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Objective: To evaluate perception of knee functionality and health-related quality of life (HRQL) in elderly patients submitted to total knee arthroplasty (TKA). Methods: 40 patients were studied at two moments of evaluation: in the preoperative period and eight weeks after surgery. HRQL was assessed using the MOS-SF-36 v2 (Medical Outcomes Study 36-Item Short-Form Health Survey) and KOOS (Knee Injury and Osteoarthritis Outcome Score). Results: Sample (71.6 ± 8.1 years), mostly female (62.5%). The SF-36 v2 MOS results show an improvement in all dimensions of physical health in the second evaluation (p

Background: Total knee replacement (TKR) is a major orthopedic surgery that is considered high risk for the development of venous thromboembolism (VTE). Objective: The aim of this study is to evaluate the clinical outcomes that resulted from the use of a new proposed VTE risk stratification protocol for selecting a suitable extended VTE prophylaxis for post TKR surgery patients administered in conjunction with patient education programs. Method: A randomized controlled trial was conducted in two medical centers in Saudi Arabia. A total of 242 patients were enrolled in the study, 121 patients in each group. The experimental group (A) was assessed by using the proposed VTE risk stratification protocol and also took part in patient education programs about TKR and its complications. The control group (B) was assessed by using the 2005 Caprini risk assessment tool and no education programs were given to this group. Both groups were followed for 35 days post operation. Results: The mean age of the participants was 65.86 (SD 8.67) and the majority of them were female 137 (56.6%). The mean body mass index of the study sample was 32.46 (SD 5.51). There were no significant differences between the two groups except for surgery type; the proportion of bilateral TKR in group A was higher than in group B (69/121 (28.5%) vs. 40/121(16.5%), p˂0.05). There were no confirmed pulmonary embolism cases in the study sample and diagnosis of deep-vein thrombosis was confirmed in 12/242 (5.0%) of patients: 1/121 (0.8%) in group A and 11/121 (9.1%) in group B (p˂0.05). The readmission rate for all patients was 2.5% (6/242), all of whom were in group B (p˂0.05). Conclusion: The proposed VTE risk stratification protocol that was applied in conjunction with patient education programs reduced VTE complications and readmission events, post TKR surgery. Trial Registration: ClinicalTrials.gov Identifier: NCT04031859.

For decades, the main cause of failure in total knee arthroplasty (TKA) is still the malalignment of prosthetic components. The authors present a case of advanced knee arthrosis, treated by TKA. Preoperative planning was performed with a mobile application and the patient was submitted to primary TKA using an implant developed with inspiration from the theory of "modified GAP" with a rotated tibial tray. Neutral mechanical alignment of the lower limbs was obtained and the application proved to be viable regarding its proposed plan for this case.

Objective: Identify the clinical and surgical complications associated with the use of a tourniquet in total knee arthroplasty in patients with or without calcification of the popliteal artery. Methods: The study was performed retrospectively, analyzing 58 patients with calcification of the popliteal artery and 57 patients as a control group. Results: The case group patients were significantly older than patients in the control group; however, this had no impact on the clinical outcome in the analyzed period.There were no complications during surgery in the groups studied, as there were no statistically significant differences between the incidence of local or systemic intercurrences in the analyzed period. Conclusion: This study found low rates of complications in patients undergoing total knee arthroplasties with use of a tourniquet, with or without calcification of the popliteal artery. RESUMO Objetivo: Identificar as complicações clínicas e cirúrgicas associadas ao uso de torniquete na artroplastia total de joelho em pacientes com ou sem calcificação da artéria poplítea. Métodos: O estudo foi feito de modo retrospectivo, analisou 64 pacientes com calcificação da artéria poplítea e 57 pacientes como grupo controle. Resultados: Os pacientes do grupo de casos eram significativamente mais velhos do que os pacientes do grupo controle. Entretanto, tal fato não teve repercussão quanto ao desfecho clínico no período analisado. Não houve complicações durante o ato cirúrgico nos grupos estudados, bem como não houve diferenças estatisticamente significantes entre a incidência de intercorrências locais ou sistêmicas no período analisado. Conclusão: O presente estudo observou baixos índices de complicações em pacientes submetidos a artroplastia total do joelho com uso de torniquete com ou sem calcificação da artéria poplítea.

Insufficiency fracture of the calcaneus is a rare entity. In the absence of trauma, evaluating a painful ankle in an elderly patient can be difficult and also it might be overlook the insufficiency fracture. We experienced a case of insufficiency calcaneus fracture that occurred after ipsilateral total knee arthroplasty. Here, we report our case with a review of literatures.

Cilj istraživanja: Utvrditi uspješnost rane rehabilitacije bolesnika nakon ugradnje totalnih endoproteza kuka odnosno koljena te detekcija razlika u uspjehu rehabilitacije u te dvije skupine usporedbom Barthel indeksa i pojavnosti komplikacija. Ispitanici i metode: U istraživanje je uključeno 230 bolesnika s ugrađenom totalnom endoprotezom kuka te 141 bolesnik s ugrađenom totalnom endoprotezom koljena. Prikupljeni su podatci o ukupnom Barthel indeksu na početku i kraju rehabilitacije te ocjene deset pojedinačnih kategorija Barthel indeksa: samostalnosti kod osobne higijene, kupanja, prehrane, korištenja toaleta, korištenja stepenica, odijevanja, kontrole stolice, kontrole mokrenja, transfera od sjedalice do kreveta te pokretljivosti. Uz to bilježena je i pojavnost komplikacija za vrijeme ranog postoperativnog razdoblja kao i tokom rehabilitacije. Za ocjenu uspjeha rehabilitacije nakon ugradnje totalne endoproteze kuka i koljena analizirane su vrijednosti Barthel indeksa na početku i na kraju rehabilitacije. Te dvije skupine bolesnika uspoređene su na osnovu razlika Barthel indeksa s početka i kraja rehabilitacije i promjena svake od deset pojedinačnih kategorija Barthel indeksa. Rezultati: Utvrđena je statistički značajna promjena Barthel indeksa nakon provedene rehabilitacije u skupini bolesnika s ugrađenim TEP-om kuka (p, Objectives: To determine the success of early rehabilitation following total knee and hip replacement. Also, to examine difference between early rehabilitation success in these two groups of patients by comparison of Barthel index scores and rate of complications. Patients and methods: This research included 230 patients with total hip replacement and 141 patients with total knee replacement. Following informations were collected: total Barthel index score as well as scores of ten Barthel index subcategories (feeding, bathing, grooming, dressing, bowels, bladder, toilet use, transfers – chair to bed, mobility on level surface and stairs) and occurance of complications in postoperative or rehabilitation period. Total Barthel index scores were used to analyze the success of early rehabilitation following total hip and knee replacement. Afterwards, differences between starting and endpoint total Barthel index scores (and differences between starting and endpoint scores of Barhel index subcategories) were used to compare the success of early rehabilitation in these two groups of patients. Results: Increase in total Barthel index score after early rehabilitation was statistically significant (p

ResumoInfecção após artroplastia total do joelho (IATJ) é complicação incomum. Está associada a aumento da morbimortalidade e dos custos de internação. Cocos gram-positivos, sobretudo Staphylococcus coagulase-negative e Staphylococcus aureus, são os germes mais comumente isolados (> 50% de todos os casos). Condições ligadas ao paciente, ao procedimento cirúrgico e mesmo ao pós-operatório têm sido identificadas como fatores de risco para IATJ. Vários são os métodos complementares que se somam à investigação clínica para o diagnóstico infeccioso e melhor caracterização do quadro. O tratamento para a IATJ deve ser individualizado, mas geralmente envolve a combinação da antibioticoterapia sistêmica com o tratamento cirúrgico. A troca do implante em um ou dois estágios é o procedimento de escolha. Desbridamento com retenção da prótese é opção em casos agudos, com implantes estáveis e com germes sensíveis aos agentes antimicrobianos.AbstractInfection after total knee replacement (IATJ) is a rare complication. It is associated with increased morbidity and mortality increasing the final costs. Gram positive coccus and Staphylococcus coagulase-negative and Staphylococcus aureus are the most common isolated germs (> 50% of the cases). Conditions related to the patient, to the surgical procedure and even to the post op have been identified as risk factors to IATJ. Many complementary methods together with clinical symptoms are useful to a proper diagnosis. Treatment for IATJ must be individualized but generally is a combination of systemic antibiotic therapy and surgical treatment. Prosthesis exchange in one or two stages is the first choice procedure. Debridement with prosthesis retention is an option in acute cases with stable implants and antibiotic sensible germs.

OBJETIVO:avaliar os resultados das cirurgias assistidas por navegação (CAN) nas artroplastias totais de joelho.MÉTODO:foram avaliados 196 pacientes submetidos à artroplastia total de joelho com auxílio da navegação por computador. Avaliados no intraoperatório os espaços (gaps) de extensão e de flexão, o alinhamento pós-operatório e o questionário funcional da Knee Society Score (KSS) pré-operatório e pós-operatório com seguimento médio de 22 meses.RESULTADOS:dos pacientes, 86,7% apresentaram bom alinhamento do eixo mecânico (dentro de 3◦ de varo ou valgo em relação ao eixo mecânico) e 96,4% apresentaram ambos os gaps de flexão e extensão balanceados. No pré-operatório, 97% dos pacientes apresentavam KSS funcional ruim ou insuficiente, no pós-operatório 77,6% apresentavam KSS funcional bom ou excelente.CONCLUSÃO:a navegação proporcionou a obtenção de implantes alinhados e balanceados com importante melhoria da função nos pacientes. Foram evidenciados sua utilidade no estudo, o entendimento e o aperfeiçoamento do conhecimento na execução das artroplastias. OBJECTIVE:to evaluate the results from surgery with computer-assisted navigation in cases of total knee arthroplasty.METHOD:a total of 196 patients who underwent total knee arthroplasty with computer-assisted navigation were evaluated. The extension and flexion spaces (gaps) were evaluated during the operation and the alignment after the operation was assessed. The Knee Society Score (KSS) questionnaire for assessing patient's function was applied preoperatively and postoperatively after a mean follow-up of 22 months.RESULTS:in all, 86.7% of the patients presented good alignment of the mechanical axis (less than 3◦ of varus or valgus in relation to the mechanical axis) and 96.4% of the patients presented balanced flexion and extension gaps. Before the operation, 97% of the patients presented poor or insufficient KSS, but after the operation, 77.6% presented good or excellent KSS.CONCLUSION:the navigation system made it possible to achieve aligned and balanced implants, with notable functional improvement among the patients. It was found to be useful in assessing, understanding and improving knowledge in relation to performing arthroplasty procedures. Universidade Federal de São Paulo (UNIFESP) Orthopedics and Traumatology Department UNIFESP, Orthopedics and Traumatology Department SciELO

FAPEMIG - Fundação de Amparo a Pesquisa do Estado de Minas Gerais O objetivo avaliar os indicadores epidemiológicos, etiopatogenia para aquisição de infecção no centro cirúrgico, na enfermaria, sítio cirúrgico de artropastias de quadril e joelho em um hospital universitário mineiro. O estudo foi de coorte de pacientes submetidos à artroplastias de quadril e joelho internados na Clínica Cirúrgica Ortopédica e Traumatologia do Hospital de Clinicas – Universidade Federal de Uberlândia, no período de maio de 2006 a dezembro de 2011, com vigilância ativa dos egressos até dezembro de 2013. Utilizados três sistemas de vigilância: National Healthcare Safety Network, laboratoriais e egressos. As identificações das amostras e resistência aos antimicrobianos foram: submetidas à discriminação clonal pela técnica de Pulsed Field Gel Electrophoresis. O projeto aprovado pelo Comitê de Ética em Pesquisa nr. 424/09. Foram analisadas 1863 artroplastias com uma taxa de infecção em 12,6%, quadril 1275(68,4%) e infecção de 14,3% e 588(31,6%) de joelho com 9,5% de infecção. O diagnóstico microbiológico em 80,0% dos episódios de infecção, com infecções agudas em 51,0%, incisionais 61,2% e as infecções de órgão/espaço, nas artroplastias de quadril foram 40,3% e de joelho 32,1%. As infecções tardias foram 31,3% e 21,4%, respectivamente. A etiologia das infecções destaca o S. aureus em 71,2% das infecções; enquanto nas infecções mistas foram 36,7%, o S. aureus (100,0%), Bacilos Gran Negativo (27,6%) com P. aeruginosa presente nas infecções nas duas artroplastias, Enterobacter spp. e E. coli nas de quadril e Proteus spp. nas de joelho. Foram preditores de infecções de quadril: desnutrição, neoplasia, mais de duas comorbidades, índice de risco de infecção do sítio cirúrgico nr 2 e transfusão sanguínea e em joelho: desnutrição, neoplasia e mais de duas comorbidades. A contaminação microbiana na sala cirúrgica foi elevada com 223UFC/m3, e os microrganismos mais frequentes foram: Staphylococcus spp. (50,7%) e com o S. aureus em 11,4%. A colonização nasal por S. aureus entre os integrantes da equipe cirúrgica foram semelhantes e altas (50,0%) entre médicos e enfermagem, enquanto na enfermaria foi maior na enfermagem (71,4%), enquanto a contaminação das mãos nestes últimos profissionais foi de 74,6% por microrganismos epidemiologicamente importantes, destacando-se S. aureus (74,2%), e o fenótipo MRSA representando 36,8% do total. Foi notada a presença de 07 linhagens de S. aureus nos diferentes sítios pesquisados (espécimes clínicos, ar, mucosa nasal e mãos), com predominância de duas, uma susceptível (A-38,9%) e outra resistente a meticilina/oxacilina (B-53,3%). A investigação revelou a gravidade do problema representado pelas infecções de natureza hospitalar em artroplastias de quadril e joelho, confirmado pelos indicadores epidemiológicos altos, bem como das condições favoráveis para aquisições de infecções tanto no centro cirúrgico quanto na enfermaria. The objective was to evaluate the epidemiological indicators, etiopathogenesis for acquisition of infection in the surgical center, in the ward, surgical site of hip and knee arthroplasty in a university hospital in Minas Gerais. The study was a cohort study of patients submitted to hip and knee arthroplasties hospitalized at the Orthopedic and Traumatology Clinic of the Hospital de Clinicas - Federal University of Uberlândia, from May 2006 to December 2011, with active surveillance of the graduates until December 2013. Three surveillance systems were used: National Healthcare Safety Network, laboratorial and graduates. Samples identification and antimicrobial resistance were submitted to clonal discrimination by the Pulsed Field Gel Electrophoresis technique. The project approved by the Research Ethics Committee nr. 424/09. We analyzed 1863 arthroplasties with a 12.6% infection rate, 1275 (68.4%) hip and 14.3% infection and 588 (31.6%) knee with 9.5% infection. The microbiological diagnosis in 80.0% of infection episodes, with acute infections in 51.0%, incisional 61.2% and organ / space infections, in hip arthroplasties were 40.3% and knee 32.1% %. The Late infections were 31.3% and 21.4%, respectively. The etiology of infections highlights S. aureus in 71.2% of infections; while S. aureus (100.0%), Bacilos Gran Negativo (27.6%) with P. aeruginosa present in infections in two arthroplasties, Enterobacter spp. and E. coli in hip and Proteus spp. in the knee. There were predictors of hip infections: malnutrition, neoplasia, more than two comorbidities, risk index of infection surgical site nr 2, and blood and knee transfusion: malnutrition, neoplasia and more than two comorbidities. The microbial contamination in the operating room was elevated with 223 UFC / m3, and the most frequent microorganisms were: Staphylococcus spp. (50.7%) and with S. aureus in 11.4%. The nasal colonization by S. aureus among the members of the surgical team were similar and high (50.0%) among physicians and nursing, while in nursing it was higher in nursing (71.4%), while the contamination of the hands in the latter professionals was 74.6% by epidemiologically important microorganisms, with S. aureus (74.2%) and MRSA phenotype representing 36.8% of the total. The presence of 07 strains of S. aureus in the different sites (clinical specimens, air, nasal mucosa and hands), with predominance of two, one susceptible (A-38.9%) and one resistant to methicillin/oxacillin (B-53.3%). The investigation revealed the seriousness of the problem of hospital-acquired infections in hip and knee arthroplasties, as confirmed by the high epidemiological indicators, as well as the favorable conditions for acquisition of infections in the surgical center and in the ward. Tese (Doutorado)

Introducción: el abordaje pararrotuliano interno es el más utilizado en la técnica estándar para el acceso a la artroplastia total de rodilla. Sin embargo, estudios recientes han reportado mejores resultados con respecto a la recuperación funcional cuando se usa el abordaje subvasto. Objetivo: evaluar el resultado funcional precoz de ambos abordajes quirúrgicos para la artroplastia de rodilla, poniendo a prueba la hipótesis de que en pacientes delgados el abordaje subvasto es significativamente mejor que el abordaje pararrotuliano interno. Material y método: un estudio prospectivo, aleatorizado y ciego simple se llevó a cabo con 44 artroplastias de rodilla consecutivas primarias comparando dos vías de abordaje: artrotomía pararrotuliana medial versus abordaje subvasto. Los pacientes recibieron la misma prótesis (Sigma Jhonson) que se realizó siempre por el mismo cirujano utilizando una técnica idéntica con la única diferencia antes mencionada. La vía pararrotuliana fue utilizada en 22 rodillas, y en las restantes 22 el abordaje subvasto. Los pacientes fueron evaluados a los tres días, al mes, a los tres y seis meses del posoperatorio. Resultados: los grupos se compararon mediante test de Student para variables independientes, chi cuadrado, y se establecieron predictores de extensión tardía mediante regresión lineal múltiple. Conclusiones: pudimos concluir que el abordaje subvasto ofrece ventajas en cuanto a la flexión de rodilla a corto plazo tendiendo a desaparecer las diferencias luego de los tres meses. Summary Introduction: the medial parapatellar is the most widely used approach in the standard method of total knee arthroplasty. However, recent studies have reported better results regarding functional recovery when the subvastus approach is used. Objective:: to evaluate early functional results of both surgical approaches to knee arthroplasty, testing the hypothesis that the subvastus approach is significantly better than the medial parapatellar approach in thin patients. Method: a retrospective, randomized and blind study of 44 consecutive primary knee arthroplasties, comparing two approaches: medial parapatellar versus subvastus approach. The patients received the same prosthesis (Sigma Johnson), and the same surgeon operated them using the exact same technique, though a different approach was used - as already mentioned. The parapatellar approach was used in 22 patients, while the remaining 22 patients were operated through the subvastus approach. Patients were assessed upon three days, and one, three and six months after surgery. Results: the groups were compared through the student t-test for independent variables and chi-square, and predictors for late extension were set by means of multiple linear regression. Conclusions: we managed to conclude that the subvastus approach is more convenient since it favors bending the knee in the short term, although differences tend to disappear after three months. Resumo Introdução: a abordagem pararrotuliana internoaé a mais utilizada na técnica padrão para o acesso à artroplastia total de joelho. No entanto estudos recentes registraram resultados melhores com respeito à recuperação funcional quando se utiliza a abordagem subvastus. Objetivo: avaliar o resultado funcional precoce de ambas abordagens cirúrgicas para a artroplastia de joelho, testando a hipótese de que em pacientes delgados a abordagem subvastus é significativamente melhor que a abordagem pararrotuliana interna. Material e método: realizou-se um estudo prospectivo, aleatório e simples cego com 44 artroplastias de joelho consecutivas primárias comparando as duas vias de abordagem: artrotomía pararrotuliana medial versus abordagem subvastus. Os pacientes receberam a mesma prótese (Sigma Johnson), a cirurgia foi realizada sempre pelo mesmo cirurgião utilizando a mesma técnica com a única diferencia mencionada anteriormente. A via pararrotuliana foi utilizada em 22 joelhos, e nos outros 22 a abordagem subvastus. Os pacientes foram avaliados três dias, um, três e seis meses depois da operação. Resultados: os grupos foram comparados utilizando teste de Student para variáveis independentes, qui quadrado, e foram estabelecidos preditores de extensão tardia por regressão lineal múltipla. Conclusões: podemos concluir que a abordagem subvastus oferece vantagens com relação à flexão do joelho a curto prazo observando-se uma tendência, depois de três meses, de desaparecimento da diferença.

OBJETIVOS: Tem-se afirmado que a via de acesso minimamente invasiva na artroplastia total de joelho (ATJ) por não agredir o músculo quadríceps femoral permite reabilitação mais precoce. A fim de verificar a influência da preservação do aparelho extensor no ato cirúrgico, avaliou-se a força da musculatura extensora e flexora do joelho em pacientes submetidos à ATJ por duas vias de acesso diferentes. MATERIAIS E MÉTODOS: Este estudo comparou, no período de janeiro de 2005 a julho de 2006, os valores de torque máximo e de trabalho total obtidos por dinamometria isocinética aos seis meses de pós-operatório. Foram avaliados 12 indivíduos submetidos a ATJ por via de acesso minimamente invasiva e 8 indivíduos submetidos a ATJ por via de acesso transquadricipital. RESULTADOS: A análise estatística dos valores de torque máximo e de trabalho total absolutos e corrigidos pelo peso corporal não demonstrou diferença entre os dois grupos. CONCLUSÃO: Não há diferença de força da musculatura extensora e flexora do joelho aos seis meses de cirurgia. OBJECTIVE: In total knee arthroplasty, the minimally-invasive approach has been claimed to enable earlier rehabilitation because it spares the femoral quadriceps muscle. To check the influence of preserving the extensor apparatus during surgery, the strength of knee extension and flexion muscles was evaluated in patients submitted to total knee arthroplasty with different approaches. MATERIALS AND METHODS: The values of maximum torque and total work obtained by isokinetic dynamometry six months after surgery were compared for the Minimally invasive surgery group constituted of 12 individuals submitted to total knee arthroplasty by the minimally invasive surgical approach and the Control group, constituted of eight patients submitted to total knee arthroplasty by the transquadricipital approach, between January 2005 and July 2006. RESULTS: Statistical analysis of the absolute values for maximum torque and total work adjusted for body weights did not show differences between both groups. CONCLUSION: There was no difference in the extension and flexion strength of the knee muscles six months after surgery.

ResumenObjetivoEstablecer la utilidad de la resonancia magnética (RM) en pacientes con reemplazo total de rodilla (RTR) dolorosa tras la aplicación de un protocolo optimizado y determinar en qué medida estos hallazgos modifican la conducta terapéutica.Materiales y métodosSe analizaron con protocolo optimizado las RM de 15 pacientes con RTR dolorosa, realizadas entre marzo de 2013 y febrero de 2014. La evaluación fue hecha por un especialista en musculoesquelético y los hallazgos fueron registrados.ResultadosDe nuestra población, el 74% eran mujeres y la media de edad fue de 74 +/– 7 años. Se identificaron posibles causas de dolor en el 80% de los casos y se modificó la conducta médica en el 33%. Se encontró líquido articular en el 93% y signos de sinovitis en el 33%. Los tendones rotuliano, cuadricipital y poplíteo se vieron correctamente en el 77%, 92% y 69%, respectivamente; mientras que los ligamentos colaterales medial y lateral fueron visibles en el 46% y 54%, respectivamente.DiscusiónSi bien hay publicaciones con diferentes prevalencias de sinovitis y demás hallazgos, la mayoría ha demostrado que la RM de rodilla con un protocolo optimizado permite generar cambios en la conducta terapéutica. A su vez, el método siempre ha visualizado los ligamentos y tendones de la rodilla con un éxito similar al de nuestro trabajo.ConclusiónAun careciendo de softwares comerciales específicos que reduzcan el artificio metálico, la aplicación de un protocolo optimizado logra identificar hallazgos que guían el tratamiento y permite evaluar las estructuras ligamentarias.AbstractObjectiveTo establish the usefulness of magnetic resonance (MR) in patients with total knee replacement (TKR) pain after applying an optimised protocol, and to determinate which of the findings influence medical decision.Materials and methodsFifteen patients suffering knee pain after TKR were studied using an optimised MR examination protocol from March 2013 to February 2014. The MR was interpreted by a musculoskeletal radiologist and findings were registered.ResultsOut of the 15 patients, 74% were female. Mean age was 74 +/– 7 years. The cause of pain was identified in 80% of the cases, and the medical decision was changed in 33%. Increased intra-articular fluid was seen in 93%, and signs of synovitis in 33%. The patellar, quadricipital, and popliteal tendons were correctly assessed in 77%, 92%, and 69% of patients, respectively, while the tibial and the fibula collateral ligaments were correctly assessed in 46% and 54% of patients, respectively.DiscussionDespite other articles showing a different prevalence of synovitis and MR findings, most of them showed that an optimised protocol impacted on clinical care. Also, most of the adjacent anatomical structures were successfully observed, as in our case.ConclusionEven in the absence of metal reduction tailored sequences, an optimised protocol manages to diagnose conditions that alter clinical decisions and allows the identification of adjacent anatomical structures.

INTRODUÇÃO: A artroplastia total de joelho (ATJ) não é um procedimento isento de riscos. A infecção na ATJ não é a complicação mais comum, porém é uma das mais graves. A revisão em 2 tempos é a escolha nos casos de infecção profunda da prótese de joelho. Por outro lado, a soltura asséptica chega a quase metade das indicações de revisão de artroplastias primárias. A queda do nível de satisfação do paciente pode cair nas revisões. OBJETIVO: O objetivo do presente estudo foi comparar através dos resultados obtidos nos escores funcionais e de qualidade de vida entre cirurgia de revisão de ATJ por soltura séptica e asséptica. MÉTODO: Realizamos escores HSS e SF-36 para avaliar a qualidade de vida e o resultado funcional entre pacientes submetidos à cirurgia de revisão da ATJ entre dois grupos, um que realizou a substituição da prótese em dois tempos (séptica) e outro no qual a substituição ocorreu em tempo único (asséptica). RESULTADOS: A análise dos dados obtidos mostra melhor desempenho do segundo grupo na pontuação do HSS e em 06 dos 08 domínios do SF-36. Conclusão: A revisão de ATJ em tempo único apresenta melhores resultados funcionais. INTRODUCTION: Total knee arthroplasty (TKA) imposes many risks. TKA infection is not the most frequent complication, but is probably the most serious one. Two-step review is the procedure of choice in deep knee prosthesis infection. On the other hand, aseptic prosthesis detachment represents almost half of the primary arthroplasty review indications. Patient's satisfaction level might diminish after reviews. OBJECTIVE: The objective of this study was to compare the quality of life and final result of TKA review for septic and aseptic failures. METHODS: The patients were assessed using the HSS and SF-36 scores. The patients were divided in two groups: one group submitted to two-step review (septic) and the other to one-step review (aseptic). The analysis of the data obtained shows better scores for the second group in HSS and in 06 of 08 domains of SF-36 classification. CONCLUSIONS: The on-step review of total knee arthroplasty leads to better functional outcomes.

In recent years a vast literature has been dedicated to cost effectiveness analysis. In the rehabilitation field, the search for less costly forms of treatment is an area under intense discussion by the rehabilitation scientific community. Group rehabilitation programs for some pathological conditions could permit better allocation of economic resources, but few studies evaluated the efficacy of group physiotherapy as opposed to individual physiotherapy.The purpose of this study is to compare the effects of group rehabilitation (GrpR) with individual rehabilitation (IndR) for inpatients that have undergone knee and hip replacement. Design. This is a pilot study with randomized, single-blind, cross-over design.Inpatients Physiotherapy Department of Don Gnocchi Foundation.Clinical disability evaluation (JOASH, IKS, DI) and patient-oriented assessment (SF-36, WOMAC and VAS) were performed on 27 patients undergoing a physical therapy program after knee or hip replacement. Patients having partial weight-bearing postoperatively (about 50% of the total) and a range of motion50% of the total in the joint replaced were included and then randomized (T0) in two intervention programs: GrpR/IndR - who performed GrpR for 15 days (T1), followed by the IndR for 15 days (T2); and IndR/GrpR - who performed the IndR for 15 days (T1), followed by GrpR for 15 days (T2).Comparing the changes from baseline T1-T0 and T2-T1 separately in the two groups most outcomes showed no significant difference.This pilot trial suggests that the group rehabilitation program is just as efficient as the individual rehabilitation for inpatients that have undergone knee and hip replacement and are able to weight-bear postoperatively. A potential benefit of group-based therapy is that it is less resource intensive.