RESUMO

The indication of shoulder arthroplasties has increased progressively. Accurate positioning of the components may have significant implications for clinical results. The navigation used to aid in the performance of anatomical and reverse total arthroplasties has provided greater precision in implant placement, especially on the glenoid. The development of the technique, material, and prosthesis design have shown encouraging results and led to a trend toward its expansion. In this way, we estimate a higher survival of the arthroplasties resulting from lower rates of dislocation and early loosening. We aim to describe the current technique and to present the results of the literature with navigation. However, comparative clinical studies with long term follow-up are necessary to prove the efficacy in the final results of total shoulder arthroplasties.

RESUMO

Abstract The indication of shoulder arthroplasties has increased progressively. Accurate positioning of the components may have significant implications for clinical results. The navigation used to aid in the performance of anatomical and reverse total arthroplasties has provided greater precision in implant placement, especially on the glenoid. The development of the technique, material, and prosthesis design have shown encouraging results and led to a trend toward its expansion. In this way, we estimate a higher survival of the arthroplasties resulting from lower rates of dislocation and early loosening. We aim to describe the current technique and to present the results of the literature with navigation. However, comparative clinical studies with long term follow-up are necessary to prove the efficacy in the final results of total shoulder arthroplasties.

Resumo A indicação de artroplastias do ombro aumentou progressivamente. O posicionamento preciso dos componentes pode ter implicações significativas para os resultados clínicos. A navegação utilizada para auxiliar no desempenho de artroplastias totais anatômicas e reversas tem proporcionado maior precisão na colocação do implante, especialmente do componente glenoidal. O desenvolvimento da técnica, do material e do desenho da prótese têm mostrado resultados encorajadores e levado a uma tendência de expansão da sua utilização. Dessa forma, estimamos uma maior sobrevida das artroplastias resultantes de menores taxas de instabilidade e soltura precoce. Nosso objetivo é descrever a técnica atual e apresentar os resultados da literatura com navegação. No entanto, estudos clínicos comparativos com acompanhamento de longo prazo são necessários para comprovar a eficácia nos resultados finais das artroplastias totais do ombro.

Assuntos

RESUMO

Objective: To assess pain, stiffness and physical function outcomes among patients undergoing total hip replacement using the Western Ontario and McMaster Universities Osteoarthritis Index. Methods: From January 2009 to July 2010, 64 male and female patients were assessed using the WOMAC questionnaire at baseline, hospital discharge, 3-month follow-up, and 6-month follow-up; one group of patients with primary hip osteoarthritis (n = 42) and another group with hip fracture (n = 22). Results: Changes in the total scores of the osteoarthritis group were statistically significant comparing baseline, hospital discharge, 3-month and 6-month assessments, demonstrating continued improvement over time up to 6-month follow-up. The total scores of the hip fracture group demonstrated a worsening from baseline to discharge, followed by improvement. The differences were statistically significant between baseline and discharge, as well as between discharge and the 6-month assessment. No statistically significant differences were found between baseline values and the 3-month assessment or baseline values and the 6-month assessment, demonstrating that the patients returned to their baseline health status after 3 months and maintained this status up to 6-month follow-up. Conclusion: The Western Ontario and McMaster Universities Osteoarthritis Index questionnaire detected changes in outcome following hip replacement surgery among patients with primary diagnoses of hip osteoarthritis and hip fracture, with differences in the pattern of changes between the two groups.

Objetivo: Avaliar resultados referentes a dor, rigidez e função física de pacientes submetidos à artroplastia total de quadril utilizando o questionário Western Ontario and McMaster Universities Osteoarthritis Index. Métodos: De Janeiro de 2009 a Julho de 2010, 64 pacientes homens e mulheres foram avaliados utilizando o questionário WOMAC no momento pré-operatório, na alta hospitalar, com 3 meses e 6 meses de seguimento; um grupo de pacientes com osteoartrite primária de quadril (n = 42) e outro grupo com fratura de quadril (n = 22). Resultados: Mudanças nos escores totais do rupo de osteoartrite foram estatisticamente significantes comparando-se a avaliações de pré-operatório, alta hospitalar, com 3 meses e 6 meses, demonstrando melhora contínua com o decorrer do tempo até o seguimento de 6 meses. Os escores totais para o grupo com fratura de quadril demonstraram uma piora entre o momento pré-cirúrgico e a alta, seguida por uma melhora nos demais seguimentos. As diferenças foram estatisticamente significantes entre o pré-operatório e a alta, assim como entre a avaliação da alta e de 6 meses. Não houve diferença estatisticamente significante entre a avaliação pré-operatória e a de 3 meses ou entre a avaliação préoperatória e a de 6 meses, demonstrando que os pacientes retornaram ao seu estado de saúde pré-cirúrgico após 3 meses, mantendo esse estado até 6 meses de seguimento. Conclusão: O questionário Western Ontário and McMaster Universities Osteoarthritis Index detectou mudanças após a cirurgia entre os pacientes com diagnóstico primário de osteoartrite de quadril e fratura de quadril, com diferenças nos padrões de mudança entre os dois grupos.

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OBJECTIVE: To present the surgical technique for the He-miCAP-Arthrosurface(®) system and evaluate our results from this technique for treating primary and/or secondary shoulder osteoarthrosis. METHOD: Between June 2007 and June 2009, 10 shoulders of 10 patients (nine with primary osteoarthrosis and one with avascular necrosis of the humeral head) underwent surface arthroplasty using the HemiCAP-Arthrosurface(®) system to correct the problem. The follow-up time ranged from six to 29 months (mean of 17 months). The patients' ages ranged from 62 to 73 years (mean of 67.5 years). Six patients were female and four patients were male. The patients were followed up weekly for the first month after the surgical procedure and every three months thereafter. The clinic evaluation was done using the criteria of the University of California at Los Angeles (UCLA) and a visual analogue pain scale. RESULTS: All the patients said that they were satisfied with the results from the surgical treatment, with a mean UCLA score of 30 points and a mean analogue pain score of two points. CONCLUSION: The HemiCAP-Arthrosurface(®) system for shoulder surgery for a specific group of patients is a technique that preserves the bone stock with good functional and antalgic results.

RESUMO

PURPOSE: Treating arthrosis in the base of the thumb has been a highly controverted subject. Many surgeries have been described, such as the isolated trapezium resection; resection with interposition with and without ligament plasty; arthrodesis, and arthroplasties. The purpose of this paper is to compare the two techniques which are currently the most used in this treatment. METHODS: A prospective study has been made to compare the surgical results between the trapezium resection with tendon interposition (tenoarthroplasty) - 22 cases - and tenoarthroplasty associated to ligament plasty-24 cases. Objective evaluation was done by measuring opponence, movements of the metacarpophalangeal joint, pinch and grasp strength, radiographic measurement of the distance between the base of first metacarpal and the scaphoid, and measurement of the angle between the first and the second metacarpals. Subjective evaluation was done with a DASH questionnaire, visual analog scale to evaluate pain and patient satisfaction. RESULTS AND CONCLUSION: After application of the criteria described and using Student 't' tests for statistical analysis, the authors concluded that the ligament reconstruction has no advantage over the simple resection and tendon interposition in carpometacarpal arthrosis of the thumb.