[Demineralised cortical bone allografting in femoral head necrosis]. / Aloenxerto ósseo cortical desmineralizado na cirurgia da osteonecrose asséptica da cabeça femoral.

We report the clinical and biological results of the surgical treatment of a femoral head osteonecrosis, Ficat classification stage III, in a 53 year old patient. The procedure included core decompression followed by insertion of a superficial demineralised and processed fibular bone allograft. A cemented total hip arthroplasty was performed at nine years follow-up. The histomorphological study of the excised femoral head showed the incorporation of the bone allograft. Although core decompression of the femoral head has been used in precollapse lesions, Ficat stage I and II, its combination with fibular allografting allowed the postponement of total hip prosthesis implantation for nine years. In this clinical case, the implantation of a total hip arthroplasty, as a primary surgical treatment, would also have been an alternative procedure, if it had only been considered the patient;s age and osteonecrosis extension.

[Surgical procedures for treatment of the rheumatoid knee]. / Procedimentos Cirurgicos do Joelho na Artrite Reumatoide.

In the last decade considerable modifications in the surgical procedures recommended for the treatment of rheumatoid knee have been observed. This was due to all the medical developments achieved in pharmacology and therapeutic as well as a significant quality improvement of the rheumatologist s intervention. The synovectomy and namely the total knee arthroplasty represent the most commonly procedures used in the surgical treatment of the rheumatoid knee. An arthroscopic followed by a radionuclide synovectomy can be an appropriate treatment in a knee with an inflammatory arthritis Larsen radiograph grade I II . The ideal patient for synovectomy must present an early disease absence of deformity or instability good range of motion and preserved articular cartilage. On the other hand a total knee arthroplasty represents the only possible operation to treat a rheumatoid knee with a severe bone and cartilage damage Larsen radiograph grade IV V including younger patients. Total knee arthroplasty is actually a successful operation providing pain relief and the restoration of the function. Nevertheless the excellent good short and medium-term results achieved do not resist over time. Similarly to what happens with every other arthoplasty joint replacements the particules that come from the wear of the biomaterials included in its composition are the cause of biological intolerance reactions which can lead to the need of a new implant. The replacement prosthesis raises technical issues related to the reconstruction of bone mass losses where the cryopreserved bone allografts can be recommended.