapse, and in 50%, total hip arthroplasty was indicated regardless of whether or not the risk factors were maintained. Conclusions: Core decompression of the femoral head improves patients' pain early in the initial stages of the pathology. However, it does not alter the prognosis and the ultimate indication of total hip arthroplasty in the final stages of the disease

TWO CLASSIFICATIONS FOR SURGICAL WOUND HEMATOMA AFTER TOTAL HIP REPLACEMENT

<div><p>ABSTRACT Objective: To determine the reliability of two classification methods for wound hematoma after total hip replacement. Methods: This prospective cohort study was conducted on patients who underwent total hip replacement for hip osteoarthritis between May 2014 and April 2015. Epidemiological, surgical, and functional data were assessed. Two experienced hip surgeons evaluated 75 pictures of wounds taken 24 hours after surgery. Both evaluators performed the analysis twice, with a 6-week interval between the two analyses. The subjective classification was divided into four different categories describing the hematoma: absent, mild, moderate, and severe. The objective classification was derived from mathematical calculation of the area of the hematoma using a grid superimposed on a picture of the wound. Results: The subjective classification demonstrated an intra-rater agreement of more than 70%, while kappa values showed poor to moderate inter-rater reliability. The objective classification based on mathematical measurements of the hematoma area was more reliable, with good to excellent intra- and inter-rater reliability. Conclusion: The objective classification demonstrated higher intra- and inter-rater reliability. The classification methods used in this study could serve as a useful instrument for orthopedic surgeons, researchers, and health care providers when assessing wound hematomas after total hip replacement. Level of Evidence II; Development of diagnostic criteria on consecutive patients (with universally applied reference ‘‘gold’’ standard).</p></div