Enquanto a cirurgia não chega: a experiência dos pacientes na fila de espera de Artroplastia total de quadril / While the surgery does not come: the experience of the patients waiting for Total Hip Arthroplasty

Este estudo tem como objetivo geral conhecer o significado que tem para a pessoa a experiência de aguardar na fila de Artroplastia total de quadril. E como objetivos específicos: analisar o significado que tem para a pessoa a experiência de aguardar na fila de Artroplastia total de quadril e propor um plano de cuidado de enfermagem para assistir o paciente que se encontra na fila baseado na teoria de enfermagem de Joyce Travelbee. Estudo do tipo descritivo com abordagem qualitativa, aprovado pelos Comitês de Ética em Pesquisada UERJ e da Instituição campo de coleta de dados, com os seguintes pareceres: CAAE 79594817.8.0000.5282 e 79594817.8.3001.5273, respectivamente. Foi desenvolvido em um Instituto especializado em traumatologia e ortopedia na cidade do Rio de Janeiro com 17 participantes, sendo sete mulheres e dez homens, na faixa etária de 31 a 80 anos. A coleta de dados ocorreu nos meses de março e abril de 2018, onde foram realizadas as entrevistas no referido Instituto. Para tratamento dos dados, utilizou-se a análise de conteúdo delineada por Bardin, emergindo quatro categorias e seis subcategorias: I- Minha vida antes do comprometimento articular; II- Mudanças na vida frente à limitação articular (Limitações físicas que causam restrição na vida; Modificações na rotina após a doença e Limitações socioafetivas geradas pela doença); III- Sentimentos vivenciados enquanto a cirurgia não vem (Sentimentos vivenciados ao receber o diagnóstico cirúrgico; Sentimentos vivenciados enquanto espera pela cirurgia e Sentimentos vivenciados pelo paciente quando ele é chamado para realizar a cirurgia); IV- Recursos utilizados para gerenciamento dos efeitos da doença enquanto a cirurgia não vem (Família como rede de apoio; Crença religiosa como suporte frente à espera e Busca de tratamentos para amenizar os efeitos da doença). Análise dos resultados se deu à luz da teoria de enfermagem de Joyce Travelbee. Os principais resultados evidenciam que os pacientes precisaram aguardar de 3 a 10 anos pela cirurgia e esse tempo os afetou tanto física quanto psicologicamente, com a piora da dor, aumento das limitações físicas, afastamento do convívio social e prejuízo emocional, trazendo implicações para o cuidado de enfermagem sob a ótica da teoria de Joyce Travelbee. Conclui-se que o tempo de espera prolongado pode afetar integralmente a saúde do paciente, sendo necessário criar estratégias como um acompanhamento por telemonitoramento com vistas a acolher as demandas desses pacientes durante o tempo de espera, favorecendo assim, a redução de danos à saúde.

This study has as general purpose to know the meaning that has for the person the experience of waiting for Total hip arthroplasty. And as specific goals: to analyze the meaning that has for the person the experience of waiting for Total hip arthroplasty and to propose a nursing care plan to assist the patient who is waiting for surgery based on the nursing theory of Joyce Travelbee. It s a descriptive study with a qualitative approach, approved by the Research Ethics Committees UERJ and the Institution data collection field, with the following opinions: CAAE 79594817.8.0000.5282 and 79594817.8.3001.5273, respectively. It was developed in an Institute specialized in traumatology and orthopedics in the city of Rio de Janeiro with 17 participants, being seven women and ten men, in the age group of 31 to 80 years. The data collection took place in March and April of 2018, where the interviews were held at the mentioned Institute. For the data treatment, the content analysis outlined by Bardin was used and four categories and six subcategories emerged: I- My life before the joint involvement; II- Changes in life in the face of joint limitation (Physical limitations that cause restriction in life; Modifications in routine after illness and Socio-affective limitations generated by the disease); III- Feelings experienced while surgery does not come (Experienced feelings when receiving the surgical diagnosis; Feelings experienced while waiting for surgery and Feelings experienced by the patient when he is called to perform the surgery); IV- Resources used to manage the effects of the disease while the surgery does not come (Family as a support network; Religious belief as support in front of waiting and Search for treatments to mitigate the effects of the disease). Analysis of the results was given in light of the nursing theory of Joyce Travelbee. The main results show that patients had to wait from 3 to 10 years for surgery and this time affected them both physically and psychologically, with worsening of pain, increased physical limitations, withdrawal from social life and emotional impairment, with implications for care from the perspective of Joyce Travelbee theory. It is concluded that prolonged waiting time can affect the patient's health, and it is necessary to create strategies such as telemonitoring to meet the demands of these patients during the waiting time, thus favoring the reduction of health damage.

Clinical Results of Lateral Unicompartmental Knee Arthroplasty: Minimum 2-Year Follow-up

BACKGROUND: We investigated the clinical results and early complications after lateral unicompartmental knee arthroplasty (UKA) using the Zimmer unicompartmental high-flex knee (ZUK) prosthesis with a minimum follow-up of 2 years. METHODS: Twenty-seven patients (30 cases) who underwent lateral UKA with the ZUK prosthesis between January 2011 and February 2014 were selected for this study. The mean age of the patients was 63.3 years at the time of surgery, and the mean follow-up was 3 years and 2 months (range, 24 to 48 months). A retrospective investigation method was used to evaluate the clinical and radiographic results with use of the Knee Society (KS) clinical rating system and plain radiography. RESULTS: The mean KS pain score was improved from 17.9 points (range, 10 to 30 points) preoperatively to 40.5 points (range, 30 to 45 points) at the final follow-up (p < 0.001). The mean KS knee score and function score significantly increased from 63.2 points (range, 48 to 70 points) and 68.6 points (range, 35 to 80 points), respectively, preoperatively to 86.0 points (range, 74 to 95 points) and 92.4 points (range, 60 to 100 points), respectively, at the final follow-up (p < 0.001). The mean range of motion of the knee was recovered from 127.1° (range, 110° to 135°) preoperatively to 131.6° (range, 120° to 135°) at the final follow-up. The mean tibiofemoral angle changed from 6.2° of valgus (range, 0.1° to 11.4° of valgus) preoperatively to 3.4°of valgus (range, 0.2° to 9.5° of valgus) at the final follow-up. The overall results classified based on the KS knee score were "excellent" in 21 cases and "good" in 8 cases. Revision total knee arthroplasty was required in one case because of consistent pain on the medial side of the knee after surgery. CONCLUSIONS: The early clinical results of lateral UKA using the ZUK prosthesis were satisfactory for improvement of pain, knee score, function score, and recovery of knee motion. Therefore, the lateral UKA could be a useful method in the treatment of osteoarthritis in the lateral compartment of the knee. Long-term survivorship remains to be confirmed through ongoing follow-up.

The effects of sonication on human osteoarthritis cartilage in ex vivo tissue culture / 대한정형외과연구학회지

This study was initiated to investigate the effect of ultrasound(US) stimulation on therapeutic effects on human osteoarthritic cartilage repair. Cartilage explants from human osteoarthritic knee were sonicated for 10 minutes every day using continuous wave at frequency 1 MHz US signals with spatial and temporal average intensities of 0, 40, 200, 500 and 700mW/cm2. One group of explants was exposed to sham ultrasound as a control. After 1 week of culture, the intensity-dependent effects of US on DNA, proteoglycan (PG) and collagen synthesis were measured by 3H-thymidine, 35S-sulfate, 3H-proline incorporation, respectively. The expression of PG and type II collagen released into medium were measured by DMB (dimethylmethylene blue) method and western blot analysis. Safranin O/fast green and immunohistochemical staining with anti-collagen type II antibody were performed using the serial sections of cartilage explants. The histochemical examination showed that the expression of PG at the pericellular area in the deep layer increased continuously up to 700mW/cm2. In contrast, the depth of the superficial layer significantly decreased after treatment of sonication at 500 and 700mW/cm2. The expression of PG and type II collagen assessed by the isotope incorporation was significantly enhanced to the level up to 140%, 120% respectively, although US had no stimulatory effect on cell proliferation. These results suggest that optimum intensity of US for the effective expression of extracellular matrix in osteoarthritic cartilage may be around 200mW/cm2. In conclusion, our study suggests the possibilities that sonication may be therapeutically utilized for the repair of human osteoarthritic cartilage.