Conservative management of knee arthropathy in a patient with Klippel Trenaunay syndrome / Manejo conservador da artropatia do joelho em paciente com síndrome de Klippel-Trenaunay

Abstract Klippel-Trenaunay syndrome (KTS) is a rare vascular malformation characterized by capillary malformation, venous malformations, and soft tissue or bone hypertrophy that affect the extremities in most cases. Knee or hip arthropathy are common associated conditions and cause serious disability. We present the case of a patient with a diagnosis of KTS and severe knee arthropathy. A 34-year-old man with KTS was referred to our hospital with severe knee arthropathy, with the joint fixed in a 90° position. CT Angiography and MRI of the left leg showed important varicose development of the superficial venous system with intraarticular vessels. After discussion of the case by a multidisciplinary committee, the patient was enrolled on a physiotherapy program and had achieved significant improvements in movement and quality of life at 12-month follow-up. Treatment of KTS is primarily conservative and a multidisciplinary approach is necessary.

Resumo A síndrome de Klippel-Trenaunay (SKT) é uma malformação vascular rara caracterizada por malformação capilar, malformações venosas e hipertrofia de tecidos moles ou ósseos que afetam as extremidades na maioria dos casos. A artropatia do joelho ou do quadril é uma condição comumente associada e causa sérias deficiências. Apresentamos o caso de um paciente com diagnóstico de SKT e artropatia grave do joelho. Um homem de 34 anos com SKT foi encaminhado ao nosso hospital com artropatia grave do joelho com articulação fixa na posição de 90 °. A angiotomografia e a ressonância magnética da perna esquerda mostraram importante desenvolvimento varicoso do sistema venoso superficial com vasos intra-articulares. Após o caso ser discutido em um comitê multidisciplinar, o paciente foi incluído em um programa de fisioterapia, obtendo uma melhora significativa nos movimentos e na qualidade de vida após 12 meses de acompanhamento. O tratamento da SKT é principalmente conservador e exige uma abordagem multidisciplinar.

Efectividad de la reflexología podal en pacientes con artrosis cervical / Effectiveness of podal reflexology in patients with cervical osteoarthritis

Se realizó una intervención terapéutica en 118 pacientes con artrosis cervical, atendidos en el Servicio de Rehabilitación Integral del Hospital Clinicoquirúrgico Docente Dr Joaquín Castillo Duany de Santiago de Cuba, desde julio de 2013 hasta diciembre de 2014, para evaluar la efectividad de la reflexología podal como modalidad de tratamiento. La muestra fue dividida en 2 grupos (de estudio y control), de 54 integrantes cada uno, pareados por edad y sexo. En ambos grupos, el mayor número de afectados superó los 50 años de edad; asimismo, poco más de dos tercios de los individuos seleccionados mejoraron a los 7 días de evolución y en tan solo 3 sesiones de tratamiento, hasta la resolución definitiva a los 21 días (9 sesiones). Se registró una reacción adversa y se concluyó que esta terapia garantiza una mejoría significativa de los síntomas, de ahí su elevada efectividad, sin consumo excesivo de tiempo

A therapeutic intervention in 118 patients with cervical osteoarthritis was carried out. They were assisted in the Comprehensive Rehabilitation Service of Dr Joaquín Castillo Duany Teaching Clinical Surgical Hospital in Santiago de Cuba, from July, 2013 to December, 2014, to evaluate the effectiveness of podal reflexology as a treatment modality. The sample was divided in 2 groups (study group and control group), of 54 members each, paired by age and sex. In both groups, the highest number of affected patients were over 50 years; also, a little more than two thirds of the selected individuals improved at 7 days of the clinical course and with only 3 treatment sessions, until the definitive resolution at 21 days (9 sessions). An adverse effect was registered and it was concluded that this therapy guarantees a significant improvement of symptoms, so its high effectiveness, without excessive consumption of time

Alcaptonúria (ocronose): relato de caso de irmãos / Alkaptonuria (ochronosis): a case report of siblings

A Alcaptonúria é uma doença autossômica recessiva rara caracterizada pelo acúmulo de ácido homogentísico. Denomina-se também ocronose e manifesta-se por pigmentação azulada de tecidos orgânicos e urina enegrecida, além de artropatia. A seguir, será relatado o caso de irmãos portadores de artropatia ocronótica e a conduta ortopédica (AU)

Alkaptonuria is a rare autosomal recessive disease characterized by the accumulation of homogentisic acid. It is also called ochronosis and is manifested by bluish pigmentation of organic tissues and blackened urine, besides arthropathy. Here the authors report the case of siblings with ochronotic arthropathy and the orthopedic management (AU)

Uso do plasma rico em plaquetas no tratamento da doença articular degenerativa em cão: relato de caso / Use of platelet-rich plasma in the treatment of degenerative joint disease in dog: case report / Uso de plasma rico en plaquetas en el tratamiento de la enfermedad degenerativa de las articulaciones en perro: relato de caso

No presente trabalho é descrito o uso do plasma rico em plaquetas (PRP) no tratamento de um caso de osteoartrose naturalmente adquirida em um cão. O PRP foi obtido a partir de sangue venoso autólogo coletado em citrato de sódio. A separação do precipitado celular do sobrenadante foi realizada de forma estéril. Após adição de cloreto de cálcio e liberação dos fatores de crescimento, o PRP foi infiltrado no joelho do animal em estudo. Após o tratamento, os parâmetros de apoio, crepitação e dor articular apresentaram melhora, não havendo intolerância do animal à infiltração. Preliminarmente, pode-se dizer que é esta é uma técnica minimamente invasiva e de alta aplicabilidade. O emprego do PRP para infiltração mostrou ser simples, rápido, barato e seguro para o tratamento da osteoartrose no animal em questão. Estudos com maior número de casos em cães são necessários, a fim de validar este procedimento como prática terapêutica na rotina clínica...

The use of platelet-rich plasma (PRP) in the treatment of a natural case of osteoarthrosis in a dog is reported in the present work. The PRP was obtained through autologous venous blood collected in sodium citrate. The cellular precipitate was separated from the supernatant in a sterile condition. After the addition of calcium chloride and the release of growth factors, the PRP was infiltrated in the knee of the dog under study. After the treatment, weight-bearing, crackle and joint pain parameters presented improvement without intolerance to the infiltration by the animal. Preliminarily, it can be concluded that this is a minimally invasive method with high applicability, as well as being simple, quick, cheap and safe for the treatment of degenerative joint disease to the described animal. The study of a larger number of cases in dogs is necessary in order to validate the procedure for clinical routine...

En este estudio se ha descrito el uso del plasma rico en plaquetas (PRP) en el tratamiento de un caso de osteoartritis, adquirido naturalmente por un perro. El PRP ha sido obtenido a partir de la sangre venosa autóloga recogido en citrato de sodio. La separación del precipitado celular del sobrenadante se ha realizado de forma estéril. Después de la adición de cloruro de calcio y liberación de los factores de crecimiento, el PRP ha sido infiltrado en la rodilla del animal en estudio. Tras el tratamiento, los parámetros de apoyo, crepitación y dolor articular presentaron mejora, no ocurriendo intolerancia del animal a la infiltración. Preliminarmente, se puede decir que esta es una técnica poco invasiva y de alta aplicabilidad. El empleo del PRP para infiltración ha mostrado ser sencillo, rápido, barato y seguro para el tratamiento de osteoartritis en el animal estudiado. Estudios con mayor número de casos en perros son necesarios, para que se pueda validar este procedimiento como práctica terapéutica en la rutina clínica...

Viscossuplementação em pacientes com artropatia hemofílica / Viscosupplementation in patients with hemophilic arthropathy

Objetivo: Avaliar se a viscossuplementação com ácido hialurônico em pacientes com artropatia hemofílica grave associada com triancinolona após a lavagem articular com soro fisiológico melhora a dor, a rigidez, a função e a qualidade de vida. Métodos: Onze pacientes com artrite hemofílica de joelhos com e sem acometimento de outras articulações (tornozelos e cotovelos) foram submetidos a lavagem articular com soro fisiológico e subsequente infiltração de hilano e triancinolona em todas as articulações acometidas. Responderam os questionários algo-funcionais (WOMAC e Lequesne), escala analógica visual para dor (VAS) e SF-36, no pré-operatório, e com um e três meses de pós-operatório. Resultados: A dor (VAS e WOMAC dor) e a rigidez (WOMAC rigidez) não apresentaram melhora significativa (p=0,3; p=0,2; p=0,1, respectivamente). Porém a função apresentou uma melhora significativa dada pelo WOMAC função e total (11 pontos em média, p=0,04 e p=0,001, respectivamente). A pontuação no questionário de Lequesne não variou significativamente (p=0,1). Porém tantos os componentes mental como físico do SF 36 tiveram melhoras clinicamente relevantes e significativas (p=0,002). Conclusão: A lavagem articular com soro fisiológico seguida pela infiltração de corticosteroide e hilano é efetiva no tratamento da artropatia hemofílica, sobretudo na melhora funcional e na qualidade de vida. Nível de Evidência IV, Série de casos.

Objective: To assess whether viscosupplementation with hyaluronic acid in patients with severe hemophilic arthropathy associated with triamcinolone after washing with saline improves joint pain, stiffness, function and quality of life. Methods: Eleven patients with hemophilic arthritis of the knee with and without involvement of other joints (elbows and ankles) underwent joint lavage with saline and subsequent injection of Hylan and triamcinolone in all affected joints. The patients answered the algo-functional (Lequesne and WOMAC), visual analog scale for pain (VAS) and SF-36 (quality of life) questionnaires preoperatively, and at one and three months postoperatively. Results: Pain (VAS and WOMAC pain) and stiffness (WOMAC stiffness) did not show significant improvement (p = 0.3, p = 0.2, p = 0.1, respectively). However function had significant improvement given by WOMAC total and function (averaging 11 points, p = 0.04 and p = 0.001). There was no significant variation in scores in Lequesne’s questionnaire (p = 0.1), yet both mental and physical components of SF-36 presented clinically relevant and significant improvements (p = 0.002). Conclusion: Joint lavage with saline followed by injection of corticosteroids and Hylan is effective in the treatment of hemophilic arthropathy, especially in functional improvement and quality of life. Level ofEvidence IV, Case series.

Treating a Disease vs. Understanding a Disease

No abstract available.

Enxerto estruturado no tratamento das perdas ósseas femorais em artroplastias de quadril infectadas / Structural allograft in the treatment of femoral bone loss in infected hip arthroplasty

Foram submetidos ao tratamento em dois tempos cirúrgicos 17 pacientes com infecções crônicas em próteses de quadril e perda óssea circunferencial do fêmur proximal, consistindo da realização, no primeiro tempo, da retirada dos componentes e materiais infectados e colocação de espaçador de cimento com vancomicina e, no segundo tempo, da reconstrução do estoque ósseo com enxerto maciço da região proximal do fêmur e fixação da prótese através de hastes longas cimentadas ao enxerto e cimentas (dez hastes) ou não (sete hastes) no fêmur hospedeiro. Após nove anos de seguimento, em média (mínimo de sete anos), apenas um caso evoluiu com recidiva infecciosa. Todos os enxertos apresentaram sinais de consolidação radiográfica com o osso hospedeiro. Não houve solturas dos componentes femorais. Funcionalmente os pacientes melhoraram, embora a maioria deambule com marcha de Trendelemburg. O enxerto maciço de fêmur proximal se apresentou como uma técnica segura e reprodutível para o tratamento das falhas ósseas após artroplastia infectada de quadril.

Treatment of pathological synovial plicae of the knee

OBJECTIVE: To analyze the incidence, clinical significance, and clinical manifestations of pathological synovial plicae of the knee. MATERIAL AND METHODS: Between 2002 and 2006, 63 patients with pathological synovial plicae of the knee were studied. Of those 63 patients, 21 had the diagnosis confirmed by previously performed magnetic resonance imaging. All of the patients initially underwent conservative treatment for 90 days that involved strengthening and improving the flexibility of the muscles surrounding the knee as well as modification of their sports activities. RESULTS: A total of 55 patients improved after conservative treatment. Six of these patients eventually experienced a recurrence of symptoms, but the symptoms were not incapacitating in any of these patients. The other eight patients underwent arthroscopic removal of the synovial plica. Of these eight patients, six returned to their pretreatment physical activities, and two had persistent symptoms during physical activity. CONCLUSION: The presence of a synovial plica of the knee should be considered as a potential diagnosis in patients with knee pain, especially those who practice sports inappropriately. Conservative treatment is effective in most cases, and surgical treatment should be reserved for exceptional cases that do not improve with conservative treatment.

Pellizcamiento fémoroacetabular parte II: tratamiento / Femoroacetabular impingement part II: treatment

El pellizcamiento fémoroacetabular (PFA) es un sindrome clínico reconocido como fuente de dolor mecánico de cadera y artrosis primaria temprana que se presenta frecuentemente en pacientes jóvenes. El tratamiento de esta patología se encuentra enfocado al manejo sintomático, corrección de las alteraciones óseas asociadas, y la prevención de la eventual progresión a la degeneración osteoarticular. El manejo médico se plantea como una primera opción terapéutica para el alivio sintomático. La infiltración articular es una opción diagnóstica y de tratamiento mínimamente invasiva. Finalmente diversas opciones quirúrgicas han sido desarrolladas para la corrección y reparación de las alteraciones morfológicas. Tradicionalmente se ha manejado de forma segura y efectiva con la luxación controlada de cadera logrando resultados promisorios a corto y mediano plazo. Técnicas artroscópicas menos invasivas son cada vez más utilizadas buscando obtener resultados comparables a la técnica abierta.

The femoroacetabular impingement (FAI), it is a clinical syndrome recognized as source of hip mechanic pain and early osteoarthritis (OA). This pathology is frequent in young patients. Treatment is focused in a symptomatic relief, correction of osseous abnormalities and the prevention of the eventual progression to osteoarticular degeneration. Non invasive medical treatment has been proposed for the symptomatic management. Joint infiltration is a diagnostic and minimally invasive treatment option. Finally multiple surgical options have been developed for the correction and repair of morphologic abnormalities. Traditionally, FAI has been managed safely and effectively by hip dislocation and had promising early and midterm results. Less invasive arthroscopic techniques are now being used to an increasing extent in order to emulate the results of the open technique.

Osteoarticular complications related to HIV infection and highly active antiretroviral therapy

With the significant increase in life expectancy for HIV-infected patients in the era of high potency antiretroviral therapy, major metabolic changes have been observed due to the prolonged period of the viral infection and the treatment itself. Osteoarticular changes resulting from these processes are mainly reported in long term HIV-infected patients receiving high potency antiretroviral therapy and include osteopenia/osteoporosis, osteonecrosis, carpal tunnel syndrome and adhesive capsulitis of the shoulder.

Arthrographic distension of the shoulder joint in the management of frozen shoulder.

The study was an open randomized controlled trial to compare the outcome at 8 weeks with two different modalities in the treatment of 'Frozen shoulder'. Clinical cases with painful limitation of movement of shoulder were randomized to receive physical therapies alone versus physical therapies and shoulder arthrography with intra-articular steroid in a sequential randomization process. Cases suspected of having a concomitant illness and has potential to cause secondary frozen shoulder were excluded, such as, history of trauma to shoulder over the last 6 months, symptomatic clinical cervical degenerative diseases, and causes in and around the shoulder (infective and non-infective). Physical Therapies provided to all patients were therapeutic exercises, transcutaneous electrical nerve stimulation (TENS) and infra-red radiation (IRR). Outcome measures were improvement of pain on a Visual Analogue Scale (VAS) score and range of motion measured by Goniometer at 8 weeks. Patients were followed weekly for 8 weeks and outcome parameters were recorded on every evaluation. The baseline range of motion in the two groups was comparable. At 8 weeks a statistically significant difference in outcome were observed in the two groups. The chi-square means difference of improvement in range of motion for abduction was p <0.00 and for external rotation was p <0. 00. The pain reduction on VAS score was not significant in the two groups (p <0. 40). In the present small series, the distension arthrography with intra-articular (IA) steroid plus physical therapy was superior over physical therapy alone in the functional improvement of the frozen shoulder. Further studies with larger sample size are required to confirm the observations.

Guias para el manejo de las infecciones osteoarticulares por Staphylococcus meticilino-resistente / [Guidelines for the management of bone and joint infections due to methicillin resistant staphylococci]

Bone and joint infections are a group of complicated diseases with high morbidity. Emerging resistant microorganisms and the use of prosthetic devices have increased the difficulty in the medical treatment of patients. The purpose of these guidelines is to offer information on the management of bone and joint infections (post-invasive septic arthritis, chronic osteomyelitis and infected arthroplasty) produced by methicillin resistant staphylococci. They are oriented to physicians dedicated to internal medicine, infectious diseases, trauma and orthopedist surgeons as well as to everybody interested in this issue. The guidelines mainly point to the rational use of diagnostic methods and describe the new treatment modalities. A group of experts analyzed the different strategies for diagnosing and treating bone and joint infections due to methicillin resistant staphylococci and attempted at setting a level of evidence level and the strength of each recommendation.

Ombro doloroso / Painful shoulder

Os autores chamam atençäo neste trabalho para observaçöes importantes: o tempo de onício da doença e o seutratamento imediato säo de grande valor na recuperaçäo total do paciente; beneficia-se aquele que procura os recursos nos primeiros 15 dias. Quanto mais cedo iniciarmos o tratamento, melhores seräo os resultados;a doença pode ser totalmente reversível quando bem diagnosticada e tratada; a crioterapia, a infiltraçäo articular bem-feita e o repouso podem ser os únicos métodos de tratamento na fase inicial; a fisioterapia éfundamental na fase crônica para restabelecimento dosmovimentos, desaparecimento da dor e a volta da potência muscular; a cirurgia do ombro somente será realizada em casos raros e bem definidos

Terapia génica y sus perspectivas clínicas en ortopedia / Gene therapy and its clinical perspectives in orthopaedics

La terapia génica se refiere a la transferencia de genes a individuos con fines terapéuticos. Esta técnica se ha desarrollado durante los últimos 10 años y tiene aplicaciones en todas las áreas de la medicina. Originalmente dirigida al tratamiento de padecimientos congénitos, actualmente también se estudian sus posibles aplicaciones en el tratamiento de padecimientos adquiridos. Presentamos los conceptos generales de la terapia génica y sus posibles aplicaciones en ortopedia como futuras opciones terapéuticas

Uso de la magnetoterapia en afecciones articulares y periarticulares / Use of magnetotherapy in articular and periarticular disorders

Se analizan los resultados obtenidos en 200 pacientes tratados en el Policlínico Integral Docente Centro, de Camagüey, con diversas artropatías y enfermedades ortopédicas y reumatológicas. Se utilizó el campo magnético producido por el equipo TERAMAG-MT-200. Se obtuvo buen resultado en 189 casos (94,5 por ciento). Las afecciones más beneficiadas fueron las de la rodilla (osteoartritis, sinovitis, fibrosis y rigideces posquirúrgicas, condromalacia y enfermedad de Hoffa), la epicondilitis y otras lesiones del codo, la periatritis escapulohumeral, tendinitis, insercionitis, trocanteritis, síndrome de Barré-Liéou y los dedos en resorte. Se describen los métodos utilizados en cada afección