Correlation between patient age at total hip replacement surgery and lifeexpectancy

ABSTRACTTotal hip arthroplasty (THA) is one of the most cost-effective hip surgeries among orthopedic procedures. We conducted an extensive literature review with 5,394 papers regarding survival rates after THA. We searched PubMed, Embase and the Cochrane library from January 1st, 1970 to July 31th, 2014 looking for all citations about total hip arthroplasty with a long term follow-up (longer than 10 years). The criteria were rigorous: no loss of follow-up, and follow-up more than 10 years. The authors should have known the complete history of patients (whether the patient is alive or dead). Considering the criteria, we found only 15 papers. To evaluate the relationship between follow-up and survival, a linear regression analysis was applied. Considering the papers analysed, and applying the search criteria, we obtained a mean age for the patients above 57.5 years. The chance of survival at 15 years was 57.6%, at 20 years it was 34.6% and at 25 years it is only 11.6%. The relationship between follow-up and survival was significantly linear (p <0.001). Only 11.6% of patients undergoing THA will be still alive 25 years after the surgical procedure. Level of Evidence I, Prognostic Study.

Femoral neck non-union treatment by valgus intertrochanteric osteotomy

ABSTRACTOBJECTIVE: The purpose of this study was to evaluate the performance of valgus intertrochanteric osteotomy in femoral neck non-union.METHODS: Forty-two patients with femoral neck fractures with non-union treated using Pauwels' intertrochanteric osteotomy were reviewed. Demographics, time elapsed between fracture and surgery, follow--up, osteosynthesis used, Garden's classification, limb shortening, and x-rays were evaluated.RESULTS: Twenty-two men and 20 women were reviewed. The youngest patient was 18 years old and the oldest 65 years old, with a mean age of 42.4 years (±11.2). The minimum follow-up was 2 years, with a mean of 10.2 years. The average time elapsed between initial fracture and osteotomy was 6.5 months. Twel-ve cases were neglected femoral neck fractures. Nineteen patients were classified as Garden III, and 23 patients as Garden IV. After valgus osteotomy, non-union healing was observed in 38 patients (38/42; 90.4%). Healing of thirty-seven cases of pseudoarthrosis were obtained after the first-attempt osteotomy, and one case required two operations for healing. The osteotomy failed in four cases. Conside-ring the healed osteotomies, good to excellent functional results were achieved in 80.9% (34/42) of the patients. Total hip replacement was subsequently performed in 14.2% (6/42) of the patients for unfavoura-ble outcomes (two for cutting out, two for osteonecrosis, and two for osteoarthritis).CONCLUSIONS: Valgus intertrochanteric osteotomy has a high success rate in archiving healing in femoral neck non-union with good functional results. It is a biological and effective method. Level of Evidence IV, Therapeutic Study.

Sangramento da cabeça femoral durante artroplastia total do quadril para tratamento de osteoartrose / Bleeding of femoral head during total hip arthroplasty for osteoarthrosis

Objetivo: Avaliar o sangramento da cabeça femoral em quadris queapresentam osteoartrose durante o procedimento cirúrgico de artroplastiatotal do quadril. Métodos: Foram avaliados 103 quadris acometidospor osteoartrose coxofemoral primária. Após a luxação cirúrgica, a cabeçafemoral foi dividida em quatro quadrantes onde eram realizadasmicroperfurações com a finalidade de observar e qualificar a presençade sangramento como tipo precoce (SP), tardio (ST) ou sem sangramento(SS). Resultados: Foi observado no quadrante superior sangramentoprecoce (SP) em 16 quadris (15.5%), sangramento tardio em 14quadris (13.6%) e não houve sangramento (SS) em 73 quadris (70.9%).No quadrante anterior, foi observado SP em 24 quadris (23.3%), ST em7 quadris (6.8%) e SS em 72 quadris (69.9%). No quadrante inferior, foidetectado SP em 40 quadris (38.8%), ST em 14 quadris (13.6%) e SSem 49 quadris (47.6%). Finalmente, no quadrante posterior, havia SPem 39 quadris (37.9%), ST em 19 quadris (18.4%) e SS em 45 quadris(43.7%). Comparando o IMC e gênero dos participantes, não encontramosnenhuma associação (p>0,05). Conclusões: Os quadrantes inferiore posterior apresentaram maior sangramento, seguindo o trajeto daartéria circunflexa medial. Nível de Evidência III, Estudo Terapêutico.

Objective: To evaluate the bleeding of the femoral head on hiposteoarthritis in patients who underwent total hip arthroplasty.Methods: One hundred and three hips affected by primary hiposteoarthritis were evaluated. After surgical dislocation, the femoralhead was divided into four quadrants, and micro perforations weremade in order to observe and assess the presence of bleeding, asearly type (EB), late type (LB) or without bleeding (WB). Results:We observed early bleeding (EB) in the upper quadrant in 16hips (15.5%), late bleeding in 14 hips (13.6%) and no bleeding(WB) in 73 hips (70.9%). The anterior quadrant showed EB in 24hips (23.3%), LB in 7 hips (6.8%) and WB in 72 hips (69.9%).The lower quadrant presented EB in 40 hips (38.8%), LB 14 hips(13.6%) and WB in 49 hips (47.6%). The posterior quadrant showedEB in 39 hips (37.9%), LB 19 hips (18.4%) and WB in 45 hips(43.7%). Comparing BMI and gender, we found no associationbetween these parameters (p> 0.05). Conclusions: The inferiorand posterior quadrant had the highest bleeding levels, followingthe path of the medial circumflex artery. Level of Evidence III,Therapeutic Study.

Femoral neck non-union treatment by valgus intertrochanteric osteotomy.

OBJECTIVE: : The purpose of this study was to evaluate the performance of valgus intertrochanteric osteotomy in femoral neck non-union. METHODS: : Forty-two patients with femoral neck fractures with non-union treated using Pauwels' intertrochanteric osteotomy were reviewed. Demographics, time elapsed between fracture and surgery, follow--up, osteosynthesis used, Garden's classification, limb shortening, and x-rays were evaluated. RESULTS: : Twenty-two men and 20 women were reviewed. The youngest patient was 18 years old and the oldest 65 years old, with a mean age of 42.4 years (±11.2). The minimum follow-up was 2 years, with a mean of 10.2 years. The average time elapsed between initial fracture and osteotomy was 6.5 months. Twel-ve cases were neglected femoral neck fractures. Nineteen patients were classified as Garden III, and 23 patients as Garden IV. After valgus osteotomy, non-union healing was observed in 38 patients (38/42; 90.4%). Healing of thirty-seven cases of pseudoarthrosis were obtained after the first-attempt osteotomy, and one case required two operations for healing. The osteotomy failed in four cases. Conside-ring the healed osteotomies, good to excellent functional results were achieved in 80.9% (34/42) of the patients. Total hip replacement was subsequently performed in 14.2% (6/42) of the patients for unfavoura-ble outcomes (two for cutting out, two for osteonecrosis, and two for osteoarthritis). CONCLUSIONS: : Valgus intertrochanteric osteotomy has a high success rate in archiving healing in femoral neck non-union with good functional results. It is a biological and effective method. Level of Evidence IV, Therapeutic Study.

Correlation between patient age at total hip replacement surgery and lifeexpectancy.

Total hip arthroplasty (THA) is one of the most cost-effective hip surgeries among orthopedic procedures. We conducted an extensive literature review with 5,394 papers regarding survival rates after THA. We searched PubMed, Embase and the Cochrane library from January 1(st), 1970 to July 31(th), 2014 looking for all citations about total hip arthroplasty with a long term follow-up (longer than 10 years). The criteria were rigorous: no loss of follow-up, and follow-up more than 10 years. The authors should have known the complete history of patients (whether the patient is alive or dead). Considering the criteria, we found only 15 papers. To evaluate the relationship between follow-up and survival, a linear regression analysis was applied. Considering the papers analysed, and applying the search criteria, we obtained a mean age for the patients above 57.5 years. The chance of survival at 15 years was 57.6%, at 20 years it was 34.6% and at 25 years it is only 11.6%. The relationship between follow-up and survival was significantly linear (p <0.001). Only 11.6% of patients undergoing THA will be still alive 25 years after the surgical procedure. Level of Evidence I, Prognostic Study.

BLEEDING OF FEMORAL HEAD DURING TOTAL HIP ARTHROPLASTY FOR OSTEOARTHROSIS.

OBJECTIVE: To evaluate the bleeding of the femoral head on hip osteoarthritis in patients who underwent total hip arthroplasty. METHODS: One hundred and three hips affected by primary hip osteoarthritis were evaluated. After surgical dislocation, the femoral head was divided into four quadrants, and micro perforations were made in order to observe and assess the presence of bleeding, as early type (EB), late type (LB) or without bleeding (WB). RESULTS: We observed early bleeding (EB) in the upper quadrant in 16 hips (15.5%), late bleeding in 14 hips (13.6%) and no bleeding (WB) in 73 hips (70.9%). The anterior quadrant showed EB in 24 hips (23.3%), LB in 7 hips (6.8%) and WB in 72 hips (69.9%). The lower quadrant presented EB in 40 hips (38.8%), LB 14 hips (13.6%) and WB in 49 hips (47.6%). The posterior quadrant showed EB in 39 hips (37.9%), LB 19 hips (18.4%) and WB in 45 hips (43.7%). Comparing BMI and gender, we found no association between these parameters (p> 0.05). CONCLUSIONS: The inferior and posterior quadrant had the highest bleeding levels, following the path of the medial circumflex artery. Level of Evidence III, Therapeutic Study.

Do patients lose weight after total hip arthroplasty?

Objective: To investigate the effect of total hip arthroplasty (THA) on body mass index (BMI), from before to after the operation. Methods: 100 patients who underwent THA were retrospectively analyzed. They were stratified according to BMI, as proposed by the World Health Organization (WHO). Results: There were 48 male patients and 52 female patients. Their mean age was 63.8 ± 13.5 years. The mean follow-up was 24.6 ± 0.6 months. The men had a mean preoperative BMI of 28.4± 3.6kg/m2 and the women, 27.5 ±5.0kg/m2. The mean postoperative BMI was 28.9 ±0.7kg/m2 for the men and 27.8 ± 0.7 kg/m2 for the women. There was a general mean increase in BMI of 0.4kg/m2. The BMI increased both in patients with normal weight and in those who were overweight, but it decreased slightly in patients who were obese. BMI remained unchanged in the majority of the patients (73%). Conclusion: The improvement in mobility achieved through THA did not promote any reduction in anthropometric measurements in the majority of the patients...

Objetiuo: Investigar o efeito da artroplastia total do quadril (ATQ) no índice de massa corporal em relação ao pré e ao pós-operatório. Métodos: Foram analisados retrospectivamente 100 pacientes submetidos à ATQ. Os pacientes foram estratificados pelo índice de massa corporal (IMC), conforme proposto pela Organização Mundial de Saúde (OMS). Resultados: Foram observados 48 pacientes do sexo masculino e 52 do feminino. A média de idade foi de 63,8 ± 13,5 anos. O seguimento médio foi de 24,6 ± 0,6 meses. Os homens apresentaram IMC pré-operatório médio de 28,4 ±3,6 kg/m2 e as mulheres, de 27,5 ±5,0 kg/m2. O IMC médio pós-operatório foi 28,9±0,7kg/m2 para os homens e 27,8±0,7kg/m2 para as mulheres. Ocorreu uma média de aumento geral do IMC em 0,4kg/m2. O IMC aumentou em pacientes com peso normal e com sobrepeso, mas diminuiu levemente em pacientes com obesidade. A maioria dos pacientes (73%) permaneceu com o IMC inalterado. Conclusão: A melhoria da mobilidade obtida com a ATQ não promoveu uma redução das medidas antropométricas na maioria dos pacientes...

Dynamic hip screw for the treatment of femoral neck fractures: a prospective study with 96 patients.

UNLABELLED: Objectives. To study the correlation between avascular necrosis and the demographics, time elapsed from fracture to surgery, quality of reduction, Garden classification, and the position of the screw following use of the dynamic hip screw (DHS) in the treatment of subcapital neck fractures. Methods. A prospective study of 96 patients with subcapital neck fractures was carried out in a faculty hospital. Patients underwent surgery with closed reduction and internal fixation with DHS. Results. There were 58% male and 42% female patients, with a mean age of 53 years (+/-14). In terms of Garden classification, 60% were Garden IV, 26% were Garden III, and 14% were Garden II. Nonunion was observed in three cases (3%) and was treated with valgus intertrochanteric osteotomy, in all cases leading to successful healing. Avascular necrosis was observed in 16% of patients. The positioning of the screw into the femoral head showed a significant correlation with necrosis. Conclusions. The incidence of necrosis in patients under the age of 50 years is twice as high as that in older patients. Displacement is a predictive factor regarding osteonecrosis and is associated with a high and anterior position of the screw in the femoral head. Level II of evidence. STUDY TYPE: therapeutic study.

Association between trochanteric bursitis, osteoarthrosis and total hip arthroplasty / Associação entre bursite trocantérica, osteoartrose e artroplastia total do quadril

OBJECTIVE: this was an epidemiological study on trochanteric bursitis at the time of performing total hip arthroplasty. METHODS: sixty-two sequential patients who underwent total hip arthroplasty due to osteoarthrosis, without any previous history of trochanteric bursitis, were evaluated. The bursas were collected and evaluated histologically. RESULTS: there were 35 female patients (56.5%) and 27 male patients (43.5%), with a mean age of 65 years (±11). Trochanteric bursitis was conformed histologically in nine patients (14.5%), of whom six were female (66.7%) and three were male (33.3%). CONCLUSIONS: 14.5% of the bursas analyzed presented inflammation at the time that the primary total hip arthroplasty due to osteoarthrosis was performed, and the majority of the cases of bursitis were detected in female patients...

OBJETIVO: fazer um estudo epidemiológico da bursite trocantérica no momento da feitura da artroplastia total do quadril (ATQ). MÉTODOS: foram avaliados 62 pacientes, sequenciais, submetidos à ATQ por osteoartrose, sem história prévia de bursite trocantérica. As bursas foram coletadas e avaliadas histologicamente. RESULTADOS: foram observados 35 pacientes do sexo feminino (56,5%) e 27 do masculino (43,5%), com média de 65 anos (+/-11). A bursite trocantérica foi confirmada histologicamente em nove (14,5%), seis do sexo feminino (66,7%) e três (33,3%) do masculino. CONCLUSÕES: das bursas analisadas, 14,5% apresentaram inflamação no momento da feitura da ATQ primária por osteoartrose. A maioria das bursites foi detectada nas pacientes femininas...

Transfusão sanguínea em artroplastia de quadril: a curva laboratorial hemática deve ser o único preditor da necessidade de transfusão? / Blood transfusion in hip arthroplasty: a laboratory hematic curve must be the single predictor of the need for transfusion?

Objetivo: verificar se a curva laboratorial hemática deve ser o único preditor de transfusão sanguínea pós-operatória em artroplastia total de quadril (ATQ). Métodos: amostras laboratoriais sanguíneas de 78 pacientes consecutivos submetidos à ATQ foram analisadas em cinco em períodos distintos (um pré-operatório e quatro pós-operatórios). Verificou-se a contagem de hemoglobina, hematócrito e plaquetas desses pacientes. Foram analisadas características antropométricas e comportamentais e comorbidades referentes à amostra, para verificação de fatores de risco associados à prática transfusional. Os indivíduos do estudo foram divididos em dois grupos: aqueles que receberam transfusão sanguínea foram alocados no Grupo 1 (G1) e os que não a receberam, no Grupo 2 (G2). As condutas transfusionais respaldaram-se dos critérios da Academia Americana de Anestesiologia e da Sociedade Britânica de Hematologia. Resultados: receberam transfusão de hemoderivados 27 (34,6%) pacientes. As análises das curvas de hemoglobina, hematócrito e plaquetas entre o G1 e o G2 nas cinco visitas distintas foram similares (p > 0,05). Todos os fatores de risco analisados, com exceção da etnia, não apresentaram repercussões nos índice de transfusão em suas análises com valor p > 0,05. A soma das comorbidades clínicas associadas aos pacientes no G1 foi mediana de 3 (IC 95% 2,29-3,40), enquanto no G2 a mediana foi 2 (IC 95% 1,90-2,61) com valor p = 0,09. Conclusão: a curva hemática apresenta confiabilidade limitada quando usada como parâmetro exclusivo e absoluto. A existência de pacientes tolerantes às variações da curva hematimétrica pressupõe que as suas avaliações de caráter clínico, funcional e de ...

Objective: to determine whether the laboratory hematic curve must be the single predictor of postoperative blood transfusion in total hip arthroplasty. Methods: the laboratory blood samples of 78 consecutive patients undergoing total hip arthroplasty was analyzed during five distinct moments: one preoperative and four postoperative. There was a count of hemoglobin, hematocrit and platelets of the patients samples. Other catalogued variables ascertain possible risk factors related to transfusional practice. They characterized the anthropometric, behavioral and co morbidities data in this population. The study subjects were divided and categorized into two groups: those who received blood transfusion during or after surgery (Group 1, G1), and those who did not accomplish blood transfusion (Group 2, G2). Transfusion rules were lead by guidelines of American Academy of Anesthesiology and the British Society of Hematology. Results: a total of 27 (34.6%) patients received blood transfusions. The curves of hemoglobin, hematocrit and platelet transfusions between G1 and G2 were similar (p > 0.05). None of the analyzed risk factors modified the rate of transfusion rate in their analysis with p value > 0.05, except the race. The sum of clinical co morbidities associated with patients in G1 was a median of 3 (95% CI 2.29-3.40), while in G2 the median was 2 (95% CI 1.90-2.61) with p = 0.09. Conclusion: the curve in red blood cells has limited reliability when used as sole parameter. The existence of tolerant patients hematimetric curve variations assumes that their assessments of clinical, functional evaluation and co-morbidities are parameters that should influence the decision to transfusion red blood cells. .

Blood transfusion in hip arthroplasty: a laboratory hematic curve must be the single predictor of the need for transfusion?

OBJECTIVE: to determine whether the laboratory hematic curve must be the single predictor of postoperative blood transfusion in total hip arthroplasty. METHODS: the laboratory blood samples of 78 consecutive patients undergoing total hip arthroplasty was analyzed during five distinct moments: one preoperative and four postoperative. There was a count of hemoglobin, hematocrit and platelets of the patients samples. Other catalogued variables ascertain possible risk factors related to transfusional practice. They characterized the anthropometric, behavioral and co morbidities data in this population. The study subjects were divided and categorized into two groups: those who received blood transfusion during or after surgery (Group 1, G1), and those who did not accomplish blood transfusion (Group 2, G2). Transfusion rules were lead by guidelines of American Academy of Anesthesiology and the British Society of Hematology. RESULTS: a total of 27 (34.6%) patients received blood transfusions. The curves of hemoglobin, hematocrit and platelet transfusions between G1 and G2 were similar (p > 0.05). None of the analyzed risk factors modified the rate of transfusion rate in their analysis with p value > 0.05, except the race. The sum of clinical co morbidities associated with patients in G1 was a median of 3 (95% CI 2.29-3.40), while in G2 the median was 2 (95% CI 1.90-2.61) with p = 0.09. CONCLUSION: the curve in red blood cells has limited reliability when used as sole parameter. The existence of tolerant patients hematimetric curve variations assumes that their assessments of clinical, functional evaluation and co-morbidities are parameters that should influence the decision to transfusion red blood cells.

OBJETIVO: verificar se a curva laboratorial hemática deve ser o único preditor de transfusão sanguínea pós-operatória em artroplastia total de quadril (ATQ). MÉTODOS: amostras laboratoriais sanguíneas de 78 pacientes consecutivos submetidos à ATQ foram analisadas em cinco em períodos distintos (um pré-operatório e quatro pós-operatórios). Verificou-se a contagem de hemoglobina, hematócrito e plaquetas desses pacientes. Foram analisadas características antropométricas e comportamentais e comorbidades referentes à amostra, para verificação de fatores de risco associados à prática transfusional. Os indivíduos do estudo foram divididos em dois grupos: aqueles que receberam transfusão sanguínea foram alocados no Grupo 1 (G1) e os que não a receberam, no Grupo 2 (G2). As condutas transfusionais respaldaram-se dos critérios da Academia Americana de Anestesiologia e da Sociedade Britânica de Hematologia. RESULTADOS: receberam transfusão de hemoderivados 27 (34,6%) pacientes. As análises das curvas de hemoglobina, hematócrito e plaquetas entre o G1 e o G2 nas cinco visitas distintas foram similares (p > 0,05). Todos os fatores de risco analisados, com exceção da etnia, não apresentaram repercussões nos índice de transfusão em suas análises com valor p > 0,05. A soma das comorbidades clínicas associadas aos pacientes no G1 foi mediana de 3 (IC 95% 2,29­3,40), enquanto no G2 a mediana foi 2 (IC 95% 1,90­2,61) com valor p = 0,09. CONCLUSÃO: a curva hemática apresenta confiabilidade limitada quando usada como parâmetro exclusivo e absoluto. A existência de pacientes tolerantes às variações da curva hematimétrica pressupõe que as suas avaliações de caráter clínico, funcional e de comorbidades sejam parâmetros que devam influenciar na decisão do uso de hemoderivados.

Association between trochanteric bursitis, osteoarthrosis and total hip arthroplasty.

OBJECTIVE: this was an epidemiological study on trochanteric bursitis at the time of performing total hip arthroplasty. METHODS: sixty-two sequential patients who underwent total hip arthroplasty due to osteoarthrosis, without any previous history of trochanteric bursitis, were evaluated. The bursas were collected and evaluated histologically. RESULTS: there were 35 female patients (56.5%) and 27 male patients (43.5%), with a mean age of 65 years (±11). Trochanteric bursitis was conformed histologically in nine patients (14.5%), of whom six were female (66.7%) and three were male (33.3%). CONCLUSIONS: 14.5% of the bursas analyzed presented inflammation at the time that the primary total hip arthroplasty due to osteoarthrosis was performed, and the majority of the cases of bursitis were detected in female patients.

OBJETIVO: fazer um estudo epidemiológico da bursite trocantérica no momento da feitura da artroplastia total do quadril (ATQ). MÉTODOS: foram avaliados 62 pacientes, sequenciais, submetidos à ATQ por osteoartrose, sem história prévia de bursite trocantérica. As bursas foram coletadas e avaliadas histologicamente. RESULTADOS: foram observados 35 pacientes do sexo feminino (56,5%) e 27 do masculino (43,5%), com média de 65 anos (+/−11). A bursite trocantérica foi confirmada histologicamente em nove (14,5%), seis do sexo feminino (66,7%) e três (33,3%) do masculino. CONCLUSÕES: das bursas analisadas, 14,5% apresentaram inflamação no momento da feitura da ATQ primária por osteoartrose. A maioria das bursites foi detectada nas pacientes femininas.

Do patients lose weight after total hip arthroplasty?

OBJECTIVE: To investigate the effect of total hip arthroplasty (THA) on body mass index (BMI), from before to after the operation. METHODS: 100 patients who underwent THA were retrospectively analyzed. They were stratified according to BMI, as proposed by the World Health Organization (WHO). RESULTS: There were 48 male patients and 52 female patients. Their mean age was 63.8 ± 13.5 years. The mean follow-up was 24.6 ± 0.6 months. The men had a mean preoperative BMI of 28.4 ± 3.6 kg/m(2) and the women, 27.5 ± 5.0 kg/m(2). The mean postoperative BMI was 28.9 ± 0.7 kg/m(2) for the men and 27.8 ± 0.7 kg/m(2) for the women. There was a general mean increase in BMI of 0.4 kg/m(2). The BMI increased both in patients with normal weight and in those who were overweight, but it decreased slightly in patients who were obese. BMI remained unchanged in the majority of the patients (73%). CONCLUSION: The improvement in mobility achieved through THA did not promote any reduction in anthropometric measurements in the majority of the patients.

OBJETIVO: Investigar o efeito da artroplastia total do quadril (ATQ) no índice de massa corporal em relação ao pré e ao pós-operatório. MÉTODOS: Foram analisados retrospectivamente 100 pacientes submetidos à ATQ. Os pacientes foram estratificados pelo índice de massa corporal (IMC), conforme proposto pela Organização Mundial de Saúde (OMS). RESULTADOS: Foram observados 48 pacientes do sexo masculino e 52 do feminino. A média de idade foi de 63,8 ± 13,5 anos. O seguimento médio foi de 24,6 ± 0,6 meses. Os homens apresentaram IMC pré-operatório médio de 28,4 ± 3,6 kg/m2 e as mulheres, de 27,5 ± 5,0 kg/m2. O IMC médio pós-operatório foi 28,9 ± 0,7 kg/m2 para os homens e 27,8 ± 0,7 kg/m2 para as mulheres. Ocorreu uma média de aumento geral do IMC em 0,4 kg/m2. O IMC aumentou em pacientes com peso normal e com sobrepeso, mas diminuiu levemente em pacientes com obesidade. A maioria dos pacientes (73%) permaneceu com o IMC inalterado. CONCLUSÃO: A melhoria da mobilidade obtida com a ATQ não promoveu uma redução das medidas antropométricas na maioria dos pacientes.

Dimensional analysis of total hip arthroplasty polyethylenes / Análise dimensional de diferentes acetábulos usados na artroplastia total do quadril

Objective: This paper performs a dimensional analysis of different total hip arthroplasty polyethylenes, cemented and non-cemented, Brazilian made and imported. Methods: It was considered acetabular components with 50 mm for the 28 mm femoral heads. Dimensional analysis was performed on a 3D coordinate Carl-Zeiss robotic device. Polyethylene thickness and its external measurements (maximum diameter and diameter for the femoral head) were measured. Results: The minimum thickness of the polyethylene was guaranteed on all tested components. The thickness of cemented acetabular varied from 19.185 mm to 25.358 mm, while the thickness of the non-cemented acetabular varied from 12.451 mm to 19.232 mm. The thickness was 27.96% lower in non-cemented acetabular components. With respect to the polyethylene acetabular cavity that receives the femoral head, all internal diameters exhibit at least 28 mm. In relation to the maximum outer diameter of the polyethylene, only one cemented acetabular component reached 50 mm in diameter. Conclusions: There are large differences in measurements between brands and models analyzed. Cementless acetabular components have the smaller thickness. The diameters of non-cemented acetabular were also lower than those cemented at the expense of their need to insert into the metal-back. .

Objetivo: O presente estudo faz uma análise dimensional dos diferentes acetábulos cimentados e não cimentados, nacionais e importados, disponíveis no mercado nacional para artroplastia total do quadril. Métodos: Foram considerados os acetábulos de 50mm, destinados às cabeças femorais de 28 mm. As análises dimensionais foram feitas em um equipamento tridimensional robótico de medição por coordenadas. Avaliou-se a menor espessura do polietileno e suas medidas externas (diâmetro do espaço para a cabeça femoral e diâmetro máximo do acetábulo). Resultados: A espessura mínima do polietileno foi garantida em todos os componentes testados. A espessura dos acetábulos cimentados variou de 19,185 mm a 25,358 mm, enquanto a espessura dos acetábulos não cimentados variou de 12,451 mm a 19,232 mm A espessura foi em média 27,96% menor nos acetábulos não cimentados. Em relação à cavidade acetabular do polietileno que recebe a cabeça femoral, todos os diâmetros internos apresentaram pelo menos 28 mm. Em relação ao diâmetro externo máximo do polietileno, apenas um acetábulo cimentado atingiu os 50 mm de diâmetro. Conclusões: Observaram-se grandes diferenças nas medidas entre as marcas e os modelos analisados. Os acetábulos não cimentados têm uma espessura menor. Os diâmetros dos acetábulos não cimentados também foram menores do que os cimentados, à custa de sua necessidade de inserção no metal-back. .

Dimensional analysis of total hip arthroplasty polyethylenes.

OBJECTIVE: This paper performs a dimensional analysis of different total hip arthroplasty polyethylenes, cemented and non-cemented, Brazilian made and imported. METHODS: It was considered acetabular components with 50 mm for the 28 mm femoral heads. Dimensional analysis was performed on a 3D coordinate Carl-Zeiss robotic device. Polyethylene thickness and its external measurements (maximum diameter and diameter for the femoral head) were measured. RESULTS: The minimum thickness of the polyethylene was guaranteed on all tested components. The thickness of cemented acetabular varied from 19.185 mm to 25.358 mm, while the thickness of the non-cemented acetabular varied from 12.451 mm to 19.232 mm. The thickness was 27.96% lower in non-cemented acetabular components. With respect to the polyethylene acetabular cavity that receives the femoral head, all internal diameters exhibit at least 28 mm. In relation to the maximum outer diameter of the polyethylene, only one cemented acetabular component reached 50 mm in diameter. CONCLUSIONS: There are large differences in measurements between brands and models analyzed. Cementless acetabular components have the smaller thickness. The diameters of non-cemented acetabular were also lower than those cemented at the expense of their need to insert into the metal-back.

OBJETIVO: O presente estudo faz uma análise dimensional dos diferentes acetábulos cimentados e não cimentados, nacionais e importados, disponíveis no mercado nacional para artroplastia total do quadril. MÉTODOS: Foram considerados os acetábulos de 50 mm, destinados às cabeças femorais de 28 mm. As análises dimensionais foram feitas em um equipamento tridimensional robótico de medição por coordenadas. Avaliou-se a menor espessura do polietileno e suas medidas externas (diâmetro do espaço para a cabeça femoral e diâmetro máximo do acetábulo). RESULTADOS: A espessura mínima do polietileno foi garantida em todos os componentes testados. A espessura dos acetábulos cimentados variou de 19,185 mm a 25,358 mm, enquanto a espessura dos acetábulos não cimentados variou de 12,451 mm a 19,232 mm A espessura foi em média 27,96% menor nos acetábulos não cimentados. Em relação à cavidade acetabular do polietileno que recebe a cabeça femoral, todos os diâmetros internos apresentaram pelo menos 28 mm. Em relação ao diâmetro externo máximo do polietileno, apenas um acetábulo cimentado atingiu os 50 mm de diâmetro. CONCLUSÕES: Observaram-se grandes diferenças nas medidas entre as marcas e os modelos analisados. Os acetábulos não cimentados têm uma espessura menor. Os diâmetros dos acetábulos não cimentados também foram menores do que os cimentados, à custa de sua necessidade de inserção no metal-back.

NEW BEARING SURFACES IN TOTAL HIP REPLACEMENT.

Total hip arthroplasty is being increasingly indicated for younger and more active patients, in addition to a naturally growing demand for the procedure because of increasing life expectancy among patients. The high costs of this surgery and the controversies regarding implant performance have made this topic the subject of constant research, seeking new materials with better resistance to wear and better biocompatibility. The present article provides a review of new surfaces in total hip arthroplasty.

COMPARISON OF VOLUMES OCCUPIED BY DIFFERENT INTERNAL FIXATION DEVICES FOR FEMORAL NECK FRACTURES.

OBJECTIVE: The objective of this paper is to measure the volume occupied by the most widely used internal fixation devices for treating femoral neck fractures, using the first 30, 40 and 50 mm of insertion of each screw as an approximation. The study aimed to observe which of these implants caused least bone aggression. METHODS: Five types of cannulated screws and four types of dynamic hip screws (DHS) available on the Brazilian market were evaluated in terms of volume differences through water displacement. RESULTS: Fixation with two cannulated screws presented significantly less volume than shown by DHS, for insertions of 30, 40 and 50 mm (p=0.01, 0.012 and 0.013, respectively), fixation with three screws did not show any statistically significant difference (p= 0.123, 0.08 and 0.381, respectively) and fixation with four cannulated screws presented larger volumes than shown by DHS (p=0.072, 0.161 and 0.033). CONCLUSIONS: Fixation of the femoral neck with two cannulated screws occupied less volume than DHS, with a statistically significant difference. The majority of screw combinations did not reach statistical significance, although fixation with four cannulated screws presented larger volumes on average than those occupied by DHS.

Comparação dos volumes ocupados pelos diferentes dispositivos de fixação interna para fraturas do colo femoral / Comparison of volumes occupied by different internal fixation devices for femoral neck fractures

OBJETIVO: Medir o volume ocupado pelos dispositivos de fixação interna mais difundidos para o tratamento das fraturas de colo femoral, usando como aproximação os primeiros 30, 40 e 50mm de cada parafuso. O estudo visa observar qual desses implantes causa menor agressão óssea. MÉTODOS: Foram avaliados cinco modelos de parafusos canulados e quatro modelos de parafusos deslizantes (DHS) encontrados no mercado nacional através de diferença de volume por deslocamento de água. RESULTADOS: A fixação com dois parafusos canulados apresentou volume significativamente menor do que com DHS nas inserções de 30, 40 e 50mm (p=0,01, 0,012 e 0,013, respectivamente), a fixação com três parafusos não apresentou significância estatística (p=0,123, 0,08 e 0,381, respectivamente) e a fixação com quatro parafusos canulados apresenta volumes maiores que o DHS (p=0,072, 0,161 e 0,033). CONCLUSÕES: A fixação da cabeça femoral com dois parafusos canulados ocupa menor volume quando comparada ao DHS com diferença estatisticamente significativa. A maioria das outras combinações de parafusos não atingiram significância estatística, apesar de a fixação com quatro parafusos canulados apresentar, em média, volumes maiores que o ocupado pelo DHS.

OBJECTIVE: The objective of this paper is to measure the volume occupied by the most widely used internal fixation devices for treating femoral neck fractures, using the first 30, 40 and 50 mm of insertion of each screw as an approximation. The study aimed to observe which of these implants caused least bone aggression. METHODS: Five types of cannulated screws and four types of dy namic hip screws (DHS) available on the Brazilian market were evaluated in terms of volume differences through water displace ment. RESULTS: Fixation with two cannulated screws presented significantly less volume than shown by DHS, for insertions of 30, 40 and 50 mm (p=0.01, 0.012 and 0.013, respectively), fixa tion with three screws did not show any statistically significant difference (p= 0.123, 0.08 and 0.381, respectively) and fixa tion with four cannulated screws presented larger volumes than shown by DHS (p=0.072, 0.161 and 0.033). CONCLUSIONS: Fixa tion of the femoral neck with two cannulated screws occupied less volume than DHS, with a statistically significant difference. The majority of screw combinations did not reach statistical significance, although fixation with four cannulated screws pre sented larger volumes on average than those occupied by DHS.

Osteotomia valgizante para pseudartrose do colo do fêmur: relato de 32 casos / Valgusing intertrochanteric osteotomy for the treatment of femoral neck non-unions: report of 32 cases

Objetivo: Avaliar a consolidação pós-osteotomia osteotomia valgizante do fêmur no tratamento do pseudartrose do colo femoral. Método: Durante 15 anos (1988-2003), 32 casos de pseudartrosedo colo do fêmur foram tratados com osteotomia valgizante e fixação. O seguimento médio dos casos foi de 9,8 anos e a média de idade dos pacientes foi de 41,7 anos. Resultados: Dos 32casos quatro evoluíram para prótese total do quadril e 28 evoluíram para consolidação (87,4%). Oito casos evoluíram necrose parcial. Conclusão: A osteotomia valgizante é altamente eficazpara obtenção da consolidação na pseudartrose do colo do fêmur 87,4% (28/32) A recuperação integral da função do quadril só foi obtida em 56,2% (18/32).

Purpose: The purpose of the present study was to review the results of femoral neck non-unions treatment with valgusing intertrochanteric osteotomy. Methods: Between 1988 and 2003 we treaded thirty two femoral neck non-unions with valgusing osteotomy and fixation. The mean follow-up time was 9.8 years and the mean age was 41.7 years. Results: Twenty eight (87.4%)of the thirty two valgusing osteotomies evolved to femoral neck union, while four cases (12.6%) evolved to total hip arthroplasty. Eight cases evolved to partial osteonecrosis. Conclusions: Thevalgusing intertrochanteric osteotomy for treating femoral neck non-unions achieved consolidation in 87.4% (28/32). However, only 56.2% (18/32) achieved full recovery of hip function.

VALGUSING INTERTROCHANTERIC OSTEOTOMY FOR THE TREATMENT OF FEMORAL NECK NON-UNIONS: REPORT OF 32 CASES.

UNLABELLED: The purpose of the present study was to review the results of femoral neck non-unions treatment with valgusing intertrochanteric osteotomy. METHODS: Between 1988 and 2003 we treaded thirty two femoral neck non-unions with valgusing osteotomy and fixation. The mean follow-up time was 9.8 years and the mean age was 41.7 years. RESULTS: Twenty eight (87.4%) of the thirty two valgusing osteotomies evolved to femoral neck union, while four cases (12.6%) evolved to total hip arthroplasty. Eight cases evolved to partial osteonecrosis. CONCLUSIONS: The valgusing intertrochanteric osteotomy for treating femoral neck non-unions achieved consolidation in 87.4% (28/32). However, only 56.2% (18/32) achieved full recovery of hip function.