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Objective To evaluate the clinical and radiographic results and survival of the acetabular revision surgery of total hip arthroplasty with cemented implant without the use of reinforcement ring, associated with structural homologous bone grafting. Methods A total of 40 patients (44 hips) operated from 1995 to 2015 were retrospectively analyzed. Radiographs were evaluated according to the classification of the acetabular bone defect, graft shape, and the presence of osseointegration. Cases were considered as failures when the migration of the implant was > 5 mm in any direction, and/or the progression of radiolucency lines around the acetabular component were > 2 mm. We verified the association of radiographic findings with cases of failure using statistical tests and analyzed survival using the Kaplan-Meier curve. Results Of the 44 hips, 45.5% of the acetabular defects were Paprosky type 3A and 50% were 3B. In 65% of the hips, the graft configuration was classified as Prieto type 1 and in 31% as type 2. No radiographic evidence of osseointegration was observed in 13.6% of the cases. We observed 9 (20.5%) reconstruction failures. A correlation was observed between reconstruction failure and the absence of radiographic signs of graft osseointegration. Conclusion We observed good clinic and radiographic results, with survival of 79.54% in a mean follow-up of 9.65 years. Also, there was an association between absence of radiographic signs of osseointegration of the structural graft and failure in this series of patients with large bone defects. The failures did not correlate with the severity of the acetabular bone defect, thickness, or graft configuration.
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Abstract Objective To evaluate the clinical and radiographic results and survival of the acetabular revision surgery of total hip arthroplasty with cemented implant without the use of reinforcement ring, associated with structural homologous bone grafting. Methods A total of 40 patients (44 hips) operated from 1995 to 2015 were retrospectively analyzed. Radiographs were evaluated according to the classification of the acetabular bone defect, graft shape, and the presence of osseointegration. Cases were considered as failures when the migration of the implant was > 5 mm in any direction, and/or the progression of radiolucency lines around the acetabular component were > 2 mm. We verified the association of radiographic findings with cases of failure using statistical tests and analyzed survival using the Kaplan-Meier curve. Results Of the 44 hips, 45.5% of the acetabular defects were Paprosky type 3A and 50% were 3B. In 65% of the hips, the graft configuration was classified as Prieto type 1 and in 31% as type 2. No radiographic evidence of osseointegration was observed in 13.6% of the cases. We observed 9 (20.5%) reconstruction failures. A correlation was observed between reconstruction failure and the absence of radiographic signs of graft osseointegration. Conclusion We observed good clinic and radiographic results, with survival of 79.54% in a mean follow-up of 9.65 years. Also, there was an association between absence of radiographic signs of osseointegration of the structural graft and failure in this series of patients with large bone defects. The failures did not correlate with the severity of the acetabular bone defect, thickness, or graft configuration.
Resumo Objetivo Avaliarosresultadosclínicos, radiográficos e a sobrevida da cirurgia de revisão acetabular de artroplastia total de quadril com implante cimentado sem uso de anel de reforço, associado à enxertia óssea homóloga estrutural. Métodos Um total de 40 pacientes (44 quadris) operados de 1995 a 2015 foram analisados retrospectivamente. As radiografias foram avaliadas de acordo com a classificação do defeito ósseo acetabular, o formato do enxerto e à presença de osteointegração. Foram considerados casos de insucesso a migração do implante > 5 mm em qualquer direção e/ou a progressão de linhas de radioluscência em torno do componente acetabular > 2mm. Verificamos a associação dos achados radiográficos com os casos de falha utilizando testes estatísticos e analisamos a sobrevida utilizando a curva de Kaplan-Meier. Resultados Dos 44 quadris, 45,5% dos defeitos acetabulares eram Paprosky tipo 3A e 50%, 3B. Em 65% dos quadris, a configuração do enxerto foi classificada como tipo 1 de Prieto e em 31% como tipo 2. Não foi observada evidência radiográfica de osteointe-gração em 13,6% dos casos. Observamos 9 (20,5%) falhas de reconstrução. Foi observada correlação entre falha da reconstrução com a ausência de sinais radiográficos de osteointegração do enxerto. Conclusão Observamos bons resultados clínicos e radiográficos, com sobrevida de 79,54% em seguimento médio de 9,65 anos. Também houve associação entre ausência de sinais radiográficos de osteointegração do enxerto estrutural e falha nesta série de pacientes com grandes defeitos ósseos. As falhas não se correlacionaram com a severidade do defeito ósseo acetabular, espessura ou configuraçãodoenxerto.
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Humanos , Reoperação , Transplante Homólogo , Estudos Transversais , Osseointegração , Transplante Ósseo , Artroplastia de QuadrilRESUMO
Objective To evaluate the clinical and radiographic results as well as complications related to patients undergoing arthroscopic treatment of subspine hip impingement. Methods We retrospectively evaluated 25 patients (28 hips) who underwent arthroscopic treatment of subspine impingement between January 2012 and June 2018. The mean follow-up was 29.5 months, and the patients were evaluated clinically by using the Harris hip score modified by Byrd (MHHS), the non-arthritic hip score (NAHS), and in terms of internal rotation and hip flexion. In addition, the following items were evaluated by imaging exams: the center-edge (CE) acetabular angle, the Alpha angle, the presence of a sign of the posterior wall, the degree of arthrosis, the presence of heterotopic hip ossification, and the Hetsroni classification for subspine impingement. Results There was an average postoperative increase of 26.9 points for the MHHS, 25.4 for the NAHS ( p < 0.0001), 10.5° in internal rotation ( p < 0.0024), and 7.9° for hip flexion ( p < 0.0001). As for the radiographic evaluation, an average reduction of 3.3° in the CE angle and of 31.6° for the Alpha angle ( p < 0.0001). Eighteen cases (64.3%) were classified as grade 0 osteoarthritis of Tönnis, and 10 (35.7%) were classified as Tönnis grade 1. Two cases (7.1%) presented grade 1 ossification of Brooker. Most hips ( n = 15, 53.6%) were classified as type II of Hetsroni et al. Conclusion In the present study, patients undergoing arthroscopic treatment with subspine impingement showed improvement in clinical aspects and radiographic patterns measured postoperatively, with an average follow-up of 29.5 months.
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Abstract Objective To evaluate the clinical and radiographic results as well as complications related to patients undergoing arthroscopic treatment of subspine hip impingement. Methods We retrospectively evaluated 25 patients (28 hips) who underwent arthroscopic treatment of subspine impingement between January 2012 and June 2018. The mean follow-up was 29.5 months, and the patients were evaluated clinically by using the Harris hip score modified by Byrd (MHHS), the non-arthritic hip score (NAHS), and in terms of internal rotation and hip flexion. In addition, the following items were evaluated by imaging exams: the center-edge (CE) acetabular angle, the Alpha angle, the presence of a sign of the posterior wall, the degree of arthrosis, the presence of heterotopic hip ossification, and the Hetsroni classification for subspine impingement. Results There was an average postoperative increase of 26.9 points for the MHHS, 25.4 for the NAHS (p < 0.0001), 10.5° in internal rotation (p < 0.0024), and 7.9° for hip flexion (p < 0.0001). As for the radiographic evaluation, an average reduction of 3.3° in the CE angle and of 31.6° for the Alpha angle (p < 0.0001). Eighteen cases (64.3%) were classified as grade 0 osteoarthritis of Tönnis, and 10 (35.7%) were classified as Tönnis grade 1. Two cases (7.1%) presented grade 1 ossification of Brooker. Most hips (n = 15, 53.6%) were classified as type II of Hetsroni et al. Conclusion In the present study, patients undergoing arthroscopic treatment with subspine impingement showed improvement in clinical aspects and radiographic patterns measured postoperatively, with an average follow-up of 29.5 months.
Resumo Objetivo Avaliar os resultados clínicos e radiográficos assim como as complicações relacionadas a pacientes submetidos ao tratamento artroscópico do impacto subespinhal do quadril. Métodos Foram avaliados retrospectivamente 25 pacientes (28 quadris) submetidos ao tratamento artroscópico de impacto subespinhal entre janeiro de 2012 e junho de 2018. O seguimento médio foi de 29,5 meses, e os pacientes foram avaliados clinicamente pelo Harris hip score modificado por Byrd (MHHS), o non-arthritic hip score (NAHS), e quanto à rotação interna e flexão do quadril. Além disso, foram avaliados por exames de imagem: o ângulo center-edge (CE) acetabular, o ângulo alfa, a presença de sinal da parede posterior, o grau de artrose, a presença de ossificação heterotópica do quadril e a classificação de Hetsroni para Impacto Subespinhal. Resultados Observou-se aumento médio pós-operatório de 26,9 pontos para o MHHS, 25,4 para o NAHS (p < 0,0001), 10,5° na rotação interna (p < 0,0024) e 7,9° para flexão do quadril (p < 0,0001). Quanto à avaliação radiográfica, observou-se redução média de 3,3° no ângulo CE e de 31,6° para o ângulo alfa (p < 0,0001). Foram classificados 18 casos (64,3%) como artrose grau 0 de Tönnis e 10 (35,7%) como Tönnis 1. Dois casos (7,1%) apresentaram ossificação grau 1 de Brooker. A maioria dos quadris (n = 15; 53,6%) foi classificada como tipo II de Hetsroni et al. Conclusão No presente estudo, os pacientes submetidos a tratamento artroscópico de impacto subespinhal apresentaram melhora nos aspectos clínicos e nos padrões radiográficos aferidos pós-operatoriamente, com seguimento médio de 29,5 meses.
Assuntos
Humanos , Masculino , Feminino , Adulto , Osteoartrite , Osteogênese , Artroscopia , Rotação , Ossificação Heterotópica , Impacto Femoroacetabular , Articulação do QuadrilRESUMO
Objective The purpose of the present study was to evaluate the pelvic bone deformities and its correlation with the acetabular center-edge (CE) angle. Methods Between August 2014 and April 2015, we prospectively evaluated patients aged between 20 and 60 years old. The exclusion criteria were: metabolic disease, previous hip or spine surgery, radiograph showing hip arthrosis ≥ Tönnis two, severe hip dysplasia, global acetabular overcoverage, acetabular crossover sign, hip deformities from slipped capital femoral epiphysis (SCFE) or Leg-Perthes-Calveé, and bad quality radiographs. At anteroposterior (AP) pelvic radiographs, we have evaluated: the CE angle, the acetabular index (IA), the acetabular crossover sign, the vertical and horizontal superior and inferior pelvic axis (H1: Horizontal line 1, superior pelvic axis; H2: Horizontal line 2, superior pelvic axis; V1: Vertical line, superior pelvic axis; HR: Horizontal line, inferior pelvic axis; VR: Vertical line, inferior pelvic axis). The superior and inferior pelvic axis were considered asymmetric when there was a difference ≥ 5 mm between both sides. Patients were divided into two groups: control and group 1. Results A total of 228 patients (456 hips) were evaluated in the period. According to the established criteria, 93 patients were included. The mean age was 39.9 years old (20 to 60 years old, standard deviation [SD] = 10,5), and the mean CE angle in the right hip was 31.5° (20 o to 40°), and in the left 32.3° (20 o to 40°). The control group had 38 patients, with asymmetric H1 in 4 cases (10.5%), H2 in 5 (13.1%), V1 in 7 (18.4%), HR in 5 (13.1%) and VR in 1 (2.63%). Group 1 had 55 patients, with asymmetric H1 in 24 cases (43.6%), H2 in 50 (90.9%), V1 in 28 (50.9%), HR in 16 (29.09%) and VR in 8 (14.5%). Comparing both groups, there was statistical significance for H1, H2 and V1 asymmetry ( p < 0.001). Conclusion In the present paper, we observed the correlation between variation in the acetabular CE angle and asymmetry of the superior hemipelvis. The present authors believe that a better understanding of the pelvic morphologic alterations allows a greater facility in the diagnosis of hip articular deformities.
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Abstract Objective The purpose of the present study was to evaluate the pelvic bone deformities and its correlation with the acetabular center-edge (CE) angle. Methods Between August 2014 and April 2015, we prospectively evaluated patients aged between 20 and 60 years old. The exclusion criteria were: metabolic disease, previous hip or spine surgery, radiograph showing hip arthrosis ≥ Tönnis two, severe hip dysplasia, global acetabular overcoverage, acetabular crossover sign, hip deformities from slipped capital femoral epiphysis (SCFE) or Leg-Perthes-Calveé, and bad quality radiographs. At anteroposterior (AP) pelvic radiographs, we have evaluated: the CE angle, the acetabular index (IA), the acetabular crossover sign, the vertical and horizontal superior and inferior pelvic axis (H1: Horizontal line 1, superior pelvic axis; H2: Horizontal line 2, superior pelvic axis; V1: Vertical line, superior pelvic axis; HR: Horizontal line, inferior pelvic axis; VR: Vertical line, inferior pelvic axis). The superior and inferior pelvic axis were considered asymmetric when there was a difference ≥ 5 mm between both sides. Patients were divided into two groups: control and group 1. Results A total of 228 patients (456 hips) were evaluated in the period. According to the established criteria, 93 patients were included. The mean age was 39.9 years old (20 to 60 years old, standard deviation [SD] = 10,5), and the mean CE angle in the right hip was 31.5º (20 o to 40º), and in the left 32.3º (20 o to 40º). The control group had 38 patients, with asymmetric H1 in 4 cases (10.5%), H2 in 5 (13.1%), V1 in 7 (18.4%), HR in 5 (13.1%) and VR in 1 (2.63%). Group 1 had 55 patients, with asymmetric H1 in 24 cases (43.6%), H2 in 50 (90.9%), V1 in 28 (50.9%), HR in 16 (29.09%) and VR in 8 (14.5%). Comparing both groups, there was statistical significance for H1, H2 and V1 asymmetry (p < 0.001). Conclusion In the present paper, we observed the correlation between variation in the acetabular CE angle and asymmetry of the superior hemipelvis. The present authors believe that a better understanding of the pelvic morphologic alterations allows a greater facility in the diagnosis of hip articular deformities.
Resumo Objetivos O objetivo do presente trabalho é avaliar a deformidade dos ossos pélvicos e sua correlação com ângulo centro-borda acetabular (CE). Métodos Foi realizado um estudo prospectivo caso-controle, entre agosto de 2014 e abril de 2015. Os critérios de inclusão foram pacientes consecutivos com idades entre 20 e 60 anos. Os critérios de exclusão foram: doença metabólica, cirurgia prévia de quadril ou coluna, radiografia evidenciando artrose de quadril ≥ Tönnis 2, displasia do desenvolvimento do quadril (DDQ) severa, sobrecobertura acetabular global, sinal do cruzamento das linhas acetabulares, deformidades decorrentes de epifisiólise ou Legg-Perthes-Calveé, e radiografia sem qualidade adequada. Foram avaliados na radiografia anteroposterior (AP) de pelve: o ângulo CE, índice acetabular (IA), sinal do cruzamento das linhas acetabulares, mensuração do eixo horizontal e vertical da hemipelve superior e inferior (H1: Linha Horizontal 1, hemipelve superior; H2: Linha Horizontal 2, hemipelve superior; V1: Linha Vertical, hemipelve superior; HR: Linha Horizontal, hemipelve inferior; VR: Linha Vertical, hemipelve inferior). As mensurações H1, H2, V1, HR e VR foram consideradas assimétricas quando, na comparação de uma hemipelve em relação ao lado contralateral, evidenciou-se uma diferença > 5 mm. Os pacientes foram separados em dois grupos: controle e grupo 1. Resultados O total de pacientes avaliados no período foi de 228 (456 quadris). De acordo com os critérios estabelecidos, foram incluídos neste estudo 93 pacientes. A idade média foi de 39,9 anos (20 a 60 anos, desvio padrão [DP] = 10,5), e o ângulo CE médio do quadril direito foi de 31,5º (20º a 40º) e do esquerdo de 32,3º (20º a 40º). Um total de 38 pacientes foi incluído no grupo controle, sendo que com relação à H1, foi constatada aferição assimétrica em 4 casos (10,5%), H2 em 5 (13,1%), V1 em 7 (18,4%), HR em 5 (13,1%), e VR em 1 caso (2,63%). No grupo 1, foram incluídos 55 pacientes, sendo que com relação à H1, foi constatada aferição assimétrica em 24 casos (43,6%), H2 em 50 (90,9%), V1 em 28 (50,9%), HR em 16 (29,09%), e VR em 8 casos (14,5%). Na comparação entre o grupo controle e o grupo 1, observou-se diferença estatisticamente significativa para a assimetria das mensurações H1, H2 e V1 (p < 0,001). Conclusão No presente trabalho, evidenciou-se correlação entre variação do ângulo CE acetabular e assimetria da hemipelve superior. Os presentes autores acreditam que o melhor entendimento das alterações morfológicas pélvicas permite uma maior facilidade no diagnóstico das deformidades articulares do quadril.
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Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Osteoartrite , Cabeça do Fêmur , Luxação do Quadril , AcetábuloRESUMO
While the value of national arthroplasty registries (NAR) for quality improvement in total hip arthroplasty (THA) has already been widely reported, some methodological limitations associated with observational epidemiological studies that may interfere with the assessment of safety and efficacy of prosthetic implants have recently been described in the literature. Among the main limitations of NAR, the need for at least 80% compliance of all health institutions covered by the registry is emphasized; completeness equal or greater than 90% of all THA performed; restricted data collection; use of revision surgery as the sole criterion for outcome; and the inability of establishing a definite causal link with prosthetic dysfunction. The present article evaluates the advantages and limitations of NAR, in the light of current knowledge, which point to the need for a broader data collection and the use of more structured criteria for defining outcomes. In this scenario, the authors describe of idealization, conceptual and operational structure, and the project of implantation and implementation of a multicenter registry model, called Rempro-SBQ, which includes healthcare institutions already linked to the Brazilian Hip Society (Sociedade Brasileira de Quadril [SBQ]). This partnership enables the collection of more reliable and comprehensive data at a higher hierarchical level, with a significant reduction in maintenance and financing costs. The quality improvement actions supported by SBQ may enhance its effectiveness and stimulate greater adherence for collecting, storing, interpreting, and disseminating information (feedback).
Ainda que os registros nacionais de artroplastias (RNAs) sejam um importante instrumento de controle e melhoria da qualidade da artroplastia total de quadril (ATQ), algumas limitações metodológicas associadas aos estudos epidemiológicos observacionais, que podem interferir na avaliação da segurança e eficácia dos implantes protéticos, têm sido recentemente descritas na literatura.Dentre as principais limitações destacam-se a necessidade de cobertura mínima de 80% das instituições hospitalares da região objeto do registro; integralidade mínima de 90% de todas as ATQs feitas; coleta de informações mais restritas; uso da cirurgia de revisão como critério único de desfecho e a dificuldade de se estabelecer um nexo causal com a disfunção protética.No presente artigo avaliamos as vantagens e limitações dos RNAs, à luz dos conhecimentos atuais, que apontam para a necessidade da coleta de informações mais amplas e de uso de critérios mais estruturados na definição de desfechos.Nesse cenário, descrevemos os processos de idealização, a estrutura conceitual e operacional e o projeto de implantação e implementação de um modelo de registro multicêntrico, denominado Rempro-SBQ, que inclui os centros hospitalares de treinamento em cirurgia de quadril já ligados institucionalmente à Sociedade Brasileira de Quadril (SBQ). Essa parceria possibilita, simultaneamente, a coleta de informações mais abrangentes e de elevado nível hierárquico, de forma confiável, com redução bastante significativa dos custos de manutenção e financiamento. As ações de melhoria da qualidade, amparadas pela SBQ, podem protagonizar uma condição de maior efetividade e maior adesão aos procedimentos de coleta, armazenamento, interpretação e divulgação das informações.
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OBJECTIVE: To compare clinical and imaging results and complications between patients treated for femoroacetabular impingement (FAI) who underwent either anterior open surgery or an arthroscopic approach, with a minimum follow-up of two years. METHODS: This retrospective case-control study included patients submitted to FAI surgical treatment between November 2007 and March 2012. Patients treated with open surgery were compared with those treated with arthroscopy. Patients were clinically assessed by the modified Harris Hip Score, Non-Arthritic Hip Score, and internal hip rotation. Patients were radiographically assessed by the center-edge angle, joint space width, alpha angle, neck-head index, degree of arthrosis, and presence of heterotopic ossification of the hip. RESULTS: In the study period, 56 patients (58 hips) with FAI were included; 16 underwent open surgery and 40 underwent arthroscopy. The 40 patients treated by the arthroscopic route had a mean follow-up of 29.1 months, and 75.6% presented good or excellent clinical results. The radiographic evaluation parameters progressed to normal levels. The 16 patients who underwent open surgery had a mean follow-up of 52 months, and 70.58% presented good or excellent clinical results. The radiographic evaluation parameters progressed to normal levels. Postoperative clinical and radiographic results were considered similar in both groups. CONCLUSIONS: Arthroscopy and open surgery treatments for FAI provided comparable clinical and radiographic results. However, a higher rate of complications was observed in the open surgery group.
OBJETIVOS: Comparar os resultados clínicos e radiográficos, bem como as complicações observadas em pacientes submetidos ao tratamento cirúrgico, devido a impacto femoroacetabular, sob abordagem artroscópica ou anterior aberta, com seguimento mínimo de dois anos. MÉTODOS: Estudo caso-controle retrospectivo, com pacientes operados entre novembro de 2007 e março de 2012 e que foram submetidos a tratamento cirúrgico de impacto femoroacetabular. Pacientes submetidos à abordagem aberta foram comparados com pacientes submetidos à abordagem artroscópica. Os pacientes foram avaliados clinicamente pelos escores clínicos Harris Hip modificado, Non Arthritic Hip e quanto à rotação interna do quadril. Os pacientes foram avaliados radiograficamente, aferiram-se o ângulo centro-borda, a dimensão do espaço articular, o ângulo alfa, o índice colo-cabeça, o grau de artrose e a presença de ossificação heterotópica do quadril. RESULTADOS: Foram incluídos no estudo 56 pacientes, 16 submetidos à abordagem aberta e 40 à artroscópica. Os 40 pacientes tratados por via artroscópica foram seguidos por, em média, 29,1 meses, 75,6% apresentaram resultados clínicos bons ou excelentes. Quanto à avaliação radiográfica, observou-se correção para índices considerados normais. Os 16 pacientes operados por via aberta obtiveram seguimento médio de 52 meses, 70,58% apresentaram resultados clínicos bons ou excelentes. Quanto à avaliação radiográfica, observou-se correção para índices considerados normais. Os resultados clínicos e radiográficos pós-operatórios foram considerados semelhantes em ambos os grupos. CONCLUSÃO: Os resultados clínicos e radiográficos do tratamento artroscópico do impacto femoroacetabular foram comparáveis aos resultados do tratamento aberto. Observamos um maior número de complicações no grupo aberto.
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Stable slipped capital femoral epiphysis (SCFE) is the most common disease in the adolescent hip, with an estimated frequency of 10.8 in every 100,000 individuals. Recent studies of the biomechanics of femoroacetabular impingement indicate that small anatomical deformities of the hip arising from SCFE can potentially cause permanent acetabular chondral damage. There is no consensus about the best treatment option, especially for cases of moderate or severe chronic slippage (Southwick classification). Some authors recommend treatment with fixation in situ, in the belief that remodeling of the residual deformity of the femoral neck during growth allows proper function of the hip joint. Others recommend correction at the site of the deformity (subcapital realignment), aiming for the anatomical reduction of the epiphysis and seeking to reduce the risk of chondral degeneration. The authors of this Technical Note present an alternative to the classical techniques of subcapital realignment for the treatment of moderate and severe chronic and stable SCFE, which allows adequate access to the hip joint and anatomical reduction of the slippage, besides having the theoretical advantage of rapid rehabilitation of the patient.
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OBJECTIVE: This study aimed to evaluate the clinical and radiographic outcomes, as well as the complications of arthroscopic subcapital realignment osteotomy in chronic and stable slipped capital femoral epiphysis (SCFE). As indicated by the literature review, this is the first time this type of arthroscopic osteotomy was described. METHODS: Between June 2012 and December 2014, seven patients were submitted to arthroscopic subcapital realignment osteotomy in chronic and stable SCFE. The mean age was 11 years and 4 months, and the mean follow-up period was 16.5 months (6-36). Clinical results were evaluated using the Modified Harris Hip Score (MHHS), which was measured pre- and postoperatively. Radiographs were evaluated using the Southwick quantitative classification and the epiphysis-diaphysis angle (pre- and postoperatively). Complications were assessed. RESULTS: The mean preoperative MHHS was 35.8 points, and 97.5 points post-operatively (p < 0.05). Radiographically, five patients were classified as Southwick classification grade II and two as grade III. The mean correction of the epiphysis-diaphysis angle was 40°. No immediate postoperatively complications were observed. One patient presented femoral head avascular necrosis, without collapse or chondrolysis at the most recent follow-up (22 months). CONCLUSION: The arthroscopic technique presented for subcapital realignment osteotomy in chronic and stable SCFE showed satisfactory clinical and radiographic outcomes in a 16.5 months follow-up period.
OBJETIVO: Avaliar os resultados clínicos e radiográficos, bem como as complicações da osteotomia de realinhamento subcapital por via artroscópica para tratamento da epifisiólise proximal do fêmur (EPF) crônica e estável, relativos a uma série inicial de pacientes. Conforme análise da literatura, o estudo apresenta a primeira descrição de técnica artroscópica desse tipo de osteotomia. MÉTODOS: Entre junho de 2012 a dezembro de 2014, sete pacientes foram submetidos à osteotomia de realinhamento subcapital por via artroscópica para tratamento da EPF crônica e estável. A idade média dos pacientes foi de 11 anos e quatro meses. O seguimento mínimo foi de seis a 36 meses (média de 16,5 meses). Os pacientes foram avaliados clinicamente de acordo com o Harris Hip Score modificado por Byrd e radiograficamente conforme a classificação quantitativa de Southwick e o ângulo epifisio-diafisário. Complicações pós-operatórias foram analisadas. RESULTADOS: Com relação à avaliação do escore clínico Harris Hip Score Modificado por Byrd, observou-se média pré-operatória de 35,8 pontos e pós-operatória de 97,5 pontos (p < 0,05). Radiograficamente, cinco pacientes foram classificados como grau II e dois como grau III de Southwick. Observou-se correção média do ângulo epifisio-diafisário de 40o. Não houve complicações pós-operatórias imediatas. Um paciente evoluiu com necrose avascular da cabeça femoral, sem colapso ou condrólise no último seguimento (22 meses). CONCLUSÃO: A técnica artroscópica apresentada pelos autores para tratamento da EPF crônica e estável resultou em melhoria clínica e radiográfica dos pacientes nesta série inicial.
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ABSTRACT OBJECTIVE: This study aimed to evaluate the clinical and radiographic outcomes, as well as the complications of arthroscopic subcapital realignment osteotomy in chronic and stable slipped capital femoral epiphysis (SCFE). As indicated by the literature review, this is the first time this type of arthroscopic osteotomy was described. METHODS: Between June 2012 and December 2014, seven patients were submitted to arthroscopic subcapital realignment osteotomy in chronic and stable SCFE. The mean age was 11 years and 4 months, and the mean follow-up period was 16.5 months (6-36). Clinical results were evaluated using the Modified Harris Hip Score (MHHS), which was measured pre- and postoperatively. Radiographs were evaluated using the Southwick quantitative classification and the epiphysis-diaphysis angle (pre- and postoperatively). Complications were assessed. RESULTS: The mean preoperative MHHS was 35.8 points, and 97.5 points post-operatively (p < 0.05). Radiographically, five patients were classified as Southwick classification grade II and two as grade III. The mean correction of the epiphysis-diaphysis angle was 40°. No immediate postoperatively complications were observed. One patient presented femoral head avascular necrosis, without collapse or chondrolysis at the most recent follow-up (22 months). CONCLUSION: The arthroscopic technique presented for subcapital realignment osteotomy in chronic and stable SCFE showed satisfactory clinical and radiographic outcomes in a 16.5 months follow-up period.
RESUMO OBJETIVO: Avaliar os resultados clínicos e radiográficos, bem como as complicações da osteotomia de realinhamento subcapital por via artroscópica para tratamento da epifisiólise proximal do fêmur (EPF) crônica e estável, relativos a uma série inicial de pacientes. Conforme análise da literatura, o estudo apresenta a primeira descrição de técnica artroscópica desse tipo de osteotomia. MÉTODOS: Entre junho de 2012 a dezembro de 2014, sete pacientes foram submetidos à osteotomia de realinhamento subcapital por via artroscópica para tratamento da EPF crônica e estável. A idade média dos pacientes foi de 11 anos e quatro meses. O seguimento mínimo foi de seis a 36 meses (média de 16,5 meses). Os pacientes foram avaliados clinicamente de acordo com o Harris Hip Score modificado por Byrd e radiograficamente conforme a classificação quantitativa de Southwick e o ângulo epifisio-diafisário. Complicações pós-operatórias foram analisadas. RESULTADOS: Com relação à avaliação do escore clínico Harris Hip Score Modificado por Byrd, observou-se média pré-operatória de 35,8 pontos e pós-operatória de 97,5 pontos (p < 0,05). Radiograficamente, cinco pacientes foram classificados como grau II e dois como grau III de Southwick. Observou-se correção média do ângulo epifisio-diafisário de 40o. Não houve complicações pós-operatórias imediatas. Um paciente evoluiu com necrose avascular da cabeça femoral, sem colapso ou condrólise no último seguimento (22 meses) . CONCLUSÃO: A técnica artroscópica apresentada pelos autores para tratamento da EPF crônica e estável resultou em melhoria clínica e radiográfica dos pacientes nesta série inicial.
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Humanos , Masculino , Feminino , Criança , Artroscopia , Epífises , Epifise Deslocada , Cabeça do Fêmur , QuadrilRESUMO
Abstract While the value of national arthroplasty registries (NAR) for quality improvement in total hip arthroplasty (THA) has already been widely reported, some methodological limitations associated with observational epidemiological studies that may interfere with the assessment of safety and efficacy of prosthetic implants have recently been described in the literature. Among the main limitations of NAR, the need for at least 80% compliance of all health institutions covered by the registry is emphasized; completeness equal or greater than 90% of all THA performed; restricted data collection; use of revision surgery as the sole criterion for outcome; and the inability of establishing a definite causal link with prosthetic dysfunction. The present article evaluates the advantages and limitations of NAR, in the light of current knowledge, which point to the need for a broader data collection and the use of more structured criteria for defining outcomes. In this scenario, the authors describe of idealization, conceptual and operational structure, and the project of implantation and implementation of a multicenter registry model, called Rempro-SBQ, which includes healthcare institutions already linked to the Brazilian Hip Society (Sociedade Brasileira de Quadril [SBQ]). This partnership enables the collection of more reliable and comprehensive data at a higher hierarchical level, with a significant reduction in maintenance and financing costs. The quality improvement actions supported by SBQ may enhance its effectiveness and stimulate greater adherence for collecting, storing, interpreting, and disseminating information (feedback).
Resumo Ainda que os registros nacionais de artroplastias (RNAs) sejam um importante instrumento de controle e melhoria da qualidade da artroplastia total de quadril (ATQ), algumas limitações metodológicas associadas aos estudos epidemiológicos observacionais, que podem interferir na avaliação da segurança e eficácia dos implantes protéticos, têm sido recentemente descritas na literatura.Dentre as principais limitações destacam-se a necessidade de cobertura mínima de 80% das instituições hospitalares da região objeto do registro; integralidade mínima de 90% de todas as ATQs feitas; coleta de informações mais restritas; uso da cirurgia de revisão como critério único de desfecho e a dificuldade de se estabelecer um nexo causal com a disfunção protética.No presente artigo avaliamos as vantagens e limitações dos RNAs, à luz dos conhecimentos atuais, que apontam para a necessidade da coleta de informações mais amplas e de uso de critérios mais estruturados na definição de desfechos.Nesse cenário, descrevemos os processos de idealização, a estrutura conceitual e operacional e o projeto de implantação e implementação de um modelo de registro multicêntrico, denominado Rempro-SBQ, que inclui os centros hospitalares de treinamento em cirurgia de quadril já ligados institucionalmente à Sociedade Brasileira de Quadril (SBQ). Essa parceria possibilita, simultaneamente, a coleta de informações mais abrangentes e de elevado nível hierárquico, de forma confiável, com redução bastante significativa dos custos de manutenção e financiamento. As ações de melhoria da qualidade, amparadas pela SBQ, podem protagonizar uma condição de maior efetividade e maior adesão aos procedimentos de coleta, armazenamento, interpretação e divulgação das informações.
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Falha de Prótese , Sistema de Registros , Artroplastia de QuadrilRESUMO
Abstract Objective To compare clinical and imaging results and complications between patients treated for femoroacetabular impingement (FAI) who underwent either anterior open surgery or an arthroscopic approach, with a minimum follow-up of two years. Methods This retrospective case-control study included patients submitted to FAI surgical treatment between November 2007 and March 2012. Patients treated with open surgery were compared with those treated with arthroscopy. Patients were clinically assessed by the modified Harris Hip Score, Non-Arthritic Hip Score, and internal hip rotation. Patients were radiographically assessed by the center-edge angle, joint space width, alpha angle, neck-head index, degree of arthrosis, and presence of heterotopic ossification of the hip. Results In the study period, 56 patients (58 hips) with FAI were included; 16 underwent open surgery and 40 underwent arthroscopy. The 40 patients treated by the arthroscopic route had a mean follow-up of 29.1 months, and 75.6% presented good or excellent clinical results. The radiographic evaluation parameters progressed to normal levels. The 16 patients who underwent open surgery had a mean follow-up of 52 months, and 70.58% presented good or excellent clinical results. The radiographic evaluation parameters progressed to normal levels. Postoperative clinical and radiographic results were considered similar in both groups. Conclusions Arthroscopy and open surgery treatments for FAI provided comparable clinical and radiographic results. However, a higher rate of complications was observed in the open surgery group.
Resumo Objetivos Comparar os resultados clínicos e radiográficos, bem como as complicações observadas em pacientes submetidos ao tratamento cirúrgico, devido a impacto femoroacetabular, sob abordagem artroscópica ou anterior aberta, com seguimento mínimo de dois anos. Métodos Estudo caso-controle retrospectivo, com pacientes operados entre novembro de 2007 e março de 2012 e que foram submetidos a tratamento cirúrgico de impacto femoroacetabular. Pacientes submetidos à abordagem aberta foram comparados com pacientes submetidos à abordagem artroscópica. Os pacientes foram avaliados clinicamente pelos escores clínicos Harris Hip modificado, Non Arthritic Hip e quanto à rotação interna do quadril. Os pacientes foram avaliados radiograficamente, aferiram-se o ângulo centro-borda, a dimensão do espaço articular, o ângulo alfa, o índice colo-cabeça, o grau de artrose e a presença de ossificação heterotópica do quadril. Resultados Foram incluídos no estudo 56 pacientes, 16 submetidos à abordagem aberta e 40 à artroscópica. Os 40 pacientes tratados por via artroscópica foram seguidos por, em média, 29,1 meses, 75,6% apresentaram resultados clínicos bons ou excelentes. Quanto à avaliação radiográfica, observou-se correção para índices considerados normais. Os 16 pacientes operados por via aberta obtiveram seguimento médio de 52 meses, 70,58% apresentaram resultados clínicos bons ou excelentes. Quanto à avaliação radiográfica, observou-se correção para índices considerados normais. Os resultados clínicos e radiográficos pós-operatórios foram considerados semelhantes em ambos os grupos. Conclusão Os resultados clínicos e radiográficos do tratamento artroscópico do impacto femoroacetabular foram comparáveis aos resultados do tratamento aberto. Observamos um maior número de complicações no grupo aberto.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Artroplastia de Quadril , Falha de Prótese , Sistema de RegistrosRESUMO
OBJECTIVES: To evaluate the clinical and radiographic results and complications relating to patients undergoing arthroscopic treatment for femoroacetabular impingement by means of an extracapsular approach. METHODS: Between January 2011 and March 2012, 49 patients (50 hips) underwent arthroscopic treatment for femoroacetabular impingement, performed by the hip surgery team of the Orthopedic Hospital of Passo Fundo, Rio Grande do Sul. Forty patients (41 hips) fulfilled all the requirements for this study. The mean follow-up was 29.1 months. The patients were assessed clinically by means of the Harris Hip score, as modified by Byrd (MHHS), the Non-Arthritic Hip score (NAHS) and the internal rotation of the hip. Their hips were also evaluated radiographically, with measurement of the CE angle, dimensions of the joint space, alpha angle, neck-head index, degree of arthrosis and presence of heterotopic ossification of the hip. RESULTS: Out of the 41 hips treated, 31 (75.6%) presented good or excellent clinical results. There was a mean postoperative increase of 22.1 points for the MHHS, 21.5 for the NAHS and 16.4Ì for the internal rotation of the hip (p < 0.001). Regarding the radiographic evaluation, correction to normal values was observed for the alpha angle and neck-head index, with a mean postoperative decrease of 32.9Ì and mean increase of 0.10, respectively (p < 0.001). CONCLUSION: Arthroscopic treatment of femoroacetabular impingement by means of an extracapsular approach presented satisfactory clinical and radiographic results over a mean follow-up of 29.1 months, with few complications.
OBJETIVOS: Avaliar os resultados clínicos e radiográficos e as complicações relativos a pacientes submetidos a tratamento artroscópico de impacto femoroacetabular com o uso da abordagem extracapsular. MÉTODOS: Entre janeiro de 2011 e março de 2012, 49 pacientes (50 quadris) foram submetidos a tratamento artroscópico de impacto femoroacetabular pela Equipe de Cirurgia do Quadril do Hospital Ortopédico de Passo Fundo (RS). Preencheram todos os requisitos necessários para este trabalho 40 pacientes (41 quadris). O seguimento médio foi de 29,1 meses. Os pacientes foram avaliados pelo Harris Hip Score modificado por Byrd (MHHS), Non-Arthritic Hip Score (NAHS) e quanto à rotação interna do quadril. Também foram avaliados radiograficamente. Aferiu-se o ângulo CE, a dimensão do espaço articular, o ângulo alfa, o índice colo-cabeça, o grau de artrose e a presença de ossificação heterotópica do quadril. RESULTADOS: Dos 41 quadris tratados, 31 (75,6%) apresentaram resultados clínicos bons ou excelentes. Observou-se um aumento médio pós-operatório de 22,1 pontos para o MHHS, 21,5 para o NAHS e 16,4° na rotação interna do quadril (p < 0,001). Quanto à avaliação radiográfica, observou-se correção para índices considerados normais do ângulo alfa e índice colo-cabeça, com diminuição média de 32,9o e aumento médio pós-operatório de 0,10, respectivamente (p < 0,001). CONCLUSÃO: O tratamento artroscópico do impacto femoroacetabular com o uso da abordagem extracapsular apresentou resultados clínicos e radiográficos satisfatórios em seguimento médio de 29,1 meses, com poucas complicações.
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Avaliar os resultados clínicos e radiográficos e as complicações relativos a pacientes submetidos a tratamento artroscópico de impacto femoroacetabular com o uso da abordagem extracapsular. MÉTODOS: Entre janeiro de 2011 e março de 2012, 49 pacientes (50 quadris) foram submetidos a tratamento artroscópico de impacto femoroacetabular pela Equipe de Cirurgia do Quadril do Hospital Ortopédico de Passo Fundo (RS). Preencheram todos os requisitos necessários para este trabalho 40 pacientes (41 quadris). O seguimento médio foi de 29,1 meses. Os pacientes foram avaliados pelo Harris Hip Score modificado por Byrd (MHHS), Non-Arthritic Hip Score (NAHS) e quanto à rotação interna do quadril. Também foram avaliados radiograficamente. Aferiu-se o ângulo CE, a dimensão do espaço articular, o ângulo alfa, o índice colo-cabeça, o grau de artrose e a presença de ossificação heterotópica do quadril. RESULTADOS: Dos 41 quadris tratados, 31 (75,6%) apresentaram resultados clínicos bons ou excelentes. Observou-se um aumento médio pós-operatório de 22,1 pontos para o MHHS, 21,5 para o NAHS e 16,4° na rotação interna do quadril (p < 0,001). Quanto à avaliação radiográfica, observou-se correção para índices considerados normais do ângulo alfa e índice colo-cabeça, com diminuição média de 32,9oe aumento médio pós-operatório de 0,10, respectivamente (p < 0,001). CONCLUSÃO: O tratamento artroscópico do impacto femoroacetabular com o uso da abordagem extracapsular apresentou resultados clínicos e radiográficos satisfatórios em seguimento médio de 29,1 meses, com poucas complicações.
To evaluate the clinical and radiographic results and complications relating to patients undergoing arthroscopic treatment for femoroacetabular impingement by means of an extracapsular approach. METHODS: Between January 2011 and March 2012, 49 patients (50 hips) underwent arthroscopic treatment for femoroacetabular impingement, performed by the hip surgery team of the Orthopedic Hospital of Passo Fundo, Rio Grande do Sul. Forty patients (41 hips) fulfilled all the requirements for this study. The mean follow-up was 29.1 months. The patients were assessed clinically by means of the Harris Hip score, as modified by Byrd (MHHS), the Non-Arthritic Hip score (NAHS) and the internal rotation of the hip. Their hips were also evaluated radiographically, with measurement of the CE angle, dimensions of the joint space, alpha angle, neck-head index, degree of arthrosis and presence of heterotopic ossification of the hip. RESULTS: Out of the 41 hips treated, 31 (75.6%) presented good or excellent clinical results. There was a mean postoperative increase of 22.1 points for the MHHS, 21.5 for the NAHS and 16.4° for the internal rotation of the hip ( p< 0.001). Regarding the radiographic evaluation, correction to normal values was observed for the alpha angle and neck-head index, with a mean postoperative decrease of 32.9° and mean increase of 0.10, respectively ( p< 0.001). CONCLUSION: Arthroscopic treatment of femoroacetabular impingement by means of an extracapsular approach presented satisfactory clinical and radiographic results over a mean follow-up of 29.1 months, with few complications.
Assuntos
Humanos , Masculino , Feminino , Adulto Jovem , Pessoa de Meia-Idade , Artroscopia , Impacto Femoroacetabular/diagnóstico , Impacto Femoroacetabular/etiologia , Impacto Femoroacetabular/terapiaRESUMO
Objective: To conduct an epidemiological analysis on the main microbiological markers in bone tissue that was processed at the musculoskeletal tissue bank of Hospital São Vicente de Paulo, in Passo Fundo, between August 2007 and October 2011. Methods: Between August 2007 and October 2011, 202 musculoskeletal tissue samples were collected for the tissue bank. Among these, 159 samples were from living donor patients and 43 were from cadaver donors. The following serological tests were requested: hepatitis B, hepatitis C, syphilis, cytomegalovirus, Chagas disease, toxoplasmosis, HIV and HTLV. Results: Among the 159 living donors, 103 (64.75%) were men and 56 (35.25%) were women. The patients' mean age was 59.35 ± 8.87 years. Out of this total, 76 tissue samples (47.8%) from donors were rejected. There was no difference in the number of rejections in relation to sex (p = 0.135) or age (p = 0.523). The main cause of rejection was serologically positive findings for the hepatitis B virus, which was responsible for 48 rejections (63.15%). Among the 43 cadaver donors, the mean age was 37.84 ± 10.32 years. Of these, 27 (62.8%) were men and 16 (37.2%) were women. Six of the samples collected from cadaver donors were rejected (13.9%), and the main cause of rejection was serologically positive findings for the hepatitis C virus, which was responsible for three cases (50%). There was no significant difference in the number of rejections in relation to sex (p = 0.21) or age (p = 0.252). Conclusion: There were a greater number of rejections of tissues from living donors (47.8%) than from cadaver donors (13.9%). Among the living donors, the main cause of rejection was the presence of serologically positive findings of the hepatitis B virus, while among the cadaver donors, it was due to the hepatitis C virus...
Objetivo: Fazer uma análise epidemiológica dos principais marcadores microbiólogicos dos tecidos ósseos processados de agosto de 2007 a outubro de 2011 no Banco de Tecidos Musculoesqueléticos do Hospital São Vicente de Paulo de Passo Fundo. Métodos: Foram feitas 202 captações de tecidos musculoesqueléticos para o Banco de Tecidos. Desse total, 159 foram de doadores e 43 de cadáveres. Foram solicitados testes sorológicos para hepatite B, hepatite C, sífilis, citomegalovírus, doença de Chagas, toxoplasmose, HIV e HTLV. Resultados: Dos 159 doadores, 103 (64,75%) eram do sexo masculino e 56 (35,25%) do feminino. A idade média foi de 59,35 ± 8,87 anos. Foram descartados 76 (47,8%) tecidos de doadores. Não houve diferença significativa no número de descartes em relação a sexo (p = 0,135) ou idade (p = 523). A principal causa de descarte foi a sorologia positiva para o vírus da hepatite B, responsável por 48 (63,15%) descartes. Já entre os 43 cadáveres, a média de idade foi de 37,84 ± 10,32 anos. Desses, 27 (62,8%) eram do sexo masculino e 16 (37,2%) do feminino. Foram descartados seis (13,9%) cadáveres. A principal causa de descarte foi a sorologia positiva para o vírus da hepatite C, responsável por três (50%) casos. Não houve diferença significativa no número de descartes em relação a sexo (p = 0,21) ou idade (p = 252). Conclusão: Houve um número maior de descarte de tecidos de doadores (47,8%) em comparação com os cadáveres (13,9%). Nos doadores, a principal causa de descarte foi a presença de sorologia positiva para o vírus da hepatite B; nos cadáveres, para o vírus da hepatite C...
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Humanos , Infecções Bacterianas , Bancos de Ossos , Transplante Homólogo/efeitos adversos , VirosesRESUMO
PURPOSE: The purpose of this study was to analyze the clinical and radiographic results of revision of loose total hip replacements, using proximal femoral allografts and a cemented implant. MATERIAL AND METHODS: We retrospectively reviewed of 28 consecutive patients. Twenty patients were available for study. Each patient was scored using a modified Harris Hip Score. Radiographs were examined for endosteal and periosteal reabsorption, allograft-host union, trochanteric migration, component loosening and heterotrophic calcification. RESULTS: The mean pre-operative Harris hip Score was 34 points. At the latest follow-up, the meanscore was 80 points. Nineteen cases (95%) had combined femoral defects and one patient (5%) had a segmental defect, according to the AAOS classification. Allograft resorption was seen in eight (40%) hips. There were 18 cases (90%) of allograft union, one (5%) of partial union and one (5%) of nonunion. There was one case of trochanteric migration (more than 1 cm). All femoral components were radiographically stable. The reconstruction was considered successful in 18 patients (90%). CONCLUSION: The use of proximal femoral allografts in femoral revision of loose total hip replacements has high survival and satisfactory clinical results at an average period of eight years postoperatively.
Assuntos
Artroplastia de Quadril/métodos , Adulto , Idoso , Aloenxertos , Feminino , Fêmur/patologia , Fêmur/transplante , Seguimentos , Prótese de Quadril , Humanos , Masculino , Pessoa de Meia-Idade , Ossificação Heterotópica , Falha de Prótese , Estudos Retrospectivos , Resultado do TratamentoRESUMO
Among the options for femoral reconstruction in total hip arthroplasty (THA) revision procedures, in cases of extensive circumferential defects, is the use of proximal femoral allografts. This technique makes it possible to correct the hip abductor mechanism and the leg length discrepancy, as well as presenting osteoconductive potential. The authors report the clinical and radiographic results from two cases of THA revision using this technique, with a minimum follow-up of 20 years.
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OBJECTIVE: To evaluate the clinical and radiographic results from patients who underwent femoral reconstruction secondary to loosening of total hip arthroplasty, using circumferential proximal femoral allografts and cemented implants. METHODS: A retrospective study was conducted on 32 patients (33 hips) who underwent femoral reconstruction secondary to loosening of total hip arthroplasty, using circumferential proximal femoral allografts and cemented implants. Among these patients, 28 (29 hips) fulfilled all the requirements for this study. The mean follow-up was five years and two months. The clinical evaluation was done in accordance with the Harris Hip Score. Radiographically, the patients were assessed regarding reabsorption and consolidation of the allograft, migration of the greater trochanter, stability of the femoral component and heterotypic calcification. RESULTS: The average preoperative Harris Hip Score was 32 points. At the last postoperative follow-up, the average score was 82 points. Allograft resorption of some degree was seen in nine hips (31%). Regarding consolidation, 24 cases (82.8%) showed full consolidation, three (10.3%) showed partial consolidation and two (6.9%) showed pseudarthrosis. All femoral components were stable. According to the criteria established, 27 cases (93.1%) were considered to be successful reconstructions after a mean follow-up of five years and two months. CONCLUSION: From the results obtained, it was concluded that use of circumferential proximal femoral allografts in selected cases of femoral reconstruction secondary to loosening of arthroplasty presented a high survival rate from the reconstruction over an average follow-up of five years and two months.
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OBJETIVO: Avaliar os resultados clínicos e radiográficos de pacientes submetidos à reconstrução femoral secundária a afrouxamento de artroplastia total de quadril, com utilização de aloenxerto circunferencial de fêmur proximal e implante cimentado. MÉTODOS: Foi efetuado um estudo retrospectivo com 32 pacientes (33 quadris) submetidos à reconstrução femoral secundária a afrouxamento de artroplastia total de quadril, com utilização de aloenxerto circunferencial de fêmur proximal e implante cimentado. Desses pacientes, 28 (29 quadris) preencheram todos os requisitos necessários. O seguimento médio foi de cinco anos e dois meses. A avaliação clínica foi realizada de acordo com o Harris Hip Score. Radiograficamente, os pacientes foram avaliados quanto à reabsorção e consolidação do aloenxerto, migração do trocânter maior, estabilidade do componente femoral e calcificação heterotópica. RESULTADOS: O Harris Hip Score apresentou resultado pré-operatório médio de 32 pontos e pós-operatório tardio de 82 pontos. Considerando-se a reabsorção do aloenxerto, visibilizou-se nove quadris (31%) com presença de reabsorção em algum grau. Com relação à consolidação, observou-se 24 casos (82,8%) consolidados, três (10,3%) consolidados parcialmente e dois (6,9%) com pseudoartrose. Conforme os critérios estabelecidos, consideraram-se 27 casos (93,1%) como sucesso da reconstrução em seguimento médio de cinco anos e dois meses. CONCLUSÕES: Com base nos resultados obtidos, conclui-se que a utilização de aloenxerto circunferencial de fêmur proximal em casos selecionados de reconstrução femoral secundária a afrouxamento de artroplastia, apresenta alto índice de sobrevida da reconstrução em seguimento médio de cinco anos e dois meses.
OBJECTIVE: To evaluate the clinical and radiographic results from patients who underwent femoral reconstruction secondary to loosening of total hip arthroplasty, using circumferential proximal femoral allografts and cemented implants. METHODS: A retrospective study was conducted on 32 patients (33 hips) who underwent femoral reconstruction secondary to loosening of total hip arthroplasty, using circumferential proximal femoral allografts and cemented implants. Among these patients, 28 (29 hips) fulfilled all the requirements for this study. The mean follow- up was five years and two months. The clinical evaluation was done in accordance with the Harris Hip Score. Radiographically, the patients were assessed regarding reabsorption and consolidation of the allograft, migration of the greater trochanter, stability of the femoral component and heterotypic calcification. RESULTS: The average preoperative Harris Hip Score was 32 points. At the last postoperative follow-up, the average score was 82 points. Allograft resorption of some degree was seen in nine hips (31%). Regarding consolidation, 24 cases (82.8%) showed full consolidation, three (10.3%) showed partial consolidation and two (6.9%) showed pseudarthrosis. All femoral components were stable. According to the criteria established, 27 cases (93.1%) were considered to be successful reconstructions after a mean follow-up of five years and two months. CONCLUSIONS: From the results obtained, it was concluded that use of circumferential proximal femoral allografts in selected cases of femoral reconstruction secondary to loosening of arthroplasty presented a high survival rate from the reconstruction over an average follow-up of five years and two months.
