Determining Reliability of Arthroscopic Classifications for Hip Labral Tears.

OBJECTIVE: Evaluate interobserver and intraobserver reliability of hip arthroscopic classifications for labral tears. DESIGN: Retrospective diagnostic study of nonconsecutive patients. SETTING: Institutional study. PATIENTS: From a database of 278 hip arthroscopy videos for treatment of femoroacetabular impingement, 70 videos were chosen by simple random sampling. Exclusion criteria included presence of radiological arthrosis (Tonnis > 2), previous hip surgery, inadequate lesion palpation, poor image quality, and refusal to participate in the study. The final sample included 60 videos. INTERVENTIONS: Four hip surgeons evaluated the videos twice at 1-month intervals and classified the lesions according to Lage, Seldes, and Beck classifications for hip labral tears. MAIN OUTCOME MEASURES: Interobserver and intraobserver reliability with the percent of agreement and weighted Cohen kappa values. RESULTS: Patients had a mean age of 33 years (SD, 7; range, 18-47 years), and 32 (53%) were men. Femoroacetabular impingement types included combined (CAM and pincer) in 31 (52%), CAM in 27 (45%), and pincer in 2 (3%). For interobserver reliability, the average weighted kappa values were 0.68, 0.65, and 0.78 for the Lage, Seldes, and Beck classifications, respectively. For intraobserver reliability, the mean weighted kappa values were 0.87, 0.64, and 0.93 for the Lage, Seldes, and Beck classifications, respectively. CONCLUSIONS: Beck classification had the highest average values for interobserver and intraobserver agreements. Lage, Seldes, and Beck scores for acetabular labrum tears showed substantial interobserver agreement. In the intraobserver evaluation, the Seldes system presented substantial agreement, whereas Lage and Beck classifications were considered excellent agreement.

Evaluation of the ischiofemoral space: a case-control study.

OBJECTIVE: To determine the size of the ischiofemoral space (IFS) and quadratus femoris space (QFS) in patients with and without ischiofemoral impingement (IFI). MATERIALS AND METHODS: Case-control study including consecutive patients submitted to magnetic resonance imaging (MRI) of the hip joint during a three-month period. Patients with deep gluteal pain who tested positive for IFI on at least one clinical test and showed signal changes in the quadratus femoris muscle on MRI were categorized as having a confirmed diagnosis of IFI. RESULTS: Final sample comprised 50 patients submitted to unilateral MRI of the hip joint. The mean age was 47.3 ± 14.0 years (range, 22-76 years), and 33 (66%) of the patients were women. A diagnosis of IFI was made in 6 patients (12%), all of whom were female. On average, IFS and QFS were significantly smaller in IFI group than in control group (11.1 ± 2.7 mm versus 27.5 ± 6.5 mm and 5.3 ± 1.8 mm versus 18.8 ± 4.8 mm, respectively; p < 0.001 for both). CONCLUSION: Results of specific clinical tests and MRI findings indicate that the IFS and QFS are significantly reduced in patients with IFI.

OBJETIVO: Avaliar, prospectivamente, os valores médios dos espaços isquiofemoral e quadrado femoral em pacientes com impacto isquiofemoral e em um grupo controle. MATERIAIS E MÉTODOS: Estudo prospectivo incluindo pacientes submetidos a ressonância magnética da articulação do quadril em um intervalo de três meses. Os pacientes com dor glútea profunda, com pelo menos um teste clínico positivo para impacto isquiofemoral e alterações de sinal no músculo quadrado femoral na ressonância magnética, foram diagnosticados com impacto isquiofemoral. RESULTADOS: A amostra final consistiu de 50 pacientes submetidos a ressonância magnética unilateral da articulação do quadril. A idade média foi 47,3 ± 14,0 anos (intervalo de 22 a 76 anos) e 33 (66%) eram mulheres. O diagnóstico de impacto isquiofemoral foi observado em 6 (12%) pacientes, todas mulheres. Os pacientes com impacto isquiofemoral mostraram redução significativa nos espaços isquiofemoral e quadrado femoral quando comparados ao grupo controle: 11,1 ± 2,7 mm versus 27,5 ± 6,5 mm e 5,3 ± 1,8 mm versus 18,8 ± 4,8 mm, respectivamente (p < 0,001 para ambos os grupos). CONCLUSÃO: Os pacientes com diagnóstico de impacto isquiofemoral apresentaram redução significativa dos espaços isquiofemoral e quadrado femoral após análise prospectiva baseada em testes clínicos específicos e ressonância magnética.

Reliability of the Arthroscopic Classifications of Hip Chondral Lesions.

Objective To evaluate the inter- and intraobserver reliability of the Outerbridge, Beck, and Haddad classifications for acetabular joint cartilage lesions through the arthroscopic procedure. Methods A total of 60 hip arthroscopy videos were evaluated twice by 4 surgeons at 2 different times to assess the inter- and intraobserver reproducibility of the classifications, and the data was analyzed by means of the weighted Cohen Kappa index. Results The mean weighted Kappa values in the interobserver assessment of the Outerbridge, Beck, and Haddad classifications were, respectively, 0.72, 0.78, and 0.68. The three classifications were considered as presenting good interobserver agreement. Regarding the intraobserver assessment of the Outerbridge, Beck, and Haddad classifications, the weighted Kappa values were, respectively, 0.9, 0.9, and 0.93. The three classifications were considered as presenting excellent intraobserver agreement. Conclusion In the present series, the Outerbridge, Beck, and Haddad classifications presented good interobserver reproducibility and excellent intraobserver reproducibility when evaluating acetabular chondral lesions by the arthroscopic approach.

Recovery of the Hip Rotation Center with Tantalum in Revision Arthroplasty.

Objective The objective of the present study is to evaluate the restoration capacity of the hip anatomic rotation center with the use of acetabular tantalum cups, associated or not with addition wedges. Methods Retrospective analysis of patients undergoing hip arthroplasty revision using tantalum between June 2013 and April 2017. The abduction angle of the acetabular component and the horizontal and vertical distances of the component to the center of anatomical rotation of the hip were evaluated. The measurements were made through baseline radiographs performed in the preoperative period and at the last follow-up visit. Results A sample of 21 patients was obtained, 11 (52%) men and 10 (48%) women, with a mean age of 62 ± 13 years old. The mean abduction angle of the acetabular cup decreased from 48.76° ± 13.88 ° in the preoperative period to 38.52° ± 10.08 ° in the postoperative period, and this difference was statistically significant ( p = 0.001). The distances from the center of rotation of the prosthesis relative to the center of anatomical rotation of the hip were also lower after revision surgery with tantalum. The mean horizontal distance of 12.74 ± 10.59 mm was reduced to 7.11 ± 4.84 mm, and the mean vertical distance was reduced from 14.79 ± 10.05 mm to 4.89 ± 6.21 mm, and these reductions were statistically significant ( p < 0.001). Conclusion Hip arthroplasty revision with tantalum cups, associated or not with addition wedges, significantly recovered the anatomical rotation center of the hip.

Evaluation of the ischiofemoral space: a case-control study / Avaliação do espaço isquiofemoral: um estudo caso-controle

Abstract Objective: To determine the size of the ischiofemoral space (IFS) and quadratus femoris space (QFS) in patients with and without ischiofemoral impingement (IFI). Materials and Methods: Case-control study including consecutive patients submitted to magnetic resonance imaging (MRI) of the hip joint during a three-month period. Patients with deep gluteal pain who tested positive for IFI on at least one clinical test and showed signal changes in the quadratus femoris muscle on MRI were categorized as having a confirmed diagnosis of IFI. Results: Final sample comprised 50 patients submitted to unilateral MRI of the hip joint. The mean age was 47.3 ± 14.0 years (range, 22-76 years), and 33 (66%) of the patients were women. A diagnosis of IFI was made in 6 patients (12%), all of whom were female. On average, IFS and QFS were significantly smaller in IFI group than in control group (11.1 ± 2.7 mm versus 27.5 ± 6.5 mm and 5.3 ± 1.8 mm versus 18.8 ± 4.8 mm, respectively; p < 0.001 for both). Conclusion: Results of specific clinical tests and MRI findings indicate that the IFS and QFS are significantly reduced in patients with IFI.

Resumo Objetivo: Avaliar, prospectivamente, os valores médios dos espaços isquiofemoral e quadrado femoral em pacientes com impacto isquiofemoral e em um grupo controle. Materiais e Métodos: Estudo prospectivo incluindo pacientes submetidos a ressonância magnética da articulação do quadril em um intervalo de três meses. Os pacientes com dor glútea profunda, com pelo menos um teste clínico positivo para impacto isquiofemoral e alterações de sinal no músculo quadrado femoral na ressonância magnética, foram diagnosticados com impacto isquiofemoral. Resultados: A amostra final consistiu de 50 pacientes submetidos a ressonância magnética unilateral da articulação do quadril. A idade média foi 47,3 ± 14,0 anos (intervalo de 22 a 76 anos) e 33 (66%) eram mulheres. O diagnóstico de impacto isquiofemoral foi observado em 6 (12%) pacientes, todas mulheres. Os pacientes com impacto isquiofemoral mostraram redução significativa nos espaços isquiofemoral e quadrado femoral quando comparados ao grupo controle: 11,1 ± 2,7 mm versus 27,5 ± 6,5 mm e 5,3 ± 1,8 mm versus 18,8 ± 4,8 mm, respectivamente (p < 0,001 para ambos os grupos). Conclusão: Os pacientes com diagnóstico de impacto isquiofemoral apresentaram redução significativa dos espaços isquiofemoral e quadrado femoral após análise prospectiva baseada em testes clínicos específicos e ressonância magnética.

Reliability of the Arthroscopic Classifications of Hip Chondral Lesions* / Confiabilidade das classificações artroscópicas das lesões condrais do quadril*

Abstract Objective To evaluate the inter- and intraobserver reliability of the Outerbridge, Beck, and Haddad classifications for acetabular joint cartilage lesions through the arthroscopic procedure. Methods A total of 60 hip arthroscopy videos were evaluated twice by 4 surgeons at 2 different times to assess the inter- and intraobserver reproducibility of the classifications, and the data was analyzed by means of the weighted Cohen Kappa index. Results The mean weighted Kappa values in the interobserver assessment of the Outerbridge, Beck, and Haddad classifications were, respectively, 0.72, 0.78, and 0.68. The three classifications were considered as presenting good interobserver agreement. Regarding the intraobserver assessment of the Outerbridge, Beck, and Haddad classifications, the weighted Kappa values were, respectively, 0.9, 0.9, and 0.93. The three classifications were considered as presenting excellent intraobserver agreement. Conclusion In the present series, the Outerbridge, Beck, and Haddad classifications presented good interobserver reproducibility and excellent intraobserver reproducibility when evaluating acetabular chondral lesions by the arthroscopic approach.

Resumo Objetivo Avaliar a confiabilidade inter- e intraobservador das classificações de Outerbridge, Beck e Haddad para lesões da cartilagem articular acetabular com o uso da via artroscópica. Métodos Foram avaliados 60 vídeos de artroscopias do quadril por 4 cirurgiões em 2 momentos para avaliar a reprodutibilidade inter- e intraobservador das classificações. Os dados foram analisados a partir do cálculo do índice Kappa de Cohen ponderado. Resultados Os valores do Kappa ponderado médio na avaliação interobservador das classificações de Outerbridge, Beck e Haddad foram, respectivamente, 0,72, 0,78 e 0,68. As três classificações foram consideradas como de boa concordância interobservador. Comrelação à avaliação intraobservador das classificações de Outerbridge, Beck e Haddad, os valores Kappa foram, respectivamente, 0,9, 0,9 e 0,93. As três classificações foram consideradas excelentes na comparação intraobservador. Conclusão Na presente série, as classificações de Outerbridge, Beck e Haddad apresentaram boa reprodutibilidade interobservador e excelente reprodutibilidade intraobservador ao avaliar lesões condrais acetabulares por via artroscópica.

Recovery of the Hip Rotation Center with Tantalum in Revision Arthroplasty / Recuperação do centro de rotação do quadril com tântalo em artroplastias de revisão

Abstract Objective The objective of the present study is to evaluate the restoration capacity of the hip anatomic rotation center with the use of acetabular tantalum cups, associated or not with addition wedges. Methods Retrospective analysis of patients undergoing hip arthroplasty revision using tantalum between June 2013 and April 2017. The abduction angle of the acetabular component and the horizontal and vertical distances of the component to the center of anatomical rotation of the hipwere evaluated. The measurements were made through baseline radiographs performed in the preoperative period and at the last follow-up visit. Results A sample of 21 patients was obtained, 11 (52%) men and 10 (48%) women, with amean age of 62 ± 13 years old. The mean abduction angle of the acetabular cup decreased from 48.76° ± 13.88 ° in the preoperative period to 38.52° ± 10.08 ° in the postoperative period, and this difference was statistically significant (p = 0.001). The distances from the center of rotation of the prosthesis relative to the center of anatomical rotation of the hip were also lower after revision surgery with tantalum. The mean horizontal distance of 12.74 ± 10.59 mm was reduced to 7.11 ± 4.84 mm, and the mean vertical distance was reduced from 14.79 ± 10.05 mm to 4.89 ± 6.21 mm, and these reductions were statistically significant (p < 0.001). Conclusion Hip arthroplasty revision with tantalum cups, associated or not with addition wedges, significantly recovered the anatomical rotation center of the hip.

Resumo Objetivo O objetivo do presente estudo é avaliar a capacidade de restauração do centro de rotação anatômico do quadril com uso de copas acetabulares de tântalo associado ou não a cunhas de adição. Métodos Análise retrospectiva dos pacientes submetidos a revisão de artroplastia do quadril comuso de tântalo entre o período de junho de 2013 e abril de 2017. Foramavaliados o ângulo de abdução do componente acetabular e as distâncias horizontal e vertical do componenteao centro de rotação anatômicodoquadril.Asmedidas foramrealizadas através de radiografias da bacia realizadas no pré-operatório e na última visita de seguimento. Resultados Obteve-se uma amostra de 21 pacientes, 11 (52%) homens e 10 (48%) mulheres, com média de idade de 62 ± 13 anos. O ângulo médio de abdução da copa acetabular reduziu de 48,76° ± 13,88° no pré-operatório para 38,52° ± 10,08° no pósoperatório, sendo esta diferença estatisticamente significativa (p = 0,001). As distâncias do centro de rotação da prótese em relação ao centro de rotação anatômico do quadril também foram menores após a cirurgia de revisão com o tântalo. A distância média horizontal de 12,74 ± 10,59 mm foi reduzida para 7,11 ± 4,84 mm, e a distância média vertical foi reduzida de 14,79 ± 10,05 mm para 4,89 ± 6,21 mm, sendo essas reduções estatisticamente significativas (p < 0,001). Conclusão As revisões de artroplastia do quadril comcopas de tântalo, associadas ou não a cunhas de adição, recuperaram de forma significativa o centro de rotação anatômico do quadril.

Clinical outcomes of arthroscopic repair of acetabular labral tears.

PURPOSE: To evaluate the primary clinical outcomes of arthroscopic labral repair. METHODS: All patients who underwent arthroscopic repair of the acetabular labrum performed by a senior surgeon between October 2010 and December 2013 were invited to participate in this prospective study. Patients included were those who had a preoperative diagnosis of labral tears, a lateral centre edge greater than 25° and a labral tear believed to be suturable during the intraoperative evaluation. Patients with Tönnis grade 2 or grade 3 hip osteoarthritis and those who had undergone a previous hip surgery were excluded. All patients were evaluated using the modified Harris Hip Score (mHHS) during the final appointment before surgery, 4 months after surgery and at the final evaluation. Interviews were conducted by the senior surgeon. RESULTS: Eighty-four patients (90 hips) underwent arthroscopic repair. The mean age was 44.2 years and the mean follow-up period was 43.0 months (minimum of 25 months and maximum of 59 months). The mean mHHS was 80.4 preoperatively, 95.0 at 4 months postoperatively and 96.6 at final evaluation. A statistically significant difference existed among these scores (p<0.001). CONCLUSION: Arthroscopic labral repair was associated with a clinically significant improvement in mHHS after short-term (4 months) and medium-term (43 months) follow-up. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

Efficacy evaluation of a protocol for safe hip surgery (total hip arthroplasty).

OBJECTIVE: To propose a multidisciplinary protocol to standardize the care of patients undergoing total hip arthroplasty (THA) and evaluate it effectiveness after implementation. METHODS: Retrospective evaluation of 95 consecutive patients undergoing THA divided into two groups, one group of 47 patients operated before the protocol implementation and 48 after. RESULTS: Assessing the re-admission rate, among 47 patients evaluated prior to implementation of the protocol, seven (14.9%) were re-admitted, and when observing the 48 patients evaluated after implementation, one (2.1%) was re-admitted, showing statistical significance (p < 0.05). The chance of re-admission before the protocol was eight times the chance of hospitalization after implementation (95% CI: 1.01 to 377.7). By comparing the clinical complications among the groups, it was observed that there was a lower rate of complications following implementation of the protocol (p = 0.006). CONCLUSION: The introduction of a multidisciplinary protocol to standardize the management of patients undergoing THA decreased the rates of rehospitalization and clinical complications after the procedure.

OBJETIVO: Propor um protocolo multidisciplinar para padronização do cuidado dos pacientes que serão submetidos a artroplastia total do quadril (ATQ) e avaliar sua eficácia após a implantação. MÉTODOS: Avaliação retrospectiva dos resultados de 95 pacientes consecutivos submetidos a ATQ divididos em dois grupos, um com 47 operados antes da implantação do protocolo e 48 após. RESULTADOS: Na avaliação da taxa de reinternação, tem-se que entre os 47 pacientes avaliados antes da implantação do protocolo, sete (14,9%) foram reinternados e dos 48 avaliados depois da implantação, um (2,1%) foi reinternado, mostrou-se significância estatística (p < 0,05). A chance de reinternação antes da implantação foi oito vezes maior do que a chance de internação após a implantação (IC 95%: 1,01 a 377,7). Ao comparar as complicações clínicas entre os grupos observou-se que houve menor taxa de complicações após a implantação do protocolo (p = 0,006). CONCLUSÃO: A introdução de um protocolo multidisciplinar para padronização do manejo do paciente submetido a ATQ diminuiu as taxas de reinternação e de complicações clínicas após o procedimento.

Efficacy evaluation of a protocol for safe hip surgery (total hip arthroplasty) / Avaliação da eficácia do protocolo para cirurgia segura do quadril (artroplastia total)

Abstract Objective To propose a multidisciplinary protocol to standardize the care of patients undergoing total hip arthroplasty (THA) and evaluate it effectiveness after implementation. Methods Retrospective evaluation of 95 consecutive patients undergoing THA divided into two groups, one group of 47 patients operated before the protocol implementation and 48 after. Results Assessing the re-admission rate, among 47 patients evaluated prior to implementation of the protocol, seven (14.9%) were re-admitted, and when observing the 48 patients evaluated after implementation, one (2.1%) was re-admitted, showing statistical significance (p < 0.05). The chance of re-admission before the protocol was eight times the chance of hospitalization after implementation (95% CI: 1.01 to 377.7). By comparing the clinical complications among the groups, it was observed that there was a lower rate of complications following implementation of the protocol (p = 0.006). Conclusion The introduction of a multidisciplinary protocol to standardize the management of patients undergoing THA decreased the rates of rehospitalization and clinical complications after the procedure.

Resumo Objetivo Propor um protocolo multidisciplinar para padronização do cuidado dos pacientes que serão submetidos a artroplastia total do quadril (ATQ) e avaliar sua eficácia após a implantação. Métodos Avaliação retrospectiva dos resultados de 95 pacientes consecutivos submetidos a ATQ divididos em dois grupos, um com 47 operados antes da implantação do protocolo e 48 após. Resultados Na avaliação da taxa de reinternação, tem-se que entre os 47 pacientes avaliados antes da implantação do protocolo, sete (14,9%) foram reinternados e dos 48 avaliados depois da implantação, um (2,1%) foi reinternado, mostrou-se significância estatística (p < 0,05). A chance de reinternação antes da implantação foi oito vezes maior do que a chance de internação após a implantação (IC 95%: 1,01 a 377,7). Ao comparar as complicações clínicas entre os grupos observou-se que houve menor taxa de complicações após a implantação do protocolo (p = 0,006). Conclusão A introdução de um protocolo multidisciplinar para padronização do manejo do paciente submetido a ATQ diminuiu as taxas de reinternação e de complicações clínicas após o procedimento.

A New Technique for Surgical Treatment of Proximal Hamstring Tendinopathy in a Triathlon Athlete.

INTRODUCTION: Proximal hamstring tendinopathy (PHT) is the result of chronic overload caused by repetitive eccentric contraction. Surgical treatment becomes an option for patients with chronic symptoms that do not respond to conservative treatment. CASE REPORT: This report describes a case of a 48-year-old man, an amateur triathlete, with deep gluteal pain in the left hip for 12 months, leading to a decline in sports performance. Magnetic resonance imaging revealed abnormalities that suggested a PHT. Surgery was indicated following the failure of conservative treatments. Debridement of the conjoint tendon and its reinsertion associated with semimembranosus tenotomy showed good results and is thus an option for the treatment of this pathology after 12 months of follow-up. CONCLUSION: This article provides surgeons with a new surgical option for this debilitating condition with clinical and functional improvement after 12 months of follow-up.

Atypical femoral fracture due to chronic use of bisphosphonates: case report.

The causal relationship between chronic use of bisphosphonates and occurrences of atypical femoral fractures has not yet been established. Nonetheless, it is known that their chronic use is more related to fractures with a pattern differing from that of classical osteoporotic fractures. Atypical fractures are still rare events and the benefit from using bisphosphonates remains greater for prevention and treatment of osteoporosis. There are few studies guiding the diagnosis and management of these fractures, thus making it difficult to achieve better results. In this report, we present the case of an elderly patient with an atypical femoral fracture that was managed in accordance with guidance from the American Society for Bone and Mineral Research.

A relação causal entre o uso crônico dos bifosfonatos e a ocorrência de fraturas femorais atípicas não tem sido ainda estabelecida. Todavia, sabe-se que o uso crônico dos bifosfonatos tem tido maior relação com fraturas com padrão diferente das clássicas fraturas osteoporóticas. Fraturas atípicas são ainda eventos raros e o benefício do uso dos bifosfonatos ainda é maior na prevenção e no tratamento da osteoporose. Pouco são os estudos que orientam o diagnóstico e a condução dessas fraturas, o que dificulta melhores resultados. Neste relato apresentamos caso de paciente da terceira idade com fratura femoral atípica conduzida segundo orientação da Sociedade Americana para Pesquisa Óssea e Mineral.

Fratura femoral atípica devida a uso crônico de bifosfonato. Relato de caso / Atypical femoral fracture due to chronic use of bisphosphonates. Case report

A relação causal entre o uso crônico dos bifosfonatos e a ocorrência de fraturas femorais atípicas não tem sido ainda estabelecida. Todavia, sabe-se que o uso crônico dos bifosfonatos tem tido maior relação com fraturas com padrão diferente das clássicas fraturas osteoporóticas. Fraturas atípicas são ainda eventos raros e o benefício do uso dos bifosfonatos ainda é maior na prevenção e no tratamento da osteoporose. Pouco são os estudos que orientam o diagnóstico e a condução dessas fraturas, o que dificulta melhores resultados. Neste relato apresentamos caso de paciente da terceira idade com fratura femoral atípica conduzida segundo orientação da Sociedade Americana para Pesquisa Óssea e Mineral.

The causal relationship between chronic use of bisphosphonates and occurrences of atypical femoral fractures has not yet been established. Nonetheless, it is known that their chronic use is more related to fractures with a pattern differing from that of classical osteoporotic fractures. Atypical fractures are still rare events and the benefit from using bisphosphonates remains greater for prevention and treatment of osteoporosis. There are few studies guiding the diagnosis and management of these fractures, thus making it difficult to achieve better results. In this report, we present the case of an elderly patient with an atypical femoral fracture that was managed in accordance with guidance from the American Society for Bone and Mineral Research.

Reducing the length of hospital stay after total knee arthroplasty: influence of femoral and sciatic nerve block.

OBJECTIVE: the aim of this study is to evaluate the change in length of hospital stay postoperatively for Total Knee Arthroplasty after using femoral and sciatic nerve block. MATERIALS AND METHODS: the medical records of 287 patients were evaluated, taking into account the number of hours of admission, the percentage and the reason for re-hospitalization within 30 days, as well as associated complications. All patients were divided into two groups according or not to whether they were admitted to ICU or not. During the years 2009 and 2010, isolated spinal anesthesia was the method used in the procedure. From 2011 on, femoral and sciatic nerve blocking was introduced. RESULTS: between the years 2009 and 2012, the average length of stay ranged from 74 hours in 2009 to 75.2 hours in 2010. The average length of stay in 2011 was 56.52 hours and 53.72 hours in 2012, all in the group of patients who did not remain in the ICU postoperatively. In the same period, among those in the group that needed ICU admission, the average length of stay was 138.7 hours in 2009, 90.25 hours in 2010, 79.8 hours in 2011, and 52.91 hours in 2012. During 2009 and 2010, the rate of re-hospitalization was 0%, while in 2011 and 2012, were 3.44% and 1%, respectively. CONCLUSION: according to this study, the use of femoral and sciatic nerve blocking after total knee arthroplasty allowed significant reduction in hospital stay.

Reducing the length of hospital stay after total knee arthroplasty: influence of femoral and sciatic nerve block / Redução do tempo de internação após artroplastia total do joelho – Influência do bloqueio do nervo femoral e do nervo ciático

Objective: the aim of this study is to evaluate the change in length of hospital stay postoperatively for Total Knee Arthroplasty after using femoral and sciatic nerve block. Materials and methods: the medical records of 287 patients were evaluated, taking into account the number of hours of admission, the percentage and the reason for re-hospitalization within 30 days, as well as associated complications. All patients were divided into two groups according or not to whether they were admitted to ICU or not. During the years 2009 and 2010, isolated spinal anesthesia was the method used in the procedure. From 2011 on, femoral and sciatic nerve blocking was introduced. Results: between the years 2009 and 2012, the average length of stay ranged from 74 hours in 2009 to 75.2 hours in 2010. The average length of stay in 2011 was 56.52 hours and 53.72 hours in 2012, all in the group of patients who did not remain in the ICU postoperatively. In the same period, among those in the group that needed ICU admission, the average length of stay was 138.7 hours in 2009, 90.25 hours in 2010, 79.8 hours in 2011, and 52.91 hours in 2012. During 2009 and 2010, the rate of re-hospitalization was 0%, while in 2011 and 2012, were 3.44% and 1%, respectively. Conclusion: according to this study, the use of femoral and sciatic nerve blocking after total knee arthroplasty allowed significant reduction in hospital stay. .

Objetivo: avaliar a mudança no tempo de permanência hospitalar (PH) no pós-operatório de artroplastia total do joelho (ATJ) após a utilização do bloqueio dos nervos femoral e ciático. Métodos: os prontuários de 287 pacientes foram avaliados, levando-se em consideração o número de horas de internação, o percentual e o motivo de reinternação em 30 dias, bem como as complicações associadas, sendo divididos em dois grupos de acordo com a permanência ou não no centro de terapia intensiva (CTI). Durante os anos de 2009 e 2010, a anestesia utilizada para a realização dos procedimentos foi a raquianestesia isolada. A partir de 2011, o bloqueio dos nervos femoral e ciático foi introduzido. Resultados: no período entre 2009 e 2012, o tempo médio de PH variou entre 74 horas, em 2009, e 75,2 horas, em 2010. A PH média em 2011 foi de 56,52 horas e de 53,72 horas em 2012, no grupo de pacientes que não permaneceram no CTI no pós-operatório. No mesmo período, no grupo que precisou de internação no CTI, a PH média foi de 138,7 horas em 2009; 90,25 horas em 2010; 79,8 horas em 2011 e 52,91 horas em 2012. Em 2009 e 2010, a taxa de reinternação foi de 0%, e em 2011 e 2012, 3,44% e 1%, respectivamente. Conclusão: de acordo com este estudo, a utilização do bloqueio dos nervos femoral e ciático após a ATJ permitiu a redução significativa da PH. .

Physical activity after distal femur osteotomy for the treatment of lateral compartment knee osteoarthritis.

PURPOSE: Distal femoral osteotomy (DFO) is the preferential treatment for the symptomatic osteoarthritis of the lateral compartment of the knee in young active patients. The objective of this study is to evaluate the physical activity and functional outcome of a group of patients presenting with lateral compartment osteoarthritis of the knee prior to and after a DFO for correction of genum valgum. METHODS: Twenty-six patients who had been submitted to complete V-shaped distal femoral osteotomy were evaluated after a mean follow-up period of 48 months by interview and questionnaire. Functional and physical activities were scored according to published rating systems. RESULTS: Twenty-two (84.6 %) patients were very satisfied or satisfied (mean satisfaction 2) with the outcome of surgery and 88.5 % of the patients had normal work duties after surgery without limitation or decline in performance. The preoperative median level for physical activity according to the Tegner activity level was 3(2-7), while the median postoperative level was 3 (1-7) (n.s.) 57.7 % had resumed physical activities at preoperative levels: some patients had increased the number and type of exercises. According to Lysholm score, the mean preoperative score for physical performance was 53.1 ± 16.2 while the mean postoperative score had increased to 77.3 ± 16.7 (p < 0.05). CONCLUSION: Based on this study, distal femoral osteotomy allowed the resumption of physical activities for individuals with symptomatic osteoarthritis of the lateral compartment of the knee, resulting in improvements in clinical conditions and, consequently, in their daily working and recreational activities.

Fratura extra-articular da extremidade medial da clavícula associada à luxação acromioclavicular tipo IV: relato de caso / Extra-articular fracture of the medial end of the clavicle associated with type IV acromioclavicular dislocation: case report

Ocorrendo isoladamente, as fraturas da clavícula e as luxações acromioclaviculares são lesões muito comuns. A combinação de uma luxação acromioclavicular e de uma fratura do terço lateral da clavícula não é rara. Entretanto, existem muito poucos casos descritos de luxações acromioclaviculares associadas a fraturas do terço médio da clavícula; aquelas associadas a fraturas do terço medial são ainda mais raras. Nós reportamos o caso de um indivíduo adulto do sexo masculino que sofreu uma luxação acromioclavicular (tipo IV) associada a uma fratura extra-articular desviada da extremidade medial da clavícula (grupo 3 de Almann) em um acidente ciclístico. O paciente foi tratado na fase aguda com redução aberta e fixação interna das duas lesões. Na avaliação clínica, 12 meses após a cirurgia, o paciente apresentava-se assintomático, com mobilidade ativa e passiva completa, força e resistência normais e simetria das cinturas escapulares. As radiografias e a tomografia computadorizada tridimensional mostravam subluxação posterossuperior persistente da articulação acromioclavicular e consolidação anatômica da fratura clavicular.

Fractures of the clavicle and acromioclavicular dislocations are very common injuries when they occur separately. The combination of an acromioclavicular dislocation and a fracture of the lateral third of the clavicle is not rare. However, there are very few reported cases of acromioclavicular dislocations associated with fractures of the middle third of the clavicle; those associated with fractures of the medial third are even rarer. We report the case of an adult male who suffered an acromioclavicular dislocation (type IV) associated with a displaced extra-articular fracture of the medial end of the clavicle (Almann group 3) in a cycling accident. The patient was treated during the acute phase with open reduction and internal fixation of the two lesions. At the clinical evaluation 12 months after the surgery, the patient was asymptomatic, with full active and passive mobility, and normal strength and endurance of the shoulder girdle. Radiographs and a three-dimensional CT scan showed persistent posterosuperior subluxation of the acromioclavicular joint and anatomical consolidation of the clavicular fracture.

PERI-INCISIONAL DYSESTHESIA FOLLOWING ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION USING CENTRAL THIRD OF PATELLAR TENDON.

OBJECTIVE: To evaluate the prevalence and type of dysesthesia around the incision used to obtain the patellar tendon for anterior cruciate ligament (ACL) reconstruction surgery. METHODS: Out of a population of 1368 ACL reconstructions using the central third of the patellar tendon, 102 patients (111 knees) were evaluated by means of telephone interview. RESULTS: The mean follow-up was 52 months (ranging from 12 to 88 months). The patients' ages ranged from 16 to 58 years (mean: 34.7 years). There was some degree of peri-incisional dysesthesia in 66 knees (59.46%). In 40.54% of the knees, this condition was not found. In all the cases of dysesthesia, the type encountered was Highet's type II. CONCLUSION: Peri-incisional dysesthesia following ACL reconstruction using the central third of the patellar tendon is highly prevalent. It affected more than half of the cases in this series.

FEMORAL ROLL BACK IN TOTAL KNEE ARTHROPLASTY: COMPARISON BETWEEN PROSTHESES THAT PRESERVE AND SACRIFICE THE POSTERIOR CRUCIATE LIGAMENT.

UNLABELLED: To compare the rollback of the contact point between the femoral component and the tibial polyethylene as the knee is flexed, in two types of total knee arthroplasty: one that sacrifices and the other that preserves the posterior cruciate ligament (PCL). METHODS: Under fluoroscopy, 36 knees from 32 patients who underwent total knee arthroplasty were evaluated. Using lateral images, the contact points between the femur and the tibial polyethylene with the knee in complete extension and at 90° of flexion were measured, thereby measuring the percentage rollback of the femur in arthroplasties in which the PCL was sacrificed and in those in which it was preserved. RESULTS: The mean percentage rollback of the femur was 13.24% in the cases in which the PCL was sacrificed and 5.75% in the cases in which it was preserved. The difference between these measurements was statistically significant (p = 0.026615). CONCLUSION: In total knee arthroplasty, sacrificing the PCL increased the rollback of the contact point between the femur and tibia as the knee was flexed up to 90°.

RELATIONSHIP BETWEEN PATELLAR HEIGHT AND RANGE OF MOTION AFTER TOTAL KNEE ARTHROPLASTY.

UNLABELLED: To evaluate whether, after total knee arthroplasty, there is any correlation between patellar height and range of motion (ROM) achieved by patients six months after the operation. METHODS: Forty-five patients who underwent total knee arthroplasty were assessed at least 12 months after the operation (total of 54 knees). The maximum and minimum ROM of all the knees was recorded under fluoroscopy, along with patellar height according to the Blackburne and Peel ratio. Two possible correlations were evaluated: patellar height and ROM; and patellar height and ROM variation from before to after the operation. RESULTS: A correlation was found between patellar height and postoperative ROM (p = 0.04). There was no correlation between patellar height and ROM variation (p = 0.182). CONCLUSION: After total knee arthroplasty, the lower the patella is, the worse the ROM is.