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1.
Orthop Traumatol Surg Res ; 107(5): 102967, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34033920

RESUMO

INTRODUCTION: Pain is the main reason why patients consult for degenerative and posttraumatic wrist conditions. While the many surgical techniques make choosing the appropriate procedure difficult, total wrist denervation, which has an "analgesic" aim, remains an accessible therapeutic solution to treat this symptomatology. Nevertheless, long-term results remain controversial, and few studies have focused on the survival of this procedure. HYPOTHESIS: Total wrist denervation provides lasting pain relief. PATIENTS AND METHODS: This was a single center, single operator (DLN), retrospective observational study. We analyzed 63 wrists. The mean age at the time of the procedure was 53.7 years. We verified the primary endpoint for survival, which included no further analgesic procedures and no significant residual pain (NRS≤3). Patient satisfaction and the quality of the wrist function were also assessed. RESULTS: The mean follow-up was 8.2 years. Some of the patients (12.7%) did not respond to treatment. We reported 1 neuroma of the superficial sensory branch of the radial nerve, 2 CRPS and 11 revision surgeries. We observed that the treatment became less effective over time. The median survival was 8.8 years. The survival rate of the procedure fell to 13.5% at the last follow-up. The mean residual pain was 3.4 on a numerical rating scale and the mean DASH score was 23.5. The mean satisfaction level, on a scale from 0 to 10, was 7.3 and most patients (79.6%) would undergo this procedure again. DISCUSSION: Survival of the total wrist denervation at the last follow-up was low in our study. Even though the treatment became less effective over time, the quality of the wrist function remained satisfactory and similar to the different studies previously published on the subject. There were very few complications and revisions. CONCLUSION: Total wrist denervation therefore remains an interesting surgical solution for patients with chronic wrist pain as it preserves mobility. LEVEL OF EVIDENCE: IV; Single center, single operator retrospective observational study.


Assuntos
Articulação do Punho , Punho , Artralgia/cirurgia , Denervação , Seguimentos , Humanos , Amplitude de Movimento Articular , Estudos Retrospectivos , Articulação do Punho/cirurgia
2.
Medicine (Baltimore) ; 100(18): e25797, 2021 May 07.
Artigo em Inglês | MEDLINE | ID: mdl-33950977

RESUMO

ABSTRACT: To compare the postoperative effects of arthroscopy for rotator cuff injury with patients in the lateral-lying position (LLP) and beach chair position (BCP), and to identify factors influencing these effects.Data from patients with rotator cuff injuries who underwent shoulder arthroscopy in the LLP (n = 115, 53.24%) or BCP (n = 101, 46.76%) between January 2013 and 2016 and were followed for >3 years were analyzed. The American Shoulder and Elbow Surgeons shoulder score, University of California at Los Angeles shoulder score (UCLASS), and visual analog scale (VAS) score were used to evaluate patients' shoulder function and pain preoperatively and at the last follow-up examination. The abduction and lateral rotation angles were measured. The influences of patient characteristics were compared between the LLP and BCP subgroups defined by UCLASSs (excellent, good, acceptable, poor).Postoperative injury characteristics, UCLASSs, and VAS scores were better in the LLP group than in the BCP group (all P < .05). Among patients with good UCLASSs, preoperative pain duration was longer in the LLP group than in the BCP group (P < .05); among those with acceptable UCLASSs, this duration was longer in the BCP group than in the LLP group (P < .05). The preoperative flexion angle differed between groups (P < .05). Among patients with excellent and good UCLASSs, the postoperative external rotation angle was greater in the LLP group than in the BCP group (P < .05). The LLP group contained more excellent UCLASSs than did the BCP group (P < .05). It also contained more small, medium, and large tear cases than did the BCP group (all P < .05).The effect of arthroscopy for rotator cuff injury was better when the operation was performed with the patient in the LLP. Either position is suitable for the arthroscopic treatment of partial rotator cuff tears. The LLP is more suitable in cases of small and medium-sized tears and those with large preoperative lateral rotation angles. The BCP should be used for patients with large preoperative flexion angles.


Assuntos
Artralgia/cirurgia , Artroscopia/métodos , Posicionamento do Paciente/métodos , Lesões do Manguito Rotador/cirurgia , Articulação do Ombro/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Artralgia/diagnóstico , Artralgia/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Amplitude de Movimento Articular , Lesões do Manguito Rotador/complicações , Lesões do Manguito Rotador/diagnóstico , Índice de Gravidade de Doença , Resultado do Tratamento
3.
Ann R Coll Surg Engl ; 103(7): 508-513, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33913774

RESUMO

INTRODUCTION: Autologous stem cell progenitor implantation into necrotic lesions of the femoral head has previously been described as a potential treatment for avascular necrosis (AVN), on the basis that there is a reduced number of functioning stem cells in the marrow within the necrotic segment. We present a case series of patients with AVN that underwent core decompression with autologous stem cell implantation using a new device. METHODS: The records and imaging of patients with AVN of the femoral head treated by a single surgeon were retrospectively reviewed. All patients were treated with core decompression and stem cell progenitor implantation, using the PerFuse system. Preoperatively, demographic information, AVN staging (as per Ficat and Arlet classification) and visual analogue pain scores (VAS) of the hips were recorded. These results were compared with postoperative VAS and imaging, with further review on the progression of AVN. RESULTS: We treated 14 hips in 13 patients with an average follow up of 12 months. Patients with Ficat I-II were selected for the procedure. The average preoperative VAS was 3.9. Postoperatively, this dropped to 2.6, with over half of patients reporting at least a two-point decrease in pain. Eight of the 14 treated hips showed no radiological progression of the disease, while six showed femoral head collapse requiring total hip arthroplasty (THA) at an average of ten months after treatment. CONCLUSION: Our early findings indicate that hip decompression with stem cell progenitor implantation for AVN of the femoral head provides symptomatic relief and may be beneficial in arresting progression of disease using this simple new device.


Assuntos
Artralgia/cirurgia , Descompressão Cirúrgica/instrumentação , Necrose da Cabeça do Fêmur/cirurgia , Transplante de Células-Tronco/métodos , Adulto , Idoso , Artralgia/diagnóstico , Artralgia/etiologia , Descompressão Cirúrgica/métodos , Progressão da Doença , Feminino , Cabeça do Fêmur/patologia , Cabeça do Fêmur/cirurgia , Necrose da Cabeça do Fêmur/complicações , Necrose da Cabeça do Fêmur/diagnóstico , Necrose da Cabeça do Fêmur/patologia , Articulação do Quadril/patologia , Articulação do Quadril/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor/estatística & dados numéricos , Período Pós-Operatório , Período Pré-Operatório , Estudos Retrospectivos , Índice de Gravidade de Doença , Transplante Autólogo , Resultado do Tratamento , Adulto Jovem
4.
Int J Surg ; 91: 105951, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33882358

RESUMO

BACKGROUND: Currently, there is poor evidence on the effect of radiofrequency ablation (RFA) on pain and knee function in patients with knee osteoarthritis (OA). We performed a meta-analysis on randomized controlled trials (RCTs) to determine the effectiveness and safety of RFA on pain and knee function in individuals with knee OA. METHODS: PubMed, EMBASE, Web of Science, Cochrane, Ovid and MEDLINE were systematically searched (up to March 20, 2021) to obtain literature focusing on the impact of RFA on knee OA, using the following keywords and their synonyms: "radiofrequency ablation", "neurotomy", "knee" and "osteoarthritis". Two authors independently evaluated the quality of the RCTs according to the Cochrane Handbook for Systematic Reviews of Interventions version. Pooled effects of this meta-analysis were calculated using STATA version 13.0. RESULTS: Eight RCTs were included for data extraction and meta-analysis. The present study indicated that there were significant differences between the two groups of patients who were treated or not treated with RFA on the pain intensity at 4 week (WMD = -0.504; 95% CI: 0.708 to -0.300; P < 0.001), 12 week (WMD = -0.280; 95% CI: 0.476 to -0.084; P = 0.005) and 24 week (WMD = -2.437; 95% CI: 4.742 to -0.132; P = 0.038). Furthermore, RFA was associated with improved outcome of the Western Ontario and McMaster Universities Arthritis index at 4 week (WMD = -3.189; 95% CI: 5.996 to -0.382, P = 0.026), 12 week (WMD = -3.706; 95% CI:-6.584 to -0.828, P = 0.012) and 24 week (WMD = -2.437; 95% CI: 4.742 to -0.132). No serious adverse events were observed in all patients who received RFA (RD = -0.019; 95% CI: 0.053 to 0.016; P = 0.294). CONCLUSION: RFA showed better effectiveness in relieving pain and promoting function recovery in patients with knee OA. Considering the small sample size of the included studies, the results should be treated with caution.


Assuntos
Artralgia/cirurgia , Osteoartrite do Joelho/cirurgia , Manejo da Dor/métodos , Ablação por Radiofrequência/métodos , Idoso , Artralgia/etiologia , Artralgia/fisiopatologia , Feminino , Humanos , Articulação do Joelho/fisiopatologia , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/complicações , Osteoartrite do Joelho/fisiopatologia , Medição da Dor , Ensaios Clínicos Controlados Aleatórios como Assunto , Recuperação de Função Fisiológica , Resultado do Tratamento
5.
Clin Orthop Relat Res ; 479(5): 1002-1013, 2021 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-33787519

RESUMO

BACKGROUND: Several classification systems have been used to describe early lesions of hip cartilage and the acetabular labrum in young adults with hip pain. Some of them were introduced before the concept of femoroacetabular impingement was proposed. Others were developed for other joints (such as the patellofemoral joint). However, these often demonstrate inadequate reliability, and they do not characterize all possible lesions. Therefore, we developed a novel classification system. QUESTION/PURPOSE: We asked: What is the (1) intraobserver reliability, (2) interobserver reproducibility, and (3) percentage of nonclassifiable lesions of the new classification system for damage to the hip cartilage and labrum compared with six established classification systems for chondral lesions (Beck et al. [4], Konan et al. [10], Outerbridge et al. [14]) and labral lesions (Beck et al. [3], Lage et al. [12], Peters and Erickson [15])? METHODS: We performed a validation study of a new classification system of early chondrolabral degeneration lesions based on intraoperative video documentation taken during surgical hip dislocations for joint-preserving surgery in 57 hips (56 patients) performed by one surgeon with standard video documentation of intraarticular lesions. The exclusion criteria were low-quality videos, inadequate exposure angles, traumatic lesions, and incomplete radiographic documentation. This left 42 hips (41 patients) for the blinded and randomized analysis of six raters, including those with cam-pincer-type femoroacetabular impingement (FAI) (19 hips in 18 patients), isolated cam-type FAI (10 hips), extraarticular FAI due to femoral anteversion (seven hips), isolated pincer-type FAI (two hips), focal avascular necrosis (two hips), localized pigmented villonodular synovitis (one hip), and acetabular dysplasia as a sequelae of Perthes disease (one hip). The raters had various degrees of experience in hip surgery: Three were board-certified orthopaedic fellows and three were orthopaedic residents, in whom we chose to prove the general usability of the classification systems in less experienced readers. Every rater was given the original publication of all existing classification systems and a visual guide of the new Bern classification system. Every rater classified the lesions according the existing classifications (cartilage: Beck et al. [4], Konan et al. [10], and Outerbridge et al. [14]; labrum: Beck et al. [3], Peters and Erickson [15], and Lage et al. [12]) and our new Bern chondrolabral classification system. The intraclass correlation coefficient with 95% confidence interval was used to assess the intraobserver reliability and interobserver reproducibility. The percentage of nonclassifiable lesions was calculated as an absolute number and percentage. RESULTS: The intraobserver intercorrelation coefficients (ICCs) for cartilage lesions were as follows: the Bern classification system (0.68 [95% CI 0.61 to 0.70]), Beck (0.44 [95% CI 0.34 to 0.54]), Konan (0.39 [95% CI 0.29 to 0.49]), and the Outerbridge classification (0.57 [95% CI 0.48 to 0.65]). For labral lesions, the ICCs were as follows: the Bern classification (0.70 [95% CI 0.63 to 0.76]), Peters (0.42 [95% CI 0.31 to 0.51]), Lage (0.26 [95% CI 0.15 to 0.38]), and Beck (0.59 [95% CI 0.51 to 0.67]). The interobserver ICCs for cartilage were as follows: the Bern classification system (0.63 [95% CI 0.51 to 0.75), the Outerbridge (0.14 [95% CI 0.04 to 0.28]), Konan (0.58 [95% CI 0.40 to 0.76]), and Beck (0.52 [95% CI 0.39 to 0.66]). For labral lesions, the ICCs were as follows: the Bern classification (0.61 [95% CI 0.49 to 0.74]), Beck (0.31 [95% CI 0.19 to 0.46]), Peters (0.28 [95% CI 0.16 to 0.44]), and Lage (0.20 [95% CI 0.09 to 0.35]). The percentage of nonclassifiable cartilage lesions was 0% for the Bern, 0.04% for Beck, 17% for Konan, and 25% for the Outerbridge classification. The percentage of nonclassifiable labral lesions was 0% for Bern and Beck, 4% for Peters, and 25% for Lage. CONCLUSION: We have observed some shortcomings with currently used classification systems for hip pathology, and the new classification system we developed seems to have improved the intraobserver reliability compared with the Beck and Konan classifications in cartilage lesions and with the Peters and Lage classifications in labral lesions. The interrater reproducibility of the Bern classification seems to have improved in cartilage lesions compared with the Outerbridge classification and in labral lesions compared with the Beck, Peters, and Lage classifications. The Bern classification identified all present cartilage and labral lesions. It provides a solid clinical basis for accurate descriptions of early degenerative hip lesions independent of etiology, and it is reproducible enough to use in the reporting of clinical research. Further studies need to replicate our findings in the hands of nondevelopers and should focus on the prognostic value of this classification and its utility in guiding surgical indications. LEVEL OF EVIDENCE: Level II, diagnostic study.


Assuntos
Acetábulo/patologia , Artralgia/patologia , Cartilagem Articular/patologia , Impacto Femoroacetabular/patologia , Articulação do Quadril/patologia , Acetábulo/diagnóstico por imagem , Acetábulo/cirurgia , Adulto , Artralgia/classificação , Artralgia/diagnóstico por imagem , Artralgia/cirurgia , Artroscopia , Cartilagem Articular/diagnóstico por imagem , Cartilagem Articular/cirurgia , Feminino , Impacto Femoroacetabular/classificação , Impacto Femoroacetabular/diagnóstico por imagem , Impacto Femoroacetabular/cirurgia , Articulação do Quadril/diagnóstico por imagem , Articulação do Quadril/cirurgia , Humanos , Masculino , Variações Dependentes do Observador , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Estudos Retrospectivos , Gravação em Vídeo , Adulto Jovem
6.
Tech Hand Up Extrem Surg ; 25(4): 264-268, 2021 Mar 29.
Artigo em Inglês | MEDLINE | ID: mdl-33782357

RESUMO

Pisotriquetral (PT) joint arthritis is a common cause of ulnar-sided wrist pain. Open pisiform excision is a well-established procedure and is indicated when the conservative treatment fails. Although arthroscopic visualization of the PT joint is part of the routine examination in a patient with ulnar-sided wrist pain, therapeutic arthroscopy of the PT joint is limited to one case in the literature through the standard dorsal portals. Arthroscopic pisiform excision is a novel technique described by the authors. The first aim of this procedure is pain relief maintaining wrist stability and strength. With this minimally invasive approach we believe that preserving the flexor carpi ulnaris and the PT ligament complex we maintain their biomechanical function, while at the same time, reducing scar tenderness and postoperative discomfort with better esthetic results and less recovery time. In addition to standard dorsal portals, a direct PT portal was used to have access to the PT space and as a working portal to complete the pisiform excision.


Assuntos
Articulações do Carpo , Osteoartrite , Pisciforme , Artralgia/cirurgia , Artroscopia , Articulações do Carpo/cirurgia , Humanos , Osteoartrite/cirurgia , Pisciforme/cirurgia , Articulação do Punho/cirurgia
7.
Medicine (Baltimore) ; 100(10): e24965, 2021 Mar 12.
Artigo em Inglês | MEDLINE | ID: mdl-33725860

RESUMO

BACKGROUND: There have been no published randomized clinical trial to assess the clinical outcomes between the articular-sided and bursal-sided tears. Therefore, a comparative analysis of evaluating and comparing the functional outcomes following arthroscopic repair of bursal-sided versus articular-sided partial-thickness rotator cuff tearsis essential. METHODS: This study is a present randomized controlled trial which is conducted in our hospital. Consecutive patients with symptomatic articular-sided or bursal-sided partial-thickness rotator cuff tears underwent arthroscopic repair between June 2020 and January 2022. The institutional review board approved the study proposal (with number 10012030), and informed consent was obtained from all patients. Inclusion criteria were existence of an articular- or bursal-sided tear involving <50% of the tendon thickness-confirmed intraoperatively and treated with arthroscopic debridement with or without other decompression surgery (acromioplasty/distal clavicle resection)-and a minimum follow-up of 2 years. All patients followed the same postoperative rehabilitation program. The patients were assessed at baseline preoperatively, and at 1 year and 2 years postoperatively. Outcome parameters were measured at each respective follow-up, which included active range of motion in forward flexion and abduction of the affected shoulder, pain score as measured on the Numeric Pain Rating Scale, as well as outcome scores in terms of the Constant-Murley Score, and Oxford Shoulder Score. RESULTS: Table 1 and Table 2 describe the data indicators that this article wants to evaluate and collect. CONCLUSIONS: We hypothesize that both groups of patients will show improvement in range of motion, functional outcome scores, and pain at 2 years, and that results would be similar between the two groups. TRIAL REGISTRATION: This study protocol was registered in Research Registry (researchregistry6496).


Assuntos
Artralgia/cirurgia , Artroscopia , Lesões do Manguito Rotador/cirurgia , Manguito Rotador/cirurgia , Articulação do Ombro/fisiopatologia , Artralgia/diagnóstico , Artralgia/etiologia , Artralgia/fisiopatologia , Braquetes , Desbridamento/métodos , Descompressão Cirúrgica/métodos , Feminino , Seguimentos , Humanos , Masculino , Medição da Dor , Ensaios Clínicos Controlados Aleatórios como Assunto , Amplitude de Movimento Articular , Lesões do Manguito Rotador/complicações , Lesões do Manguito Rotador/fisiopatologia , Lesões do Manguito Rotador/reabilitação , Articulação do Ombro/cirurgia , Resultado do Tratamento
8.
Sports Med Arthrosc Rev ; 29(1): 2-8, 2021 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-33395223

RESUMO

The origin of pain around the hip is commonly more elusive than other joints; often obscured by compensatory disorders. Hip problems tend to be multifactorial and require a multidisciplinary approach in the evaluation. The best strategy is to team with a capable physical therapist to unveil the layers of problems. Ultrasonography and imaging/ultrasound-guided injections can be the most valuable adjunct to the history and physical examination. Plain radiographs are an essential element in the workup. Magnetic resonance imaging can underestimate damage in the joint, but positive findings can sometimes be the normal consequence of age and activity. Magnetic resonance imaging is often as important for what it rules out as much as what it rules in. Computed tomography scans with 3-dimensional reconstructions can be especially helpful in surgical planning but are not used in routine screening, being thoughtful of radiation exposure even with low-dose protocols. Arthroscopic access to the hip is more challenging than other joints, and similarly, unlocking its clinical secrets can be more imposing as well.


Assuntos
Artralgia/diagnóstico por imagem , Artralgia/etiologia , Articulação do Quadril/diagnóstico por imagem , Artralgia/cirurgia , Artroscopia , Articulação do Quadril/cirurgia , Humanos , Imageamento Tridimensional , Injeções Intra-Articulares , Imageamento por Ressonância Magnética , Anamnese , Equipe de Assistência ao Paciente , Exame Físico , Radiografia , Ultrassonografia
9.
Jt Dis Relat Surg ; 32(1): 234-238, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33463443

RESUMO

Tenosynovial giant cell tumor (TGCT) is a systematically benign but locally aggressive lesion arising from the synovium, tendon sheath or joint bursae. Even in athletes, soft tissue tumors may be the underlying reason or a component of posterior ankle impingement, although the most common mechanism is forceful and repetitive plantar flexion. In this article, we present a case of localized TGCT in a 15-year-old female patient presenting with symptoms of posterior ankle impingement. The preferred technique for treatment was complete local resection via posterior ankle endoscopy. The patient returned to sports at three months and no recurrence was observed on the last follow-up at the first postoperative year. Although rare, soft tissue tumors should be taken into consideration in posterior ankle impingement in athletes. Such benign soft tissue tumors in the posterior ankle can be treated safely and effectively via two-portal posterior endoscopic approach.


Assuntos
Articulação do Tornozelo , Artralgia , Artroscopia/métodos , Tumor de Células Gigantes de Bainha Tendinosa , Adolescente , Articulação do Tornozelo/patologia , Articulação do Tornozelo/fisiopatologia , Articulação do Tornozelo/cirurgia , Artralgia/diagnóstico , Artralgia/etiologia , Artralgia/cirurgia , Atletas , Dissecação/métodos , Feminino , Tumor de Células Gigantes de Bainha Tendinosa/patologia , Tumor de Células Gigantes de Bainha Tendinosa/fisiopatologia , Tumor de Células Gigantes de Bainha Tendinosa/cirurgia , Humanos , Imageamento por Ressonância Magnética/métodos , Neoplasias de Tecidos Moles/patologia , Neoplasias de Tecidos Moles/fisiopatologia , Neoplasias de Tecidos Moles/cirurgia , Resultado do Tratamento
10.
Arthritis Care Res (Hoboken) ; 73(9): 1354-1362, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-32491247

RESUMO

OBJECTIVE: Knee osteoarthritis (OA) is a heterogeneous disease, with most patients experiencing slow disease progression and some with rapid deterioration. We aimed to identify groups of patients with symptomatic knee OA experiencing rapid structural progression. METHODS: We selected participants from the Osteoarthritis Initiative with baseline Kellgren/Lawrence (K/L) grades 1-3 and knee pain, and with joint space width (JSW) on fixed-flexion knee radiographs assessed at baseline and with ≥1 follow-up over 8 years. We used latent class growth analysis to identify subgroups of JSW progression, jointly modeling time to knee replacement (KR) to account for potential informative dropouts. After identifying trajectories, we used logistic regression to assess the association between baseline characteristics and the JSW trajectory group. RESULTS: We used data from 1,578 participants. Baseline radiographic severity was K/L grade 1 in 17%, K/L grade 2 in 50%, and K/L grade 3 in 33%. We identified 3 distinct JSW trajectories: 86% stable, 6% with stable JSW followed by late progression, and 8% with early progression. Incorporating information about KR resulted in 47% of KRs initially classified as stable being reclassified to 1 of the progressing trajectories. Prior knee surgery was associated with being in the late-progressing versus the stable trajectory, while obesity was associated with being in the early-progressing versus stable trajectory. CONCLUSION: In addition to a subgroup of individuals experiencing early structural progression, 8-year longitudinal data allowed the identification of a late-progressing trajectory. Incorporating information about KR was important to properly identify longitudinal structural trajectories in knee OA.


Assuntos
Artralgia/diagnóstico por imagem , Artrografia , Articulação do Joelho/diagnóstico por imagem , Osteoartrite do Joelho/diagnóstico por imagem , Idoso , Artralgia/fisiopatologia , Artralgia/cirurgia , Artroplastia do Joelho , Avaliação da Deficiência , Progressão da Doença , Feminino , Humanos , Articulação do Joelho/fisiopatologia , Articulação do Joelho/cirurgia , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/fisiopatologia , Osteoartrite do Joelho/cirurgia , Medição da Dor , Valor Preditivo dos Testes , Índice de Gravidade de Doença , Fatores de Tempo , Estados Unidos
11.
J Knee Surg ; 34(2): 164-170, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31390672

RESUMO

Lack of full extension of the knee is a disabling condition that sometimes needs to be treated by a posterior capsulotomy of the knee. However, it is not clear if the full extension acquired can be kept throughout long-time follow-up. We conducted a retrospective cohort study of 20 patients diagnosed with minimal flexion contracture of the knee who underwent open posterior capsulotomy between 1990 and 2010. All patients (100%) presented with a preoperative Lysholm's score classified as poor or fair (mean = 58.6 ± 13.8, 95% confidence interval [CI]: 52.3-64.9), but 14 patients (70%) experienced an improvement to good or excellent scores (mean = 87.6 ± 8.8, 95% CI: 83.6-91.6) after the follow-up. The mean preoperative angle of fixed flexion was 25.0 ± 9.1 degrees (95% CI: 20.8-29.2), and it decreased to 4.2 ± 4.1 degrees (95% CI: 2.3-6.1) after the follow-up. We conclude that posterior capsulotomy of the knee proved to be an effective procedure to treat properly patients with painful knees secondary to lack of full extension after 10.3 years of follow-up.


Assuntos
Artralgia/cirurgia , Contratura/cirurgia , Cápsula Articular/cirurgia , Articulação Patelofemoral/cirurgia , Adulto , Artralgia/etiologia , Contratura/etiologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Amplitude de Movimento Articular , Estudos Retrospectivos
12.
Arthritis Care Res (Hoboken) ; 73(8): 1140-1145, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-32339441

RESUMO

OBJECTIVE: To appraise the highest available evidence provided by randomized controlled trials (RCTs) on the effectiveness of hip arthroscopy versus physical therapy in patients with femoroacetabular impingement syndrome (FAIS). METHODS: Four databases (Medline, Embase, Web of Science, and Scopus) were systematically searched until October 1, 2019. Eligible studies were RCTs in which patients with FAIS underwent hip arthroscopy or physical therapy. The study outcome was the International Hip Outcome Tool, 33 Items (iHOT-33) score, a measure of hip pain, function, and quality of life, assessed at baseline and at the follow-up closer to 12 months after randomization. The pooled mean difference in iHOT-33 scores within and between the treatment arms was computed using a random effects model. The minimum clinically important difference in the iHOT-33 scores was set at 10 points. RESULTS: Three RCTs evaluating iHOT-33 scores between 6 and 8 months after the interventions were included. Significant increases in iHOT-33 scores were observed from baseline to follow-up for both hip arthroscopy (22.3 points [95% confidence interval (95% CI) 17.3-27.4]) and physical therapy (13.0 points [95% CI 9.5-16.4]). Hip arthroscopy demonstrated significantly higher iHOT-33 scores at follow-up compared with physical therapy (10.9 points [95% CI 4.7-17.0]). CONCLUSION: Both hip arthroscopy and physical therapy resulted in statistically and clinically significant short-term improvements in hip pain, function, and quality of life in patients with FAIS. Hip arthroscopy was statistically superior to physical therapy in improving the outcome at follow-up even if improvement may not be detected by patients.


Assuntos
Artralgia/cirurgia , Artroscopia , Impacto Femoroacetabular/cirurgia , Articulação do Quadril/cirurgia , Adulto , Artralgia/diagnóstico , Artralgia/fisiopatologia , Artroscopia/efeitos adversos , Fenômenos Biomecânicos , Feminino , Impacto Femoroacetabular/diagnóstico por imagem , Impacto Femoroacetabular/fisiopatologia , Estado Funcional , Articulação do Quadril/diagnóstico por imagem , Articulação do Quadril/fisiopatologia , Humanos , Masculino , Diferença Mínima Clinicamente Importante , Modalidades de Fisioterapia , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Amplitude de Movimento Articular , Recuperação de Função Fisiológica , Fatores de Tempo , Resultado do Tratamento
13.
Clin Orthop Relat Res ; 479(5): 974-987, 2021 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-33300754

RESUMO

BACKGROUND: Assessment of AP acetabular coverage is crucial for choosing the right surgery indication and for obtaining a good outcome after hip-preserving surgery. The quantification of anterior and posterior coverage is challenging and requires either other conventional projections, CT, MRI, or special measurement software, which is cumbersome, not widely available and implies additional radiation. We introduce the "rule of thirds" as a promising alternative to provide a more applicable and easy method to detect an excessive or deficient AP coverage. This method attributes the intersection point of the anterior (posterior) wall to thirds of the femoral head radius (diameter), the medial third suggesting deficient and the lateral third excessive coverage. QUESTION/PURPOSE: What is the validity (area under the curve [AUC], sensitivity, specificity, positive/negative likelihood ratios [LR(+)/LR(-)], positive/negative predictive values [PPV, NPV]) for the rule of thirds to detect (1) excessive and (2) deficient anterior and posterior coverages compared with previously established radiographic values of under-/overcoverage using Hip2Norm as the gold standard? METHODS: We retrospectively evaluated all consecutive patients between 2003 and 2015 from our institutional database who were referred to our hospital for hip pain and were potentially eligible for joint-preserving hip surgery. We divided the study group into six specific subgroups based on the respective acetabular pathomorphology to cover the entire range of anterior and posterior femoral coverage (dysplasia, overcoverage, severe overcoverage, excessive acetabular anteversion, acetabular retroversion, total acetabular retroversion). From this patient cohort, 161 hips were randomly selected for analysis. Anterior and posterior coverage was determined with Hip2Norm, a validated computer software program for evaluating acetabular morphology. The anterior and posterior wall indices were measured on standardized AP pelvis radiographs, and the rule of thirds was applied by one observer. RESULTS: The detection of excessive anterior and posterior acetabular wall using the rule of thirds revealed an AUC of 0.945 and 0.933, respectively. Also the detection of a deficient anterior and posterior acetabular wall by applying the rule of thirds revealed an AUC of 0.962 and 0.876, respectively. For both excessive and deficient anterior and posterior acetabular coverage, we found high specificities and PPVs but low sensitivities and NPVs. CONCLUSION: We found a high probability for an excessive (deficient) acetabular wall when this intersection point lies in the lateral (medial) third, which would qualify for surgical correction. On the other hand, if this point is not in the lateral (medial) third, an excessive (deficient) acetabular wall cannot be categorically excluded. Thus, the rule of thirds is very specific but not as sensitive as we had expected. LEVEL OF EVIDENCE: Level II, diagnostic study.


Assuntos
Acetábulo/diagnóstico por imagem , Retroversão Óssea/diagnóstico por imagem , Regras de Decisão Clínica , Cabeça do Fêmur/diagnóstico por imagem , Luxação do Quadril/diagnóstico por imagem , Articulação do Quadril/diagnóstico por imagem , Acetábulo/fisiopatologia , Acetábulo/cirurgia , Adolescente , Adulto , Idoso , Pontos de Referência Anatômicos , Artralgia/diagnóstico , Artralgia/fisiopatologia , Artralgia/cirurgia , Retroversão Óssea/fisiopatologia , Retroversão Óssea/cirurgia , Feminino , Cabeça do Fêmur/fisiopatologia , Luxação do Quadril/fisiopatologia , Luxação do Quadril/cirurgia , Articulação do Quadril/fisiopatologia , Articulação do Quadril/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Valor Preditivo dos Testes , Interpretação de Imagem Radiográfica Assistida por Computador , Reprodutibilidade dos Testes , Estudos Retrospectivos , Adulto Jovem
14.
Arthritis Care Res (Hoboken) ; 73(6): 818-827, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33053273

RESUMO

OBJECTIVE: To assess the proportion of participants reconsidering their willingness to undergo surgery after 3 and 12 months. Secondary aims were to analyze and compare the characteristics of individuals willing and unwilling to undergo joint surgery for osteoarthritis (OA) before a first-line intervention, and to study the association between pain intensity, walking difficulties, self-efficacy, and fear of movement with the willingness to undergo surgery. METHODS: This was an observational study based on Swedish register data. We included 30,578 individuals with knee or hip OA who participated in a first-line intervention including education and exercise. RESULTS: Individuals willing to undergo surgery at baseline showed a higher proportion of men (40% versus 27%) and more severe symptoms and disability. Respectively, 45% and 30% of the individuals with knee and hip OA who were willing to undergo surgery at baseline became unwilling after the intervention. At the end of the study period (12 months), 35% and 19% of those with knee and hip OA, respectively, who were willing to undergo surgery at baseline became unwilling. High pain intensity, walking difficulties, and fear of movement were associated with higher odds of being willing to undergo surgery at both follow-ups, while increased self-efficacy showed the opposite association. CONCLUSION: A first-line intervention for OA is associated with reduced willingness to undergo surgery, with a greater proportion among patients with knee OA than hip OA. Due to its temporal variability, willingness to undergo surgery should be used with care to deem surgery eligibility.


Assuntos
Artralgia/cirurgia , Artroplastia , Articulações/cirurgia , Osteoartrite/cirurgia , Aceitação pelo Paciente de Cuidados de Saúde , Idoso , Artralgia/diagnóstico , Artralgia/fisiopatologia , Artralgia/psicologia , Artroplastia/efeitos adversos , Avaliação da Deficiência , Medo , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Articulações/fisiopatologia , Masculino , Pessoa de Meia-Idade , Limitação da Mobilidade , Osteoartrite/diagnóstico , Osteoartrite/fisiopatologia , Osteoartrite/psicologia , Medição da Dor , Sistema de Registros , Autoeficácia , Índice de Gravidade de Doença , Suécia , Fatores de Tempo , Resultado do Tratamento , Caminhada
15.
Orthop Surg ; 13(1): 14-27, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33354916

RESUMO

OBJECTIVE: The effect of patellar denervation with electrocautery (PD) on anterior knee pain (AKP) after total knee arthroplasty (TKA) is still debated. The aim of this meta-analysis was to evaluate the current evidence regarding the use of PD in TKA without patellar resurfacing. METHODS: A computerized search of published studies was performed in the PubMed, Embase and Cochrane Library databases in December 2019. Eligible studies were randomized controlled trials (RCTs) comparing clinical outcomes of the PD group and the non-PD group. Subgroup analyses were carried out according to the follow-up time (3, 12 months, and over 12 months) to evaluate whether the clinical effect of PD changed with time. RESULTS: Ten RCTs were included in this meta-analysis. Pooled results showed a lower rate of AKP (Risk Ratio [RR] = 0.70; 95% confidence interval [CI], 0.50 to 0.97; P = 0.03) and a reduction in visual analogue scale (VAS) for AKP (mean difference, -0.37; 95% CI, -0.69 to -0.05; P = 0.02) in the PD group when compared to the non-PD group. Subgroup analyses found the differences in AKP incidence and VAS for AKP were significant at 3- and 12-month follow-up but not after 12-month follow-up. No significant difference was observed in functional scores between the two groups. No specific complication directly or indirectly related to PD was found. CONCLUSION: PD can decrease the incidence and severity of AKP within 12 months after TKA, but the effect cannot be maintained after 12-month follow-up. Without significant associated complication and reoperation, the use of PD is still recommended in TKA without patellar resurfacing.


Assuntos
Artralgia/cirurgia , Artroplastia do Joelho , Denervação/métodos , Eletrocoagulação/métodos , Dor Pós-Operatória/cirurgia , Patela/inervação , Patela/cirurgia , Humanos , Manejo da Dor/métodos , Medição da Dor , Ensaios Clínicos Controlados Aleatórios como Assunto , Inquéritos e Questionários
16.
Tech Vasc Interv Radiol ; 23(4): 100706, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33308582

RESUMO

Knee osteoarthritis, a chronic degenerative condition, can be a debilitating and limiting process with affected patients presenting with symptoms such as pain, restrictive range of motion, and swelling. This condition commonly afflicts millions of people with a higher incidence among the elderly that results from chronic mechanical repetitive loading. The treatment of pain generating conditions such as arthritis in large joints is complex requiring interventions of varying focuses such as weight loss, anti-inflammatory medications, corticosteroid, hyaluronic and viscosupplementation injections, and prescription opioids. A gap in the treatment options of this ailment currently exists between short term pain solutions and surgical approaches such as total knee arthroplasty that may offer longer pain relief. Cooled radiofrequency ablation is an emerging technique that offers a minimally invasive alternative for treating knee pain with a clinical relevance in patients who are not surgical candidates due to coexistent medical comorbidities or those who are undesiring of surgery. This procedure uses radiofrequency ablation that blocks genicular nerves from transmitting knee pain signals to the brain. Further research will allow the application of this technique to treat other sensory nerves in large joints such as the hip and shoulder.


Assuntos
Artralgia/cirurgia , Denervação , Articulação do Joelho/cirurgia , Osteoartrite do Joelho/cirurgia , Manejo da Dor , Ablação por Radiofrequência , Radiografia Intervencionista , Artralgia/diagnóstico por imagem , Artralgia/fisiopatologia , Denervação/efeitos adversos , Humanos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/fisiopatologia , Osteoartrite do Joelho/diagnóstico por imagem , Osteoartrite do Joelho/fisiopatologia , Manejo da Dor/efeitos adversos , Complicações Pós-Operatórias/etiologia , Ablação por Radiofrequência/efeitos adversos , Radiografia Intervencionista/efeitos adversos , Fatores de Risco , Resultado do Tratamento
17.
J Hand Surg Asian Pac Vol ; 25(4): 474-480, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33115362

RESUMO

Background: The purpose of this study was to report the results of metaphyseal and diaphyseal ulnar shortening osteotomies (USO) for the treatment of ulnar abutment syndrome (UAS). Methods: From 2011 to 2016, we performed metaphyseal USO in 8 patients (8 wrists) and diaphyseal USO in 6 patients (7 wrists). The results were investigated in terms of bone union and cast immobilization, wrist and forearm range of motion (ROM). The mean follow-up duration was 29 months. Results: All 14 patients had bone union. The mean duration of bone union in metaphyseal USO and diaphyseal USO were 3.5 months and 4.3 months and the duration of cast immobilization after surgery were 24.2 days and 29.2 days. The mean forearm ROM (degree) were 134.3 (pronation/supination: 66.7/67.6) and 169.3 (pronation/supination: 84.3/85.0) at 3 months after surgery and 173.4 (pronation/supination: 86.0/87.4) and 172.8 (pronation/supination: 87.1/85.7) at 6 months after surgery. Conclusions: The results from this study suggest that metaphyseal osteotomies are an effective alternative to diaphyseal osteotomies for the treatment of ulnar abutment syndrome. Although metaphyseal osteotomies were associated with temporary decrease of pronation, this discrepancy resolved at 6 months postoperatively. Metaphyseal USO has the potential to promote primary bone union and appears to be an alternative treatment for UAS.


Assuntos
Artralgia/cirurgia , Osteotomia/métodos , Ulna/cirurgia , Articulação do Punho/fisiopatologia , Adolescente , Adulto , Idoso , Artralgia/fisiopatologia , Feminino , Força da Mão/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Pronação/fisiologia , Estudos Retrospectivos , Supinação/fisiologia , Escala Visual Analógica , Adulto Jovem
18.
J Knee Surg ; 33(11): 1088-1099, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33124010

RESUMO

Articular cartilage of the knee can be evaluated with high accuracy by magnetic resonance imaging (MRI) in preoperative patients with knee pain, but image quality and reporting are variable. This article discusses the normal MRI appearance of articular cartilage as well as the common MRI abnormalities of knee cartilage that may be considered for operative treatment. This article focuses on a practical approach to preoperative MRI of knee articular cartilage using routine MRI techniques. Current and future directions of knee MRI related to articular cartilage are also discussed.


Assuntos
Doenças das Cartilagens/diagnóstico por imagem , Cartilagem Articular/diagnóstico por imagem , Articulação do Joelho/diagnóstico por imagem , Imageamento por Ressonância Magnética , Artralgia/diagnóstico por imagem , Artralgia/etiologia , Artralgia/cirurgia , Doenças das Cartilagens/cirurgia , Cartilagem Articular/cirurgia , Humanos , Imageamento Tridimensional , Traumatismos do Joelho/diagnóstico por imagem , Traumatismos do Joelho/cirurgia , Articulação do Joelho/anatomia & histologia , Articulação do Joelho/cirurgia , Imageamento por Ressonância Magnética/métodos , Osteoartrite do Joelho/diagnóstico por imagem , Osteoartrite do Joelho/cirurgia , Cuidados Pré-Operatórios
20.
Pain Med ; 21(8): 1532-1537, 2020 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-32803218

RESUMO

OBJECTIVE: This study aimed to investigate the effectiveness of repeat cooled radiofrequency ablation (CRFA) in chronic posterior sacroiliac joint (SIJ) pain. DESIGN: The electronic records of 41 adult patients who had successful CRFA were reviewed for duration of pain relief and utilization of medical care for six months before and after each CRFA procedure. SETTING: Academic, tertiary medical center. PATIENTS: Forty-one adult patients who had CRFA for chronic posterior SIJ pain. RESULTS: A repeat ipsilateral CRFA ablation procedure provided 9.0 months of pain relief compared with 5.5 months after the first CRFA procedure (P = 0.0378). The total number of medical treatments decreased after the first CRFA procedure (from 343 to 201). The medical cost decreased by 51.0% after the first CRFA and by 70.4% after the repeated CRFA procedure. CONCLUSIONS: Using repeated nonsurgical, minimally invasive approach, CRFA relieves chronic posterior SIJ pain and reduces patients' utilization of medical services.


Assuntos
Dor Crônica , Ablação por Radiofrequência , Adulto , Artralgia/cirurgia , Dor Crônica/cirurgia , Humanos , Articulação Sacroilíaca/cirurgia , Resultado do Tratamento
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