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1.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 36(9): 1084-1089, 2022 Sep 15.
Artigo em Chinês | MEDLINE | ID: mdl-36111469

RESUMO

Objective: To explore the feasibility and effectiveness of total hip arthroplasty (THA) with acetabulum structural bone grafting using autogenous femoral head through direct anterior approach (DAA) in lateral decubitus position in the treatment of Crowe type Ⅲ and Ⅳ developmental dysplasia of the hip (DDH). Methods: Between June 2016 and July 2020, 12 patients with Crowe type Ⅲ and Ⅳ DDH were treated with THA with acetabulum structural bone grafting using autogenous femoral head through DAA in lateral decubitus position. There were 2 males and 10 females with an average age of 60.2 years (range, 50-79 years). Crowe classification was type Ⅲ in 10 hips and type Ⅳ in 2 hips. The preoperative Harris score of hip joint was 48.8±7.5, the difference in length of both lower extremities was (3.0±0.7) cm, and the visual analogue scale (VAS) score during activity was 7.2±0.9. The surgical incision length, operation time, intraoperative blood loss, and complications were recorded; the position and press-fitting of acetabulum and femoral prosthesis were observed after operation, and the difference in length of both lower extremities was measured; the horizontal coverage of acetabular cup and bone graft were measured, the healing with the host bone and the loosening of the prosthesis were evaluated; Harris score was used to evaluate hip joint function, and VAS score was used to evaluate patients' pain during activity. Results: The average surgical incision length was 9.3 cm, the average operation time was 117 minutes, and the average intraoperative blood loss was 283 mL. Two patients (16.7%) received blood transfusion during operation. There was no acetabular and femoral fractures during operation. All incisions healed by first intention, without dislocation, periprosthetic infection, sciatic nerve injury, deep venous thrombosis, and other complications. One patient had lateral femoral cutaneous nerve injury after operation. X-ray films at discharge showed a total acetabular cup level coverage of 93%-100%, with an average of 97.8%, and a bone graft level coverage of 25%-45%, with an average of 31.1%. All the 12 patients were followed up 22-71 months, with an average of 42.2 months. At last follow-up, the Harris score of hip joint was 89.7±3.9, the difference in length of both lower extremities was (0.9±0.4) cm, and the VAS score during activity was 1.1±0.6, which were significantly different from those before operation (P<0.05). During follow-up, there was no patient who needed hip revision surgery because of prosthesis loosening. At last follow-up, there was no translucent line between the graft and the host bone, the graft was fused, the position was good, and there was no obvious movement. One patient had one screw fracture and bone resorption at the outer edge of the graft, but the bone graft did not displace and healed well. Conclusion: THA with acetabulum structural bone grafting using autogenous femoral head through DAA in lateral decubitus position in the treatment of Crowe type Ⅲ and Ⅳ DDH is safe and reliable, and has satisfactory short-term effectiveness.


Assuntos
Artroplastia de Quadril , Displasia do Desenvolvimento do Quadril , Luxação Congênita de Quadril , Prótese de Quadril , Ferida Cirúrgica , Antivirais , Artroplastia de Quadril/efeitos adversos , Perda Sanguínea Cirúrgica , Transplante Ósseo , Feminino , Luxação Congênita de Quadril/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Ferida Cirúrgica/etiologia , Ferida Cirúrgica/cirurgia , Resultado do Tratamento
2.
Acta Orthop ; 93: 732-738, 2022 09 12.
Artigo em Inglês | MEDLINE | ID: mdl-36097694

RESUMO

BACKGROUND AND PURPOSE: The posterolateral and direct lateral surgical approach are the 2 most common surgical approaches for performing a hemiarthroplasty in patients with a hip fracture. It is unknown which surgical approach is preferable in terms of (cost-)effectiveness and quality of life. METHODS AND ANALYSIS: We designed a multicenter randomized controlled trial (RCT) with an economic evaluation and a natural experiment (NE) alongside. We will include 555 patients ≥ 18 years with an acute femoral neck fracture. The primary outcome is patient-reported health-related quality of life assessed with the EQ-5D-5L. Secondary outcomes include healthcare costs, complications, mortality, and balance (including fear of falling, actual falls, and injuries due to falling). An economic evaluation will be performed for quality adjusted life years (QALYs). We will use variable block randomization stratified for hospital. For continuous outcomes, we will use linear mixed-model analysis. Dichotomous secondary outcome measures will be analyzed using chi-square statistics and logistic regression models. Primary analyses are based on the intention-to-treat principle. Additional as treated analyses will be performed to evaluate the effect of protocol deviations. Study summary: (i) Largest RCT addressing the health-related patient outcome of the main surgical approaches of hemiarthroplasty. (ii) Focus on outcomes that are important for the patient. (iii) Pragmatic and inclusive RCT with few exclusion criteria, e.g., patients with dementia can participate. (iv) Natural experiment alongside to amplify the generalizability. (v) The first study conducting a costutility analysis comparing both surgical approaches.


Assuntos
Artroplastia de Quadril , Fraturas do Colo Femoral , Hemiartroplastia , Fraturas do Quadril , Artroplastia de Quadril/métodos , Análise Custo-Benefício , Fraturas do Colo Femoral/cirurgia , Hemiartroplastia/efeitos adversos , Hemiartroplastia/métodos , Fraturas do Quadril/cirurgia , Humanos , Estudos Multicêntricos como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto
3.
Biomed Res Int ; 2022: 4219131, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36119938

RESUMO

Objective: To explore the clinical significance of protective motivation intervention nursing on functional recovery of patients after hip arthroplasty. Methods: Sixty patients after hip arthroplasty treated in our hospital from February 2019 to April 2021 were selected. The patients were randomly divided into the control group and the research group. The routine nursing mode was adopted in the control group, and the protective motivation intervention nursing mode was adopted in the research group. Nursing satisfaction, FIM score, Harris hip function score, WOMAC score, Barthel index score, and quality of life score were compared between the two groups. Results: The nursing satisfaction of the research group was higher than that of the control group, and there are statistically significant differences between the groups (P < 0.05). The FIM scores of the research group at discharge and 1 month, 3 months, and 6 months after discharge were significantly higher than those in the control group. The Harris hip function score of the research group was significantly higher than that of the control group at discharge and 1 month, 3 months, and 6 months after discharge. The WOMAC scores of the research group at discharge and 1 month, 3 months, and 6 months after discharge were significantly lower than those in the control group, and the difference was statistically significant (P < 0.05). The scores of the Barthel index at discharge and 1 month, 3 months, and 6 months after discharge in the research group were significantly higher than those in the control group. The scores of physiological function, psychological function, social function, and health self-cognition in the research group were significantly lower than those in the control group, and the difference was statistically significant (P < 0.05). Conclusion: The nursing model of protective motivation intervention for patients after hip arthroplasty can effectively improve the function of hip joint, improve the quality of life, promote the establishment of harmonious nurse-patient relationship, and play a positive role in improving the prognosis of patients.


Assuntos
Artroplastia de Quadril , Articulação do Quadril/cirurgia , Humanos , Motivação , Qualidade de Vida/psicologia , Recuperação de Função Fisiológica/fisiologia
4.
Acta Orthop ; 93: 742-749, 2022 Sep 19.
Artigo em Inglês | MEDLINE | ID: mdl-36121126

RESUMO

BACKGROUND AND PURPOSE: To determine whether the Hip disability and Osteoarthritis Outcome Score-Physical function Short-form (HOOS-PS) is able to appropriately evaluate physical function in revision hip arthroplasty patients, this study assesses psychometric properties of the Dutch HOOS-PS in this patient population. PATIENTS AND METHODS: We assessed psychometric properties of the HOOS-PS following the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) criteria. Content validity, including comprehensibility, comprehensiveness, and relevance of the items, was assessed using cognitive debriefing interviews in hip revision patients (n = 8) and orthopedic surgeons specialized in revision surgery (n = 7). Construct validity, responsiveness, and interpretability (floor/ceiling effects) were assessed in revision hip arthroplasty patients (baseline n = 136, follow-up n = 67). We formulated hypotheses a priori to assess construct validity and responsiveness using the EuroQol 5-Dimensions Health Questionnaire, Numeric Rating scale for pain, and Oxford Hip Score as comparators. All questionnaires were measured at baseline and 1 year postoperatively. RESULTS: We found insufficient content validity of the HOOS-PS, as relevance and comprehensibility of the items scored < 85% on the COSMIN criteria for revision hip arthroplasty patients. Construct validity was sufficient as all hypotheses were confirmed (≥ 75% COSMIN criteria). Interpretability was sufficient (< 15% COSMIN criteria) and responsiveness was insufficient (< 75% COSMIN criteria). INTERPRETATION: The Dutch HOOS-PS is not able to sufficiently evaluate physical function in revision hip arthroplasty patients. Minor changes in the items are needed for the HOOS-PS to become sufficiently content valid, because the HOOS-PS lacks relevant items and comprehensiveness.


Assuntos
Artroplastia de Quadril , Osteoartrite do Quadril , Atividades Cotidianas , Avaliação da Deficiência , Humanos , Osteoartrite do Quadril/cirurgia , Medição da Dor/métodos , Reoperação , Reprodutibilidade dos Testes
5.
BMC Anesthesiol ; 22(1): 290, 2022 09 14.
Artigo em Inglês | MEDLINE | ID: mdl-36104664

RESUMO

BACKGROUND: Obstructive sleep apnea (OSA) is associated with neurocognitive impairment - a known risk factor for postoperative delirium. However, it is unclear whether OSA increases the risk of postoperative delirium and whether treatment is protective. The objectives of this study were to identify OSA with a home sleep apnea test (HSAT) and to determine whether auto-titrating positive airway pressure (APAP) reduces postoperative delirium in older adults with newly diagnosed OSA undergoing elective hip or knee arthroplasty. METHODS: We conducted a multi-centre, randomized controlled trial at three academic hospitals in Canada. Research ethics board approval was obtained from the participating sites and informed consent was obtained from participants. Inclusion criteria were patients who were [Formula: see text]0 years and scheduled for elective hip or knee replacement. Patients with a STOP-Bang score of ≥ 3 had a HSAT. Patients were defined as having OSA if the apnea-hypopnea index was ≥ 10/h. These patients were randomized 1:1 to either: 1) APAP for 72 h postoperatively or until discharge, or 2) routine care after surgery. The primary outcome was postoperative delirium, assessed twice daily with the Confusion Assessment Method for 72 h or until discharge or by chart review. The secondary outcome measures included length of stay, and perioperative complications occurring within 30 days after surgery. RESULTS: Of 549 recruited patients, 474 completed a HSAT. A total of 234 patients with newly diagnosed OSA were randomized. The mean age was 68.2 (6.2) years and 58.6% were male. Analysis was performed on 220 patients. In total, 2.7% (6/220) patients developed delirium after surgery: 4.4% (5/114) patients in the routine care group, and 0.9% (1/106) patients in the treatment group (P = 0.21). The mean length of stay for the APAP vs. the routine care group was 2.9 (2.9) days vs. 3.5 (4.5) days (P = 0.24). On postoperative night 1, 53.5% of patients used APAP for 4 h/night or more, this decreased to 43.5% on night 2, and 24.6% on night 3. There was no difference in intraoperative and postoperative complications between the two groups. CONCLUSIONS: We had an unexpectedly low rate of postoperative delirium thus we were unable to determine if postoperative delirium was reduced in older adults with newly diagnosed OSA receiving APAP vs. those who did not receive APAP after elective knee or hip arthroplasty. TRIAL REGISTRATION: This trial was retrospectively registered in clinicaltrials.gov NCT02954224 on 03/11/2016.


Assuntos
Artroplastia de Quadril , Artroplastia do Joelho , Delírio , Síndromes da Apneia do Sono , Apneia Obstrutiva do Sono , Acetaminofen , Idoso , Artroplastia de Quadril/efeitos adversos , Artroplastia do Joelho/efeitos adversos , Delírio/epidemiologia , Delírio/etiologia , Delírio/prevenção & controle , Feminino , Humanos , Masculino , Apneia Obstrutiva do Sono/complicações
7.
J Orthop Traumatol ; 23(1): 45, 2022 Sep 16.
Artigo em Inglês | MEDLINE | ID: mdl-36112243

RESUMO

PURPOSE: In clinical practice, serum C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) levels are routinely used to screen for periprosthetic joint infection (PJI), but the effectiveness of predicting the success of reimplantation is variable. This study aimed to evaluate the diagnostic effectiveness of serum CRP, ESR, plasma D-dimer, and fibrinogen values in groups achieving treatment success or failure for PJI. METHODS: A total of 119 PJI cases between January 2012 and January 2017 were identified and included in this study. The most recent serum CRP, ESR, plasma D-dimer, and fibrinogen values obtained prior to performing second-stage revision or spacer exchange were collected for analysis. Treatment failure was defined as having been unable to undergo reimplantation due to clinically persistent infection or reinfection after reimplantation. RESULTS: All these tests showed significantly lower values in the treatment success group than in the treatment failure group. The optimal cutoff serum CRP, ESR, plasma D-dimer, and fibrinogen levels for predicting the success of reimplantation were 9.4 mg/L, 29 mm/h, 1740 ng/mL, and 365.6 mg/dL, respectively. All tests had the same sensitivity (72.7%) except for ESR (63.6%), while their specificities were 92.6%, 88.0%, 72.3%, and 83.2%, respectively. Plasma fibrinogen had the highest AUC value of 0.831 [95% confidence interval (CI), 0.685 to 0.978], followed by serum CRP (0.829) and ESR (0.795); plasma D-dimer had the lowest AUC value of 0.716 (95% CI, 0.573 to 0.859). CONCLUSION: Plasma CRP and fibrinogen are good tests for predicting reimplantation success after two-stage revision procedures for patients with PJI.


Assuntos
Artrite Infecciosa , Artroplastia de Quadril , Artroplastia do Joelho , Infecções Relacionadas à Prótese , Biomarcadores , Proteína C-Reativa/metabolismo , Fibrinogênio/análise , Fibrinogênio/metabolismo , Humanos , Infecções Relacionadas à Prótese/diagnóstico , Infecções Relacionadas à Prótese/cirurgia , Reimplante
8.
BMC Musculoskelet Disord ; 23(1): 868, 2022 Sep 16.
Artigo em Inglês | MEDLINE | ID: mdl-36114570

RESUMO

BACKGROUND: Hybrid total hip replacement (THR) is commonly used in the management of proximal femur fractures in elderly individuals. However, in the context of the revision, the literature on hybrid THR is limited, and differences in the long-term survival outcomes reported in the literature are obvious. This retrospective study aimed to evaluate the long-term survival of hybrid THR for failed proximal femoral nail antirotation (PFNA) in elderly individuals aged ≥ 75 years. METHODS: An observational cohort of 227 consecutive individuals aged ≥ 75 years who experienced hybrid THRs following prior primary PFNAs was retrospectively identified from the Joint Surgery Centre, the First Affiliated Hospital, Sun Yat-sen University. Implant survival was estimated using the Kaplan-Meier method. The primary end point was the implant survivorship calculated using the Kaplan-Meier method with revision for any reason as the end point; secondary end points were the function score measured using the modified Harris Hip Score (mHHS) and the incidence of main orthopaedic complications. RESULTS: In total, 118 individuals (118 THRs) were assessed as available. The median follow-up was 10 (3-11) years. The 10-year survivorship with revision for any reason as the endpoint was 0.914 (95% confidence interval [CI], 0.843-0.960). The most common indication for revision was aseptic loosening (70.0%), followed by periprosthetic fracture (30.0%). At the final follow-up, the median functional score was 83.6 (79.0-94.0). Among the 118 patients included in this study, 16 experienced 26 implant-related complications. The overall incidence of key orthopaedic complications was 13.5% (16/118). CONCLUSION: For patients aged ≥ 75 years old with prior failed PFNAs, hybrid THR may yield satisfactory long-term survival, with good functional outcomes and a low rate of key orthopaedic complications.


Assuntos
Artroplastia de Quadril , Idoso , Artroplastia de Quadril/efeitos adversos , Fêmur , Seguimentos , Humanos , Reoperação , Estudos Retrospectivos
9.
ANZ J Surg ; 92(9): 2261-2268, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-36097420

RESUMO

BACKGROUND: To determine the prevalence of opioid use in Australian hip (THA) or knee (TKA) cohort, and its association with outcomes. METHODS: About 837 primary THA or TKA subjects prospectively completed Oxford Scores, and Knee or Hip Osteoarthritis Outcomes Score(KOOS/HOOS) and opioid use in the previous week before arthroplasty. Subjects repeated the baseline survey at 6 months, with additional questions regarding satisfaction. RESULTS: Opioid use was reported by 19% preoperatively and 7% at 6 months. Opioid use was 46% at 6 weeks and 10% at 6 months after TKR, and 16% at 6 weeks and 4% at 6 months after THR. Preoperative opioid use was associated with back pain(OR 2.2, P = 0.006), anxiety or depression(OR 1.8, P = 0.001) and Oxford knee scores <30(OR 5.6, P = 0.021) in TKA subjects, and females in THA subjects(OR 1.7, P = 0.04). There was no difference between preoperative opioid users and non-users for satisfaction, or KOOS or HOOS scores at 6 months. 77% of patients taking opioids before surgery had ceased by 6 months, and 3% of preoperative non users reported opioid use at 6 months. Opioid use at 6 months was associated with preoperative use (OR 6.6-14.7, P < 0.001), and lower 6 month oxford scores (OR 4.4-83.6, P < 0.01). CONCLUSION: One in five used opioids before arthroplasty. Pre-operative opioid use was the strongest risk factor for opioid use at 6 months, increasing odds 7-15 times. Prolonged opioid use was rarely observed in the opioid naïve (<5% TKA and 1% THA). Preoperative opioid use was not associated with inferior outcomes or satisfaction.


Assuntos
Artroplastia de Quadril , Artroplastia do Joelho , Transtornos Relacionados ao Uso de Opioides , Analgésicos Opioides/uso terapêutico , Austrália/epidemiologia , Feminino , Humanos
10.
Sci Rep ; 12(1): 15327, 2022 Sep 12.
Artigo em Inglês | MEDLINE | ID: mdl-36096936

RESUMO

We investigated the differences in outcomes after total hip arthroplasty (THA) for hip osteoarthritis (HOA) between patients with and without central sensitivity syndromes (CSSs) other than fibromyalgia (FM). After excluding two patients with FM, we compared the clinical data of 41 patients with CSSs and 132 patients without CSSs. Clinical data included scores on the central sensitization inventory, visual analog scale for pain (VAS pain), and Japanese Orthopedic Association Hip Disease Evaluation Questionnaire (JHEQ). VAS pain was significantly higher at 3 and 6 months after THA in patients with CSSs than in those without CSSs (3 and 6 months, P < 0.001). Satisfaction, pain, and mental JHEQ scores were lower in patients with CSSs than in those without CSSs (satisfaction, P < 0.001; pain, P = 0.011; mental, P = 0.032). Multiple regression analyses indicated that one and ≥ 2 CSS diagnoses significantly impacted the satisfaction score (one CSS, ß = - 0.181, P = 0.019; ≥ 2 CSSs, ß = - 0.175, P = 0.023). Two or more CSSs were the only factor influencing the pain score (ß = - 0.175, P = 0.027). Pain in patients with CSSs reflects central sensitization, which may adversely affect post-operative outcomes. Surgeons should pay attention to patients with a history of CSSs diagnoses who undergo THA for HOA.


Assuntos
Artroplastia de Quadril , Fibromialgia , Osteoartrite do Quadril , Artroplastia de Quadril/efeitos adversos , Fibromialgia/complicações , Fibromialgia/diagnóstico , Fibromialgia/cirurgia , Humanos , Osteoartrite do Quadril/complicações , Osteoartrite do Quadril/cirurgia , Dor/etiologia , Síndrome
11.
JBJS Case Connect ; 12(3)2022 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-36099360

RESUMO

CASE: A 69-year-old male patient, 5 years after a well-functioning total hip arthroplasty for severe osteoarthritis, presented with a 3-month history of progressive, unrelenting, "burning" pain in his right hip with accompanying fullness of the right thigh. Inflammatory markers were elevated, and imaging revealed a large unilocular fluid collection with communication to the hip joint. Aspiration was positive for Mycobacterium senegalense. A combination of surgical and antibiotic therapy successfully treated this patient. CONCLUSION: Mycobacterium senegalense is a rare cause of prosthetic joint infection. A combination of surgical and antimicrobial management is required for effective treatment.


Assuntos
Artrite Infecciosa , Artroplastia de Quadril , Mycobacteriaceae , Animais , Antibacterianos/uso terapêutico , Artrite Infecciosa/tratamento farmacológico , Artroplastia de Quadril/efeitos adversos , Bovinos , Articulação do Quadril , Humanos , Masculino
12.
JBJS Case Connect ; 12(2)2022 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-36099455

RESUMO

CASE: A 64-year-old man presented 18 months after total hip arthroplasty complicated by vascular injury with a history of leg pain, inability to mobilize, and progressive chronic leg edema. It is presumed that there was persistent subtle bleeding over time with pseudoaneurysm formation and prosthetic hip dislocation secondary to the mass effect. CONCLUSION: Physicians should consider pseudoaneurysm as a possible diagnosis when confronted with a large intra-articular mass in the hip after a relatively short follow-up period, particularly in the context of a prior vascular injury at the time of the index procedure.


Assuntos
Falso Aneurisma , Artroplastia de Quadril , Luxação do Quadril , Luxações Articulares , Lesões do Sistema Vascular , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/etiologia , Falso Aneurisma/cirurgia , Artroplastia de Quadril/efeitos adversos , Luxação do Quadril/diagnóstico por imagem , Luxação do Quadril/etiologia , Luxação do Quadril/cirurgia , Humanos , Luxações Articulares/cirurgia , Masculino , Pessoa de Meia-Idade , Lesões do Sistema Vascular/complicações
13.
JBJS Case Connect ; 12(2)2022 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-36099530

RESUMO

CASE: Total hip arthroplasty with an uncemented, tapered, fluted stem was performed in a 79-year-old woman with known osteoporosis to treat an intertrochanteric fracture. Exertional thigh pain and cortical thickening developed at the tip of the stem. The patient was treated with teriparatide for a total of 2 years and became asymptomatic within months. Radiographs showed improved bone quality around the stem of the prosthesis, and dual-energy x-ray absorptiometry scans confirmed remineralization. CONCLUSION: Stem tip pain is a well-known complication of distally engaging arthroplasty implants. Various surgical options have been suggested to address this condition. Teriparatide is known to help prevent fractures and improve bone healing. This successful off-label use might be of interest for the future treatment of this biomechanical complication.


Assuntos
Artroplastia de Quadril , Fraturas do Quadril , Osteoporose , Idoso , Artroplastia de Quadril/efeitos adversos , Feminino , Fraturas do Quadril/cirurgia , Humanos , Dor , Teriparatida/uso terapêutico
14.
Acta Ortop Mex ; 36(1): 26-32, 2022.
Artigo em Espanhol | MEDLINE | ID: mdl-36099570

RESUMO

INTRODUCTION: Major orthopedic surgery such as total hip arthroplasty (THA) is associated with an increased risk of postoperative complications. Candidates for THA are often older adults, with comorbidities that increase the risk of major bleeding, the IMPROVE scale has independent actors on the risk of bleeding according to the characteristics of the patients at hospital admission. It foresees the possibility of hemorrhage and the need for blood transfusion, being support in decision-making in the planning of a safe THA with the provision of the necessary resources. OBJECTIVE: To evaluate the sensitivity, validity and reliability of the modified IMPROVE scale in patients undergoing primary total hip arthroplasty. MATERIAL AND METHODS: Study of processes with a sample of 131 patients undergoing primary THA, in the period from January 01, 2018 to July 01, 2018. RESULTS: The scale presents good reliability, as for the performance of the scale, a good sensitivity was obtained, classifying 96.9% of the patients correctly; which is suitable for the type of scale. CONCLUSIONS: The modified IMPROVE scale is a discretely adequate and useful tool for the prognosis of bleeding risk in patients who undergo THA, compared with other assessment scales developed in other geographical areas. It is recommended to continue with the study of risk factors for major bleeding in this specific population.


INTRODUCCIÓN: La cirugía ortopédica mayor, como la artroplastía total de cadera (ATC), se asocia con mayor riesgo de complicaciones postoperatorias. Los candidatos a ATC con frecuencia son adultos mayores, con comorbilidades que aumentan el riesgo de hemorragia mayor. La escala IMPROVE tiene factores independientes sobre el riesgo de sangrado según las características de los pacientes al ingreso hospitalario, prevé la posibilidad de hemorragia y la necesidad de transfusión sanguínea, siendo apoyo en la toma de decisiones en la planeación de ATC seguras con la probabilidad de prever los recursos necesarios. OBJETIVO: Evaluar la sensibilidad, validez y confiabilidad de la escala IMPROVE modificada en los pacientes sometidos a artroplastía total de cadera primaria. MATERIAL Y MÉTODOS: Estudio de procesos con una muestra de 131 pacientes sometidos a ATC primaria, en el período del 01 de Enero al 01 de Julio de 2018. RESULTADOS: La escala presenta una buena confiabilidad, en cuanto al rendimiento se obtuvo una buena sensibilidad, clasificando al 96.9% de los pacientes correctamente, lo cual es adecuado para el tipo de escala. CONCLUSIONES: La escala IMPROVE modificada es una herramienta discretamente adecuada y útil para el pronóstico del riesgo hemorrágico en pacientes que se someten a una ATC primaria comparada con otras escalas de valoración desarrolladas en otras zonas geográficas. Se recomienda seguir con el estudio de los factores de riesgo de sangrado mayor en esta población en específico.


Assuntos
Artroplastia de Quadril , Idoso , Artroplastia de Quadril/efeitos adversos , Transfusão de Sangue , Humanos , Complicações Pós-Operatórias/etiologia , Reprodutibilidade dos Testes , Fatores de Risco
15.
Cad Saude Publica ; 38(8): e00298221, 2022.
Artigo em Português | MEDLINE | ID: mdl-36074441

RESUMO

Population aging brings challenges to the health system. Increased degenerative joint diseases and occurrence of falls may require hip arthroplasties. The objective of this study was to evaluate factors associated with hospital deaths due to hip arthroplasties in the Brazilian Unified National Health System (SUS), in the State of Rio de Janeiro, Brazil. A cross-sectional study was carried out using the Brazilian Hospital Information System of the SUS, considering hospitalizations and deaths from hip arthroplasties that occurred between 2016 to 2018. The analyses considered hospitalizations by type of care (elective, urgency and accidents or injury and poisoning). Binary logistic regression was performed to obtain a ratio for the chance of death. Mortality increased according to the severity of hospitalization. Most of the hospitalizations with death were due to femoral fracture, demanded intensive care, had mean length of stay of 21.5 days, and involved women aged 80 years and over, of the white race/color, who had their procedure performed in municipal units qualified in orthopedics and traumatology of high complexity and classified as general II, located in the patients' region of residence. The chance of death was significant for the age of the patient, use of intensive care unit (ICU), and length of hospital stay. We expect an increase in the demand for hip arthroplasties and physical rehabilitation due to population aging. Health teams must be prepared to deal with an ageing population. Knowing the factors that increase the risk of death favors care planning and management by hospital staff, including in the reduction of hospital stay, which is so impactful on the functional condition of the elderly.


O envelhecimento populacional traz desafios ao sistema de saúde. O aumento das doenças degenerativas articulares e a ocorrência de quedas podem demandar a realização de artroplastia de quadril. Objetivou-se avaliar os fatores associados a óbitos hospitalares por artroplastia de quadril no Sistema Único de Saúde (SUS), no Estado do Rio de Janeiro, Brasil. Realizou-se um estudo transversal utilizando o Sistema de Informações Hospitalares do SUS, considerando internações e óbitos por artroplastias de quadril ocorridos entre 2016-2018. As análises consideraram as internações por caráter de atendimento (eletivo, urgência e acidentes ou lesão e envenenamento). Realizou-se regressão logística binária para obter a razão de chance de óbito. A mortalidade aumentou conforme a gravidade da internação. A maioria das internações com óbito foi por fratura de fêmur, demandando cuidados intensivos, tempo médio de permanência de 21,5 dias, envolveu mulheres com 80 anos e mais, da raça/cor branca, que realizaram procedimento em unidades habilitadas em alta complexidade em ortopedia e traumatologia, municipais e classificadas como geral II, localizadas na região de moradia do usuário. A chance de óbito se mostrou significativa para a idade do usuário, uso de unidade de terapia intensiva (UTI) e permanência hospitalar. Espera-se aumento da demanda por artroplastias de quadril e reabilitação física com o envelhecimento populacional. As equipes de saúde devem estar preparadas para lidar com uma população envelhecida. Conhecer os fatores que incrementem o risco de óbito favorece o planejamento e o manejo do cuidado pela equipe hospitalar, inclusive no sentido de diminuir a permanência hospitalar, tão impactante na condição funcional de pessoas idosas.


El envejecimiento poblacional trae desafíos al sistema de salud. El aumento de las enfermedades degenerativas articulares y la incidencia de caídas pueden demandar la realización de artroplastias de cadera. Tuvo como objetivo evaluar los factores asociados a las muertes hospitalarias por artroplastias de cadera en el Sistema Único de Salud (SUS), en el Estado de Rio de Janeiro, Brasil. Se realizó un estudio transversal utilizando el Sistema de Información Hospitalaria del SUS, considerando hospitalizaciones y muertes por artroplastias de cadera ocurridas entre 2016-2018. Los análisis consideraron las hospitalizaciones según la naturaleza de la atención (electiva, urgencia y accidentes o lesiones e intoxicaciones). Se realizó una regresión logística binaria para obtener la razón de probabilidad de muerte. La mortalidad aumentó según la gravedad de la hospitalización. La mayoría de las hospitalizaciones con muerte se debió a la fractura de fémur, y requirió cuidados intensivos, tiempo promedio de estancia de 21,5 días, correspondió a mujeres de 80 años o más, de raza/color blanca, a quienes se sometió al procedimiento en unidades habilitadas de alta complejidad en ortopedia y traumatología, municipal y clasificadas como general II, ubicadas en la región de residencia del usuario. La probabilidad de muerte se mostró significativa para la edad del usuario, el uso de la unidad de cuidados intensivos (UCI) y la estancia hospitalaria. Se espera que la demanda de artroplastias de cadera y rehabilitación física aumente a medida que la población envejece. Los equipos de salud deben estar preparados para atender a una población que envejece. El conocimiento de los factores que incrementan el riesgo de muerte favorece la planificación y el manejo del cuidado por parte del equipo hospitalario, incluso en el sentido de reducir la estancia hospitalaria, que tanto afecta la condición funcional de la persona mayor.


Assuntos
Artroplastia de Quadril , Idoso , Brasil/epidemiologia , Estudos Transversais , Feminino , Hospitalização , Hospitais , Humanos
16.
Acta Chir Orthop Traumatol Cech ; 89(4): 286-292, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36055669

RESUMO

PURPOSE OF THE STUDY To compare topical and intravenous (IV) administration of tranexamic acid (TXA) 2 g in patients undergoing total hip arthroplasty (THA), or total knee arthroplasty (TKA). MATERIAL AND METHODS In total, 452 patients undergoing THA or TKA were randomised to 3 groups: 1) the IV TXA group received 2 doses of TXA 1 g intravenously 3 hours apart; 2) the topical TXA group received TXA 2 g topically, and 3) the NO TXA - control group. Furthermore, each group was divided in two subgroups by performed surgery (THA versus TKA). The following endpoints were used for final analysis: postoperative blood loss, transfusion requirement, haemoglobin drop and postoperative complications (haematoma, surgical site infection, thromboembolism, early surgical revision). RESULTS Both topical and IV administration of TXA significantly reduced postoperative bleeding (mean ± standard deviation) after THA and TKA (topical 504.4±281.0 ml, IV 497.3±251.7 ml, NO 863.1±326.4 ml, p<0.001). Topical use was superior to IV in reducing postoperative drainage output in THA (topical 377±213.3 ml, IV 518.1±259.0 ml, p<0.01). On the opposite, IV use was superior to topical in drainage output in TKA (topical 646.1±281.3 ml, IV 457.8±235.8 ml, p<0.01). The differences in transfusion requirement and Hb drop between these administration methods were not statistically significant (p≥0.05), but any TXA administration was significantly better than no TXA in all endpoints of efficacy (p<0.001). The lowest complication rate was observed in the topical group (NO 24%, IV 19%, topical 7.5%). DISCUSSION Consensus on optimal TXA dosing regime in primary hip and knee arthroplasties is still missing. Use of TXA therapy in routine clinical practice is highly individualized in accordance with the current approach of personalized medicine. Topical application seems to be the safest route of TXA administration. However, precise application technique is essential. IV TXA is beneficial especially in patients with some bleeding coagulopathies undergoing TKA with a tourniquet. Repeat doses of TXA are not usually necessary after completed primary arthroplasties. CONCLUSIONS IV and topical TXA 2 g have similar effect on reduction of transfusion requirements and haemoglobin drop in THA and TKA. The IV route is superior to topical in TKA while topical TXA reduces complications in both THA and TKA. Key words: tranexamic acid, total hip arthroplasty, total knee arthroplasty, topical administration, intravenous administration.


Assuntos
Antifibrinolíticos , Artroplastia de Quadril , Artroplastia do Joelho , Ácido Tranexâmico , Administração Intravenosa , Administração Tópica , Artroplastia de Quadril/efeitos adversos , Artroplastia de Quadril/métodos , Artroplastia do Joelho/efeitos adversos , Artroplastia do Joelho/métodos , Perda Sanguínea Cirúrgica/prevenção & controle , Hemoglobinas , Humanos
17.
Sci Rep ; 12(1): 15094, 2022 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-36064964

RESUMO

A growing number of recent investigations on the human genome, gut microbiome, and proteomics suggests that the loss of mucosal barrier function, particularly in the gastrointestinal tract, may substantially affect antigen trafficking, ultimately influencing the close bidirectional interaction between the gut microbiome and the immune system. This cross-talk is highly influential in shaping the host immune system function and ultimately affecting the outcome of interventions. We hypothesized that the loss of mucosal barrier in the gut may be associatedto acute and chronic periprosthetic joint infections (PJI). Zonulin, soluble CD14 (sCD14), and lipopolysaccharide (LPS) were tested in plasma as part of a prospective cohort study of patients undergoing primary arthroplasty or revision arthroplasty because of an aseptic failure or PJI (as defined by the 2018 criteria). All blood samples were collected before antibiotic administration. Samples were tested using commercially available enzyme-linked immunosorbent assays as markers for gut permeability. A total of 134 patients were included in the study of which 44 patients had PJI (30 chronic and 14 acute), and the remaining 90 patients were categorized as non-infected that included 64 patients revised for aseptic failure, and 26 patients undergoing primary total joint arthroplasty. Both Zonulin (7.642 ± 6.077 ng/mL vs 4.560 ± 3.833 ng/mL; p < 0.001) and sCD14 levels (555.721 ± 216.659 ng/mL vs 396.872 ± 247.920 ng/mL; p = 0.003) were significantly elevated in the PJI group compared to non-infected cases. Higher levels of Zonulin were found in acute infections compared to chronic PJI (11.595 ± 6.722 ng/mL vs. 5.798 ± 4.841 ng/mL; p = 0.005). This prospective study reveals a possible link between gut permeability and the 'gut-immune-joint axis' in PJI. If this association continues to be borne out with a larger cohort and more in-depth analysis, it will have a clinically significant implication in managing patients with PJI. It may be that in addition to the administration of antimicrobials, patients with PJI and other orthopaedic infections may benefit from administration of gastrointestinal modulators such as pro and prebiotics.


Assuntos
Artrite Infecciosa , Artroplastia de Quadril , Artroplastia do Joelho , Infecções Relacionadas à Prótese , Artrite Infecciosa/etiologia , Artroplastia de Quadril/efeitos adversos , Artroplastia do Joelho/efeitos adversos , Humanos , Receptores de Lipopolissacarídeos , Permeabilidade , Estudos Prospectivos , Infecções Relacionadas à Prótese/cirurgia , Reoperação/efeitos adversos , Estudos Retrospectivos
18.
BMC Musculoskelet Disord ; 22(Suppl 2): 1068, 2022 Sep 06.
Artigo em Inglês | MEDLINE | ID: mdl-36068628

RESUMO

BACKGROUND: Hip megaprostheses are a long known reconstructive method in the treatment of proximal femur metastases. The use of cemented or uncemented stems is still matter of debate. The aim of this study to compare cemented and uncemented megaprostheses on functional outcomes and complications, in order to establish the role of cementation. METHODS: We retrospectively analysed 51 metastatic patients with proximal femur metastases treated with endoprosthetic reconstruction by megaprostheses, 25 with cementless stems and 26 with cemented ones with different megaprosthetic implants. The primary endpoint was MSTS score, and the secondary endpoint was to state the incidence of surgical and clinical complications in the two groups. An un-paired T test was used to compare anthropometric, anamnestic data, and MSTS. Chi-square test was performed for evaluation of complication in the two group. Multiple linear regression was used to match the functional outcomes and complications' incidence in the population study. Logistic regression was performed to analyse the odds ratio of different parameters and their role in the incidence of complications. RESULTS: The mean follow-up was 50.1 months (+ 12.5). In thirty case right side was involved. No statistical differences were noticed between Group A and B regard the age, gender, active fracture/impending fracture. Comparing the MSTS results within the two groups at last follow-up, the score cemented group was higher than cementless one (17.9 + 7.8 vs 24.2 + 5.3; statistical significance p = 0.001). Regarding surgical complications a logistic regression was performed to analyse the odds ratio of age, cementation and length of resection; cementation confirm and odds ratio of 11 times in the incidence of surgical complications. CONCLUSIONS: Cementation seems to be more liable to complications onset, while improves functional score in metastatic patients compared to uncemented megaprostheses. More studies have to be conducted in order to create a protocol and establish criteria to use cemented or uncemented stems in a frail population like metastatic patients.


Assuntos
Artroplastia de Quadril , Prótese de Quadril , Artroplastia de Quadril/efeitos adversos , Artroplastia de Quadril/métodos , Cimentos Ósseos/uso terapêutico , Cimentação/efeitos adversos , Cimentação/métodos , Fêmur/cirurgia , Humanos , Estudos Retrospectivos , Resultado do Tratamento
19.
Vopr Kurortol Fizioter Lech Fiz Kult ; 99(4. Vyp. 2): 37-42, 2022.
Artigo em Russo | MEDLINE | ID: mdl-36083816

RESUMO

OBJECTIVE: To assess the quality of life and efficacy of telemedicine technologies for rehabilitation after total hip replacement. MATERIAL AND METHODS: The study included 60 patients aged 40-75 years after total hip replacement. All patients were divided into two groups by simple randomization. All patients underwent a 7-day course of complex in-hospital postoperative rehabilitation. At discharge, patients of the main group received an access to telemedicine program for 3-month physical exercises (3 times a week for 30 minutes). In the control group, patients received routine recommendations for rehabilitation procedures and orthopedic recommendations. RESULTS: A course of rehabilitation with telemedicine technologies after total hip replacement was accompanied by significant clinical effect according to EQ5D, SF-36 and STAI questionnaires. CONCLUSION. T: Elemedicine technologies in postoperative rehabilitation after total hip replacement are accompanied by QoL improvement. It is an effective form of medical rehabilitation.


Assuntos
Artroplastia de Quadril , Telemedicina , Artroplastia de Quadril/reabilitação , Humanos , Modalidades de Fisioterapia , Qualidade de Vida , Inquéritos e Questionários , Resultado do Tratamento
20.
PLoS One ; 17(9): e0274384, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36084121

RESUMO

Dislocation is one of the most common complications after primary total hip arthroplasty (THA). Several patient-related risk factors for dislocation have been reported in the previous literature, but only few prediction models for dislocation have been made. Our aim was to build a prediction model for an early (within the first 2 years) revision for dislocation after primary THA using two different statistical methods. The study data constituted of 37 pre- or perioperative variables and postoperative follow-up data of 16 454 primary THAs performed at our institution in 2008-2021. Model I was a traditional logistic regression model and Model II was based on the elastic net method that utilizes machine learning. The models' overall performance was measured using the pseudo R2 values. The discrimination of the models was measured using C-index in Model I and Area Under the Curve (AUC) in Model II. Calibration curves were made for both models. At 2 years postoperatively, 95 hips (0.6% prevalence) had been revised for dislocation. The pseudo R2 values were 0.04 in Model I and 0.02 in Model II indicating low predictive capability in both models. The C-index in Model I was 0.67 and the AUC in Model II was 0.73 indicating modest discrimination. The prediction of an early revision for dislocation after primary THA is difficult even in a large cohort of patients with detailed data available because of the reasonably low prevalence and multifactorial nature of dislocation. Therefore, the risk of dislocation should be kept in mind in every primary THA, whether the patient has predisposing factors for dislocation or not. Further, when conducting a prediction model, sophisticated methods that utilize machine learning may not necessarily offer significant advantage over traditional statistical methods in clinical setup.


Assuntos
Artroplastia de Quadril , Luxação do Quadril , Prótese de Quadril , Luxações Articulares , Artroplastia de Quadril/efeitos adversos , Artroplastia de Quadril/métodos , Luxação do Quadril/etiologia , Luxação do Quadril/cirurgia , Prótese de Quadril/efeitos adversos , Humanos , Luxações Articulares/cirurgia , Falha de Prótese , Reoperação/efeitos adversos , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
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