Introduction: Osteoarthritis (OA) is the most common rheumatologic disease in the world and the elderly are the most affected, although there is no defined age for its onset. Obesity is a risk factor, with healthy eating habits and physical exercise practices being recommended for treatment and prevention. The pharmacological treatment for OA is oral chondroprotective agents and viscosupplements, although anti-inflammatory drugs are widely prescribed, they do not cause clinical improvement, they only treat the symptoms of the disease. Objective: This study gathered articles from clinical trials in Brazil with the purpose of investigating whether the pharmacological treatments used are effective. Methods: The electronic platforms used for data collection were: Scielo, CAPES Journal Portal and Google Academic. Articles published in the last six years with clinical trials in Brazil were considered. Articles involving surgeries, those that used physiotherapy as an adjunct therapy and those that used animal or non-human research in their research were excluded. The search was through the descriptors: hyaluronic acid, glucosamine and chondroitin. Results: The search resulted in six articles, in which three were used chondroprotectors and the other three viscosupplements. Chondroprotectors were effective in 66.66% of clinical trials and viscosupplements in 100%. Conclusion: Pharmacological treatments for OA showed high efficacy, however the sample of the present work was small, thus, further studies are needed to confirm the results obtained.
EFFECTIVENESS OF KINESIOTHERAPEUTIC EXERCISES IN LOMBALGY SECONDARY TO BONE DEMINERALIZATION AND LUMBAR HYPOLORDOSIS: AN EXPERIENCE REPORT
Objective: To report the experience of the effects of kinesiotherapy exercises applied to a patient with low back pain associated with bone demineralization and lumbar hypolordosis. Methods: Physiotherapeutic monitoring of a 55-year-old female patient from Bahia is presented, presenting a condition compatible with low back pain, secondary to bone demineralization in the lumbosacral spine, dorsal and lumbar hypolordosis. In the assessment, the Owestry questionnaires (14 points), Visual Analogue Scale (grade 6), FABQ-Brazil subscale (43 points), absence of lateral shift, hip movement (internal rotation D = 27º, E = 31º) were applied , segmental mobility test of the thoracolumbar spine (hypermobile vertebrae = L1 to S1), Pronation Instability test (positive), symptoms longer than 16 days, aberrant movements with finger climbing, centralization of symptoms in the flexion and lateral inclination movements, and periphery to knee E. in extension. Thus, it was classified in the Mobilization / Manipulation and Stabilization groups, which was subjected to physical therapy intervention during 12 visits. Therapeutic approaches were based on segmental stabilization exercises associated with co-contraction of the abdominal and pelvic muscles, passive stretching, myofascial release with digit pressure and pelvic, sacroiliac and thoracic mobilization exercises. Results: After treatment, there were positive effects on low back pain and when performing movements, gaining flexibility, mobility and muscle strength, as well as feeling of well-being and improved sleep. Conclusion: It is inferred, therefore, that the conduct based on clinical reasoning is of paramount importance for the physiotherapeutic performance in the kinetic-functional problems arising from low back pain, which contributed to the improvement of the pathological condition and promotion of quality of life.
EXPIRED AIR CARBON MONOXIDE TESTING IS EFFECTIVE FOR PREOPERATIVE SCREENING OF CIGARETTE USE IN ORTHOPAEDIC PATIENTS: A PROSPECTIVE PILOT STUDY OF 70 VETERANS
Introduction: Screening for cigarette use is standard in the orthopedic pre-operative clinic, however traditional biochemical testing methods, including serum and urine cotinine assays, do not differentiate active smoking from nicotine replacement therapy (NRT). In this prospective pilot study, we hypothesize that exhaled carbon monoxide (eCO) testing will be non-inferior to the gold standard serum cotinine (SC) test in screening for pre-operative cigarette use, will differentiate active smoking from NRT, and will allow for substantial cost savings in a clinic setting. Methods: Adult orthopaedic veterans indicated for elective surgery at our institution were offered inclusion. Self-reported smoking status (SRS), eCO and SC levels were obtained preoperatively. An eCO level of >6 parts per million and a SC level >3 ng/ml were considered positive for recent cigarette use. Agreement between SRS, eCO levels and SC levels, and eCO level test-retest reliability were evaluated. Results: Of the 55 patients enrolled into the study, 4 were self-reported Current Smokers and 51 were self-reported Ex-Smokers or Non-Smokers. Combining SRS with eCO levels as a screening tool for recent cigarette use yielded a sensitivity of 100%, a specificity of 98%, a positive predictive value of 95% and a negative predictive value of 100%. eCO testing differentiated NRT from cigarette use in all non-smoking patients. Test-retest reliability for eCO levels showed perfect agreement for 16 patients that had two or more eCO levels pre-operatively. Conclusion: Exhaled CO testing is as effective as SC testing but can differentiate active smoking from NRT, while maintaining a high level of accuracy and reliability when combined with SRS as a screening tool.
MOTION AND ITS EFFECTS ON THE CEMENT MANTLE – A BIOMECHANICAL ANALYSIS OF FEMORAL STEM DISPLACEMENT DURING IMPLANT CEMENTATION
Background: It is a common notion that motion of a femoral component during cementation should be avoided as it may weaken the cement mantle. We created an in vitro model of cemented femoral components and subjected them to varying rotational motion during the cement curing process, to measure the effect on the pullout strength of the stem. Methods: 21 sawbones femurs were separated into four groups. The first group served as control and was cemented in a standard fashion. The remainder of the stems were divided into groups and subjected to angular rotational displacement within the cement mantle during curing . Anteroposterior and lateral radiographs were obtained of each model to evaluate for cement defects. Pullout strength testing was performed. Results: Despite rotational displacement, no cement defects were noted on imaging. The control stems showed an average pullout strength of 3735.79N. The experimental groups showed a trend for lower failure loads but it was not statistically significant (P=0.063). Of the 21 stems tested, three encountered cement mantle failure and associated stem pullout and the remainder failed by peripros-thetic fracture. Conclusion: Despite conventional thinking that rotational displacement during the cementing process leading to disruption of the cement mantle integrity, this was not borne out in our study. This should give surgeons confidence that in the set-ting of unintended rotational displacement of a femoral stem, returning the stem to its original position does not significantly compromise the integrity of the cement mantle or the pullout strength of the femoral implant. Small displacement of the femoral stem with prompt correction during cement curing does not cause evident cement mantle defects or a loss of femoral stem pullout strength.
We report in the light of a literature review the results of 10 patients followed for anterior instability of the gleno-humeral joint treated by open Latarjet procedure between January 2017 and December 2020 with a view to a prospective study with longer following up and a greater number of patients.
SINGLE STAGE KNEE ARTHROPLASTY REVISION SURGERY, OUR EXPERIENCE WITH ELEVEN CASES AND REVIEW OF THE LITERATURE
Knee replacement is a widely performed and very successful procedure for the management of knee arthritis. Nevertheless, it is postulated that a total of 2-5% of primary and revision total knee arthroplasties (TKAs) is infected every year [1,2]. Despite the low incidence, the absolute numbers of prosthetic joint infections (PJIs) are growing, owing to an increased number of replacement surgeries, and are associated with significant morbidity and socioeconomic burden [3,4]. Although several definitions of PJI exist, Musculoskeletal Infection’s Society (MSIS) definition is based on strict criteria and is one of the most used . Patients with certain risk factors have an increased risk to develop PJI [6,7]. Risk factors include presence of systemic or local active infection in an arthritic knee; previous operative procedures in the same knee, diabetes mellitus, malnutrition, smoking, alcohol consumption, co-morbidities, and immunosuppression; end-stage renal disease on hemodialysis, liver disease, intravenous drug abuse, and low safety operative room environment. PJIs are classified according to the depth of infection, to superficial and deep infections. Superficial infections are limited to the incision and superficial tissues, while deep infections, that involve deep layers, may occur up to one year postoperatively, and influence surgical management strategy. Timing of infection is also an important factor in guiding treatment. PJIs are classified to acute postoperative, within a month of the index procedure, acute haematogenous, presenting with acute symptoms in a previously well – functioning joint, and late chronic, where infection develops later than one month postoperatively . Management of PJI’s is mainly surgical, reserving conservative treatment for patients unable to undergo surgery . Surgical options include debridement and retention of the prosthetic implants (DAIR), two – stage exchange revision, single – stage exchange revision, permanent resection arthroplasty, and finally amputation as the last measure . DAIR is a viable option in early…
Femoral neck fractures are common fractures in the elderly, especially in elderly women. There are many mature treatment methods for femoral neck fractures. However, which option is better is still controversial. In order to allow clinicians to better develop treatment plans for elderly patients with femoral neck fractures, this article summarizes the diagnosis and treatment status of elderly femoral neck fractures from the aspects of epidemiology, etiology and diagnosis, treatment methods and progress of elderly femoral neck fractures.
Background: Anterior talofibular ligament (ATFL) injuries are the most common in ankle torsional injuries. ATFL and peroneal tendons are both important stabilizers of lateral ankle joint. We aimed to evaluate peroneal tendons and ATFL. Methods: Fifteen nonpaired leg of fresh frozen cadavers were assessed in this study. After harvesting, ATFL diameters were measured at three points by calipers, these are fibular side, intermediate side and talar side. The mean of these three measurements were assessed and tissue a 15 lb load was applied to the peroneal tendons for 10 minutes, and the transverse diameters were measured by folding the thickest part of the tendon in a double-strand. Results: 5 single bundle, 8 double-bundle and 2 three bundles of ATFL were obtained after dissection. . There was no correlation between ATFL diameter, peroneus longus, peroneus brevis and total tendon diameters of peroneus longus and peroneus brevis in women (p> 0.05). A strong correlation was found between ATFL diameter, peroneus longus (r: 0.95), peroneus brevis (r: 0.81) and total tendon diameters of peroneus longus and peroneus brevis (r: 0.92) in men. Conclusion: Relationship between the diameter of the ATFL and peroneal tendons diameters were evaluated and a correlation was observed in males, while no correlation was observed in females.
A desmoid tumor (DT) was first described by MacFarlane in 1832. DTs are rare tumors, corresponding to only 0.03% of all neoplasia and less than 3% of all soft tissue tumors. Most of the tumors occur in the abdomen and presentation in the extremities is uncommon. Here, we present a review of the literature and the 27th case of DT of the foot.
SEMI-RIGID LUMBAR SPINE FIXATION WITH PEEK RODS AS A TREATMENT OPTION FOR MONO-SEGMENTAL DEGENERATIVE DISK DISEASE
Long lasting back pain due to degenerative disc disease is one of the major reasons for reduced quality of life and work incapacity. In some of these patients conservative treatment will not improve back pain significantly. Therefore fusion surgery as a surgical option is offered to these patients. The main aim of this kind of treatment is the reduction of segmental motion leading to an improvement in pain. Rigid fixation leads to high fusion rates but may also contribute to stress shielding and adjacent segment degeneration. Therefore a semi-rigid stabilization with PEEK rods may be an option because it is associated with less implant related rigidity and is a less invasive procedure. The aim of this retrospective study was to evaluate the improvement in back pain after minimally invasive semi-rigid lumbar stabilization with screws and PEEK rods in 45 patients and to identify potential implant failures during a follow up of two years. Six weeks after surgery the patients showed a significant improvement in their back pain, which persisted during the whole observation time of two years (p