RESUMEN
Background: Tourniquet is widely used in total knee replacement surgery because it reduces intraoperative hemorrhage and provides a comfortable surgical area for the surgeon. It's possible that its use could lead to impaired postoperative functional and motor recovery, as well as local and systemic complications. Our goal was to compare the outcomes of total knee replacement without ischemia using an optimized protocol, consisting of tourniquet inflation before skin incision and deflation after cementing, with a pressure of one hundred millimeters above systolic blood pressure and without postoperative articular suction drains.). We believed that tourniquet effectively would result in no additional muscle damage and no functional or knee strength impairment compared to no tourniquet. Methods: In a prospective and randomized study, 60 patients with osteoarthritis were evaluated for total knee replacement, divided in two groups: 'without tourniquet' and 'optimized tourniquet'. Outcomes were mean creatine phosphokinase levels, Knee Society Score and knee isokinetic strength. Data were considered significant when p < 0.05. Results: Creatine phosphokinase levels and functional score were similar between groups. There were no differences between groups regarding knee extension strength on the operated limbs, although the knee flexors' peak torque in the operated limb in the optimized tourniquet group was significantly higher at 6 months relative to preoperative and 3 months assessments. Conclusions: The optimized tourniquet protocol use in total knee replacement combines the benefits of tourniquet use without compromising functional recovery and without additional muscle damage and strength deficits compared to surgery without its use.
RESUMEN
Injuries to the patellar tendon (PT) are associated with knee function deterioration and loss of the capacity to perform daily and sports activities. Patellar tendon injury is often misdiagnosed at emergency rooms, leading to chronic proximal retraction and a challenging clinical scenario. Proximal PT injuries are more common, while distal ones, which can involve tibial bone avulsion fractures or direct tendon avulsion, are rarer. The low incidence of distal PT rupture and the variety of injury patterns make a personal approach reasonable when based on the intraoperative findings and the surgeon's experience. Our purpose is to describe a surgical technique to restore the knee extensor mechanism after chronic distal PT rupture using two kinds of graft, one as a waveform augmentation of the native tendon and the other as reinforcement in a letter X aspect.
RESUMEN
The medial meniscal root tear, a particular meniscal injury at the level of its posterior bone insertion, leads to a loss of impact absorption and load distribution capacity, similar to total meniscectomy. Therefore, its repair is fundamental for knee joint longevity. This type of injury often occurs in middle-aged patients with lower limbs varus malalignment, which results in mechanical overloading of the medial compartment and induces premature cartilage wear out. The success of meniscal root repair, with meniscal bone reinsertion, depends on the correction and realignment of varus deformities greater than 5° for physiological levels. In this situation, corrective tibial osteotomy combined with meniscal repair is indicated. Our goal is to describe the step-by-step technique of the valgus opening wedge tibial osteotomy combined with the arthroscopic reinsertion of the posterior meniscal root in tibia during the treatment of a patient with varus deformity and medial meniscus root tear.
RESUMEN
Patellar fractures, which constitute approximately 1% of bone lesions, may lead to severe impairment of the extensor mechanism. When conservative or surgical treatment fails, the patella may develop pseudoarthrosis. Neglect or delayed treatment of this type of injury may lead to significant diastasis between the patellar fragments. There is no consensus regarding the best treatment for such cases. This study is aimed at describing a rare case of patellar pseudoarthrosis in a patient who underwent two-step surgical treatment comprising transskeletal patellar traction followed by osteosynthesis with a tension band. A 17-year-old male patient presented with a left patellar fracture that resulted from a fall from a standing height 8 years ago. He did not undergo any type of surgical treatment during that time, but the fracture was immobilized for only 2 weeks. The two-step surgical treatment with transskeletal patellar traction and patellar osteosynthesis was performed and provided satisfactory functional clinical results in this patient. This two-step surgical treatment can be performed in cases similar to ours with satisfactory results.
RESUMEN
A artroplastia total de joelho (ATJ) está relacionada a um sangramento peroperatório significativo que pode gerar complicações relacionadas à perda sanguínea e à hemotransfusão quando necessária. A administração intravenosa (IV) do ácido tranexâmico (ATX) tem apresentado bons resultados em reduzir a perda sanguínea visível em ATJ. O objetivo principal deste estudo foi avaliar o efeito do uso de múltiplas doses de ATX sobre a perda sanguínea na ATJ. De modo prospectivo e randomizado foram avaliados 60 participantes de ambos os sexos com idade superior a 50 anos, internados no INTO para realização de ATJ cimentada no período de agosto de 2017 a maio de 2018. Estes foram divididos em três grupos, com 20 pacientes cada, de acordo com a intervenção: Grupo I, composto por pacientes que receberam a dosagem IV de 15mg/kg de ATX 30 minutos antes da cirurgia e de 8/8 horas (h) por 24h no pósoperatório; Grupo II composto por pacientes que receberam ATX somente no pré-operatório na forma IV de 15mg/kg em dose única 30 minutos antes da cirurgia; Grupo III, controle, composto por pacientes que não receberam nenhuma dose de ATX. Em relação aos resultados, os grupos foram homogêneos em relação a sexo, idade, peso, hemoglobina (Hb) pré-operatória e volemia. Não houve diferença significativa entre os grupos I e II em relação ao grupo controle no que tange à queda de Hb em 24 e 48h. Em relação a perda sanguínea estimada em 24 e 48h, apenas o grupo II teve menor perda em relação ao grupo controle, apesar de as perdas nos grupos I e II não serem significativamente diferentes. Houve diferença significativa em relação à perda sanguínea avaliada pelo dreno nos grupos de intervenção, onde os grupos I e II apresentaram menor volume coletado em relação ao grupo III. Concluímos que o uso do ATX em uma e em múltiplas doses, utilizados nas ATJs realizadas com isquemia e revisão da hemostasia, se mostrou eficaz em reduzir as perdas visíveis aferidas no dreno. Contudo a utilização de múltiplas doses de ATX não se mostrou superior ao uso de uma única dose em reduzir a queda nos níveis pós-operatórios de Hb e em reduzir a perda sanguínea na ATJ. O uso de múltiplas doses não se correlacionou ao aumento de complicações tromboembólicas. Palavras-chave: Ácido tranexâmico, artroplastia total de joelho, osteoartrite de joelho, perda sanguínea
Total knee arthroplasty (TKA) is related to significant perioperative bleeding that can lead to complications related to blood loss and blood transfusion when necessary. Intravenous (IV) administration of tranexamic acid (ATX) has shown good results in reducing visible blood loss in TKA. The main objective of the study was to evaluate the effect of multiple-dose ATX use on blood loss in TKA. Prospectively and randomly, 60 participants of both sexes over 50 years of age, admitted to INTO for cemented TKA from August 2017 to May 2018, were evaluated. They were divided into three groups, with 20 patients each, according to the intervention: Group I, composed of patients who received the IV dose of 15mg / kg ATX 30 minutes before surgery and 8/8 hours (h) for 24h postoperatively; Group II consisted of patients receiving ATX only in the preoperative form IV of 15mg / kg in a single dose 30 minutes before surgery; Group III, control, composed of patients who received no dose of ATX. Regarding the results, the groups were homogeneous regarding gender, age, weight, preoperative hemoglobin (Hb) and blood volume. There was no significant difference between groups I and II in relation to the control group regarding the loss of Hb at 24 and 48h. Regarding the estimated blood loss at 24 and 48h, only group II had less loss compared to the control group, although the losses in groups I and II were not significantly different. There was a significant difference regarding the blood loss assessed by the drain in the intervention groups, where groups I and II had a smaller volume collected compared to group III. We conclude that the use of ATX in one and multiple doses, used in TKA performed with ischemia and revision of hemostasis, was effective in reducing the visible losses measured in the drain. However, the use of multiple doses of ATX was not superior to the use of a single dose in reducing the drop in postoperative Hb levels and reducing blood loss in TKA. The use of multiple doses did not correlate with increased thromboembolic complications