RESUMO

PURPOSE: The purpose of this study was to assess patient satisfaction and identify risk factors for dissatisfaction after anterior stabilised conventional total knee arthroplasty (TKA) without patellar resurfacing, using the Goodman score. METHODS: We conducted a cross-sectional study using data from our institutional database from 1 January 2018 to 1 March 2021. Patients who underwent TKA with the Vanguard® Cruciate Retaining Anterior Stabilized Knee System (Zimmer Biomet, Warsaw, Indiana, USA) without patellar replacement were included. Patients with other bearing surfaces (posterior stabilised or medial congruent) or diagnosed with infection or instability were excluded. Patients' reported outcomes, body mass index (BMI), passive range of motion, the timed up-and-go test, sit-up test, and algometry were assessed. Patients were also asked if they had anterior knee pain. Satisfaction was assessed using the Goodman scale, and logistic multivariate regression was used to identify variables associated with dissatisfaction and perceived improvement in quality of life. RESULTS: A total of 131 TKA patients were included in the study. The median satisfaction score was 100 (interquartile range [IQR], 87.5 to 100), with the 75-point threshold at the 90th percentile according to Section A of Goodman. Section B of Goodman showed that 113 TKA patients (86.26%) reported "great improvement" or "more than I ever dreamed." Multivariate logistic regression revealed that anterior knee pain (OR 5.16, 95% CI 1.24 to 21.39), the sit-up test (OR 0.63, 95% CI 0.49 to 0.81), and BMI (OR 0.84, 95% CI 0.70 to 0.99) were significantly associated with patient dissatisfaction and a worse perceived improvement in quality of life. The receiver operating characteristics curve for the models had areas under the curve of 0.83 (95% CI 0.69 to 0.97) and 0.82 (95% CI 0.70 to 0.94), respectively. CONCLUSION: Anterior stabilised TKA without patellar resurfacing can achieve 90% satisfaction and 86% improvement in quality of life. To improve these results, it is essential to prevent and treat anterior knee pain and enhance quadriceps strength. LEVEL OF EVIDENCE: Level III (retrospective cohort study).

RESUMO

Equus members exhibit very divergent karyotype, genetic plasticity, and significant differences in their reproductive physiology. Despite the fact that somatic cell nuclear transfer and intracytoplasmic sperm injection (ICSI) has gained relevance in the last few years in horses, few reports have been published exploring ovum pick up (OPU) and in vitro maturation (IVM) of cumulus-oocyte complexes (COCs) in donkeys. Yet, some donkey species and breeds are considered endangered, and these assisted-reproductive technologies could help to preserve the genetic of valuable individuals. In this study, we tested the hypothesis that supplementation with jenny preovulatory follicular fluid (PFF) during IVM could improve oocyte developmental competence in the donkey. For this, in vitro nuclear maturation rates, cumulus cell expansion, and embryo development after ICSI of donkey COCs matured in culture media supplemented with fetal bovine serum (FBS) or donkey PFF, with a known metabolomic profile, were assessed. Time-lapse imagining was performed after ICSI of horse and donkey oocytes. Eight OPU sessions were done in five jennies with an average recovery rate of 69.2% (n = 45 COCs). Although lower cumulus cells expansion was observed in oocytes of PFF group (P = 0.0010), no significant differences were described in nuclear maturation rates and preimplantation embryo development between groups. Donkey ICSI embryos showed similar morphokinetics to horse ICSI embryos. Our study shows that supplementing IVM media with FBS or donkey PFF supports nuclear maturation and early preimplantation embryo development after ICSI in donkeys. To our knowledge, the present study is the first report of ICSI, time-lapse imaging and in vitro blastocyst production in donkey.

Assuntos

RESUMO

The purpose of this study was to compare the efficacy of periarticular infiltration of gonyautoxin 2/3 (GTX 2/3) and a mixture of levobupivacaine, ketorolac, and epinephrine for pain management after total knee arthroplasty (TKA). Forty-eight patients were randomly allocated to receive periarticular infiltration of 40 µg GTX 2/3 (n = 24) diluted in 30 mL of sodium chloride 0.9% (study group) or a combination of 300 mg of levobupivacaine, 1 mg of epinephrine, and 60 mg ketorolac (n = 24) diluted in 150 mL of sodium chloride 0.9% (control group). Intraoperative anesthetic and surgical techniques were identical for both groups. Postoperatively, all patients received patient-controlled analgesia (morphine bolus of 1 mg; lockout interval of 8 minutes), acetaminophen, and ketoprofen for 72 hours. A blinded investigator recorded morphine consumption, which was the primary outcome. Also, the range of motion (ROM) and static and dynamic pain were assessed at 6, 12, 36, and 60 hours after surgery. The incidence of adverse events, time to readiness for discharge, and length of hospital stay were also recorded. The median of total cumulative morphine consumption was 16 mg (range, 0-62 mg) in the GTX 2/3 group and 9 mg (range, 0-54 mg) in control group, which did not reach statistical difference (median test, p = 0.40). Furthermore, static and dynamic pain scores were similar at all time intervals. GTX 2/3 was inferior in range of motion at 6 and 12 hours; nevertheless, we noted no difference after 36 hours. No differences between groups were found in terms of complications, side effects, or length of hospital stay. No significant differences were found between groups in terms of breakthrough morphine requirement. However, local anesthetic use resulted in an increased ROM in the first 12 hours. This prospective randomized clinical trial shows that GTX 2/3 is a safe and efficient drug for pain control after TKA; nevertheless, more studies using GTX 2/3 with larger populations are needed to confirm the safety profile and efficiency. This is level 1 therapeutic study, randomized, double-blind clinical trial.

Assuntos

RESUMO

OBJETIVO Describir el resultado funcional informado por el paciente de una cohorte de pacientes sometidos a artroplastia unicompartimental de rodilla (AUR) en un hospital universitario chileno. MÉTODOS Se diseñó un estudio de cohorte histórica. Se incluyeron todos los pacientes que se sometieron a AUR de platillo fijo entre 2003 y 2019. Un evaluador independiente se puso en contacto con los pacientes en junio de 2020. Se utilizó el índice de artritis de las universidades de Western Ontario y McMaster (WOMAC) para comparar los procedimientos de AUR (medial o lateral), la edad (mayor o menor de 70 años), y el seguimiento (más o menos de 5 años). RESULTADOS Se incluyeron 78 pacientes, en un total de 94 AURs. La mediana de edad fue de 64 años (rango: 43 a 85 años). Hubo 72 (76,6%) casos de AUR medial. Un paciente necesitó revisión para artroplastia total de rodilla (ATR). Un total de 60 pacientes (76,9%), correspondientes a 72 AURs (76,7%), fueron contactados con éxito por teléfono para el seguimiento final. La mediana del puntaje en los dominios del WOMAC fue: dolor ­ 1 (rango: 0 a 12); rigidez ­ 0 (rango: 0 a 4); y función física ­ 2 (rango: 0 a 29). La mediana del puntaje total en el WOMAC fue de 4 (rango: 0 a 44). Los pacientes sometidos a AUR lateral lograron mejores puntuaciones funcionales (p » 0,0432), y el puntaje total en el WOMAC fue similar en pacientes mayores o menores de 70 años (p » 0,3706). CONCLUSIONES La AUR es un tratamiento eficaz y reproducible para pacientes con artrosis de rodilla unicompartimental. La edad parece no afectar los resultados funcionales, y la AUR es un tratamiento eficaz en pacientes mayores de 70 años. Estos resultados deberían animar a los cirujanos de rodilla a aprender esta técnica y a los responsables de las políticas de salud pública a considerar la AUR para la osteoartritis de rodilla.

PURPOSE To describe the patient-reported functional outcome of a cohort of patients undergoing unicompartmental knee arthroplasty (UKA) in a Chilean university hospital. METHODS A historical cohort study was designed. All patients who underwent fixedbearing UKA between 2003 and 2019 were included. An independent evaluator contacted the patients in June 2020. The Western Ontario and McMaster Universities Arthritis Index (WOMAC) was used to compare UKA procedures (medial or lateral), age (over or under 70 years), and follow up (longer or shorter than 5 years). RESULTS A total of 78 patients, corresponding to 94 UKAs, were included. The median age was 64 years (range: 43 to 85 years). There were 72 (76.6%) cases of medial UKA. One patient needed revision to total knee arthoplasty (TKA). A total of 60 patients (76.9%), corresponding to 72 UKAs, were successfully contacted by phone for the final follow-up. The median scores on the WOMAC domains were: pain ­ 1 (range: 0 to 12); stiffness ­0 (range: 0 to 4); and physical function ­ 2 (range: 0 to 29). The median total score on the WOMAC was 4 (range: 0 to 44). Patients submitted to lateral UKA had better functional scores (p » 0.0432), and the total WOMAC score was similar among patients older or younger than 70 years of age (p » 0.3706). CONCLUSIONS For patients with unicompartmental knee osteoarthritis, UKA is an effective and reproducible treatment. Age does not seem to affect the functional results, and UKA is an effective treatment in patients over 70 years old. These results should encourage knee surgeons to learn this technique and those responsible for public health policies to consider UKA for knee osteoarthritis

Assuntos

RESUMO

OBJETIVO: Evaluar la tendencia de la letalidad al año y a 2 años, tiempo de espera de cirugía y estadía hospitalaria en fractura de cadera entre 2002 y 2016. Además, evaluar la correlación entre letalidad a uno y dos años. MÉTODO: Diseño transversal. Fueron incluidos pacientes mayores de 60 años que ingresaron por fractura de cadera entre 2002 y 2016. Se solicitó al Registro Civil reportar si los pacientes estaban con vida al 30 de junio de 2019. La correlación de Spearman fue estimada para determinar la tendencia de la letalidad a uno y dos años, la edad, el tiempo de espera de cirugía, y la estadía hospitalaria durante el periodo estudiado. Además, una regresión linear fue estimada entre letalidad a un año y dos años. RESULTADOS: Fueron incluidos 961 fracturas de cadera. Se observó una tendencia a la disminución en la letalidad a 1 (rho » -0.23) y 2 años (rho » -0.29), en la proporción de hombres (rho » -0.25), en la estadía hospitalaria (rho » -0.06), y en el tiempo de espera de cirugía (rho » -0.11), sin alcanzar significancia estadística. La letalidad a 1 año fue de 0,17 (intervalo de confianza de 95% [IC95%]: 0,14 a 0,19), y a 2 años, de 0,26 (IC 95%: 0,23 a 0,29). Se estimó un R2 de 0,60 entre la letalidad a 1 y 2 años. CONCLUSIONES: La letalidad a uno y dos años, el tiempo de espera de cirugía, la edad de presentación, y la estadía hospitalaria no han variado significativamente en el periodo estudiado. Se observa una fuerte correlación entre la letalidad a uno y dos años, lo que sugiere un riesgo constante de mortalidad después de una fractura de cadera.

PURPOSE: To evaluate the trend in 1 and 2 years, the fatality rate, the waiting time for surgery, and the length of hospital stay in a single center between 2002 and 2016. Also, to evaluate the relationship between the one-year and two-year fatality rates. METHODS: A cross-sectional study. Patients older than 60 years of age who were admited due to hip fracture between 2002 and 2016 were included. A request was made to the Chilean National Civil Registry to determine if the patients were alive on June 30, 2019. The Spearman correlation was estimated to determine the trend of the one-year and two-year fatality rates, the age, the type of fracture, and the waiting time for surgery. Also, a linear regression analysis was estimated between the one-year and two-year fatality rates. RESULTS: A total of 961 hip fractures were included. From 2002 to 2016, a downward trend was found in the 1-year (rho » -0.23) and 2-year fatality rates (rho » -0.29), in the proportion of male patients (rho » -0.25), in the length of hospital stay (rho » -0.06), and in the waiting time for surgery (rho » -0.11), not reaching statistical difference. The 1-year fatality rate was of 0,17 (95% confidence interval [95%CI]: 0.14 to 0.19) and the 2-year fatality rate was of 0,26 (95%CI: 0.23 to 0.29). An R2 of 0.60 was estimated between the 1-year and 2-year fatality rates. CONCLUSIONS: The one-year and two-year fatality rates, the waiting time for surgery, and the length of hospital stay remained constant during the period analyzed. A strong correlation between the one-year and two-year fatality rates was found, which suggests a constant risk of death after hip fracture.

Assuntos

RESUMO

INTRODUCCIÓN: La artroplastia total de cadera (ATC), es la cirugía del siglo XX por el impacto en la calidad de vida. Por su parte, la artroplastia de rodilla (AR), ha demostrado ser un procedimiento costo-efectivo en gonartrosis. OBJETIVO: Describir la evolución de ATC y AR, en cuanto a número de procedimientos, edad y género en pacientes operados en un hospital general. MÉTODO: Estudio transversal analítico. Fueron incluidos todos los procedimientos realizados en un único centro, entre enero de 2002 y diciembre 2018, que estuvieran registrados por los códigos de prestación Fonasa 2104129 y 2104153. Fueron excluidos todos los procedimientos de revisión de artroplastia, tumores y fracturas. Se realizó un análisis de correlación de Spearman, se estableció una significancia de 0,05. RESULTADOS: Fueron incluidos 3270 procedimientos, 1975 corresponden a ATC (60,4%) y 1295 AR (39,6%). El número de ATC ha ido aumentando, en 2002 fueron realizados 122, mientras que en 2018, fueron 164. Por su parte, las AR también aumentaron, en 2002 fueron realizadas 40, mientras que en 2018 fueron 155. La proporción ATC/AR ha disminuido significativamente. La edad promedio ha disminuido en AR y aumentado en ATC, sin significación estadística. En ATC, se observa un incremento en la proporción de hombres operados. CONCLUSIONES: El perfil epidemiológico de los pacientes operados de artroplastia ha cambiado significativamente. La epidemiología mundial y la de este estudio muestran un significativo incremento de pacientes que requieren AR, por lo cual, parece importante incluir ese procedimiento en las necesidades sanitarias a satisfacer, en el diseño de nuevas políticas públicas.

OBJECTIVE: To describe the evolution of hip and knee arthroplasty in a general hospital, in terms of number of procedures, average age and gender. METHOD: Analytical cross-sectional study. All procedures performed between January 2002 and December 2018 in a single center were included. All procedures performed for revision surgery, tumors or fracture were excluded. The following data were obtained from the registry: age at the time of surgery, gender of the patient and year of the procedure. A Spearman correlation analysis was performed, a significance of 0.05 was established. RESULTS: 3270 procedures were included, 1975 correspond to hip arthroplasty (60.4%) and 1295 to knee arthroplasty (39.6%). The number of hip arthroplasty has increased over time, in 2002 a total of 122 procedures were performed and in 2018 there were 164. On the other hand, knee arthroplasty procedures have also increased, from 40 in 2002 to 155 in 2018. The ratio between hip and knee arthroplasty has been decreasing, this finding being significant. The average age has been decreasing in knee arthroplasty, meanwhile, decreasing in hip arthroplasty during the studied period. On the other hand, the proportion of men that underwent hip arthroplasty has been increasing over time. CONCLUSIONS: The number of knee arthroplasty has increased significantly, decreasing its difference with respect to the number of hip arthroplasty. An explosive increase in knee arthroplasty has been described in the literature, consistent with the outcomes of this study, so it seems important to include this procedure the new health public policies.

Assuntos

RESUMO

PURPOSE: To estimate survival curves in patients with hip fracture according to gender, age, type of fracture, and waiting time for surgery and to compare them with the life expectancy of the general population. The study hypothesis is that survival after hip fractures is significantly lower than in the general population, especially in cases that underwent delayed surgery, regardless of age and gender. METHODS: A survival analysis study was designed and approved by our institutional ethics review board. All patients who were coded with a diagnosis of hip fracture from 2002 to 2018 were included in the study. A total of 1176 patients were included, and the median age was 81 years (18-105 years). Kaplan-Meier curves and log-rank tests were performed to compare survival curves between those who underwent surgery on time and those with surgical delays. An exponential multivariate regression model was estimated, and a hazard ratio (HR) was reported for age, gender, and wait time for surgery. A significance of 5% was used, and a confidence interval level of 95% was reported. RESULTS: The Kaplan-Meier curves for delayed surgery (log-rank, p = 0.00) and the age group (log-rank, p = 0.00) were significantly different. Exponential regression estimated an HR 1.05 (1.05-1.07) for age, HR 1.80 (1.51-2.13) for men, and HR 1.93 (1.61-2.31) for each day of wait for surgery. CONCLUSIONS: The 2 significant findings of this study are that hip fracture patients over 40 years old have a higher risk of dying at any time compared to the general population and that the waiting time for surgery (a modifiable factor) decreases survival rates at any time.

Assuntos

RESUMO

Acute septic arthritis is a common clinical problem in emergency departments. Primary meningococcal arthritis (PMA) is very rare and few cases are reported in literature. D. B. M. consulted the emergency department for knee pain and fever; analysis showed that the cause was a Neisseria meningitidis type C infection. He received a treatment consisting of 2 arthroscopies and 5 weeks of antibiotics. At five weeks he returned to work and at 2 months he resumed sports (jogging and soccer) without complaints. Primary arthritis of the knee caused by Neisseria meningitidis is very rare. It has a very good response to antibiotics and arthroscopy procedure. Short-term follow-up and functional results are often good or excellent.

RESUMO

BACKGROUND: Complications related to hip arthroscopy are rare, with a current rate of <2%. Some complications are related to fluid extravasation, which has been associated with life-threatening conditions such as abdominal compartment syndrome, cardiopulmonary arrest, hypothermia, and atelectasis. PURPOSE: To identify risk factors for fluid volume extravasation in hip arthroscopy and to determine the relationship between anatomical location on computed tomography (CT) and extravasated volume. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: We performed a prospective cohort study of 40 consecutive arthroscopies for femoroacetabular impingement. Patient demographics and procedures performed (ie, acetabuloplasty and its size, femoral osteoplasty, and psoas tenotomy) were recorded. The extravasated volume was estimated by the difference between the infused volume and the intraoperatively collected volume. Within 12 hours after the procedure, the pelvis was scanned by CT. We created a 3-stage radiological classification based on progressive involvement of anatomical structures attributed to liquid extravasation. Statistical analyses were performed with a 95% CI and a significance level of 5%. RESULTS: No relevant clinical symptoms related to fluid extravasation were recorded. The mean extravasated volume was 3.06 L at a rate of 1.05 L/h, corresponding to nearly 10% of the infused volume. There was a trend toward greater extravasated volume with longer operative time and longer time in the peripheral compartment (without axial traction); however, there was no statistical significance. The anatomical classification on CT imaging was directly related to the extravasated volume and compromised the thigh, gluteus, and retroperitoneum and intraperitoneal spaces. There was a 6-fold greater probability of female patients having an advanced stage extravasation on CT classification. CONCLUSION: In our series, 10% of the infused volume was extravasated in uncomplicated hip arthroscopy. Risk factors for extravasation were related to operative time, particularly during peripheral compartment intervention (ie, without traction). The anatomical classification proposed in this study reflects the progressive involvement of the thigh, gluteus, iliopsoas, and retroperitoneal and intraperitoneal spaces after increase in extravasated volume. Compared with males, females were associated with more severe anatomical compromise for the same extravasated volume.

RESUMO

Although most primary bone tumors and soft tissue tumors arise around the knee joint, many patients with tumoral conditions attribute their symptoms to traumatic events. This may lead to misdiagnosis and mistakes in selection of therapeutic approach. Arthroscopy is the preferred method for diagnosis and treatment of knee joint disease, but even a minimally invasive procedure may have adverse consequences in the presence of an unsuspected neoplasm. Thus, evaluation of all patients who may benefit from knee arthroscopy requires a careful and systematic workup that consists of appropriate noninvasive imaging studies and thoughtful consideration regarding the need for magnetic resonance imaging. Arthroscopic biopsy and treatment are recommended for selected intra-articular tumors. In addition, arthroscopy is a useful adjunct during surgical treatment of patients with certain juxta-articular benign bone tumors. In this Current Concepts review, we consider the risks and benefits of arthroscopy in the presence of tumors about the knee joint.

Assuntos

RESUMO

Las facturas de cadera constituyen una entidad clínica de gran relevancia cuya incidencia mundial se estimó en 1,6 millones para el año 1990. Es sabido que su mayor prevalencia se asocia con los grupos etarios de mayor edad, constituyendo una patología de gran impacto para la salud de la población tanto por su manejo y costos económicos, como por la elevada tasa de morbilidad asociada y el riesgo de mortalidad inherente (14 a 36 por ciento según distintas series). El crecimiento de la población, avalado en estudios demográficos, revela un envejecimiento poblacional ineludible por lo que es de esperar que a futuro esta patología sea cada vez más frecuente, estimándose para el año 2050 un incidencia global de 6,26 millones de casos. Es por ello que el médico clínico debe estar familiarizado con esta patología y así poder responder a las exigencias del mañana. En esta revisión se analizan los aspectos más importantes en el manejo clínico de esta entidad, a saber, consideraciones anatómicas, factores de riesgo, clasificación y tratamiento poniendo especial énfasis en los factores predictores sobre los cuales se podrá actuar en forma preventiva

Assuntos

Assuntos

Assuntos

Assuntos