A survey to assess the educational-level interference on self-evaluation of acute pain.

OBJECTIVE: The present study aimed to evaluate whether patient education level interferes in the percentage of pain relief or increase using visual analogue scale (VAS) and subjective pain perception. PATIENTS AND METHODS: Ninety-five patients presenting acute shoulder pain due to enthesitis were evaluated. They were asked to quantify the pain using VAS before steroid articular infiltration. One week later, patients reevaluated the pain using VAS and orally stated the percentage of perceived pain increase or relief. The information gathered was then compared among three patient educational levels (elementary, high school, and university). RESULTS: Percentages of improvement stated orally and utilizing VAS presented no statistically significant differences among the three educational status levels (p = 0.804). CONCLUSION: Patient educational status caused no impact in the results of acute pain self-assessment with VAS and oral evaluation.

Total knee arthroplasty after high tibial osteotomy: a comparison of opening and closing wedge osteotomy.

PURPOSE: High tibial osteotomy (HTO) is frequently used to treat varus osteoarthritis in younger patients with the goal of delaying the need for total knee arthroplasty (TKA). While it has been reported that the results of TKA following HTO are worse than those in patients without prior knee surgery, the influence of osteotomy technique (medial opening-wedge versus lateral closing-wedge) has not been explored. The purpose of this study was to evaluate the influence of HTO technique on the performance and results of TKA. METHODS: A total of 141 TKA's performed in 118 patients with prior HTO (24 opening wedge and 117 closing wedge) were reviewed at a mean follow-up of two years. Reviewed data included intra-operative factors (tourniquet time, the need for additional exposure, and intra-operative complications), clinical results (International Knee Score (IKS)) and radiographic assessment of limb alignment. RESULTS: The average IKS knee and function scores improved from 54.0 and 60.3 to 87.0 and 79.5 (p < 0.0001). There was no significant difference in IKS scores based on osteotomy technique. There was a trend toward an increased need for tibial tubercle osteotomy in the closing wedge group. There was an increased need for extensive medial release in the opening wedge group and extensive lateral release in the closing wedge group. No differences in tourniquet time, complication rates, or hip-knee-ankle angle were noted between the two groups. CONCLUSIONS: Radiographic limb alignment, patient-reported outcomes, and complication rates are equal in patients undergoing TKA after opening and closing wedge HTO.

Cell therapy of pseudarthrosis.

OBJECTIVE: To assess the safety and efficiency of cell therapy for pseudarthrosis. Implant of the bone marrow aspirate was compared to mononuclear cells purified extemporaneously using the Sepax(®) equipment. METHODS: Six patients with nonunion of the tibia or femur were treated. Four received a percutaneous infusion of autologous bone marrow aspirated from the iliac crest, and two received autologous bone marrow mononuclear cells separated from the aspirate with the Sepax(®). The primary fixation method was unchanged, and the nonunion focus was not exposed. Physical examination and radiographies were performed 2, 4 and 6 months after the treatment by the same physician. After consolidation of the fracture the satisfaction of the patients was estimated using the adapted QALY scale. RESULTS: No complications occurred as a result of the referred procedures. Bone consolidation was obtained in all cases within 3 to 24 weeks. The degree of patient satisfaction before and after bone consolidation was assessed, with the average value increasing from two to nine (p=0.0156). CONCLUSION: We conclude that the proposed method is effective and safe for the treatment of nonunion of long bones regardless of the stabilization method used. Level of Evidence II, Prospective Comparative Study.

Terapia celular da pseudoartose / Cell therapy of pseudarthrosis

OBJETIVO: Analisar a segurança e a eficácia da infusão percutânea no foco da pseudoartrose do aspirado de medula óssea total e da infusão de células mononucleares purificadas e concentradas. MÉTODOS: Foram tratados seis pacientes portadores de pseudoartrose de tíbia ou de fêmur. Quatro receberam infusão do aspirado de medula óssea autóloga total obtida da crista ilíaca e dois receberam o aspirado de medula óssea autóloga processada com Sepax®. Não foi alterado o método de fixação primária ou exposto o foco da pseudoartrose. Realizou-se exame físico e avaliação radiográfica 2, 4 e 6 meses após o procedimento. Após a consolidação, foi avaliado o grau de satisfação do paciente. RESULTADOS: Não verificamos qualquer complicação decorrente dos procedimentos. No primeiro grupo (aspirado total) a consolidação foi obtida entre três e vinte e quatro semanas e, no segundo grupo (Sepax®), entre 12 e 16 semanas. O grau de satisfação dos pacientes teve a média aumentada de 2,75 para 9 no grupo I e de 1 para 8,5 no grupo II (p=0,0156). CONCLUSÃO: Concluímos que o tratamento das pseudoartroses com os métodos avaliados mostraram-se eficazes e seguros independente do método de estabilização utilizado. Nível de Evidência II, Estudo Prospectivo Comparativo.

OBJECTIVE: To assess the safety and efficiency of cell therapy for pseudarthrosis. Implant of the bone marrow aspirate was compared to mononuclear cells purified extemporaneously using the Sepax® equipment. METHODS: Six patients with nonunion of the tibia or femur were treated. Four received a percutaneous infusion of autologous bone marrow aspirated from the iliac crest, and two received autologous bone marrow mononuclear cells separated from the aspirate with the Sepax®. The primary fixation method was unchanged, and the nonunion focus was not exposed. Physical examination and radiographies were performed 2, 4 and 6 months after the treatment by the same physician. After consolidation of the fracture the satisfaction of the patients was estimated using the adapted QALY scale. RESULTS: No complications occurred as a result of the referred procedures. Bone consolidation was obtained in all cases within 3 to 24 weeks. The degree of patient satisfaction before and after bone consolidation was assessed, with the average value increasing from two to nine (p=0.0156). CONCLUSION: We conclude that the proposed method is effective and safe for the treatment of nonunion of long bones regardless of the stabilization method used. Level of Evidence II, Prospective Comparative Study.