Translation, cross-cultural adaptation and validation of the Brazilian Portuguese version of the Victorian Institute of Sports Assessment for Gluteal Tendinopathy patient reported-outcome measure (VISA-G.BR).

BACKGROUND: Different outcome measures can be used to assess pain and disability in individuals with Greater Trochanteric Pain Syndrome (GTPS), including the Victorian Institute of Sports Assessment for Gluteal Tendinopathy (VISA-G), Oswestry Disability Index (ODI), Patient Specific Functional Scale (PSFS) and Global Perceived Effect (GPE). OBJECTIVE: To translate, cross-culturally adapt and validate VISA-G to Brazilian Portuguese and to evaluate the measurement properties of the VISA-G.BR, ODI, GPE, and PSFS in individuals with GTPS. DESIGN: This is a longitudinal clinimetric study. METHODS: Sixty-eight individuals with GTPS participated in this study. The questionnaires VISA-G.BR, ODI, PSFS, and GPE were administered to participants at the initial assessment, 24-48 h and 30 days after the initial assessment. Internal consistency and construct validity for the VISA-G.BR were assessed. Reliability, agreement, ceiling and floor effect, and responsiveness were described for all instruments. RESULTS: The Cronbach Alpha for internal consistency value for VISA-G.BR was 0.65. The construct validity analysis showed a strong correlation value between ODI and VISA-G.BR (r = -0.77). The agreement analysis performed for all questionnaires showed standard error of measurement values ranging from 0.64 (PSFS) to 4.2 (VISA-G.BR). GPE scale had a floor effect. The responsiveness analysis performed for all questionnaires showed low values of effect size ranging from -0.07 to 0.3. CONCLUSION: The VISA-G.BR is a valid and reliable instrument to assess the disability of individuals with GTPS. The ODI and PSFS instruments can also be used in the evaluation of this population.

Pelvic Rotation in Femoroacetabular Impingement Is Decreased Compared to Other Symptomatic Hip Conditions.

Study Design Cross-sectional, case-control design. Background Pelvic movement has been considered a possible discriminating parameter associated with femoroacetabular impingement (FAI) symptom onset. Decreased pelvic rotation has been found during squatting in people with FAI when compared to people with healthy hips. However, it is possible that changes in pelvic movement may occur in other hip conditions because of pain and may not be specific to FAI. Objectives To compare sagittal pelvic rotation during hip flexion and in sitting between people with FAI and people with other symptomatic hip conditions. Methods Thirty people with symptomatic FAI, 30 people with other symptomatic hip conditions, and 20 people with healthy hips participated in the study. Sagittal pelvic rotation was calculated based on measures of pelvic alignment in standing, hip flexion to 45° and 90°, and sitting. Results There were significant differences in sagittal pelvic rotation among the 3 groups in all conditions (P<.05). Post hoc analyses revealed that participants in the symptomatic FAI group had less pelvic rotation during hip flexion to 45° and 90° compared to participants in the other symptomatic hip conditions group and the hip-healthy group (mean difference, 1.2°-1.9°). In sitting, participants in the other symptomatic hip conditions group had less posterior pelvic rotation compared to those in the hip-healthy group (mean difference, 3.9°). Conclusion People with symptomatic FAI have less posterior pelvic rotation during hip flexion when compared to people with other symptomatic hip conditions and those with healthy hips. Level of Evidence Diagnosis, level 4. J Orthop Sports Phys Ther 2016;46(11):957-964. Epub 29 Sep 2016. doi:10.2519/jospt.2016.6713.

Influence of age on delayed surgical treatment of proximal femoral fractures

ABSTRACTOBJECTIVE: To investigate the influence of patients' age on the delay between diagnosis and surgical treatment of proximal femoral fracturesMETHODS: This is a retrospective study, con-ducted at a tertiary university hospital, including all patients admitted with proximal femoral fractures between March 2013 and March 2014. The participants were categorized into four groups according to age levels. The groups were compared according to demographics, comorbidities, fracture type, trau-ma circumstances, and time between diagnosis and surgical procedureRESULTS: One hundred and sixty one patients were included, 37 adults and 124 elderly. Among adults, the mean delay between diagnosis and surgical procedure was 6.4±5.3 days; among elderly the delay was 9.5±7.6 days. There was a progressive increase in the delay from the young-adults group through the elderly individuals (Kruskal-Wallis: 13.7; p=0.003)CONCLUSION: In spite of being the patients most susceptible to complications due to surgical delay, the elderly individuals pre-sented the longest delays from admission to surgical treatment. Level of Evidence III, Retrospective Study.

Inflammatory pseudotumor of the hip: a complication of arthroplasty to be recognized by the radiologist.

Soft tissue complications following hip arthroplasty may occur either in cases of total hip arthroplasty or in hip resurfacing, a technique that has become popular in cases involving young patients. Both orthopedic and radiological literatures are now calling attention to these symptomatic periprosthetic soft tissue masses called inflammatory pseudotumors or aseptic lymphocytic vasculites-associated lesions. Pseudotumors are associated with pain, instability, neuropathy, and premature loosening of prosthetic components, frequently requiring early and difficult reoperation. Magnetic resonance imaging plays a relevant role in the evaluation of soft tissue changes in the painful hip after arthroplasty, ranging from early periprosthetic fluid collections to necrosis and more extensive tissue damage.

Complicações em partes moles pós-artroplastia do quadril são suscetíveis de ocorrer, seja quando da artroplastia total, seja quando se utiliza a técnica de recapeamento da cabeça femoral, opção que se tornou popular em casos de pacientes jovens. Tanto a literatura ortopédica quanto a radiológica têm chamado a atenção para massas "sintomáticas" que surgem em partes moles adjacentes a próteses, denominadas pseudotumores inflamatórios ou lesões associadas a vasculite linfocítica asséptica. Os pseudotumores estão associados a dor, instabilidade, neuropatia e afrouxamento prematuro dos componentes da prótese, geralmente levando a cirurgias de revisão precoces e difíceis. A ressonância magnética tem papel muito importante na avaliação das alterações em partes moles do quadril doloroso pós-artroplastia, que variam desde coleções fluidas periprotéticas precoces até necrose e dano tecidual mais extenso.

Inflammatory pseudotumor of the hip: a complication of arthroplasty to be recognized by the radiologist / Pseudotumor inflamatório do quadril: uma complicação da artroplastia a ser reconhecida pelo radiologista

AbstractSoft tissue complications following hip arthroplasty may occur either in cases of total hip arthroplasty or in hip resurfacing, a technique that has become popular in cases involving young patients. Both orthopedic and radiological literatures are now calling attention to these symptomatic periprosthetic soft tissue masses called inflammatory pseudotumors or aseptic lymphocytic vasculites-associated lesions. Pseudotumors are associated with pain, instability, neuropathy, and premature loosening of prosthetic components, frequently requiring early and difficult reoperation. Magnetic resonance imaging plays a relevant role in the evaluation of soft tissue changes in the painful hip after arthroplasty, ranging from early periprosthetic fluid collections to necrosis and more extensive tissue damage.

ResumoComplicações em partes moles pós-artroplastia do quadril são suscetíveis de ocorrer, seja quando da artroplastia total, seja quando se utiliza a técnica de recapeamento da cabeça femoral, opção que se tornou popular em casos de pacientes jovens. Tanto a literatura ortopédica quanto a radiológica têm chamado a atenção para massas “sintomáticas” que surgem em partes moles adjacentes a próteses, denominadas pseudotumores inflamatórios ou lesões associadas a vasculite linfocítica asséptica. Os pseudotumores estão associados a dor, instabilidade, neuropatia e afrouxamento prematuro dos componentes da prótese, geralmente levando a cirurgias de revisão precoces e difíceis. A ressonância magnética tem papel muito importante na avaliação das alterações em partes moles do quadril doloroso pós-artroplastia, que variam desde coleções fluidas periprotéticas precoces até necrose e dano tecidual mais extenso.

Profile of hip arthroplasty patients in a teaching hospital.

OBJECTIVE: to characterize the epidemiological profile of patients undergoing hip replacement, primary or revisional. METHODS: we conducted a retrospective, descriptive study, including hip arthroplasties performed from January 2009 to June 2012 in a Belo Horizonte teaching hospital, Minas Gerais State - MG, Brazil. Data were analyzed using descriptive statistics. RESULTS: orthopedic procedures represented 45% of the operations at the hospital in the period, 1.4% hip arthroplasties. There were 125 hip replacements, 85 total, 27 partial and 13 reviews. Among the patients, 40% were male and 60% were female. Age ranged between 20 and 102 years, mean and median of 73 and 76 years, respectively. The most frequent diagnosis (82%) was femoral neck fracture by low-energy trauma caused by falling form standing position. In 13 revision operations, 12 required removal of the prosthesis. The infectious complication led to revision in 54% of the time, followed by dislocation (15%), peri-prosthetic fracture (15%) and aseptic loosening (15%). The infection etiologic agent was identified in 43% of occasions. The average length of the prosthesis to a revision operation was eight months. CONCLUSION: patients undergoing hip arthroplasty are elderly, with femoral neck fracture caused by falling form standing position, affecting more women. The incidence of hip prosthesis loosening was 10%. The main cause of the infection was loosening. The incidence of revisional hip arthroplasty was 10% and the incidence of hospital mortality in patients undergoing hip arthroplasty was 7.2%.

Profile of hip arthroplasty patients in a teaching hospital / Perfil dos pacientes submetidos à artroplastia do quadril em hospital de ensino

OBJECTIVE: To characterize the epidemiological profile of patients undergoing hip replacement, primary or revisional. METHODS: we conducted a retrospective, descriptive study, including hip arthroplasties performed from January 2009 to June 2012 in a Belo Horizonte teaching hospital, Minas Gerais State - MG, Brazil. Data were analyzed using descriptive statistics. RESULTS: orthopedic procedures represented 45% of the operations at the hospital in the period, 1.4% hip arthroplasties. There were 125 hip replacements, 85 total, 27 partial and 13 reviews. Among the patients, 40% were male and 60% were female. Age ranged between 20 and 102 years, mean and median of 73 and 76 years, respectively. The most frequent diagnosis (82%) was femoral neck fracture by low-energy trauma caused by falling form standing position. In 13 revision operations, 12 required removal of the prosthesis. The infectious complication led to revision in 54% of the time, followed by dislocation (15%), peri-prosthetic fracture (15%) and aseptic loosening (15%). The infection etiologic agent was identified in 43% of occasions. The average length of the prosthesis to a revision operation was eight months. CONCLUSION: patients undergoing hip arthroplasty are elderly, with femoral neck fracture caused by falling form standing position, affecting more women. The incidence of hip prosthesis loosening was 10%. The main cause of the infection was loosening. The incidence of revisional hip arthroplasty was 10% and the incidence of hospital mortality in patients undergoing hip arthroplasty was 7.2%.

OBJETIVO: Caracterizar perfil epidemiológico de pacientes submetidos à artroplastia do quadril, primária ou de revisão. MÉTODOS: estudo retrospectivo, descritivo, incluindo artroplastias do quadril realizadas no período de janeiro/2009 a junho/2012 em hospital de ensino de Belo Horizonte, MG. Os dados foram analisados por estatística descritiva. RESULTADOS: as operações ortopédicas correspondem a 45% das realizadas no Hospital e 1,4% à artroplastias do quadril. No período, foram realizadas 125 artroplastias do quadril, sendo 85 totais, 27 parciais e 13 revisões. Dentre os pacientes, 40% pertenciam ao sexo masculino e 60%, ao feminino. A idade variou entre 20 e 102 anos, com média e mediana de 73 e 76 anos. O diagnóstico mais frequente (82%) foi fratura de colo de fêmur por trauma de baixa energia causado por queda da própria altura. Em 13 operações de revisão, 12 necessitaram a remoção da prótese. A complicação infecciosa motivou a revisão em 54% das ocasiões, seguida de luxação (15%), fratura periprótese (15%) e soltura asséptica (15%). O agente etiológico de infecção foi identificado em 43% das ocasiões. O tempo médio de prótese até a operação de revisão foi oito meses. CONCLUSÃO: os pacientes submetidos à artroplastia do quadril são idosos, com fratura de colo fêmur, causada por queda da própria altura, que acometeu mais as mulheres. A incidência de soltura de prótese do quadril foi 10%. A principal causa de soltura foi a infecção. A incidência de revisão cirúrgica de artroplastia do quadril foi 10% e a incidência de mortalidade hospitalar nos pacientes submetidos à artroplastia do quadril foi 7,2%.

Influence of age on delayed surgical treatment of proximal femoral fractures.

OBJECTIVE: : To investigate the influence of patients' age on the delay between diagnosis and surgical treatment of proximal femoral fractures. METHODS: : This is a retrospective study, con-ducted at a tertiary university hospital, including all patients admitted with proximal femoral fractures between March 2013 and March 2014. The participants were categorized into four groups according to age levels. The groups were compared according to demographics, comorbidities, fracture type, trau-ma circumstances, and time between diagnosis and surgical procedure. RESULTS: : One hundred and sixty one patients were included, 37 adults and 124 elderly. Among adults, the mean delay between diagnosis and surgical procedure was 6.4±5.3 days; among elderly the delay was 9.5±7.6 days. There was a progressive increase in the delay from the young-adults group through the elderly individuals (Kruskal-Wallis: 13.7; p=0.003). CONCLUSION: : In spite of being the patients most susceptible to complications due to surgical delay, the elderly individuals pre-sented the longest delays from admission to surgical treatment. Level of Evidence III, Retrospective Study.

Artoplastias totais do quadril com prótese PCA (Porous Coated Anatomic) / Total HIP arthroplasty with PCA (Porous Coated Anatomic) prosthesis

Foram realizadas 27 artroplastias totais do quadril nos anos de 1988 e 1993, com próteses do quadril PCA (Anatômica com revestimento poroso) em 26 pacientes. O tempo médio de seguimento foi de nove anos. Foram excluídos desta avaliação sete quadris: um devido a infecção profunda precoce, dois referentes a pacientes falecidos de causa não relacionada a operação e quatro em que os pacientes não foram localizados para a presente avaliação. A idade média no tempo da operação foi de 53 anos. O diagnóstico pré-operatório foi de osteoartrite primária em nove pacientes, osteoartrite secundária em sete pacientes e artrite inflamatória em quatro pacientes. Os pacientes foram avaliados do ponto de vista clínico, radiográfico e subjetivo. As radiografias foram estudadas em relação a ocorrência de osteólise, migração ou afrouxamento da taça, desgaste do polietileno, desprendimento de contas, afundamento ou afrouxamento da hasta femoral, reabsorção proximal do fêmur, reação periosteal, hipertrofia cortical e pedestal. Os resultados clínicos foram bons em 17 quadris (85 por cento). Três quadris apresentaram maus resultados (15 por cento) devido a migração e soltura da taça em dois casos e desgaste do polietileno em um caso. Houve concordância entre os resultados clínicos e subjetivos. Entretanto algumas alterações radiográficas observadas não se relacionaram com maus resultados.

Revisäo de solturas assépticas acetabulares em atroplastias totais do quadril: revisöes com taça rosqueada de titânio e enxerto ilíaco autólogo / Revision of aseptic loosening in total hip arthroplasty: revision with threaded titanium cup and iliac autologous graft

Os autores avaliaram 44 pacientes e 56 quadris submetidos a revisöes das taças acetabulares para soltura em artroplastias totais do quadril. Foram usadas taças porosas rosqueadas de titânio revestidas de hidroxiapatita inseridas com adiçäo de enxerto ilíaco autológo. A duraçäo média do acompanhamento foi de 30 meses, variando de seis a 70 meses. Os resultados clínicos foram satisfatórios em 50 quadris (89,3 por cento). Os seis maus resultados foram devidos a soltura asséptica (cinco quadris) e metalose (um quadril), os quais necessitaram revisäo adicional. Os resultados clínicos foram relacionados aos resultados radiográficos e subjetivos, havendo concordância entre eles. Procurou-se relacionar as variáveis com os achados clínicos e observou-se que, quanto maior o acompanhamento, maior o número de maus resultados (dado significante). Foi também observado que pacientes com artrose secundária, bem como os casos em que a taça foi colocada muito verticalizada, relacionaram-se com um número superior de maus resultados (esses dados näo foram significantes). As complicaçöes mais comuns foram migraçäo da taça e luxaçäo pós-operatória.

Drenagem pós operatória após artroplastia total do joelho / Postoperative drain following total knee replacement

Os autores compraram o volume de drenagem pós-operatória entre o 1º e o 2º dias em 33 pacientes submetidos à artroplastia total do joelho entre setembro de 1995 e junho de 1996. Observam que 84 por cento da drenagem ocorrem nas primeiras 24 horas e somente 16 por cento no 2º dia (estatisticamente significativo, p<0,05). Concluem pela utilizaçao do dreno por somente 24 horas, correlacionando o risco de sua permanência prolongada com os problemas de sua retirada precoce.