Frequencia da discrepancia de membros inferiores apos artroplastia total de quadril / Frequency of leg-length discrepancy following total hip arthroplasty

Verificar a frequencia da ocorrencia de discrepancia de membros inferiores apos a artroplastia total de quadril, por meio de analise radiografica. Sao apresentados o conceito de discrepancia de membros inferiores, os metodos de avaliacao existentes para obtencao da discrepancia de membros inferiores e sua importancia clinica. Material e metodos: foram analisados examesde 120 pacientes portadores de osteoartrose primaria ou secundaria unilateral, sendo 72 do sexo masculino e 48 dp feminino, com idades variando entre a segunda e setima decada de vida. Os participantes dessa pesquisa foram pacientes operados pelo Grupo do Quadril, do departamento de Ortopedia e Traumatologia do Hospital Sao Paulo. Com radiografias simples em plano anteroposterior utilizando osoftware Corel Draw, versao 10, foram realizadas tres linhas para medida e pela diferenca entre essas linhas de medida foi obtida a diferenca entre os membros inferiores. O teste de hipotese foi verificado pela aplicacao de teste parametrico da diferenca das medias. A apresentacao estatistica inclui o calculo de medidas de tendencia central e de dispersao. Resultados? foi observado que entre os 120 pacientes submetidos a artroplastia total de quadril avaliados neste estudo, 100 apresentaram discrepancia de membros inferiores, sendo (35 por cento) alongamentos (discrepancias positivas) e (65 por cento) encurtamentos (discrepancias negativas). Essas diferencas foram maiores que 1 cm, seja negativos ou positivos, em (36 por cento) dos pacientes avaliados. Conclusao: houve discrepancias entre os membros inferiores apos artroplastia total de quadril, sendo maiores de 1 cm em 36 por cento dos pacientes

Fractures of the proximal femur: correlation with vitamin D receptor gene polymorphism

Fractures are the feared consequences of osteoporosis and fractures of the proximal femur (FPF) are those that involve the highest morbidity and mortality. Thus far, evaluation of bone mineral density (BMD) is the best way to determine the risk of fracture. Genetic inheritance, in turn, is one of the major determinants of BMD. A correlation between different genotypes of the vitamin D receptor (VDR) and BMD has been recently reported. On this basis, we decided to determine the importance of the determination of VDR genotype in the presence of an osteoporotic FPF in a Brazilian population. We studied three groups: group I consisted of 73 elderly subjects older than 65 years (78.5 + 7.2 years) hospitalized for nonpathological FPF; group II consisted of 50 individuals older than 65 years (72.9 + 5.2 years) without FPF and group III consisted of 98 young normal Brazilian individuals aged 32.6 + 6.6 years (mean+SD). Analysis of VDR gene polymorphism by restriction fragment lenght polymorphism (RFLP) was performed by PCR amplification followed by BsmI digestion of DNA isolated from peripheral leukocytes. The genotype distribution in group I was 20.5 percent BB, 42.5 percent and 37 percent bb did not differ significantly from the values obtained for group II (16 percent BB, 36 percent Bb and 48 percent bb) or for group III (10.2 percent BB, 47.6 percent Bb and 41.8 percent bb). No differences in genotype distribution were observed between sexes or between the young and elderly groups. We conclude that determination of VDR polymorphism is of no practical use for the prediction of FPF. Other nongenetic factors probably start to affect bone mass, the risk to fall and consequently the occurence of osteoporotic fractures with advancing age.