Osteonecrose dos maxilares relacionada ao uso demedicamentos: características patológicas, diagnóstico,prevenção e estratégias terapêuticas / Medication-related osteonecrosis of the jaws: pathological characteristics, diagnosis, prevention and therapeutic strategies

Objetivo: Este trabalho tem como propósito fornecer uma análise abrangente das características clínicas, etiológicas, radiográficas e histopatológicas da osteonecrose dos maxilares relacionada ao uso de medicamentos, além de abordar os métodos de diagnóstico, prevenção e estratégias terapêuticas. Materiais e métodos: foi realizada uma busca por artigos científicos publicados no período de 2015 a 2023, utilizando as bases de dados Scientific Electronic Library Online (SciELO), US National Library of Medicine (PubMed) e ScienceDirect. Conclusão: Embora infrequente, há um considerável potencial de ocorrência de osteonecrose dos maxilares em pacientes submetidos a terapia prolongada com medicamentos antirreabsortivos e antiangiogênicos, especialmente quando não são adotadas medidas preventivas adequadas. A implementação de práticas preventivas, a vigilância das condições bucais e a colaboração de uma equipe multidisciplinar são fundamentais para reduzir os riscos associados a essa condição patológica.(AU)

Objective: This work aims to provide a comprehensive analysis of the clinical, etiological, radiographic and histopathological characteristics of Medication-Related Jaw Osteonecrosis, in addition to addressing diagnostic methods, prevention and therapeutic strategies. Materials and methods: A search was carried out for scientific articles published between 2015 and 2023, using the Scientific Electronic Library Online (SciELO), US National Library of Medicine (PubMed) and ScienceDirect databases. Conclusion: Although infrequent, there is a considerable potential for osteonecrosis of the jaw to occur in patients undergoing prolonged therapy with antiresorptive and antiangiogenic medications, especially when adequate preventive measures are not adopted. The implementation of preventive practices, surveillance of oral conditions and the collaboration of a multidisciplinary team are essential to reduce the risks associated with this pathological condition.(AU)

Reconstrução de úmero e reanimação do cotovelo com retalho osteomiocutâneo da escápula: relato de caso / Reconstruction of the humerus and rehabilitation of the elbow using an osteomyocutaneous scapular flap: a case report

Introdução: No presente trabalho, relatamos um caso de reconstrução do terço proximal do úmero direito e reanimação do cotovelo de um paciente masculino, de 20 anos, vítima de acidente automobilístico, com necrose óssea de 5 cm no terço proximal do úmero e avulsão do bíceps braquial. Métodos: Utilizamos o retalho ósseo da escápula, associado ao retalho miocutâneo do grande dorsal, tendo como pedículo os vasos subescapulares. Resultados: O paciente teve excelente evolução no pós-operatório, apresentando-se, no pós-operatório de 2 meses, com consolidação óssea e iniciando a flexão do cotovelo. Conclusões: Perante a utilização do retalho descrito, concluímos que esta modalidade de retalho se insere no arsenal dos retalhos ósseos de maior segurança nas reconstruções ósseas em geral.

Introduction: We report a case of reconstruction of the proximal third of the right humerus and rehabilitation of the elbow in a 20-year-old male patient who was injured in an automobile accident and developed bone necrosis of 5 cm at the proximal third of the humerus and avulsion of the brachial biceps. Methods: A scapular bone flap was used, together with a latissimus dorsi myocutaneous flap, using subscapular vessels for the pedicle. Results: The patient had excellent postoperative course, presenting in the 2-month postoperative period with bone consolidation and initiation of elbow flexion. Conclusions: This flap modality is a safe and useful option for bone reconstruction.

Tratamento da osteonecrose mandibular medicamentosa usando a fibrina leucoplaquetária autóloga ­ Dez meses de acompanhamento sem recidiva / Treatment of medicamentous mandibular osteonecrosis through autologous leukocyte platelet-rich fibrin ­ a 10 months follow-up without signs of recurrence

Uma paciente do sexo feminino, com 72 anos de idade e exposição óssea intraoral, portadora de osteoporose, fazia uso de bifosfonatos há mais de cinco anos. Na região posterior mandibular direita havia osso exposto, hiperemia dos tecidos moles e exsudato purulento. A região mandibular anterior mostrava drenagem de secreção purulenta. Como havia necessidade de cirurgia de fêmur por recomendação médica, a paciente foi submetida à medicação específica (amoxicilina 500 mg, metronidazol 400 mg) e irrigação local com clorexidina 0,12%. Seis meses depois, e mediante os exames de TCFC e CTx sérico, foi realizada a terapia com fibrina leucoplaquetária autóloga. Estas biomembranas foram colocadas nas áreas de osso necrótico. Depois de 15 dias, observou-se uma grande exposição da área operada. Porém, clinicamente, já se notava neovascularização. Após 30 dias, havia grande epitelização da área que se encontrava exposta anteriormente. O caso foi controlado por mais 30 dias, totalizando 60 dias, podendo ser observada uma grande cobertura de tecido mole bem vascularizada e queratinizada na região. As terapias propostas para tratamento não apresentam eficácia suficiente para serem consideradas como protocolos. Dentro dos limites deste relato, a utilização da fibrina leucoplaquetária autóloga apresentou-se favorável como alternativa após dez meses e sem recidivas, abrindo perspectivas para tratar as necroses induzidas por estes medicamentos.

A 72 years-old female patient presented with intraoral bone exposure, osteoporosis, and bisphosphonate use (> 5 years). Also, at the posterior mandible, there was soft tissue hyperemia and pus. On the other hand, the anterior mandible presented with purulent drainage. Due to the need of a hip replacement by medical recommendation, the patient was submitted to specific pharmacological regimen (Amoxicillin 500 mg, Metronidazole 400 mg), and 0.12% chlorhexidine rinses. Six months later, and after CBCT and seric CTx exams, the autologous leukocyte platelet-rich fibrin therapy was applied. These biomembranes covered areas of necrotic bone. After 15 days, there was great exposition at the surgical area. However, neovascularization was clinically observed followed 30 days later by epithelization of previously exposed areas. The case was controlled for more 30 days, where well-vascularized and keratinized soft tissue coverage was identified. The proposed therapy does not provide efficacy to be considered as protocols. However, within the limits of this presentation, the autologous leukocyte platelet-rich fibrin seems to be favorable as an alternative and after 10 months no complications were observed. This opens new perspectives to treat bisphosphonate induced bone necrosis.

Cytotherapy for Osteonecrosis of Hip.

Osteonecrosis of hip is a pathological condition that leads to collapse of the femoral head, & the need for total hip replacement (THR). Research has shown that at the cellular level there is decrease in osteoblastic activity & the local mesenchymal stem cells (MSC) population that leads to osteonecrosis of femoral head (ONFH). Cellular therapy could thus be used to improve the local cellular environment. Th is can be achieved by implanting bone marrow, containing osteogenic precursors into the necrotic lesion of the femoral head.

Endodoncia en pacientes oncohematológicos / Endodontic therapy in oncohematological patients

Los pacientes oncohematológicos y oncológicos en general pueden recibir una atención endodóntica normal, siempre y cuando tengamos en cuenta su patología sistémica. El objetivo del presente trabajo es exponer las principales pautas que se deben considerar para realizar un tratamiento de endodoncia adecuado en pacientes oncológicos sometidos a quimioterapia y/o radioterapia.

Betacrosslaps sérico para determinar el riesgo de osteonecrosis inducida por bifosfonatos: ¿predictor fiable? Revisión bibliográfica / Serum C-terminal crosslinking telopeptide to determine the risk of biphosphonate-induced osteonecrosis: a reliable predictor? Review of the literature

La osteonecrosis de los maxilares asociada al uso de bifosfonatos (OMIB) es una de las complicaciones más serias es una de las complicaciones másserias de la terapia con bifosfonatos.La OMIB puede ser observada en pacientes que reciben bifosfonatos por vía sistémica para la terapéutica delmieloma múltiple o metástasis óseas y, también en pacientes medicados con bifosfonatos por vía oral para el tratamiento de la osteoporosis. De acuerdo a la American Association of Oral and MaxillofacialSurgeons (AAOMS), la OMIB es definida como la exposición de hueso necrótico en la región maxilofacial con una persistencia mayor a 8 semanas, en asociación con una terapia previa o en curso de bifosfonatos y que no ha sido sometido a radioterapia dirigida a cabeza y cuello.El objeto de esta revisión bibliográfica fue, de acuerdo a los artículos estudiados, determinar la efectividad delestudio Beta crosslaps sérico (CTX) en la prevención de la osteonecrosis de los maxilares, en pacientes medicadoscon bifosfonatos.

Effect of D-003, a mixture of high molecular weight aliphatic acids, on glucocorticoid- and lipopolysaccharides [LPS]-induced osteonecrosis

Osteonecrosis [ON] is characterized through the impairment of osseous blood flow that leads to the collapse of femur head. Corticoid-induced ON in rats and lipopolysaccharide [LPS]-induced in rabbits are useful models to assess the efficacy of potential treatments on this disease. D-003 inhibits the mevalonate pathway, lipid peroxidation and prevents osteoporosis in rats through increasing the osteoclast apoptosis. This study investigated the effects of D-003 on corticoid- and LPS-induced ON in rats and rabbits. Corticoid-induced ON: Rats were randomized into five groups. A negative control and four groups treated with prednisolone 6 mg/Kg: a positive control and three treated with D-003 [5, 25 and 200 mg/Kg] for 80 days. All positive controls presented ON areas. D-003 significantly reduced the numbers and proportions of ON lesions, as compared to the positive control group. LPS-induced ON in rabbits: Rabbits were randomized into five groups: a negative control and four injected with a single intra-venous injection of LPS [10 micro g/Kg] including a positive control and three with D-003 [5, 25 and 200 mg/Kg] for 30 days. ON was seen in all positive controls. The incidence of ON and the number of ON lesions in the groups treated with D-003 [25 and 200 mg/Kg] was significantly lower compared to the positive controls. LPS injection significantly increased the size of bone marrow fat cells in positive controls and such increase was significantly decreased by D-003. In conclusion, D-003 reduced ON lesions in corticoid-and LPS-induced ON and also the size of bone marrow fat cells in rabbits with LPS

Osteonecrosis maxilar por bifosfonatos: diagnóstico, prevención y tratamiento / Biphosphonates-induced osteonecrosis of the jaws: diagnosis, prevention and treatment

El empleo de los bifosfonatos es una medicación eficaz en el tratamiento de lesiones osteolíticas. Sin embargo, con el tiempo de su utilización, se observaron en algunos casos la aparición de osteonecrosis en los huesos maxilares. Ante esta patología agregado, se determinaron procedimientos para minimizar estos efectos secundarios.

Osteonecrosis maxilar: una problemática onco-odontológica / Maxillary osteonecrosis: an onco-odontologic problematic

Los bifosfonatos fueron sintetizados en el siglo XIX por químicos alemanes, los cuales buscaban prevenir el depósito industrial de carbonato de calcio en sus chimeneas. Más tarde se observó la gran afinidad de la droga con el tejido óseo y que además inhibía la conversión de fosfato de calcio amorfo a hidroxiapatita (HA), lo cual reducía la velocidad de disolución de los cristales óseos. Por lo antedicho, estos compuestos sintéticos son utilizados hace más de tres décadas para el tratamiento de desórdenes esqueletales: osteoporosis, enfermedad de Paget, hipercalcemia asociada a mieloma múltiple y metástasis óseas propias de cáncer de próstata y mama, osteogénesis imperfecta y displasia fibrosa. Recientemente se han descripto algunos casos de osteonecrosis maxilar a causa de tratamiento crónico con bifosfonatos, a altas dosis en la prescripción de dichas drogas utilizadas como terapéutica oncológica.

Biphosphonates, synthesized in the mid 19th century by German chemists, were initially used in industry due to their capacity to prevent the deposits of calcium carbonate, which made them especially useful in avoiding the deposit of calcium salt in pipes. Later it was shown that they had great affinity with osseous tissue, where they inhibitedthe conversion of amorphous calcium phosphate in hydroxyapatite and they reduced the dissolution speed o the later. Biphosphonates are synthetics compounds used in the treatment of various metabolic and malignant bone diseases: Osteoporosis, Paget Disease, Hypercalcemia, Multiple Mieloma, Metastatic breast cancer and Metastatic prostate cancer, Osteogenesis Imperfecta, Fibrous Dysplasia. Recently, have been described some cases of Osteonecrosis of the jaw because of biphosphonate treatment in high doses for oncology administration.

Doença de Paget na implantodontia

A Doença de Paget é caracterizada pelo aumento irregular do volume ósseo através de ações celulares específicas. Foi relatada inicialmente na década de 70 e seu diagnóstico evoluiu com o advento de novas tecnologias e maior abrangência de exames complementares...

Postermomedial surgical approach with or without selective medial release of the subtalar joint in clubfoot surgery

Congenital clubfoot is a variable three dimensional complex system of chondroosseous and joints deformity. Its treatment possess a controversial issue since dates of Hippocrates. In clubfoot surgery many complications as stiffness, overcorrection, talar avascular necrosis and subsequently poor functional results were postulated by many as a sequlae to simultaneous complete subtalar release . This is a prospective study of 33 patients with 40 idiopathic clubfeet. There were 28 males [84.8%] and 5 were female [15.2%] patients.The affected sides were [left =11; right= 15; bilateral = 14 feet]. The feet were divided randomly into 2 equal groups [A and B][20 feet each]. The initial deformity was very severe in 32 feet and severe in 8 by using the Simon scale and allocated equally in both groups. All the feet were treated at a mean age of 8 months by means of posteromedial surgical soft tissue release. In addition selective medial capsular release of the subtalar joint with release of talocalcaneal interosseous ligament was done in group [A] feet where it was left intact in group [B]. At a mean follow-up period of 26 months range [24-30], the total satisfactory results were [85%]. In both groups the result was [90%] satisfactory in group [A] and [85%] in group [B] feet . When their mean overall clinical and radiological scores were investigated and comparing their satisfactory results together, group [A] feet showed statistically significant improvement of clinical and radiological parameters than those of group [B]. This was reflected clinically on better hindfoot alignment with the release of the TCIL in group [A] feet. Neither any evidence of overcorrection nor talar avascular necrosis was detected either clinically or radiologically by conventional x-ray as well as by MRI of all the studied feet in both groups. Posteromedial surgical approach with release of TCIL proved to be a good contribution in the treatment of severe and relapsing clubfeet, which gave significantly better hindfoot alignment without aforementioned serious complication

La hemicallotasis: una alternativa en el tratamiento ante la necrosis ósea por quemaduras eléctricas: a propósito de un caso / The hemicallotasis: an alternative in the treatment to the bone necrosis by electric burns: propuse of case

Las quemaduras eléctricas causan daños severos en tejidos y órganos, los vasos sanguíneos pueden trombosarse y progresivamente producir necrosis. La tibia es uno de los huesos con menos vascularidad, donde las quemaduras condicionan graves defectos óseos y de partes blandas. Se realizó un estudio observacional, descriptivo, donde presentamos un paciente masculino indígena de 27 años de edad, quien sufrió descarga eléctrica de alto voltaje, en el cual se observó defecto de partes blandas con exposición de la cara anteromedial distal de la tibia derecha, nuestro objetivo fue realizar una ostectomía de la cara anteromedial, para resecar el segmento óseo necrótico, seguidamente se realiza osteotomía percutánea de una hemicortical de la diáfisis de la tibia y se colocó un fijador externo lizarov para el transporte óseo. Obtuvimos 15 mcs. aproximadamente de transporte, desde la diáfisis proximal con media de la cara anteromedial de la tibia hacia el defecto óseo resecado. Con la hemicallotasis se logra un hueso nuevo, provisto de tejido y piel necesarios cuando se ve comprometida la circulación de los huesos. La hemicallotasis es una alternativa de tratamiento de paciente con lesiones de huesos largos con desvascularización y pérdida detejidos blandos.

Electrical burns cause terrible damage to tissues and organs, blood vessels and thrombi can produce progressive necrosis. The tibia is one of the bones with less vascularity, where serious condition from burns and bone defects of soft tissue. Indian male 27 years old, who had ruled out high-voltage power, with necrosis of the right tibia, being transferred to the University Hospital "Manuel Nuñez Tovar". A descriptive study: Where an osteotomy is performed to resect the necrotic bone segment, then performs a hemicortical percutaneous osteotomy of the diaphysis of the tibia and placed an lizarov type external fixator with a rail for the transport bone. Carriage, from the diaphysis with the proximal half of the front of the tibia to the bone defect surgically resected. Hemicallotasis is achieved with a new bone, tissue and skin provided when needed is compromised the circulation of bone. Hemicallotasis is an alternative treatment in patients with lesions of long bones with little loss of vascularity and soft tissue.

Bisphosphonates and jaw osteonecrosis / Bisfosfonatos e osteonecrose dos maxilares

Bisphosphonates have been widely prescribed for treatment of diseases characterized by intense bone resorption. These drugs have also been associated with a serious side effect, avascular osteonecrosis of the jaws. The authors present a literature review on bisphosphonates, focusing on their pharmacological features and their reported association with jaw osteonecrosis. The morbidity and lack of treatment response of this condition are serious facts to be considered when prescribing bisphosphonate therapy. The risk-benefit relationship needs to be seriously analyzed, and the treatment pros and cons should be explained to the patient. If the therapy with bisphosphonate is indicated, rigorous oral health adequacy must be performed and periodic evaluation of oral conditions is mandatory. At this moment, caution in treatment seems to be the best way to approach bisphosphonate users.

Os bisfosfonatos têm sido amplamente empregados no tratamento de enfermidades cuja característica principal é a intensa reabsorção óssea. Tais drogas também têm sido associadas a um importante efeito colateral - a osteonecrose avascular dos maxilares. Os autores apresentam uma revisão da literatura sobre bisfosfonatos, enfocando aspectos farmacológicos e a osteonecrose dos maxilares. A morbidade e a falta de resposta ao tratamento desta condição são fatores importantes a serem considerados na prescrição de terapia com bisfosfonatos. A relação risco-benefício precisa ser seriamente analisada, e os prós e contras do tratamento devem ser explicados ao paciente. Se a terapia for indicada, uma rigorosa adequação bucal deve ser realizada e o paciente necessita ser periodicamente avaliado. No presente momento, a precaução parece ser o melhor modo de abordar os usuários de bisfosfonatos.

Osteonecrosis de los maxilares inducida por el uso de bifosfonatos: prevención y pautas de tratamiento / Osteonecrosis of the jaws associated with biphosphonates: prevention and treatment

La osteonecrosis de los maxilares relacionada con los bifosfonatos (ONMB) es una enfermedad que puede afectar la calidad de vida y provocar significativa morbilidad a los pacientes. Los bifosfonatos son drogas que se utilizan para el tratamiento de osteoporosis, osteopenia, metástasis ósea, mieloma múltiple, enfermedad de Paget, etc. Esta complicación puede aparecer usualmente después de una simple cirugía dentoalveolar. La patogénesis estaría relacionada con la inhibición de la función de los osteoclastos y de la remodelación ósea. El objetivo de nuestro trabajo es informar a odontólogos, pacientes y partes interesadas sobre el riesgo del uso de los bifosfonatos, así comotambién sobre la prevención, estadificación y pautas de tratamiento de la ONMB basados en la conducta de trabajo actual de la Asociación Americana de Cirugía Oral y maxillofacial (AAOMS). Asimismo se presentan 2 casos clínicos y su resolución.

Resultados funcionales de carpectomía proximal en estadios avanzados en pacientes con enfermedad de Kienbock / Functional results of proximal carpectomyin advanced Kienbock disease

La carpectomía proximal es una de las técnicas más recomendadas para los pacientes con enfermedad de Kienbock en estadios avanzados (IIIa y IIIb). Se estudiaron 5 pacientes sometidos a carpectomía proximal en un periodo de 17 meses. Los resultados mostraron dorsiflexión de 58,8%, flexión palmar de 43,7% y fuerza de 15 Kg respecto al lado no operado. Un paciente presentó dolor persistente con gran limitación funcional. Los resultados clínicos de estos pacientes no alcanzaron los rangos de movimiento y fuerza reportados en la literatura después de esta intervención, posiblemente por el tiempo tan corto de seguimiento.

O uso de bifosfonatos e sua relação com a osteonecrose / The use of bisphosphonates and its relation to osteonecrosis

O uso dos bifosfonatos vem sendo amplamente indicado no tratamento da osteoporose, em alguns tipos de câncer e de metástases tumorais em tecidos ósseos. O bifosfonato inibe a formação de osteoclastos, interferindo no processo de reabsorção óssea, no entanto, o uso destas drogas vem sendo relacionado a casos de osteonecrose em maxila e mandíbula de pacientes que se submeteram a exodontia ou procedimentos cirúrgicos que tenham tido o tecido ósseo exposto ou manipulado. Procedimentos invasivos como exodontias ou cirurgias que manipulem o tecido ósseo devem ser submetidos a uma avaliação criteriosa em pacientes que estejam sob tratamento com bifosfonatos. Diante disso, este estudo tem como objetivo alertar o cirurgião-dentista em relação aos cuidados no manejo de pacientes que estejam sob tratamento com bifosfonatos, por meio de uma revisão na literatura e descrições de casos clínicos relatados.

The use of bisphosphonates has been widely used in the treatment of osteoporosis, in some cancer types and in metastases to bone. Bisphosphonates inhibit osteoclast formation, interfering in the process of bone reabsorption. However, the use of these drugs has been found to be related to osteonecrosis of maxillary and mandibular bones of patients which underwent to tooth extraction or surgical procedures with manipulation or exposure of bone tissue. Patients under treatment with bisphosphonates should be carefully assessed prior to undergoing invasive procedures such as tooth extraction or surgery that involves bone tissue. Therefore, the goal of this paper is to alert the dentist about the care of patients which are under treatment with bisphosphonates through a literature review that includes scientific papers and clinical cases.

Bifosfonatos y osteonecrosis de los maxilares: consideraciones sobre su tratamiento / Biphosphonate and jaws osteonecrosis: considerations about of treatment

Los bifosfonatos son potentes inhibidores de los osteoclastos, son drogas usadas principalmente para el tratamiento de mieloma múltiple y en metástasis óseas de tumores sólidos como el cáncer de mama. En el año 2003 fue relatado el primer caso de osteonecrosis de los maxilares (ONM) asociado al uso de bifosfonatos, sin embargo aun no se ha establecido una relación causa efecto de estas drogas sobre la ONM. La incidencia en tiempos anteriores en relación al uso de bifosfonatos era muy baja, siendo que hoy día alcanza 10 por ciento o más en las patologías mencionadas tratadas con estas drogas. Este artículo tiene por objetivo alertar sobre una posible complicación en pacientes que hacen uso de bifosfonatos, a través de la revisión de la literatura y la presentación de un caso clínico.

Bisphosphonates are strong osteoclastic inhibitor activities, being these drugs usually for treatment of multiple myeloma and bone metastases of solid tumors like breast cancer. The osteonecrosis of the maxillary bones was first described in 2003. The relation of these medicines and maxillary bone osteonecrosis still uncertain. The incidence of this bone necrosis was very low before biphosphonates using. Nowadays this complication reach at least 10 percent of patients in these therapy using. The present work mean to alert for possible complication in biphosphonates using patients, thru a literature review and a clinical case presentation.

Osteonecrosis en lupus eritematoso sistémico / Osteonecrosis in systemic lupus erythematosus

Osteonecrosis (ON) is a clinical entity characterized by aseptic necrosis of bone marrow and trabecular bone as a result of significant disruption of blood supply to the bone. In patients with systemic lupus erythematosus (SLE), ON is a well recognized complication, which also results in significant morbidity. The clinical course is usually progressive to end stage degenerative changes of the joints causing significant secondary pain and limitation of movement, and reducing the quality of life in these patients. Corticosteriod therapy is the major predisposing factor for ON in SLE. This article reviews the causes, clinical and epidemiological features, diagnosis and treatment options for ON among patients with SLE.

Dissociaçäo clínico-radiológica após a "core decompression" (CD) no tratamento da osteonecrose da cabeça femoral / Clinical and radiological dissociation after core decompression (CD) in the treatment of femoral head osteonecrosis

Os autores apresentam uma revisao sobre a osteonecrose (ON) da cabeça femoral, apontando aspectos importantes de sua patologia e tratamento. Destaca-se o papel da core decompression (CD), mais especificamente a sua evoluçao clínica e radiológica, num grupo bem definido, constituíndo por pacientes jovens (< 41 anos), no estágio I e II de Ficat & Arlet. Para tanto, realizou-se uma análise retrospectiva de sete pacientes tratados no período de 1992 a 1998. Como resultado, observou-se a progressao radiológica após o CD no período em estudo, dissociada do quadro clínico. Apesar desta, concluiu-se a favor da realizaçao deste procedimento, uma vez que se obteve alívio sintomático em todos os pacientes, retardando durante este período a realizaçao da artroplastia total do quadril (ATQ). Fato desejável se considerarmos a faixa etária acometida, bem como a possibilidade de um melhor preparo dos pacientes e conseqüentemente seus resultados com ATQ.