Early Postoperative Results in Robotic-Arm-Assisted Total Knee Replacement versus Conventional Technique: First Latin American Experience.

Early results with robotic-arm-assisted total knee arthroplasty (TKA) are encouraging; nevertheless, literature might be unrepresentative, as it comes mostly from American, European, and Asian countries. There is limited experience and no comparative clinical reports in Latin America, a region of mainly low- and middle-income countries with limited access to these promising technologies. This study aims to compare the early postoperative results of the first Latin American experience with robotic-arm-assisted TKA versus conventional TKA. A cohort study was performed, including 181 consecutive patients (195 knees) with advanced symptomatic knee osteoarthritis (OA) undergoing primary TKA between March 2016 and October 2019. The cohort included 111 consecutive patients (123 knees) undergoing conventional TKA, followed by 70 consecutive patients (72 knees) undergoing robotic-arm-assisted TKA. The same surgical team (surgeon 1 and surgeon 2) performed all procedures. Patients with previous osteotomy, posttraumatic OA, and revision components were not considered. The same anesthetic and rehabilitation protocol was followed. The investigated clinical outcomes (for the first 60 postoperative days) were: surgical tourniquet time, time to home discharge, time to ambulation, postoperative daily pain (Visual Analog Scale), opioid use, range of motion, blood loss, complications, and postoperative mechanical axis. The early clinical postoperative results of this first Latin American comparative experience of robotic-arm-assisted TKA versus conventional technique showed lower opioids requirements and faster functional recovery of ambulation in those patients operated with the robotic system; nevertheless, surgical times were higher, without differences in total postoperative complications and other clinical outcomes.

Cross-cultural adaptation and validation of the KOOS, JR questionnaire for assessing knee osteoarthritis in Spanish-speaking patients.

PURPOSE: The present study aims to translate, adapt and validate a Spanish version of the Knee Injury and Osteoarthritis Outcome Score, Joint Replacement (KOOS, JR), including a reliability and validity analysis in patients with knee osteoarthritis (OA). METHODS: This study conducted a prospective validation study following the six stages of the "Guidelines for the Process of Cross-Cultural Adaptation of Self-Report Measures". Psychometric testing was conducted in patients with knee osteoarthritis. Subjects answered the Spanish KOOS, JR (S-KOOS, JR) and a validated Spanish Oxford Knee Score (S-OKS). Retest was conducted at 10 days. Acceptability, floor and ceiling effect, internal consistency (Cronbach's α), reproducibility (mixed-effect model coefficient [MEMC]) and construct validity (Spearman's correlation; p = 0.05) were assessed. RESULTS: Forty-one patients (mean age: 65.6 ± 5.39; 48.8% female) participated in the study. All patients (100%) answered both scores during the first assessment and 38 (92.7%) during the second assessment. All patient-reported outcomes measures were answered completely (100%). The S-KOOS, JR resulted in 100% acceptability when answered. There were no ceiling or floor effects detected. The Cronbach's α for the S-KOOS, JR was 0.927 and its MEMC was 0.852 (CI 95% 0.636-1.078). The Spearman's correlation between the S-KOOS, JR and the S-OKS was 0.711 (CI 0.345-0.608; p < 0.001) and 0.870 (CI 0.444-0.651; p < 0.001) for the first and second assessments, respectively. CONCLUSION: The S-KOOS, JR has very high internal consistency and reproducibility, with a high correlation with the S-OKS; it is a reliable and valid instrument for characterising Spanish-speaking patients suffering from knee OA. LEVEL OF EVIDENCE: IV.

Abordaje anterolateral extendido y fijación con placa rim en fragmentos posterolaterales en fracturas de platillo tibial / Extended anterolateral approach and rim plate fixation for posterolateral fragments in tibial plateau fractures

Los fragmentos posterolaterales (FPLs) en fracturas de platillo tibial son frecuentes, pero difíciles de reducir y estabilizar. Actualmente existe controversia sobre cómo deben ser abordados; si bien un abordaje anterolateral es más seguro, este puede ser insuficiente para lograr una correcta reducción. Los abordajes posterolaterales y posteriores ofrecen una visión directa y permiten una fijación con ventaja biomecánica; sin embargo, son más demandantes y exponen al paciente a una mayor morbilidad. A continuación, se presenta una nota técnica sobre la reducción y fijación de FPLs con una placa rim por medio de un abordaje anterolateral extendido a través del espacio paraligamento colateral lateral.

Posterolateral fragments (PLFs) are commonly seen in tibial plateau fractures, but their reduction and fixation are challenging. There is no consensus about the ideal approach to fix this particular fragment. Even though an anterolateral approach is a safe option, it may impair a correct reduction. The posterolateral and posterior approaches offer direct visualization of the fragment, and enable a fixation with a biomechanical advantage; however, they are more demanding and expose the patient to a higher risk if morbidity. The following technical note describes the reduction and fixation of PLFs with a rim plate through an extended anterolateral approach using the paralateral collateral ligament space.

DOENÇA MENTAL E AUTORIA COM BASE NA ARQUEOLOGIA DE FOUCAULT / ENFERMEDAD MENTAL Y AUTORÍA BASADAS EN LA ARQUEOLOGÍA DE FOUCAULT / MENTAL ILLNESS AND AUTHORSHIP BASED ON FOUCAULT'S ARCHEOLOGY

Doença mental e autoria formam importantes limites temáticos nas investigações arqueológicas de Michel Foucault. Dentro desses limites, desrazão e autoria se encontram, conforme o seu diagnóstico da modernidade, em uma experiência extraordinária com a linguagem. Fora de tais limites, loucura e autoria possuem irreconciliáveis diferenças de status social. As implicações práticas da relação entre a razão e os associais, já presentes no diagnóstico da época clássica, adquirem então a primazia da análise, e a trama da linguagem dá lugar, nas investigações do filósofo, à trama política.(AU)

Enfermedad mental y autoría han sido importantes límites temáticos en las investigaciones arqueológicas de Michel Foucault. Dentro de estos límites, desrazón y autoría se encuentran, conforme su diagnóstico de la modernidad, en una experiencia extraordinaria con el lenguaje. Fuera de estos límites, locura y autoría tienen irreconciliables diferencias de status social. Las implicaciones prácticas de la relación entre razón y los asociales, ya presentes en el diagnóstico de la época clásica, adquieren entonces la primacía del análisis, y la trama del lenguaje da lugar, en las investigaciones del filósofo, a la trama política. .(AU)

Mental illness and authorship are two important themes in the boundaries of Michel Foucault's archaeological investigations. Within these limits, unreason and authorship meet, as his diagnosis of modernity, in an extraordinary experience with the language. Outside these limits, madness and authorship have irreconcilable differences in social status. The practical implications of the relationship between reason and asocial, already present in the diagnosis of classical times, acquires the primacy in his analysis, and woof of language gives rise, in the investigations of the philosopher, to the political plot.(AU)

DOENÇA MENTAL E AUTORIA COM BASE NA ARQUEOLOGIA DE FOUCAULT / ENFERMEDAD MENTAL Y AUTORÍA BASADAS EN LA ARQUEOLOGÍA DE FOUCAULT / MENTAL ILLNESS AND AUTHORSHIP BASED ON FOUCAULT'S ARCHEOLOGY

Doença mental e autoria formam importantes limites temáticos nas investigações arqueológicas de Michel Foucault. Dentro desses limites, desrazão e autoria se encontram, conforme o seu diagnóstico da modernidade, em uma experiência extraordinária com a linguagem. Fora de tais limites, loucura e autoria possuem irreconciliáveis diferenças de status social. As implicações práticas da relação entre a razão e os associais, já presentes no diagnóstico da época clássica, adquirem então a primazia da análise, e a trama da linguagem dá lugar, nas investigações do filósofo, à trama política...

Enfermedad mental y autoría han sido importantes límites temáticos en las investigaciones arqueológicas de Michel Foucault. Dentro de estos límites, desrazón y autoría se encuentran, conforme su diagnóstico de la modernidad, en una experiencia extraordinaria con el lenguaje. Fuera de estos límites, locura y autoría tienen irreconciliables diferencias de status social. Las implicaciones prácticas de la relación entre razón y los asociales, ya presentes en el diagnóstico de la época clásica, adquieren entonces la primacía del análisis, y la trama del lenguaje da lugar, en las investigaciones del filósofo, a la trama política...

Mental illness and authorship are two important themes in the boundaries of Michel Foucault's archaeological investigations. Within these limits, unreason and authorship meet, as his diagnosis of modernity, in an extraordinary experience with the language. Outside these limits, madness and authorship have irreconcilable differences in social status. The practical implications of the relationship between reason and asocial, already present in the diagnosis of classical times, acquires the primacy in his analysis, and woof of language gives rise, in the investigations of the philosopher, to the political plot...

Instabilidade cervical devido a artrite reumatóide / Cervical instability due to rheumatoid arthritis

Instabilidade cervical se caracteriza por um conjunto de alterações estruturais da coluna cervical e suas estruturas. Indivíduos com artrite reumatóide apresentam alta prevalência desta patologia em relação a população em geral . Uma vez diagnosticada a lesão, tem se mostrado uma tarefa desafiadora. Esse trabalho e uma revisão bibliográfica e visa esclarecer os achados mais freqüentes desta entidade.