Clinical and Radiological Results after Endoscopic Treatment for Gluteal Tendon Injuries with a Minimum Follow-Up of 12 Months.

Objectives: The study aimed to evaluate the clinical and radiological results after endoscopic repair of gluteus medius muscle injuries and proposed an anatomical classification for the different injury classes. Methods: A retrospective case series, including patients who had undergone endoscopic repair of the hip abductor tendon. The surgical procedure was standardized. Magnetic resonance imaging (MRI) studies were analyzed, and the injuries were classified into three types: nontransfixing partial-extension (nTPE) tear, transfixing partial-extension (TPE) tear, and transfixing full-extension (TFE) tear. TPE and TFE were considered high-grade tears. The postoperative outcomes were as follows: duration of walking aid requirement, duration of physical therapy, time to return to daily activities, modified Harris Hip score (mHHS) and Nonarthritic Hip Score (NAHS) functional scores, pain visual analog scale (VAS), satisfaction, claudication, Trendelenburg test, and reoperation. Results: Sixteen patients were included (94% women; mean age 65 years), with a mean follow-up of 42 months (12-131, range). Out of the cases with preoperative exams available for analysis, four cases (31%) were nTPE, three (23%) TPE, and six (46%) TFE tears. Thus, 69% of the patients had high-grade injuries. These patients had a higher degree of fat infiltration (P = 0.034), but this was not correlated with inferior postoperative clinical or radiological results. One patient required reoperation due to a recurrent injury. Conclusion: Isolated extra-articular injuries to the tendons of the gluteus medius and minimus evolved satisfactorily after endoscopic repair. Due to the small number of cases, it was not possible to observe differences in outcomes between high-and low-grade injuries.

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.

Morphofunctional and ultrastructural evaluation of hip joint development in human fetuses / Evaluación morfofuncional y ultraestructural del desarrollo de la articulación de la cadera en fetos humanos

SUMMARY: The normal sequential development of the hip joint (HJ) was considered for the evaluation of the morphological and ultrastructural aspects of the joint cartilage of the proximal femoral head epiphysis in human fetuses between 16 to 31 weeks of intra uterine life (IUL). Twenty human fetuses were fixed in 10 % formalin solution. Fetuses were divided into 4 groups (n=5): Group 1 (G1): 16-19 weeks IUL; Group 2 (G2): 20-23 weeks IUL; Group 3 (G3): 24-27 weeks IUL and Group 4 (G4): 28-31 weeks IUL. The right moieties of the HJ were subjected to light microscopy to determine the chondrocyte area, volume, and density and the extracellular matrix (ECM) density. The collagen component in ECM was qualitatively evaluated using Safranin-O and picrosirius techniques under polarized light. The left portions were analyzed using scanning electron microscopy (SEM). The advance of age revealed a gradual increase in chondrocyte area and volume and in ECM density, and a decrease in chondrocyte density. The apparent prevalence of type II collagen fibers in G1 and type III collagen fibers in G4, as well as a balance between type I and III collagen fibers in G2 and G3 suggest a process of cartilaginous evolution and repair. The pantographic organization of the collagen fiber meshes from the depth to the cartilage surface of the femoral head suggests that the arcade collagen network architecture starts at the fetal stage, regardless of the compressive forces applied. The morphological data may contribute not only to a better understanding of the maturation and cartilage organization in this area but also to serve as a theoretical basis for aspects related to diseases and joint malformations.

RESUMEN: El desarrollo secuencial normal de la articulación de la cadera (AC) se consideró para la evaluación de los aspectos morfológicos y ultraestructurales del cartílago articular de la epífisis proximal y de la cabeza femoral en fetos humanos entre 16 y 31 semanas de vida intrauterina (SVIU). Veinte fetos humanos fueron fijados en solución de formalina al 10 %. Los fetos se dividieron en 4 grupos (n = 5): Grupo 1 (G1), 1619 semanas de IUL; Grupo 2 (G2), 20-23 semanas SVIU; Grupo 3 (G3), 24-27 semanas SVIU y Grupo 4 (G4), 28-31 semanas SVIU. Las muestras derechas de la AC se sometieron a microscopía óptica para determinar el área, el volumen y la densidad de los condrocitos y la densidad de la matriz extracelular (MEC). El componente de colágeno en la MEC se evaluó cualitativamente utilizando técnicas de safranina-O y picrosirius bajo luz polarizada. Las muestras de la AC izquierda se analizaron utilizando microscopía electrónica de barrido (MEB). El avance de la edad reveló un aumento gradual en el área y el volumen de los condrocitos y en la densidad de la MEB, y una disminución en la densidad de los condrocitos. La aparente prevalencia de las fibras de colágeno tipo II en G1 y tipo III en G4, así como el equilibrio entre las fibras de colágeno tipo I y III en G2 y G3 sugieren un proceso de evolución y reparación cartilaginosa. La organización pantográfica de las mallas de fibra de colágeno desde la profundidad a la superficie del cartílago de la cabeza femoral sugiere que la arquitectura de la red de colágeno comienza en la etapa fetal, independientemente de las fuerzas compresivas aplicadas. Los datos morfológicos pueden contribuir no solo a una mejor comprensión de la organización de la maduración y el cartílago en esta área, sino también servir de base teórica para los aspectos relacionados con enfermedades y malformaciones articulares.

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.

A artroscopia de quadril é um método seguro para o tratamento de diversas patologias desconhecidas até a última década. O impacto femoroacetabular é a patologia mais comum e com melhores resultados quando tratada precocemente. O instrumental e a técnica cirúrgica da artroscopia de quadril continuam em evolução. Novas indicações de artroscopia de quadril vem sendo estudadas, como o tratamento das lesões do ligamento redondo, capsulorrafia nas instabilidades, dissecação do nervo ciático e reparo de lesões dos músculos glúteos (lesões do manguito rotador do quadril), porém ainda com reprodutibilidade discutível. A taxa de complicações é baixa e resultados cada vez melhores e com menor número de complicações devem ser esperados com a progressão da curva de aprendizado.

Artroscopia de quadril / Hip arthroscopy

A artroscopia de quadril é um método seguro para o tratamento de diversas patologias desconhecidas até a última década. O impacto femoroacetabular é a patologia mais comum e com melhores resultados quando tratada precocemente. O instrumental e a técnica cirúrgica da artroscopia de quadril continuam em evolução. Novas indicações de artroscopia de quadril vem sendo estudadas, como o tratamento das lesões do ligamento redondo, capsulorrafia nas instabilidades, dissecação do nervo ciático e reparo de lesões dos músculos glúteos (lesões do manguito rotador do quadril), porém ainda com reprodutibilidade discutível. A taxa de complicações é baixa e resultados cada vez melhores e com menor número de complicações devem ser esperados com a progressão da curva de aprendizado.

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.

Proposal for a new clinical test for diagnosing lateral hip snapping.

Lateral 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.

O 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.

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

In a study of the acetabular component in total hip arthroplasty, 20 hips were operated on using imageless navigation and 20 hips were operated on using the conventional method. The correct position of the acetabular component was evaluated with computed tomography, measuring the operative anteversion and the operative inclination and determining the cases inside Lewinnek's safe zone. The results were similar in all the analyses: a mean anteversion of 17.4° in the navigated group and 14.5° in the control group (P=.215); a mean inclination of 41.7° and 42.2° (P=.633); a mean deviation from the desired anteversion (15°) of 5.5° and 6.6° (P=.429); a mean deviation from the desired inclination of 3° and 3.2° (P=.783); and location inside the safe zone of 90% and 80% (P=.661). The acetabular component position's tomography analyses were similar whether using the imageless navigation or performing it conventionally.

Necrose avascular da cabeça femoral em pacientes HIV positivos: resultados iniciais do tratamento cirúrgico por substituição articular cerâmica-cerâmica / 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.

OBJECTIVES: To evaluate the initial functional results and early complication rate of ceramic-ceramic total hip replacements among patients living with HIV who presented osteonecrosis of the femoral head. METHOD: Twelve HIV-positive patients with a diagnosis of osteonecrosis of the incongruent femoral head were evaluated using clinical and laboratory criteria and the WOMAC functional scale before and after treatment with joint replacement. RESULTS: We observed that 83.3% of the subjects were taking protease inhibitors, 75% had dyslipidemia and 66.6% had lipodystrophy syndrome. The improvement over the evolution of the WOMAC score was statistically significant at six and twelve months after the operation, in comparison with the preoperative score. We did not observe complications secondary to this procedure. CONCLUSION: Total hip arthroplasty with a ceramic-ceramic implant for treating avascular necrosis of the hip is an appropriate surgical option for this portion of the population. It provides a significant initial functional improvement and a low early complication rate.

A comparative radiographic investigation of femoroacetabular impingement in young patients with and without hip pain

OBJECTIVE: To compare the existence of radiographic abnormalities in two groups of patients, those with and without hip pain. METHODS: A total 222 patients were evaluated between March 2007 and April 2009; 122 complained of groin pain, and 100 had no symptoms. The individuals in both groups underwent radiographic examinations of the hip using the following views: anteroposterior, Lequesne false profile, Dunn, Dunn 45º, and Ducroquet. RESULTS: A total of 1110 radiographs were evaluated. Female patients were prevalent in both groups (52% symptomatic, 58% asymptomatic). There were statistically significant differences between the groups in age (p<0.0001), weight (p = 0.002) and BMI (p = 0.006). The positive findings in the group with groin pain consisted of the presence of a bump on the femoral head in the anteroposterior view (p<0.0001) or in the Dunn 45º view (p = 0.008). The difference in the a angle in the anteroposterior, Dunn, Dunn 45º, and Ducroquet views for all of the cases studied was p,0.0001. The joint space measurement differed significantly between groups in the Lequesne view (p = 0.007). The Lequesne anteversion angle (ρ) and the femoral offset measurement also differed significantly (p = 0.005 and p = 0.0001, respectively). CONCLUSIONS: We conclude that the best views for diagnosing a femoroacetabular impingement are the anteroposterior pelvic orthostatic, the Dunn 45º, and the Ducroquet views. The following findings correlated with hip pain: a decrease in the femoral offset, an increase in the α angle, an increase in the Lequesne ρ angle, a decrease in the CE angle of Wiberg, a thinner articular space and the presence of a bump on the femoral head-neck transition.

Tratamento artroscópico de lesões do quadril em 35 atletas / Arthroscopic treatment of hip pathology in 35 athletes

Introdução: A artroscopia do quadril ganhou espaço recentemente como parte do instrumental no tratamento de afecções do quadril no atleta. Objetivo: Apresentar o resultado de 35 artroscopias realizadas em atletas federados. Métodos: Análise retrospectiva do prontuário de pacientes. Resultados: Durante o procedimento cirúrgico 31 pacientes apresentaram como diagnóstico impacto femoroacetabular e lesão do lábio acetabular. Duas complicações ocorreram uma neuropraxia do nervo pudendo e uma úlcera escrotal. Após um seguimento médio de 2,8 anos o Western Ontario and MacMacter Universities Osteoarthritis Index (WOMAC) melhorou de uma média de 68,4 pré-operatória para uma média de 89,5 pós-operatória. Conclusão: A artroscopia do quadril é uma cirurgia com bons resultados em atletas com dor no quadril.

Enxerto estruturado no tratamento das perdas ósseas femorais em artroplastias de quadril infectadas / Structural allograft in the treatment of femoral bone loss in infected hip arthroplasty

Foram submetidos ao tratamento em dois tempos cirúrgicos 17 pacientes com infecções crônicas em próteses de quadril e perda óssea circunferencial do fêmur proximal, consistindo da realização, no primeiro tempo, da retirada dos componentes e materiais infectados e colocação de espaçador de cimento com vancomicina e, no segundo tempo, da reconstrução do estoque ósseo com enxerto maciço da região proximal do fêmur e fixação da prótese através de hastes longas cimentadas ao enxerto e cimentas (dez hastes) ou não (sete hastes) no fêmur hospedeiro. Após nove anos de seguimento, em média (mínimo de sete anos), apenas um caso evoluiu com recidiva infecciosa. Todos os enxertos apresentaram sinais de consolidação radiográfica com o osso hospedeiro. Não houve solturas dos componentes femorais. Funcionalmente os pacientes melhoraram, embora a maioria deambule com marcha de Trendelemburg. O enxerto maciço de fêmur proximal se apresentou como uma técnica segura e reprodutível para o tratamento das falhas ósseas após artroplastia infectada de quadril.

Anterograde removal of broken femoral nails without opening the nonunion site: a new technique

OBJECTIVE: We describe a new technique for removing the distal fragments of broken intramedullary femoral nails without disturbing the nonunion site. METHODS: This technique involves the application of an AO distractor prior to the removal of the nail fragments, with subsequent removal of the proximal nail fragment in an anterograde fashion and removal of the distal fragment through a medial parapatellar approach. Impaction of the fracture site is then performed with a nail that is broader than the remaining fragmented material. RESULTS: Nails were removed from five patients using the technique described above without any complications. After a mean follow-up period of 61.8 months, none of these patients showed worsened knee osteoarthritis. CONCLUSION: The original technique described in this article allows surgeons to remove the distal fragment of fractured femoral intramedullary nails without opening the nonunion focus or using special surgical instruments.

Prospective study of the treatment of infected hip arthroplasties with or without the use of an antibiotic-loaded cement spacer.

PURPOSE: Our purpose was to compare 2 methods of treatment of chronic infection in hip arthroplasties--with or without an antibiotic-loaded cement spacer. METHODS: In a prospective study, we treated 68 infected hip arthroplasties with discharging sinuses and bone loss, comparing 30 patients treated in 2 stages without the use of a spacer (control group) and 38 patients treated with a vancomycin-loaded spacer (study group). The average follow-up was 4 years (2-8.5 years). One patient died of unrelated causes 4 months after first-stage surgery and was excluded from the study. RESULTS: The 2-stage surgery without spacer controlled the infection in 66.7% of patients, and the 2-stage surgery using the spacer controlled it in 89.1% (P < 0.05). At last follow-up, the average Harris Hip Score increased from 19.3 to 69.0 in the control group versus 19.7 to 75.2 in the study group (P > 0.05). The average leg length discrepancy was 2.6 cm in the control group and 1.5 cm in the study group (P < 0.05). The patients treated with a spacer had better clinical results (81.5% of patients with good results against 60.0% for the control group). CONCLUSION: The use of an antibiotic-loaded spacer in the 2-stage treatment of infected hip arthroplasties provides better infection control with good functional results and is superior to treatment in 2 stages without a spacer. LEVEL OF EVIDENCE: Therapeutic study, Level I-1.

Prospective study of the treatment of infected hip arthroplasties with or without the use of an antibiotic-loaded cement spacer

PURPOSE: Our purpose was to compare 2 methods of treatment of chronic infection in hip arthroplasties-with or without an antibiotic-loaded cement spacer. METHODS: In a prospective study, we treated 68 infected hip arthroplasties with discharging sinuses and bone loss, comparing 30 patients treated in 2 stages without the use of a spacer (control group) and 38 patients treated with a vancomycin-loaded spacer (study group). The average follow-up was 4 years (2-8.5 years). One patient died of unrelated causes 4 months after first-stage surgery and was excluded from the study. RESULTS: The 2-stage surgery without spacer controlled the infection in 66.7 percent of patients, and the 2-stage surgery using the spacer controlled it in 89.1 percent (P < 0.05). At last follow-up, the average Harris Hip Score increased from 19.3 to 69.0 in the control group versus 19.7 to 75.2 in the study group (P > 0.05). The average leg length discrepancy was 2.6 cm in the control group and 1.5 cm in the study group (P < 0.05). The patients treated with a spacer had better clinical results (81.5 percent of patients with good results against 60.0 percent for the control group). CONCLUSION: The use of an antibiotic-loaded spacer in the 2-stage treatment of infected hip arthroplasties provides better infection control with good functional results and is superior to treatment in 2 stages without a spacer. Level of Evidence: Therapeutic study, Level I-1.

OBJETIVO: As revisões em dois tempos continuam sendo os métodos preferidos no tratamento das artroplastias infectadas do quadril. O procedimento em dois estágios apresenta várias desvantagens teóricas, ainda não comprovadas por estudos comparativos. MATERIAIS E MÉTODOS: Em um estudo prospectivo, tratamos 68 pacientes com artroplastias infectadas de quadril com perdas ósseas e fístulas ativas, comparando 30 casos tratados em dois tempos sem espaçador (grupo controle) e 38 casos tratados em dois tempos com o uso de um espaçador de cimento adicionado a vancomicina (grupo de estudo). Um paciente faleceu após quatro meses da cirurgia e foi excluído do estudo. O seguimento médio foi de quatro anos (2-8,5 anos). RESULTADOS: A cirurgia em dois tempos sem espaçador controlou a infecção em 66,7 por cento dos casos comparada a 89,1 por cento (p<0,05) nos casos tratados com espaçador. No último seguimento, o Escore de Harris para Quadril passou de 19,3 a 69,0 no grupo controle e de 19,7 para 75,2 no grupo do estudo (p>0,05). A média de discrepância de membros inferiores foi de 2,6cm no grupo controle e de 1,5cm nos grupo do estudo (p<0,05). O grupo tratado com espaçador teve melhores resultados clínicos ao final do estudo (81,5 por cento de bons resultados comparados a 60,0 por cento do grupo tratado sem espaçador). CONCLUSÃO: O uso de espaçador adicionado a antibióticos no período intermediário do tratamento das artroplastias infectadas do quadril em dois tempos proporciona melhor controle de infecção, com bons resultados funcionais, sendo superior à cirurgia em dois tempos sem espaçador.

Estudo comparativo do tratamento das artroplastias infectadas do quadril sem e com o uso do espaçador de cimento com antibiótico / Prospective study of the treatment of chronically infected hip replacements with and without the use of an antibioticloaded acrylic cement spacer

Em um estudo prospectivo sobre o tratamento das artroplastias de quadril infectadas, com perdas ósseas e fístulas ativas, 25 pacientes foram tratados em dois tempos e 36 pacientes foram tratados em dois tempos com espaçador de cimento impregnado com vancomicina. O acompanhamento médio foi de dois anos e onze meses. A taxa de recidiva infecciosa foi de 29,2 por cento nos tratados em dois tempos e de 8,8 por cento nos tratados com espaçador. O Escore de Harris para Quadril médio passou de 19,3 para 69,0 pontos nos casos tratados em dois tempos e de 19,7 para 72,2 pontos nos pacientes tratados com espaçador. Ao final do estudo, 86,1 por cento dos tratados com espaçador e em 33,3 por cento dos tratados em dois tempos tinham próteses em bom funcionamento e sem infecção. O espaçador de cimento com antibiótico é o tratamento de escolha nas próteses infectadas de quadril/We report a prospective study of 61 patients with chronically deep infected hip replacements with actively discharging sinuses, treated with a two-stage revision protocol, with and without a cement spacer impregnated with vancomycin. The average follow-up was two years and eleven months. Twenty-five patients were treated without a spacer and seven had recurrence of infection. Thirty-three patients were treated with a spacer and three had recurrence of infection. The average Harris Hip score increased from 19,3 to 69,0 on the non-spacer patients and from 19,7 to 75,2 on the spacer group. At the end of the study, the success rate was 86,1 per cent for the spacer group and 33,3 per cent for the non-spacer group. The use of the spacer increased the results of the two-stage chronic infected hip replacements...

Trombose venosa profunda em artroplastia total de quadril / Deep venous thrombosis in total hip arthroplasty

Total hip arthroplasty is a common surgical procedure in a population with the organic frailty of aging. Deep venous thrombosis and pulmonary thromboembolism are the more common and dangerous complications of this procedure. Therefore, surgeon knowledge of diagnosis, prevention and treatment of these complications is mandatory both technically and ethically. The authors make a descriptive and critical revision of the literature regarding the most recent acquisitions in diagnosid, prevention, and treatment of these complications

Artroplastia total do quadril cimentada de Charnley: estudo retrospectivo ce 115 casos / Charnley's cemented total hip arthroplasty: retrospective study of 115 cases

Realizou-se um estudo retrospectivo clínico e radiológico de 115 artroplastias totais do quadril cimentadas tipo Charnley, efetuadas entre 1976 e 1991, no Instituto de Ortopedia e Traumatologia do Hospital das Clínicas da FMUSP. Foram avaliados 88 pacientes, com 27 deles submetidos à artroplastia bilateral (30,6 por cento). A idade dos pacientes variou de 23 a 83 anos, com média de 56,4 anos. O tempo de seguimento variou de 7,3 anos a 22,8 anos, com média de 11,8 anos. O diagnóstico mais freqüente foi o de osteoartrose (35,7 por cento). Realizou-se avaliaçao clínica pelos critérios de Merle D'Aubigné e a avaliaçao radiológica pelos critérios de Gruen para o componente femoral e de DeLee e Charnley para o componente acetabular. Obtiveram-se 98,8 por cento de bons resultados contra 1,7 por cento de resultados regulares. Observaram-se sinais de soltura acetabular em 41,7 por cento e de soltura femoral em 33,0 por cento. Os autores concluem que a prótese de Charnley é uma boa opçao entre as próteses cimentadas.

Luxaçäo traumática anterior do quadril. Relato de caso / Late anterior traumatic dislocation of the hip

Os autores apresentam caso de luxaçäo traumática anterior inveterada do quadril direito em paciente masculino de 22 anos que apresentava luxaçäo näo reduzida de 30 dias. O tratamento cirúrgico chegou a ser indicado, depois que algumas tentativas de reduçäo incruenta näo alcançaram sucesso. A reduçao foi conseguida incruentamente, mesmo após decorrido esse longo período.

Repercussäo no aparelho locomotor da prática do judô de alto nível: estudo epidemiológico / Impact of high level judo practice in the locomotor apparatus: epidemiologic study

Os autores, analisando os dados constantes em formulários especialmente elaborados para ser preenchidos por 129 atletas praticantes de judô de alto nível (estadual, nacional e internacional), puderam observar considerável incidência de lesoes no aparelho locomotor. Verificaram que houve predominância das lesöes articulares nos atletas de maior nível e de maior peso. Notaram ainda incidência maior de lesöes nos atletas que iniciaram seus treinamentos em idade mais precoce e que permaneceram em atividade competitiva por mais tempo.