ABSTRACT
The success of joint replacement surgery has been responsible for raising patients' expectations regarding the procedure. Many of these procedures are currently designed not only to relive the pain caused by arthrosis, but also to enable patients to achieve functional recovery and to engage in some degree of physical activity and sports. However, as physical exercise causes an increase in forces exercised through the articular prosthesis, it can be an important risk factor for its early failure. Scientific literature on sports after arthroplasty is limited to small-scale retrospective studies with short-term follow-up, which are mostly insufficient to evaluate articular prosthesis durability. This article presents a review of the literature on sports in the context of hip, knee, shoulder and intervertebral disc arthroplasty, and puts forward general recommendations based on the current scientific evidence. Systematic Review, Level of Evidence III.
O sucesso da artroplastia tem sido responsável pelo aumento das expectativas dos pacientes, sendo que, atualmente, muitos pretendem não apenas o alívio da dor causada pela artrose, mas também a recuperação funcional e praticar algum grau de atividade física e esportiva. No entanto, a prática de exercício físico, ao provocar um aumento das forças exercidas através da prótese articular, pode ser um importante fator de risco para a falha precoce. A literatura científica sobre esportes depois de artroplastia é limitada a pequenos estudos retrospectivos com pouco tempo de acompanhamento, na maioria insuficiente para a avaliação da duração da prótese articular. Este artigo apresenta uma revisão da literatura sobre prática desportiva no contexto de artroplastia do quadril, joelho, ombro e isco intervertebral e propõe recomendações gerais com base na evidência científica atual. Nível de Evidência III, Revisão Sistemática/Atualização.
ABSTRACT
ABSTRACT The success of joint replacement surgery has been responsible for raising patients' expectations regarding the procedure. Many of these procedures are currently designed not only to relive the pain caused by arthrosis, but also to enable patients to achieve functional recovery and to engage in some degree of physical activity and sports. However, as physical exercise causes an increase in forces exercised through the articular prosthesis, it can be an important risk factor for its early failure. Scientific literature on sports after arthroplasty is limited to small-scale retrospective studies with short-term follow-up, which are mostly insufficient to evaluate articular prosthesis durability. This article presents a review of the literature on sports in the context of hip, knee, shoulder and intervertebral disc arthroplasty, and puts forward general recommendations based on the current scientific evidence. Systematic Review, Level of Evidence III.
RESUMO O sucesso da artroplastia tem sido responsável pelo aumento das expectativas dos pacientes, sendo que, atualmente, muitos pretendem não apenas o alívio da dor causada pela artrose, mas também a recuperação funcional e praticar algum grau de atividade física e esportiva. No entanto, a prática de exercício físico, ao provocar um aumento das forças exercidas através da prótese articular, pode ser um importante fator de risco para a falha precoce. A literatura científica sobre esportes depois de artroplastia é limitada a pequenos estudos retrospectivos com pouco tempo de acompanhamento, na maioria insuficiente para a avaliação da duração da prótese articular. Este artigo apresenta uma revisão da literatura sobre prática desportiva no contexto de artroplastia do quadril, joelho, ombro e isco intervertebral e propõe recomendações gerais com base na evidência científica atual. Nível de Evidência III, Revisão Sistemática/Atualização.
ABSTRACT
Bilateral patellar tendon rupture is a rare entity, often associated with systemic diseases and patellar tendinopathy. The authors report a rare case of a 34-year-old man with simultaneous bilateral rupture of the patellar tendon caused by minor trauma. The patient is a retired basketball player with no past complaints of chronic knee pain and a history of steroid use. Surgical management consisted in primary end-to-end tendon repair protected temporarily with cerclage wiring, followed by a short immobilization period and intensive rehabilitation program. Five months after surgery, the patient was able to fully participate in sport activities.
As rupturas bilaterais dos tendões patelares são uma entidade rara, muitas vezes associadas com doenças sistêmicas e tendinopatia patelar. Apresentamos um caso raro de um homem de 34 anos com rotura bilateral simultânea dos tendões patelares causada por trauma leve. O paciente é um jogador de basquetebol aposentado, sem queixas de dor crônica do joelho e com história de consumo de esteroides. O tratamento cirúrgico consistiu na reparação tendinosa primária de ponta a ponta, protegida temporariamente com banda de cerclage, seguida de curto tempo de imobilização e programa intensivo de reabilitação. Aos cinco meses após a cirurgia, o paciente era capaz de participar sem restrições em atividades desportivas.
ABSTRACT
ABSTRACT Bilateral patellar tendon rupture is a rare entity, often associated with systemic diseases and patellar tendinopathy. The authors report a rare case of a 34-year-old man with simultaneous bilateral rupture of the patellar tendon caused by minor trauma. The patient is a retired basketball player with no past complaints of chronic knee pain and a history of steroid use. Surgical management consisted in primary end-to-end tendon repair protected temporarily with cerclage wiring, followed by a short immobilization period and intensive rehabilitation program. Five months after surgery, the patient was able to fully participate in sport activities.
RESUMO As rupturas bilaterais dos tendões patelares são uma entidade rara, muitas vezes associadas com doenças sistêmicas e tendinopatia patelar. Apresentamos um caso raro de um homem de 34 anos com rotura bilateral simultânea dos tendões patelares causada por trauma leve. O paciente é um jogador de basquetebol aposentado, sem queixas de dor crônica do joelho e com história de consumo de esteroides. O tratamento cirúrgico consistiu na reparação tendinosa primária de ponta a ponta, protegida temporariamente com banda de cerclage, seguida de curto tempo de imobilização e programa intensivo de reabilitação. Aos cinco meses após a cirurgia, o paciente era capaz de participar sem restrições de atividades desportivas.
Subject(s)
Humans , Male , Adult , General Surgery , Patellar Ligament , Rehabilitation , Rupture, Spontaneous , Steroids , Tendon InjuriesABSTRACT
OBJECTIVE: SLE has a relapsing-remitting course with disease activity flares over time. This study aims to identify clinical predictors of SLE flares. METHODS: This prospective cohort study over 24 months included all SLE patients on follow-up at one academic lupus clinic. Flare was defined as an increase in SLEDAI-2K score ≥4 points. Baseline clinical and demographic parameters were compared using survival analysis for time-to-flare outcome with univariate log-rank tests. Variables with significant differences were further evaluated as predictors with multivariate Cox regression models adjusting for potential confounding or contributing factors and hazard ratio (HR) calculation. RESULTS: A total of 202 SLE patients were included. Over the follow-up period, 1083 visits were documented and 16.8% of patients presented with flares. In multivariate analysis, the following parameters emerged as flare predictors: SLE diagnosis up to 25 years of age (HR = 2.14, P = 0.03), lupus nephritis previous to baseline visit (HR = 4.78, P < 0.0001) and immunosuppressor treatment for severe SLE (HR = 3.22, P < 0.001). Baseline disease activity, disease duration and treatment with prednisone or HCQ were not predictive factors. CONCLUSION: Patients with an SLE diagnosis before age 25 years, lupus nephritis or immunosuppressor treatment for severe SLE present greater HRs for flares, suggesting the need for tighter clinical monitoring. Current immunosuppressive strategies seem to be inefficient in providing flare prevention.
