Isokinetic dynamometry in elderly women undergoing total knee arthroplasty: a comparative study

OBJETIVO: O presente estudo avaliou a dinamometria isocinética na determinação qualitativa da evolução da artroplastia total do joelho. CASUÍSTICA E MÉTODO: Vinte pacientes com média de 71, 35 anos, submetidas a artroplastia de joelho e 25 controles com média de 71,36 anos. Foi utilizada avaliação isocinética computadorizada para os músculos flexores e extensores dos joelhos num dinamômetro marca CYBEX® 6000. RESULTADOS: A análise estatística dos valores da relação entre o trabalho total flexor e extensor não demonstrou diferenças significativas entre o lado operado das pacientes e o lado não dominante das voluntárias. A relação flexão/extensão do torque máximo demonstrou uma diferença significativa entre o lado operado das pacientes e o lado não-dominante das voluntárias. CONCLUSÃO: Por detecção de deficiências do equilíbrio dos músculos flexores e extensores (equilíbrio este necessário para uma marcha uniforme), poderão ser enfatizados exercícios de reabilitação específicos conforme a necessidade de cada paciente operada.

Osteotomia valgizante de tíbia com placa calço de Puddu combinada com a reconstrução do ligamento cruzado anterior do joelho / Valgus osteotomy of the tibia with a Puddu plate combined with anterior cruciate ligament reconstruction

Anterior knee instability associated with a varus deformity is a complex condition with several treatment possibilities. Among these, anterior cruciate ligament (ACL) associated to a simultaneous valgus tibial osteotomy is a increasing indication. This simultaneous procedure adds technical issues to those related to the isolated surgeries. Thus, the osteotomy plane and location of fixation hardware shouldnÆt conflict with tibial tunnel and ACL graft fixation. Authors analyze the relations between a opening tibial valgus osteotomy stabilized with a Puddu plate and ACL reconstruction with a patellar tendon graft fixated with interference screws in 10 human cadaver knees. A straight oblique tibial osteotomy starting on the medial tibial cortex and oriented laterally and proximally was performed on all knees with a 10mm opening medially and stabilized with a Puddu plate on the most posterior aspect of the medial tibia, and a tibial tunnel drilled 50° to tibial plateau. With this technique there was no intersection between tibial tunnel or interference screw and the osteotomy or the plate fixation screws.

Dinamometria isocinética em idosas: estudo comparativo entre pacientes submetidas a artroplastia total do joelho e mulheres sem afecções do sistema músculo-esquelético / Isokinetic dynamometry in elder women: a comparative study involving patients submitted to total knee arthroplasty and women with no history of musculoskeletal disorders

Comparamos, através de uma avaliação isocinética concêntrica, o torque dos músculos flexores e extensores dos joelhos de 20 pacientes portadoras de osteoartrose submetidas a artroplastia total unilateral do joelho com o de voluntárias. A faixa etária foi entre 65 e 75 anos. O estudo foi realizado na velocidade angular de 60º/s. Os parâmetros avaliados foram: torque máximo, trabalho total e relação flexão/extensão do torque máximo e trabalho total. Concluímos que a dinamometria isocinética é um método fidedigno de avaliação muscular e que, em relação aos valores isocinéticos, o lado contralateral não é um bom parâmetro de comparação nas pacientes submetidas a artroplastia total do joelho.Using concentric isokinetic assessment, this study compared the knee flexor/extensor muscular strength in 20 patients with osteoarthritis submitted to unilateral total knee arthroplasty to women volunteers. The patients’ age varied from 65 to 75 years old. The angular velocity was 60º/s. The parameters evaluated were: peak torque, total work, flexor/extensor torque rate. We concluded that the isokinetic dynamometry is a reliable method of muscle assessment, and it can be used in clinical trials including patients submitted to total knee arthroplasty. In addition, regarding isokinetic values, the contralateral side is not a good parameter to compare patients submitted to this kind of procedure...

Isokinetic assessment of knee flexor/extensor muscular strength in elderly women

OBJECTIVE: To assess knee flexor-extensor muscular strength in elderly women with no previous history of musculoskeletal disorders on the lower limbs using an isokinetic dynamometer, in order to obtain data that could be used as a comparative parameter in the evaluation of elderly women with knee disorders, thus facilitating a better rehabilitation of these patients. METHODS: Twenty-six volunteers aged 75 to 83 years were studied using a Cybex® 6000 isokinetic dynamometer. The chosen angular velocity was 60 º/s, and concentric exercise was used for either flexion or extension. The studied parameters were: peak torque, angle of peak torque, and flexor-extensor torque rate. RESULTS: There were no differences between dominant (D) and nondominant (ND) knee peak torque values. This was true for both flexor (D = 42.46 ± 9.09 Nm / ND = 40.65 ± 9.38 Nm) and extensor (D = 76.92 ± 13.97 Nm / ND = 77.65 ± 15.21 Nm) movements. The descriptive statistical analysis of the values obtained for the flexor-extensor peak torque rate and for the angle of occurrence of peak torque was the same for the dominant and nondominant sides. CONCLUSIONS: The values of peak torque for the contralateral side can be used as a reference during rehabilitation of elderly women with acute disease of the knee, and the angular velocity of 60 º/s is proper and safe for isokinetic assessment of elderly people

Trombose venosa profunda em artroplastia total de quadril / Deep venous thrombosis in total hip arthroplasty

Total hip arthroplasty is a common surgical procedure in a population with the organic frailty of aging. Deep venous thrombosis and pulmonary thromboembolism are the more common and dangerous complications of this procedure. Therefore, surgeon knowledge of diagnosis, prevention and treatment of these complications is mandatory both technically and ethically. The authors make a descriptive and critical revision of the literature regarding the most recent acquisitions in diagnosid, prevention, and treatment of these complications