Estudo comparativo funcional e radiográfico preliminar da artroplastia total do joelho com componente tibial metal-backed e all-polyethylene / A functional and roentgenographic preliminary comparative study using metal-backed and all-polyethylene tibial components in total knee arthroplasty

OBJETIVO: Descrever e comparar clínica e radiograficamente pacientes submetidos a artroplastia total do joelho (ATJ) com implantes tibiais tipo all-polyethylene (ALP) e metal-backed (MTB). MÉTODOS: Pacientes submetidos a ATJ realizadas entre janeiro de 1998 e dezembro de 2004 foram agrupados de acordo com o tipo de implante recebido: all-polyethylene ou metal-backed. Sessenta pacientes compareceram para a avaliação, totalizando 82 joelhos operados. Destes, 22 pacientes haviam sido submetidos a ATJ apenas com ALP (12 unilaterais e 10 bilaterais), 33 pacientes apenas com MTB (26 unilaterais e sete bilaterais) e cinco pacientes foram submetidos a ATJ com ALP em um joelho e MTB em outro joelho, assim divididos: Grupo 1-37 joelhos com ALP e Grupo 2 - 45 joelhos com MTB. RESULTADOS: Não houve diferença na avaliação clínica e funcional entre os grupos. A média de radioluscência no fêmur foi de 0,838mm para os pacientes do grupo 1 e 0,356mm para os pacientes do grupo 2 (p = 0,049). Para a tíbia, na incidência AP, houve um valor médio de 2,703mm para o grupo 1 e de 0,733mm para o grupo 2 (p = 0,000). Na incidência em perfil, o valor médio de osteólise foi de 0,405mm para o grupo 1 e de 0,200mm para o grupo 2 (p = 0,074). CONCLUSÕES: Não houve diferença entre os grupos na avaliação clínica e funcional. Houve aumento da radioluscência nas artroplastias com ALP, tanto no fêmur na incidência em perfil quanto na tíbia na incidência em AP. Nível de evidência IV - Estudo tipo série de caso.

OBJECTIVE: To evaluate and clinically and roentgenographically compare two populations who had undergone total knee arthroplasty (TKA) with all-polyethylene (ALP) and metal-backed (MTB) tibial components. METHODS: Two groups of 40 patients underwent TKA between January 1988 and December 2004. Sixty patients showed up for evaluation, totaling 82 operated knees. From these, 22 patients had undergone TKA with only ALP (12 unilateral and 10 bilateral), 33 patients with only MTB (26 unilateral and 7 bilateral) and 5 patients had undergone both implants. The 82 operated knees were divided into two groups according to the type of tibial implant: Group 1 - 37 knees with ALP and Group 2 - 45 knees with MTB. RESULTS: There was no clinical or functional difference in outcome between the studied groups. The measurement of radioluscent line in the femoral component averaged 0.838 mm in Group 1 and 0.356 mm in Group 2 (p=0.049). For the tibial component, in the AP view radioluscent line measurement averaged 2.703 mm in Group 1 and 0.733 mm in Group 2 (p=0.000); and in the lateral view, the average values were 0.405 mm in Group 1 and 0.200 mm in Group 2 (p=0.074). CONCLUSIONS: There was no difference in the functional or clinical outcomes between the groups. However, radioluscent line was observed more frequently in the ALP arthroplasty group, in the lateral view in the femoral component as well as the AP view of the tibial component. Level of evidence IV - case series study.

A FUNCTIONAL AND ROENTGENOGRAPHIC PRELIMINARY COMPARATIVE STUDY USING METAL-BACKED AND ALL-POLYETHYLENE TIBIAL COMPONENTS IN TOTAL KNEE ARTHROPLASTY.

OBJECTIVE: To describe and clinically and radiographically compare patients who underwent total knee arthroplasty (TKA) with all-polyethylene (ALP) and metal-backed (MTB) tibial implants. METHODS: Patients who underwent TKA between January 1988 and December 2004 were grouped according to the type of implant received: all-polyethylene or metal-backed. Sixty patients came for evaluations, totaling 82 operated knees. Among these, 22 patients had undergone TKA only with ALP (12 unilateral and 10 bilateral cases), 33 patients only with MTB (26 unilateral and 7 bilateral cases) and five patients underwent TKA with ALP in one knee and MTB in the other. The knees were divided thus: group 1, 37 knees with ALP; and group 2, 45 knees with MTB. RESULTS: There were no differences in clinical or functional evaluations between the groups. The mean radiolucency in the femur was 0.838 mm for the patients in group 1 and 0.356 mm for the patients in group 2 (p = 0.049). For the tibia, in the AP view, there was a mean value of 2.703 mm for group 1 and 0.733 mm for group 2 (p = 0.000). In the lateral view, the mean values for osteolysis was 0.405 mm for group 1 and 0.200 mm for group 2 (p = 0.074). CONCLUSIONS: There were no differences between the groups in the functional and clinical evaluations. However, greater radiolucency was observed in the arthroplasties with ALP, both in the femur in the lateral view and in the tibia in the AP view. Level of evidence IV - case series study.

SIX MONTH FOLLOW-UP OF PATIENTS SUBMITTED TO TOTAL KNEE ARTHROPLASTY WITH AND WITHOUT PLACEMENT OF SUCTION DRAINAGE DEVICES.

OBJECTIVE: The aim of this study was to prospectively evaluate the evolution and postoperative complication patterns relating to the use of suction drains, in comparison with not using these devices in total knee arthroplasty (TKA) procedures. METHODS: Forty-two patients at a knee surgery referral clinic were included. Fifteen patients did not receive suction drainage postoperatively and 27 received suction drainage. The parameters evaluated were the range of motion, hematological indices, knee circumference and complication rate. The observation period was for six months after the surgical procedure. RESULTS: There were no statistically significant differences between the groups regarding knee circumference, hemoglobin, hematocrit, transfusion rate or infection index. Regarding range of motion, there was no statistically significant difference between the groups with and without drains preoperatively (p = 0.126), during the first postoperative day (p = 0.583), on the fifth to seventh postoperative day (p = 0.076) or at the six-month follow-up (p = 0.848). There was a statistically significant difference between the groups in the evaluation performed between the 14th and 28th postoperative days (p = 0.025). CONCLUSION: From this study, it was concluded that there was no benefit from using closed suction drains in TKA cases beyond six months after the operation. However, the range of movement at the end of the first month was greater in the patients that received suction drainage.

Avaliação prospectiva dos pacientes submetidos à artroplastia total do joelho com e sem colocação de dreno de sucção / Six month follow-up of patients submitted to total knee arthroplasty with and without placement of suction drainage devices

OBJETIVO: O objetivo deste trabalho é avaliar prospectivamente o padrão de evolução e complicações pós-operatórias relacionadas ao uso de drenos de sucção quando comparado à não utilização destes dispositivos na ATJ. MÉTODOS: Foram incluídos 42 pacientes de um serviço de referência em cirurgia do joelho. Quinze pacientes não receberam e 27 receberam dreno de sucção no pós-operatório. Os parâmetros avaliados foram: amplitude de movimento (ADM), índices hematimétricos, circunferência do joelho e taxa de complicações. O período de observação estendeu-se até o sexto mês de pós-operatório. RESULTADOS: Não foi observada diferença estatisticamente significativa entre os grupos quanto à circunferência do joelho, hemoglobina, hematócrito, taxa de transfusão e índice de infecção. Com relação à amplitude de movimentos, não houve diferença estatística entre os grupos com e sem dreno no pré-operatório (p = 0,126), primeiro DPO (p = 0,583), quinto ao sétimo DPO (p = 0,076) e seis meses de pós-operatório (p = 0,848). Foi identificada diferença estatisticamente significante entre os grupos na avaliação entre o 14º e 28º DPO (p = 0,025). CONCLUSÃO: Este estudo conclui que não existe benefício no uso de dreno de sucção fechado na ATJ além de seis meses de pós-operatório. No entanto, a ADM ao final do primeiro mês é melhor no grupo que utilizou o dreno de sucção.

OBJECTIVE: Our aim is to prospectively evaluate the standard evolution and post-operative complications related to the use of suction drainage devices when compared to not using these devices in TKA. METHODS: Forty-two patients from a clinic referred to knee surgery were included. Fifteen patients did not receive suction drainage postoperatively and 27 received suction drainage. The parameters evaluated were the range of movement, hematometric indices, knee circumference, and complications for each group. Patients were observed for six months after the surgical procedure. RESULTS: There were no statistically significant differences in knee circumference, hemoglobin, hematocrit, transfusion rate, and infection index. The analysis of the range of movement did not reveal statistically significant differences between the groups preoperatively (p=0.126), during the first postoperative day (p=0.583), fifth to seventh postoperative day (p=0.076) and at six months follow-up (p=0.848). There was a statistically significant difference between groups in the comparison during the 14th and 28th postoperative days (p=0.025). CONCLUSION: In conclusion, there is no benefit to using closed suction drains beyond six months after TKA. However, the range of movement at the end of the first month is superior in patients that received suction drainage.