Results of Medium-Term Survival of the Non-Cemented Logical Femoral Stem.

Objective The main objective of the present study was to evaluate the clinical and radiographic results of the Logical (Baumer, Mogi Mirim, SP, Brasil) cementless femoral stem in primary total hip arthroplasties (THAs). Methods A retrospective cohort study of 632 patients submitted to primary THA with the Logical cementless femoral stem. The study period was between January 2004 and January 2015. The outcome defined to evaluate the survival of the stem was the clinical and radiographic indication of the revision hip arthroplasty or the actual revision of the femoral stem for any cause. Results Kaplan-Meier survival curves were estimated at > 95%, with a follow-up ranging from 2 to 13 years. There was a low incidence of transoperative periprosthetic fractures (0.02%). No axial migration or cortical bone atrophy was observed in the radiographic sample evaluated. Conclusions In the intermediate follow-up, there was excellent survival of the Logical cementless femoral stem. Although long-term studies are still awaited, this implant appears to be safe and promising to be used for primary THAs.

Results of Medium-Term Survival of the Non-Cemented Logical Femoral Stem / Resultados de sobrevida no médio prazo da haste femoral não cimentada Logical

Abstract Objective The main objective of the present study was to evaluate the clinical and radiographic results of the Logical (Baumer, Mogi Mirim, SP, Brasil) cementless femoral stem in primary total hip arthroplasties (THAs). Methods A retrospective cohort study of 632 patients submitted to primary THA with the Logical cementless femoral stem. The study period was between January 2004 and January 2015. The outcome defined to evaluate the survival of the stem was the clinical and radiographic indication of the revision hip arthroplasty or the actual revision of the femoral stem for any cause. Results Kaplan-Meier survival curves were estimated at > 95%, with a follow-up ranging from 2 to 13 years. There was a low incidence of transoperative periprosthetic fractures (0.02%). No axial migration or cortical bone atrophy was observed in the radiographic sample evaluated. Conclusions In the intermediate follow-up, there was excellent survival of the Logical cementless femoral stem. Although long-term studies are still awaited, this implant appears to be safe and promising to be used for primary THAs.

Resumo Objetivo Avaliar os resultados clínicos e radiográficos da haste femoral não cimentada Logical (Baumer, Mogi Mirim, SP, Brasil) nas artroplastias totais do quadril (ATQs). Método Foi realizada uma coorte retrospectiva de 632 pacientes submetidos à artroplastia primária do quadril por coxartrose nos quais foram implantadas hastes femorais não cimentadas Logical. Todos os pacientes eram provenientes do ambulatório de Cirurgia do Quadril da instituição. O período do estudo compreendeu de janeiro de 2004 a janeiro de 2015. O desfecho definido para avaliar a sobrevida da haste foi a indicação clínica e radiográfica da revisão ou a revisão propriamente dita da haste femoral por qualquer causa. Resultado Observaram-se curvas de sobrevida estimadas > 95%, com um seguimento variando de 2 até 13 anos. Houve baixa incidência de fraturas periprotéticas transoperatórias (0,02%). Não foi observada migração axial ou atrofia óssea cortical na amostra radiográfica avaliada. Conclusão Os resultados demonstram, nomédio prazo, excelente sobrevida da haste femoral não cimentada Logical. Embora ainda sejam aguardados estudos no longo prazo, este implante parece ser seguro e promissor para ser utilizado nas artroplastias primárias do quadril.

Is there a relationship between the neutrophil/lymphocyte ratio and bilaterality in patients with coxarthrosis? / Existe relação entre a razão neutrófilo/linfócito e a bilateralidade para artrose de quadril?

ABSTRACT Objective: The objective of this study was to evaluate the relationship between the neutrophil/lymphocyte ratio and the presence of signs of arthrosis in both hips in patients followed at this medical center. Methods: This was a cross-sectional, retrospective study through the analysis of medical records and database review of patients over 18 years of age with hip arthrosis, followed at the outpatient clinic of this hospital. Results: Regarding the analysis of the Mann-Whitney test to correlate the neutrophil/lymphocyte ratio and laterality, a bi-lateral test result of p = 0.036 was obtained, thus demonstrating a significant difference between the observed groups. When we analyzed the absolute values of neutrophils and lymphocytes, the authors obtained results of p = 0.14 and p = 0.24. Therefore, it was not possible to observe statistically significant differences between the absolute values in the two groups. Conclusion: Considering the interactions between the inflammatory mechanisms in osteoarthritis and the fact that the interaction between neutrophils and lymphocytes has differences in relation to the laterality of the coxarthrosis, it is hypothesized that the inflammatory etiology of unilateral and bilateral osteoarthritis could have different dynamics. However, more in-depth studies with flow cytometry are needed to assess the possible impact of these differences in the inflammatory mechanisms observed in this study.

RESUMO Objetivo: Avaliar a relação entre a razão neutrófilo/linfócito e a presença de sinais de artrose em ambos os quadris em pacientes acompanhados neste serviço. Métodos: Estudo transversal, retrospectivo, que usou análise de prontuários e revisão de banco de dados de pacientes maiores de 18 anos com diagnóstico de artrose de quadril acompanhados no ambulatório deste hospital. Resultado: Com relação à análise do teste de Mann-Whitney para correlacionar a razão neutrófilo/linfócito e a lateralidade, observou-se um resultado de teste bilateral de 0,036, evidenciou desse modo a diferença entre os grupos. Quando os valores absolutos de neutrófilos e linfócitos foram analisados, observaram-se p = 0,14 e p = 0,24, não foi possível observar diferenças estatisticamente significativas entre os valores absolutos nos dois grupos. Conclusões: Considerando-se as interações entre os mecanismos inflamatórios na osteoartrose e o fato de que a interação entre os neutrófilos e os linfócitos tem diferenças com relação à lateralidade da coxartrose, é possível levantar a hipótese de que a etiologia inflamatória da osteoartrose unilateral e da bilateral tem dinâmicas diferentes. Entretanto, são necessários estudos mais aprofundados, com citometria de fluxo, para avaliar o impacto com relação às diferenças nos mecanismos inflamatórios observados nesse estudo.

Is there a relationship between the neutrophil/lymphocyte ratio and bilaterality in patients with coxarthrosis?

OBJECTIVE: The objective of this study was to evaluate the relationship between the neutrophil/lymphocyte ratio and the presence of signs of arthrosis in both hips in patients followed at this medical center. METHODS: This was a cross-sectional, retrospective study through the analysis of medical records and database review of patients over 18 years of age with hip arthrosis, followed at the outpatient clinic of this hospital. RESULTS: Regarding the analysis of the Mann-Whitney test to correlate the neutrophil/lymphocyte ratio and laterality, a bi-lateral test result of p = 0.036 was obtained, thus demonstrating a significant difference between the observed groups. When we analyzed the absolute values of neutrophils and lymphocytes, the authors obtained results of p = 0.14 and p = 0.24. Therefore, it was not possible to observe statistically significant differences between the absolute values in the two groups. CONCLUSION: Considering the interactions between the inflammatory mechanisms in osteoarthritis and the fact that the interaction between neutrophils and lymphocytes has differences in relation to the laterality of the coxarthrosis, it is hypothesized that the inflammatory etiology of unilateral and bilateral osteoarthritis could have different dynamics. However, more in-depth studies with flow cytometry are needed to assess the possible impact of these differences in the inflammatory mechanisms observed in this study.

OBJETIVO: Avaliar a relação entre a razão neutrófilo/linfócito e a presença de sinais de artrose em ambos os quadris em pacientes acompanhados neste serviço. MÉTODOS: Estudo transversal, retrospectivo, que usou análise de prontuários e revisão de banco de dados de pacientes maiores de 18 anos com diagnóstico de artrose de quadril acompanhados no ambulatório deste hospital. RESULTADO: Com relação à análise do teste de Mann-Whitney para correlacionar a razão neutrófilo/linfócito e a lateralidade, observou-se um resultado de teste bilateral de 0,036, evidenciou desse modo a diferença entre os grupos. Quando os valores absolutos de neutrófilos e linfócitos foram analisados, observaram-se p = 0,14 e p = 0,24, não foi possível observar diferenças estatisticamente significativas entre os valores absolutos nos dois grupos. CONCLUSÕES: Considerando-se as interações entre os mecanismos inflamatórios na osteoartrose e o fato de que a interação entre os neutrófilos e os linfócitos tem diferenças com relação à lateralidade da coxartrose, é possível levantar a hipótese de que a etiologia inflamatória da osteoartrose unilateral e da bilateral tem dinâmicas diferentes. Entretanto, são necessários estudos mais aprofundados, com citometria de fluxo, para avaliar o impacto com relação às diferenças nos mecanismos inflamatórios observados nesse estudo.

Acetabular revision in total hip arthroplasty with tantalum augmentation and lyophilized bovine xenograft.

OBJECTIVE: To evaluate a mixed technique of acetabular reconstruction, which uses trabecular metal in the form of tantalum augments associated with lyophilized bovine xenograft. METHODS: Fifteen patients were evaluated prospectively, who underwent acetabular reconstruction with impacted lyophilized bovine xenograft associated with the use of tantalum augments. The main outcome was the failure of the tantalum-bone interface. RESULTS: The population had a mean age of 58.33 years ± 14.27; the majority was female, 80%. Of the total subjects, 66.7% were operated for failure in primary arthroplasty. The mean follow-up time was 45.2 months ± 11.39. The failure rate of the method in the period and population studied was 6.7%. CONCLUSION: An extremely high index (93.3%) of success was observed in an average time of 45.2 months of follow-up. Data were comparable to current literature, demonstrating that the technique employed and proposed is adequate for hip reconstruction in young patients.

OBJETIVO: Avaliar uma técnica mista de reconstrução acetabular que usa metal trabecular na forma de cunhas de tântalo associadas com enxerto ósseo bovino liofilizado. MÉTODOS: Foram avaliados prospectivamente 15 pacientes submetidos à reconstrução acetabular com enxerto bovino liofilizado impactado associado ao uso de cunhas de tântalo. O principal desfecho avaliado foi a falha da interface tântalo-osso. RESULTADOS: A população apresentou idade média de 58,33 anos ± 14,27, a maioria do sexo feminino 80%. Do total, 66,7% foram operados por falha da artroplastia primária. O tempo médio de seguimento foi de 45,2 meses ± 11,39 meses. A taxa de falha do método no período e na população estudada foi de 6,7%. CONCLUSÃO: Observou-se um índice extremamente elevado (93,3%) de sucesso em um tempo médio de 45,2 meses de seguimento. Os dados são comparáveis à literatura corrente, o que demonstra que a técnica empregada e proposta é adequada para reconstrução de quadril em pacientes jovens.

Total hip arthroplasty: a still evolving technique.

It has been advocated that total hip arthroplasty (THA) is probably the most successful surgical intervention performed in Medicine. In the 1960s, Sir John Charnley not only introduced, but also modified and improved the technique of cemented arthroplasties. The concepts on biological fixation established by Pillar and Galante served as the foundation for the development of uncemented implants that are now used worldwide. Currently, THA is a worldwide widespread surgery performed on millions of people. However, keeping abreast of the large number of information available on these procedures, especially on implant fixation, designs, different tribological pairings, and the long-term results can be challenging at times. This article is a brief update on the main aspects of THA.

A artroplastia total do quadril (ATQ) é uma das cirurgias de maior sucesso na história da medicina. Nos anos 1960, Sir John Charnley introduziu e aperfeiçoou as artroplastias cimentadas. Pillar e Galante estabeleceram os conceitos da fixação biológica, base para o desenvolvimento das artroplastias não cimentadas. Atualmente, a ATQ é uma cirurgia mundialmente difundida e feita em milhões de pessoas. No entanto, o grande número de informações disponíveis sobre as artroplastias, especialmente quanto à forma de fixação do implante ao osso, aos diferentes designs das hastes e dos acetábulos, aos diferentes pares tribológicos e aos resultados no longo prazo por vezes dificulta a tomada de decisão. Este artigo é uma breve atualização sobre os principais aspectos da ATQ.

Acetabular revision in total hip arthroplasty with tantalum augmentation and lyophilized bovine xenograft / Revisão acetabular em artroplastia total de quadril com cunhas de tântalo associadas a enxerto ósseo bovino liofilizado

Abstract Objective To evaluate a mixed technique of acetabular reconstruction, which uses trabecular metal in the form of tantalum augments associated with lyophilized bovine xenograft. Methods Fifteen patients were evaluated prospectively, who underwent acetabular reconstruction with impacted lyophilized bovine xenograft associated with the use of tantalum augments. The main outcome was the failure of the tantalum-bone interface. Results The population had a mean age of 58.33 years ± 14.27; the majority was female, 80%. Of the total subjects, 66.7% were operated for failure in primary arthroplasty. The mean follow-up time was 45.2 months ± 11.39. The failure rate of the method in the period and population studied was 6.7%. Conclusion An extremely high index (93.3%) of success was observed in an average time of 45.2 months of follow-up. Data were comparable to current literature, demonstrating that the technique employed and proposed is adequate for hip reconstruction in young patients.

Resumo Objetivo Avaliar uma técnica mista de reconstrução acetabular que usa metal trabecular na forma de cunhas de tântalo associadas com enxerto ósseo bovino liofilizado. Métodos Foram avaliados prospectivamente 15 pacientes submetidos à reconstrução acetabular com enxerto bovino liofilizado impactado associado ao uso de cunhas de tântalo. O principal desfecho avaliado foi a falha da interface tântalo-osso. Resultados A população apresentou idade média de 58,33 anos ± 14,27, a maioria do sexo feminino 80%. Do total, 66,7% foram operados por falha da artroplastia primária. O tempo médio de seguimento foi de 45,2 meses ± 11,39 meses. A taxa de falha do método no período e na população estudada foi de 6,7%. Conclusão Observou-se um índice extremamente elevado (93,3%) de sucesso em um tempo médio de 45,2 meses de seguimento. Os dados são comparáveis à literatura corrente, o que demonstra que a técnica empregada e proposta é adequada para reconstrução de quadril em pacientes jovens.

Total hip arthroplasty: a still evolving technique / Atualização em artroplastia total de quadril: uma técnica ainda em desenvolvimento

ABSTRACT It has been advocated that total hip arthroplasty (THA) is probably the most successful surgical intervention performed in Medicine. In the 1960s, Sir John Charnley not only introduced, but also modified and improved the technique of cemented arthroplasties. The concepts on biological , fixation established by Pillar and Galante served as the foundation for the development of uncemented implants that are now used worldwide. Currently, THA is a worldwide widespread surgery performed on millions of people. However, keeping abreast of the large number of information available on these procedures, especially on implant fixation, designs, different tribological pairings, and the long-term results can be challenging at times. This article is a brief update on the main aspects of THA.

RESUMO A artroplastia total do quadril (ATQ) é uma das cirurgias de maior sucesso na história da medicina. Nos anos 1960,SirJohn Charnley introduziu e aperfeiçoou as artroplastias cimentadas. Pillar e Galante estabeleceram os conceitos da fixação biológica, base para o desenvolvimento das artroplastias não cimentadas. Atualmente, a ATQ é uma cirurgia mundialmente difundida e feita em milhões de pessoas. No entanto, o grande número de informações disponíveis sobre as artroplastias, especialmente quanto à forma de fixação do implante ao osso, aos diferentesdesignsdas hastes e dos acetábulos, aos diferentes pares tribológicos e aos resultados no longo prazo por vezes dificulta a tomada de decisão. Este artigo é uma breve atualização sobre os principais aspectos da ATQ.

The prevalence of femoroacetabular impingement in radiographs of asymptomatic subjects: a cross-sectional study.

BACKGROUND: There is a lack of uniformity in the diagnostic criteria for femoroacetabular impingement (FAI), and few studies discuss the prevalence of radiographic changes in asymptomatic individuals. These factors make it difficult to establish a natural history of this disease. The aim of this study was to assess the prevalence of radiographic signs of CAM and Pincer FAI in an asymptomatic population. METHODS: A cross-sectional study was performed from July 2013 to December 2013. A total of 185 subjects were analysed. INCLUSION CRITERIA: no history of hip pain or orthopedic disease; and being 20-60 years old. EXCLUSION CRITERIA: athletically active; or patients who would not allow acquisition of appropriate radiographs for analysis. Radiographs were obtained in anteroposterior and Dünn 45° view to access: alpha angle (AA), triangular index (TI), crossover sign (CS), lateral-centre edge (LCE) angle and acetabular index (AI). RESULTS: Median age was 34 years (27-49.5) and FAI was present in 53% of all subjects. 32.44% (60) was the overall CAM-type prevalence and 42.7% (79) the overall Pincer-type prevalence. Only 2 subjects presented the 3 overcoverage signs (AI, LCE and CS). An association was noted between the presence of AI <0° and the LCE >40° (p = 0.05). CONCLUSIONS: Our study established a higher prevalence of radiographic markers of FAI in an asymptomatic population.

Lyophilized xenograft: a case series of histological analysis of biopsies.

The reconstruction of an acetabular bone defect is one of the most important aspects of revision total hip arthroplasty surgery. It can be done by the use of grafts. Therefore, many kinds of grafts may be used and lyophilized xenograft is an alternative example. The purpose of the study was to evaluate the histological findings of lyophilized bovine xenografts used in previous total hip arthroplasty revision surgery. A case series was carried out from July 2000 to April 2013 with the approval of the Hospital Ethics Committee. Fourteen subjects were analyzed. Of these, 64.3 % were female. The average age of the patients was 52.36 ± 18.55. Neoformed bone was present in 85.7 % of subjects, and constituted 61.79 % of the total bone matrix area. The diagnosis of xenograft absorption was present in 12 subjects. A strong inverse correlation between the percentage of neoformed bone and the percentage of xenograft in the total bone matrix by analysis of biopsies was found by the Pearson test (p = 0.001). No inflammatory response was found in the clinical status of the patients or in the histological analysis. Lyophilized bovine xenograft shown to be safe until the present moment, with acceptable results. Most of the cases presented new bone formation as expected (considered values greater than 30 %) and for this reason the xenograft has proven to be an osteoconductive compatible scaffold/trellis for the bone ingrowth. Therefore, it can be considered an alternative to other bone grafts in the treatment of bone loss.

Prevalence of radiographic markers of femoroacetabular impingement in asymptomatic adults.

OBJECTIVE: to determine the prevalence of radiographic signs of femoroacetabular impingement (FAI) in asymptomatic adults and correlate them with data from physical examinations. METHODS: We conducted a cross-sectional study with 82 asymptomatic volunteers, 164 hips, between 40 and 60 years of age, selected by convenience. They were submitted to anamnesis and clinical examination of the hip, anteroposterior (AP) pelvis radiographs with three incidences, Dunn 45° and Lequesne false profile of each hip, to measure the variables. We measured the alpha angle, anterior offset of the femoral neck, cervical diaphyseal angle, CE angle of Wiberg, acetabular index, Sharp angle, and the crossing, ischial spine and posterior wall signs. RESULTS: our sample consisted of 66% women, mean age of 50.4 years. The average alpha angle was 45.10°, SD=8.6. One quarter of the hips showed alpha angle greater than or equal to 50°; among men the prevalence was 34%, and among women, 11%. We found indicative radiographic signs of femoroacetabular impingement in 42.6% of hips, whether femoral or acetabular, and the increased alpha angle was related to the decrease in hip internal rotation (p<0.001). CONCLUSION: the radiographic findings of femoroacetabular impingement in asymptomatic patients were frequent in the studied sample. The increase in alpha angle was associated with decreased internal rotation.

Prevalence of radiographic markers of femoroacetabular impingement in asymptomatic adults / Prevalência dos achados radiográficos de impacto femoroacetabular em adultos assintomáticos

OBJECTIVE: to determine the prevalence of radiographic signs of femoroacetabular impingement (FAI) in asymptomatic adults and correlate them with data from physical examinations. METHODS: We conducted a cross-sectional study with 82 asymptomatic volunteers, 164 hips, between 40 and 60 years of age, selected by convenience. They were submitted to anamnesis and clinical examination of the hip, anteroposterior (AP) pelvis radiographs with three incidences, Dunn 45° and Lequesne false profile of each hip, to measure the variables. We measured the alpha angle, anterior offset of the femoral neck, cervical diaphyseal angle, CE angle of Wiberg, acetabular index, Sharp angle, and the crossing, ischial spine and posterior wall signs. RESULTS: our sample consisted of 66% women, mean age of 50.4 years. The average alpha angle was 45.10°, SD=8.6. One quarter of the hips showed alpha angle greater than or equal to 50°; among men the prevalence was 34%, and among women, 11%. We found indicative radiographic signs of femoroacetabular impingement in 42.6% of hips, whether femoral or acetabular, and the increased alpha angle was related to the decrease in hip internal rotation (p<0.001). CONCLUSION: the radiographic findings of femoroacetabular impingement in asymptomatic patients were frequent in the studied sample. The increase in alpha angle was associated with decreased internal rotation. .

OBJETIVO: determinar a prevalência dos sinais radiográficos de impacto femoroacetabular (IFA) em adultos assintomáticos e correlacionar com dados do exame físico. MÉTODOS: estudo transversal, com 82 voluntários, 164 quadris, selecionados por conveniência, assintomáticos, entre 40 e 60 anos de idade. Esses foram submetidos à anamnese e exame clínico do quadril, exame radiográfico com três incidências, antero-posterior (AP) de bacia, Dunn a 45° e falso perfil de Lequesne de cada quadril, para mensuração das variáveis. Aferimos o ângulo alfa, offset anterior do colo femoral, ângulo cérvico diafisário, ângulo CE de Wiberg, índice acetabular, ângulo de Sharp, além dos sinais do cruzamento, da espinha isquiática e da parede posterior. RESULTADOS: nossa amostra foi formada por 66% de mulheres, com média de idade de 50,4 anos. O ângulo alfa médio foi de 45.10º, DP = 8.6. 25% dos quadris apresentaram ângulo alfa maior ou igual a 50°; entre os homens a prevalência foi 34% e entre as mulheres 11%. Encontramos sinais radiográficos indicativos de impacto femoroacetabular em 42,6% dos quadris, sejam eles femorais ou acetabulares, e o aumento do ângulo alfa esteve relacionado com o decréscimo na rotação interna do quadril (p < 0,001). CONCLUSÃO: Os achados radiográficos de impacto femoroacetabular em pacientes assintomáticos foram frequentes na amostra estudada. O aumento do ângulo alfa esteve relacionado com o decréscimo da rotação interna. .