Pulmonary hypertension could be a risk for deep vein thrombosis in lower extremities after joint replacement surgery

SUMMARY A background of Pulmonary Hypertension (PH) indicates a progressive elevation of pulmonary vascular resistance, leading to overfilling, elevation of venous pressure, congestion in various organs, and edema in the venous system. This study aimed to investigate whether PH is a risk factor for deep vein thrombosis (DVT) of the lower extremities after hip and knee replacement surgery. METHODS A total of 238 patients who received joint replacement of lower extremities in our department of orthopedics from January 2009 to January 2012 were examined by echocardiography and Color Doppler flow imaging (CDFI) of the lower extremities. Based on pulmonary artery pressure (PAP), the patients were divided into a normal PAP group (n=214) and PH group (n=24). All the patients were re-examined by CDFI during post-operative care. RESULTS Among the 238 patients, 18 had DVT in the lower extremities after the operation. DVT total incidence rate was 7.56% (18/238). In the PH group, 11 patients had DVT (45.83%, 11/24), but in the normal PAP group, only 7 had DVT (3.27%, 7/214). The incidence of DVT was significantly lower in the normal PAP group than in the PH group (P<0.01). In addition, there was a positive correlation between PAP and the incidence of DVT. CONCLUSION PH could be a high-risk factor for the occurrence of DVT in patient's lower extremities after joint replacement surgeries.

RESUMO OBJETIVO A hipertensão pulmonar (HP) indica elevação progressiva da resistência vascular pulmonar, levando ao excesso de enchimento, elevação da pressão venosa, congestão em vários órgãos e edema no sistema venoso. Este estudo teve como objetivo investigar se a HP é um fator de risco para trombose venosa profunda (TVP) das extremidades inferiores após cirurgia de prótese de quadril e joelho. MÉTODOS Um total de 238 pacientes que receberam a substituição da articulação das extremidades inferiores em nosso departamento de ortopedia de janeiro de 2009 a junho de 2012 foi examinado por ecocardiograma e fluxo de imagem Doppler colorido (CDFI) dos membros inferiores. De acordo com a pressão arterial pulmonar (PAP), os pacientes foram divididos em grupo PAP normal (n=214) e grupo PH (n=24). Todos os pacientes foram reexaminados por CDFI durante os cuidados pós-operatórios. RESULTADOS Entre os 238 pacientes, 18 pacientes tiveram TVP nas extremidades inferiores após a operação. A taxa de incidência total de TVP foi de 7,56% (18/238). No grupo PH, 11 pacientes tiveram TVP (45,83%, 11/24), mas no grupo PAP normal, apenas sete pacientes tiveram TVP (3,27%, 7/214). A incidência de TVP foi significativamente menor no grupo PAP normal do que no grupo PH (P<0,01). Além disso, houve uma correlação positiva entre a PAP e a incidência de TVP. CONCLUSÃO A HP poderia ser um fator de alto risco para a ocorrência de TVP nas extremidades inferiores do paciente após cirurgias de substituição articular.

Ultrasound-guided adductor canal block using levobupivacaine versus periarticular levobupivacaine infiltration after totalknee arthroplasty: a randomized clinical trial

ABSTRACT BACKGROUND: Both postoperative pain control and range of motion are important in total knee arthroplasty (TKA). However, in the literature, there is little comparison of peripheral nerve blocks and periarticular infiltration techniques using levobupivacaine. The aim of our study was to measure pain with visual analogue scale (VAS) and knee range of motion (ROM) between in patients undergoing adductor canal block (ACB) for TKA using levobupivacaine compared to periarticular levobupivacaine infiltration (PAI-L). DESIGN AND SETTING: Prospective randomized clinical trial in a university hospital. METHODS: Patients aged 40-85 years who underwent unilateral TKA were included; 39 were treated withperiarticular infiltration using 40 ml (0.125 mg) of levobupivacaine (PAI-L group); and 40 were treated with ACB using 20 ml of 0.25% levobupivacaine (ACB-L group). Postoperative pain scores at rest and during active physical therapy were assessed using a VAS, along with knee ROM in flexion and extension. In addition, 100-foot walking time results, total morphine consumption and time of first analgesia requirement were recorded postoperatively. RESULTS: VAS scores at rest and during active physical therapy and the total amount of morphine consumed were lower in the ACB-L group than in the PAI-L group (P < 0.05). In contrast, knee ROM in flexion and extension and 100-foot walking times were greater in the PAI-L group than in the ACB-L group (P < 0.05). CONCLUSION: ACB-L was superior to PAI-L regarding pain treatment after TKA; however, PAI-L was superior to ACB-L regarding postoperative ROM and walking ability. CLINICAL TRIAL REGISTRY: ACTRN-12618000438257.

Incidence of delirium in postoperative patients treated with total knee and hip arthroplasty / Avaliação da incidência de delirium no pós-operatório de pacientes submetidos a artroplastia total de joelho e quadril

Summary Introduction: Delirium is a common disorder that can potentiate mortality and comorbidity rates of patients hospitalized in intensive care units. Patients undergoing major orthopedic surgeries, such as knee and hip arthroplasty, are particularly vulnerable as they often have multiple risk factors for this disorder. Method: Descriptive study of the incidence of delirium in patients treated with total knee and hip arthroplasty, given the advanced age and comorbidities in this population. We evaluated the medical records of patients who had previously undergone the designated surgeries for identification of postoperative delirium. Results: We observed in this study an incidence of 8.92% of delirium, mostly affecting females with a mean age of 73 years and hypertension. Conclusion: The incidence of delirium in our study is similar to that observed in the general population, according to the literature. We found no correlation with sleep disorders, smoking or diabetes mellitus in this study, even though the importance of these factors for the onset of delirium is well-established in the literature.

Resumo Introdução: Delirium é um transtorno comum e que pode potencializar a taxa de mortalidade e de comorbidade de pacientes internados em unidades de terapia intensiva. Dentre esses pacientes, aqueles submetidos a cirurgias ortopédicas de grande porte, como as artroplastias de joelho e quadril, apresentam especial vulnerabilidade, já que em muitos casos os pacientes são portadores de diversos fatores de risco para esse transtorno. Método: Este é um estudo descritivo retrospectivo da incidência de delirium em pacientes submetidos a artroplastia total de quadril e joelho, tendo em vista a idade avançada e a presença de comorbidades nessa população. Avaliamos o prontuário de pacientes que foram submetidos anteriormente às cirurgias designadas, para identificar casos de delirium pós-operatório e elaborar este estudo descritivo. Resultados: Observamos uma incidência de 8,92% de delirium em sua maioria em pacientes do sexo feminino e com média de idade de 73 anos, portadores de hipertensão arterial. Conclusão: A incidência de delirium neste estudo assemelhou-se à observada na população geral em outros estudos da literatura. Não foi possível estabelecer uma correlação com distúrbios do sono, diabetes melito, ou tabagismo, apesar de a importância desses fatores para o acometimento de delirium já estar bem-estabelecida na literatura.

Fracturas periprotésicas de fémur en artroplastia total de rodilla: experiencia con técnica mínimamente invasiva / Peri-prosthetic femoral fractures in total knee arthroplasty: experience using minimally invasive plate osteosynthesis

ANTECEDENTES: La fractura periprótesica de fémur en artroplastia total de rodilla supone uno de los mayores retos quirúrgicos. La tasa de complicaciones generales supera el 30% tanto con tratamiento conservador como con el quirúrgico. Parece que la técnica de osteosíntesis con placas bloqueadas de manera mínimamente invasiva ofrece buenos resultados para el tratamiento de las fracturas en las que no existe movilización del componente femoral. MÉTODOS: Se estudian retrospectivamente, desde enero de 2005 hasta diciembre del 2011, 32 pacientes, evaluando el tiempo de consolidación, el rango de movilidad, la deambulación y el alineamiento final mediante la realización de telemetrías en carga. El seguimiento medio fue de 56,5 meses (25-144). RESULTADOS: Se siguieron 32 pacientes (31 mujeres; un hombre) de los cuales el rango medio de edad fue de 77 años (70-89). Tres pacientes fallecieron (9%) y 4 pacientes (12%) se perdieron en la evolución final. La tasa media de consolidación fue de 16,5 semanas (8-24); no se produjeron infecciones, presentaron 3 seudoartrosis y solo se produjo un alineamiento en excesivo valgo (15°). El balance articular fue similar al previo a la fractura. La deambulación final fue igual a la previa en 24 de los 25 casos. CONCLUSIONES: Es una técnica adecuada para conseguir la consolidación en este tipo de fracturas y restablecer tanto la movilidad previa como un alineamiento correcto de la extremidad.

BACKGROUND: Peri-prosthetic fracture of the distal femur above total knee arthroplasty presents a challenging surgical problem for orthopaedic surgeons, as complication rates for both surgical and non-surgical treatment have been reported to be as high as 30%. The minimally invasive plate osteosynthesis (MIPO) technique seems to have better results than other techniques in this type of fracture when there is no loosening of the femoral implant. METHODS: A total of 32 patients with this fracture were treated from January 2005 to December 2011. A retrospective review was conducted on the weeks of consolidation, range of motion, final alignment, and the ability to walk. The mean follow up was 56.5 months (25-144). RESULTS: A total of 32 (31 female, 1 male) patients, with a mean age 77 (70-89) years old were treated, of whom 3 (9%) died and 4 were lost to follow-up. The mean time of consolidation was 16.5 weeks (8-24). There were no infections, although there were 3 non-unions and 1 malalignment (15° of valgus). We were able to restore the range of motion in every patient as it was before the fracture, as well as the ability to walk outdoors in 24 patients. CONCLUSION: The MIPO technique is a great technique in order to achieve a good range of motion and alignment of these fractures.

Dolor anterior de rodilla en pacientes operados de artroplastía de rodilla con o sin remplazo del componente patelar / Anterior knee pain in knee arthroplasty with or without a patellar component

Resumen: Introducción: La aparición de dolor patelofemoral postoperatorio en la artroplastía de rodilla, sobre todo en pacientes reumáticos, resultó en la incorporación de la sustitución del componente patelar en la mayoría de los diseños. Esta se convirtió en una parte estándar de la artroplastía total de rodilla; la controversia sobre si restituir o no el componente patelar continúa siendo debatida por los cirujanos ortopedistas que realizan artroplastías de rodilla. Objetivo: Realizar un análisis de la incidencia de dolor anterior de rodilla en pacientes sometidos a artroplastía primaria de rodilla con o sin remplazo del componente patelar. Material y métodos: Estudio observacional, retrospectivo, descriptivo y transversal de Enero de 2011 a Diciembre de 2013. Resultados: 54 individuos, 12 hombres (con un promedio de edad de 63 años) y 42 mujeres (con un promedio de edad de 71 años), que dieron un total de 64 rodillas intervenidas quirúrgicamente. Conclusión: No se encontró diferencia significativa en cuanto al dolor anterior de rodilla, en la función de la articulación patelofemoral y de la rodilla en los grupos de sujetos que fueron analizados con las diferentes escalas.

Abstract: Introduction: The appearance of patellofemoral pain after a knee arthroplasty, particularly in rheumatic diseases, resulted in the incorporation of the substitution of the patellar component in all designs. The replacement of the patella became a standard part of knee arthroplasty, but the controversy over whether to restore it or not continues among orthopedists that perform knee arthroplasties. Objective: To analyze the incidence of anterior knee pain in patients who underwent primary knee arthroplasty with or without replacement of the patellar component. Material and methods: Observational, retrospective, descriptive and transversal study from January 2011 to December 2013. Results: A total of 54 patients were included, 12 men (with an average age of 63 years) and 42 women (with an average age of 71 years), totaling 64 knees that were surgically intervened. Conclusion: This study found no significant difference in anterior knee pain and in the function of the patellofemoral joint and the knee in the groups of patients who were tested with the different scales.

Espaciadores estáticos de cemento con antibiótico en la infección protésica de rodilla: técnica de elaboración y movilidad posoperatoria / Static cement spacers in total knee infection: custom manufacturing technique and postoperative motion

Introducción: A pesar de las mejoras en la técnica quirúrgica en reemplazos totales de rodilla, el número de infecciones posquirúrgicas continúa en aumento. En la bibliografía mundial, está demostrado que las revisiones en dos tiempos logran mayores porcentajes de curación que las de un solo tiempo. El objetivo de este trabajo es mostrar nuestra técnica de elaboración de los espaciadores estáticos y los resultados obtenidos con estos espaciadores en revisiones de reemplazos totales de rodillas infectadas, tratadas en dos tiempos y, además, evaluar la movilidad obtenida. Materiales y Métodos: De 1997 y 2010, en nuestro Centro, se efectuaron 153 revisiones de reemplazos totales de rodilla, 33 (21 %) fueron a causa de una infección periprotésica crónica, tratada en dos tiempos, con el uso de un espaciador estático de cemento con antibiótico. La serie estaba conformada por 33 rodillas en 32 pacientes, con un promedio de edad de 69 años y un seguimiento de 3.5 años. Resultados: Treinta (91%) de las 33 rodillas se curaron. Veintiocho fueron reimplantadas exitosamente, 2 rodillas con infección curada no fueron reimplantadas por distintos motivos y permanecieron con el espaciador en forma definitiva y la infección persistió en 3 casos. Las 28 rodillas reimplantadas evolucionaron favorablemente, con una movilidad de 90° a los 3.15 meses de posoperatorio promedio. Conclusiones: Con el empleo de espaciadores estáticos de rodilla, obtuvimos un porcentaje de curación similar al publicado con espaciadores articulados. La ventaja de los primeros es su fácil fabricación y colocación, le otorgan a la articulación una adecuada estabilidad y un aceptable rango de movilidad posoperatoria.

Background: Despite improvements in surgical technique, the number of infections after total knee arthroplasty continues to rise. According to bibliographic reviews, the two-stage exchange procedure has obtained higher percentages of cure than that performed in a single stage. The purpose of this paper was to show our technique for preparing the static spacer, the results and the range of motion achieved with two-stage revision of infected total knee arthroplasty using those spacers. Methods: We performed 153 total knee arthroplasty revisions between 1997 and 2010, 33 (21%) of them due to a prosthetic chronic infection, treated with a two-stage procedure with cement static spacer with antibiotic. We evaluated 33 total knee arthroplasties in 32 patients, with an average age of 69 years and an average postoperative follow-up of 3.5 years. Results: Healing was achieved in 30 (91%) of the 33 knees. Twenty-eight knees were successfully reimplanted, two with healing infection were not reimplanted for different reasons and 3 had persistent infection. The 28 reimplanted knees evolved favorably, achieving a range of motion of 90º in an average of 3 months after surgery. Conclusions: The static knee spacer achieved a similar healing rate to that obtained with articulated spacers. The advantage of static spacers is its easy manufacture and placement, giving greater stability and an acceptable range of motion.

Estudio comparativo para el manejo del dolor en el reemplazo total de rodilla: infiltración tisular intraoperatoria versus bloqueo de nervios periféricos / Comparative study for pain management in total knee replacement: intraoperative tissue infiltracion versus peripheral nerve block

Introducción: El objetivo de este trabajo es comparar la infiltración intraoperatoria de los tejidos blandos periarticulares versus la utilización de bloqueos de los nervios periféricos (ciático y femoral) para el manejo del dolor posoperatorio de la artroplastia total de rodilla. Materiales y Métodos: Se evaluaron, en forma prospectiva, 60 pacientes tratados, que fueron divididos en dos grupos iguales: grupo A, con infiltración intraoperatoria y grupo B, con bloqueo de los nervios femoral y ciático antes de la cirugía. Resultados: El dolor fue significativamente menor en el grupo B (bloqueados) que en el grupo de control A (infiltrados) entre las 4 y las 8 horas poscirugía (p = 0,008). Al segundo y al tercer días de la cirugía, la curva de dolor se invirtió y fue estadísticamente menor en el grupo A (p = 0,009 y p = 0,023, respectivamente). Conclusiones: Al evaluar los resultados se observó que ambos métodos fueron eficaces para el tratamiento del dolor posquirúrgico e, incluso, para disminuir el consumo de opiáceos. Los bajos niveles de dolor y el menor uso de opiáceos en el posoperatorio inmediato dieron lugar a una mejor rehabilitación y a un mayor bienestar general para el paciente.

Background: The aim of this study is to compare intraoperative infiltration of periarticular soft tissues versus the use of peripheral nerve blocks (sciatic and femoral) for postoperative pain management in total knee arthroplasty. Methods: We prospectively evaluated 60 patients who were divided into two equal groups: group A, with intraoperative infiltration and group B, with femoral and sciatic nerve block before surgery. Results: Pain was significantly lower in group B (block) than in the control group A (infiltration) at 4 and 8 hours after surgery (p = 0.008). Two and three days after surgery, pain curve was inverted and it was statistically lower in group A (p = 0.009 and p = 0.023, respectively). Conclusions: Results showed that both methods were effective in the treatment of pain after surgery and even to reduce opiate use. Low levels of pain and less use of opioids in the immediate postoperative period led to a better rehabilitation and comfort of the patient.

Effect of postoperative use of nasal oxygen catheter supplementation in wound healing following total knee arthroplasty

OBJECTIVES: Healing is an event that is fundamental to the success of total knee arthroplasty. The aims of the present study were to compare the rates of complications related to wound healing between two groups of volunteers submitted to total knee arthroplasty and to evaluate the effects of postoperative oxygen supplementation by means of a nasal catheter. METHOD: A total of 109 patients who underwent total knee arthroplasty were randomized into two groups, namely, groups that did and did not receive postoperative oxygen supplementation via a nasal catheter. The surgical wound was monitored every day during the hospital stay and on the 7th, 14th, 21st, 30th and 42nd postoperative days. Characteristics related to healing were observed, including hyperemia, dehiscence, necrosis, phlyctenules and deep and superficial infection. RESULTS: There were no cases of deep infection. Hyperemia was statistically correlated with the total number of complications in the groups, with oxygen demonstrated to be a protective factor against hyperemia. Approximately 30% of the patients who exhibited hyperemia had other complications, independent of oxygen supplementation. CONCLUSION: Oxygen supplementation following total knee arthroplasty was shown to be effective in diminishing hyperemia around the operative wound. The development of hyperemia was a precursor to other complications, irrespective of whether oxygen supplementation was used. .

Retalhos de rotação para cobertura após artroplastia total de joelho / Rotation flaps for coverage after total knee arthroplasty

Objetivo: Avaliar os resultados obtidos com o uso de retalhos miocutâneos de rotação local nos casos de deiscência da ferida operatória após artroplastia total de joelho. Métodos: Os pacientes submetidos a esse procedimentos cirúrgicos foram selecionados no período de 2000 a 2012. Os nove casos selecionados neste período foram submetido a retalhos de cobertura devido a deiscência de pele associada a infecção. Em oito casos utilizamos retalhos de rotação local do gastrocnêmio medial e um caso de avanço de pele. Resultados: em 89% destes casos houve sucesso quanto à cobertura da prótese e viabilidade dos retalhos. Em quatro casos foi possível manter ou revisar a prótese. Outros quatro casos evoluíram com necessidade de amputação por falha no tratamento infeccioso e um caso permaneceu sem a prótese. A avaliação funcional mostrou um resultado insatisfatório em 89% desses casos. Conclusão: Os retalhos de cobertura são uma boa opção para o tratamento dos casos de deiscência com exposição da prótese e que o insucesso funcional esteve associado à falha no controle do quadro infeccioso e aos danos causados por este. Nível de Evidência IV, Série de Casos.

Objective: To evaluate the results obtained using local rotation myocutaneous flaps in cases of wound dehiscence after total knee arthroplasty. Methods: Patients undergoing these surgical procedures were selected in the period 2000-2012. The nine selected cases in this period were subjected to flap coverage due to skin dehiscence associated with infection. In eight cases we used rotation flaps of the medial gastrocnemius and in one case, we used advancing skin. Results: 89% of the cases were successful in the coverage of the prosthesis and the viability of the flaps. In four cases it was possible to maintain or review the prosthesis. Four other cases progressed to amputation for infectious treatment failure and a case remained without the prosthesis. The functional evaluation showed an unsatisfactory outcome in 89% of cases. Conclusion: Coverage flaps are a good option for the treatment of cases of dehiscence with exposure of the prosthesis and the functional failure was associated with the inability to control the infection and the damage caused by this. Level of Evidence IV, Case Series.

Does thromboprophylaxis prevent venous thromboembolism after major orthopedic surgery? / A tromboprofilaxia evita o tromboembolismo venoso após cirurgia ortopédica de grande porte?

OBJECTIVE: Pulmonary embolism (PE) is an important complication of major orthopedic surgery. The aim of this study was to evaluate the incidence of venous thromboembolism (VTE) and factors influencing the development of VTE in patients undergoing major orthopedic surgery in a university hospital. METHODS: Patients who underwent major orthopedic surgery (hip arthroplasty, knee arthroplasty, or femur fracture repair) between February of 2006 and June of 2012 were retrospectively included in the study. The incidences of PE and deep vein thrombosis (DVT) were evaluated, as were the factors influencing their development, such as type of operation, age, and comorbidities. RESULTS: We reviewed the medical records of 1,306 patients. The proportions of knee arthroplasty, hip arthroplasty, and femur fracture repair were 63.4%, 29.9%, and 6.7%, respectively. The cumulative incidence of PE and DVT in patients undergoing major orthopedic surgery was 1.99% and 2.22%, respectively. Most of the patients presented with PE and DVT (61.5% and 72.4%, respectively) within the first 72 h after surgery. Patients undergoing femur fracture repair, those aged ≥ 65 years, and bedridden patients were at a higher risk for developing VTE. CONCLUSIONS: Our results show that VTE was a significant complication of major orthopedic surgery, despite the use of thromboprophylaxis. Clinicians should be aware of VTE, especially during the perioperative period and in bedridden, elderly patients (≥ 65 years of age). .

OBJETIVO: A embolia pulmonar (EP) é uma complicação importante de cirurgia ortopédica de grande porte. Este estudo visou avaliar a incidência de tromboembolismo venoso (TEV) e os fatores que influenciam o desenvolvimento de TEV em pacientes submetidos a cirurgia ortopédica de grande porte em um hospital universitário. MÉTODOS: Pacientes submetidos a cirurgia ortopédica de grande porte (artroplastia de quadril, artroplastia do joelho ou reparação de fratura de fêmur) entre fevereiro de 2006 e junho de 2012 foram incluídos retrospectivamente no estudo. As incidências de EP e de trombose venosa profunda (TVP) foram avaliadas, assim como os fatores que influenciaram sua ocorrência, tais como o tipo de cirurgia, idade e comorbidades. RESULTADOS: Foram revisados os prontuários médicos de 1.306 pacientes. As proporções de artroplastia do joelho, artroplastia de quadril e reparação de fratura de fêmur foram, respectivamente, de 63,4%, 29,9% e 6,7%. A incidência cumulativa de EP e TVP nos pacientes submetidos a cirurgia ortopédica de grande porte foi, respectivamente, de 1,99% e 2,22%. A maioria dos pacientes apresentou EP e TVP (61,5% e 72,4 %, respectivamente) nas primeiras 72 h após a cirurgia. Pacientes submetidos à reparação de fratura de fêmur, aqueles com idade ≥ 65 anos, e pacientes acamados tinham um risco maior de desenvolver TVP. CONCLUSÕES: Nossos resultados demonstram que o TEV foi uma complicação importante de cirurgia ortopédica de grande porte, apesar da utilização de tromboprofilaxia. Os médicos clínicos devem estar alerta para a ocorrência ...

Artroplastia de cadera y rodilla / Hip and knee arthroplasty

En este número de la serie Publicaciones Técnicas del Fondo Nacional de Recursos se recogen tres trabajos sobre temas diversos. Si bien en algunos casos los datos corresponden a pacientes atendidos hace ya algunos años, se ha considerado que existen varios motivos que justifican esta edición.En primer lugar, la importancia de los temas en sí mismos. Se trata en todos los casos de patologías y procedimientos de alto impacto en la salud de las personas y de alta significación para el sistema de salud, por lo cual se mantienen en la cobertura del Fondo. Documentar los hallazgos de estudios sobre estos temas, aunque sean de años anteriores, tiene importancia relevante para decisiones que se adoptan hoy. Las variables que específicamente se relevaron son también un factor a tener en cuenta, ya que se abordan específicamente resultados (mortalidad, calidad de vida, infecciones...) que requieren también hoy la máxima atención. Por último, ha parecido de interés dar a conocer la metodología de investigación que se utilizó en dos de los trabajos: se trata de estudios prospectivos en los que los pacientes fueron captados en el momento de la cirugía, a partir de la cual el seguimiento se realizó acompañando su evolución en el post operatorio inmediato y alejado. No es frecuente encontrar este tipo de estudio, lo que ha constituido un incentivo adicional para su inclusión en este número. El Fondo Nacional de Recursos considera relevante la información que se está publicando. Permite el análisis de tendencias y aporta a un mejor conocimiento de la realidad de estas especialidades en nuestro país.

Comparação funcional entre revisão de artroplastia de joelho séptica e asséptica / Functional comparison between septic and aseptic knee arthroplasty review

INTRODUÇÃO: A artroplastia total de joelho (ATJ) não é um procedimento isento de riscos. A infecção na ATJ não é a complicação mais comum, porém é uma das mais graves. A revisão em 2 tempos é a escolha nos casos de infecção profunda da prótese de joelho. Por outro lado, a soltura asséptica chega a quase metade das indicações de revisão de artroplastias primárias. A queda do nível de satisfação do paciente pode cair nas revisões. OBJETIVO: O objetivo do presente estudo foi comparar através dos resultados obtidos nos escores funcionais e de qualidade de vida entre cirurgia de revisão de ATJ por soltura séptica e asséptica. MÉTODO: Realizamos escores HSS e SF-36 para avaliar a qualidade de vida e o resultado funcional entre pacientes submetidos à cirurgia de revisão da ATJ entre dois grupos, um que realizou a substituição da prótese em dois tempos (séptica) e outro no qual a substituição ocorreu em tempo único (asséptica). RESULTADOS: A análise dos dados obtidos mostra melhor desempenho do segundo grupo na pontuação do HSS e em 06 dos 08 domínios do SF-36. Conclusão: A revisão de ATJ em tempo único apresenta melhores resultados funcionais.

INTRODUCTION: Total knee arthroplasty (TKA) imposes many risks. TKA infection is not the most frequent complication, but is probably the most serious one. Two-step review is the procedure of choice in deep knee prosthesis infection. On the other hand, aseptic prosthesis detachment represents almost half of the primary arthroplasty review indications. Patient's satisfaction level might diminish after reviews. OBJECTIVE: The objective of this study was to compare the quality of life and final result of TKA review for septic and aseptic failures. METHODS: The patients were assessed using the HSS and SF-36 scores. The patients were divided in two groups: one group submitted to two-step review (septic) and the other to one-step review (aseptic). The analysis of the data obtained shows better scores for the second group in HSS and in 06 of 08 domains of SF-36 classification. CONCLUSIONS: The on-step review of total knee arthroplasty leads to better functional outcomes.

Evaluación del componente patelar en artroplastía total de rodilla / Evaluation of patellar resurfacing in total knee arhtroplasty

Ever since the first Total Knee Arthroplasty was made to our present times, a point that still generates controversy is, if the accomplishment of patellar resurfacing will take to a higher global rate of complications. It was the final objective of our work to analyze clinically and radiologically, in addition to satisfaction degree and quality of life surveys, the patellar resurfacing in a sample of total knee arthroplasty made in our center. We can conclude that in our experience, the patellar resurfacing has a low incidence of complications, which do not affect in a significant way the quality of life of the patients carrying on a total knee arthroplasty, which justifies this procedure absolutely.

Desde que se realizan las Artroplastías Totales de Rodilla hasta la fecha, un punto que genera controversia, es, si la realización de un componente protésico patelar llevará a una mayor tasa global de complicaciones. Es por eso que el objetivo de nuestro trabajo fue analizar clínica y radiológicamente, además de encuestas del grado de satisfacción, el componente de recubrimiento patelar en una muestra de las artroplastías totales de rodilla realizadas en nuestro centro. Se concluye que en nuestra experiencia, el uso de recubrimiento patelar tiene una baja incidencia de complicaciones, las cuales no afectan de manera significativa la calidad de vida de los pacientes con artroplastía total de rodilla, lo que justifica plenamente su utilización.

Urinary retention and the role of indwelling catheterization following total knee arthroplasty

INTRODUCTION: We aimed to investigate the rate of urinary retention after knee arthroplasty, the various factors involved in predicting those at risk for retention and to assess the impact of retention and catheterization on joint sepsis. MATERIALS AND METHODS: A retrospective review was conducted of all available case notes of patients undergoing total knee arthroplasty in a consecutive 2-year period (2000-2002). Adequate data was available for 142 patients. RESULTS: 142 patients underwent total knee arthroplasty. 19 patients were catheterized preoperatively for monitoring urine output. 123 patients were not catheterized. Urinary retention occurred in 19.7 percent (28/142). The mean day of catheterization for retention was 0.66. The mean duration of catheterization in patients developing retention was 3.58 days and was 3 days in the patients catheterized pre - or perioperatively. Deep joint sepsis occurred in 2.1 percent (3/142) - only one had been catheterized and that was preoperatively. No case of infection had urinary retention or had a symptomatic urinary tract infection. The only factors predicting those at significant risk of retention following knee arthroplasty was a past medical history of urinary retention (p = 0.049) and postoperative morphine requirement (p = 0.035). No patients required urological surgical intervention at mean follow up of 1.97 years. CONCLUSIONS: This study supports the use of indwelling urinary catheterization for patients developing urinary retention after total knee arthroplasty.