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Objective: The present study was performed in order to evaluate the use of platelet rich plasma associated to bone marrow aspirate, substituting autologous iliac bone graft in medial opening wedge osteotomy (OWHTO). Methods: Twenty-five patients were submitted to tibial opening wedge osteotomy, being divided into two groups. Iliac group: 14 patients submitted to OWHTO, using autologous iliac bone graft to fill the gap. PRP group: 11 patients using platelet rich plasma associated to bone marrow aspirate to fill the gap. We evaluated bleeding (hemoglobin and hematocrit levels) and pain (visual analogic scale-VAS), then we compared the groups regarding these variables. Results: Differences between the groups were not found regarding hemoglobin levels (p=0.820) and hematocrit levels (p=0.323). The groups were not different regarding pain measured with VAS (p=0.538). Conclusion: The use of platelet rich plasma associated to bone marrow aspirate in medial opening wedge osteotomy did not offer advantages over autologous iliac bone graft regarding bleeding and pain.

Objective: The aim of this study was to compare the surgical results from reconstruction of the medial patellofemoral ligament (MPFL) with non-operative treatment of primary patellar dislocation. Methods: Thirty-nine patients (41 knees) with patellar dislocation were randomized into two groups. One group was treated conservatively (immobilization and physiotherapy) and other was treated surgically with reconstruction of the MPFL, and the results were evaluated with a minimum follow-up of two years. The Kujala questionnaire was applied to assess pain and quality of life, and recurrences were evaluated. Pearson's chi-square test and Fisher's exact test were used in the statistical evaluation. Results: The statistical analysis showed that the mean Kujala score was significantly lower in the conservative group (70.8), compared with the mean value in the surgical group (88.9), with p = 0.001. The surgical group presented a higher percentage of “good/excellent” Kujala score results (71.43%) than in the conservative group (25.0%), with p = 0.003. The conservative group presented a greater number of recurrences (35% of the cases), while in the surgical group there were no reports of recurrences and/or subluxation. Conclusions: Treatment with reconstruction of the medial patellofemoral ligament using the patellar tendon produced better results, based on the analysis of post-treatment recurrences and the better final results from the Kujala questionnaire after a minimum follow-up period of two years.

Background: Over the long term, acute patellar dislocations can result in patellar instability, with high recurrence rates after nonoperative treatment. Purpose: To compare the results of operative (reconstruction of the medial patellofemoral ligament [MPFL]) versus nonoperative treatment of primary patellar dislocation. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: Thirty-nine patients (41 knees) (mean age, 24.2 years; range, 12-38 years) with acute patellar dislocation were randomized into 2 groups. One group was treated nonoperatively with immobilization and physiotherapy, the other was treated surgically with MPFL reconstruction; both groups were evaluated with minimum follow-up of 2 years. The Kujala questionnaire was applied to assess pain and quality of life, and recurrence was evaluated. Pearson χ2 or Fisher exact test was used in the statistical evaluation. Results: The statistical analysis showed that the mean Kujala score was significantly lower in the nonoperative group (70.8), when compared with the mean value of the surgical group (88.9; P = .001). The surgical group presented a higher percentage of “good/excellent” results (71.43%) on the Kujala score when compared with the nonoperative group (25.0%; P = .003). The nonoperative group presented a large number of recurrences and subluxations (7 patients; 35% of cases), whereas there were no reports of recurrences or subluxations in the surgical group. Conclusion: Treatment with MPFL reconstruction using the patellar tendon produced better results, based on the analyses of posttreatment recurrences and the better final results of the Kujala questionnaire after a minimum follow-up period of 2 years.

OBJECTIVE: The objective of this study was to describe the methodology of knee rotation analysis using biomechanics laboratory instruments and to present the preliminary results from a comparative study on patients who underwent anterior cruciate ligament (ACL) reconstruction using the double-bundle technique. METHODS: The protocol currently used in our laboratory was described. Three-dimensional kinematic analysis was performed and knee rotation amplitude was measured on eight normal patients (control group) and 12 patients who were operated using the double-bundle technique, by means of three tasks in the biomechanics laboratory. RESULTS: No significant differences between operated and non-operated sides were shown in relation to the mean amplitudes of gait, gait with change in direction or gait with change in direction when going down stairs (p > 0.13). CONCLUSION: The preliminary results did not show any difference in the double-bundle ACL reconstruction technique in relation to the contralateral side and the control group.

Objective: Platelet-rich plasma (PRP) has the capacity to improve the bone-healing process. The aim of this pilot study was to investigate the occurrence of bone healing and the time taken to achieve this in patients submitted to medial opening wedge high tibial osteotomy (MOWHTO), comparing platelet-rich plasma with bone marrow aspirate to autologous iliac graft. Design: Twenty-five patients who underwent tibial osteotomy were randomly divided into 2 groups: a control group, which received autologous iliac grafts (14 patients), and a study group, which received a compound of PRP and bone marrow aspirate (11 patients). Results: The bone-healing rates achieved were 100% in the control group and 91% in the study group. There was no difference in the time taken to achieve bone healing between the groups. Conclusions: The use of a combination of PRP and bone marrow aspirate, as a bone substitute, did not demonstrate any advantage over the use of an autologous iliac graft in MOWHTO.

Femoral and acetabular loosening can be attributed different factors, but the causes and mechanism of early failure are still obscure. The objective of this study was to investigate the relationship between gene polymorphisms and early implant failure. Fifty-eight patients older than 50 years was recruited for analysis of MMP-1 promoter polymorphisms in early osseointegrated implant failure. The results showed in control group a frequency of 20.97% of 2G allele and 67.74% the genotype 1G/1G whereas, in the test group, a frequency of 83.33% of 2G allele and 66.66% the genotype 2G/2G. These results indicate that the polymorphism in the promoter of the MMP-1 gene could be a risk factor for early implant failure of total hip arthroplasty.

Few complications regarding the use of bioabsorbable suture anchors in the shoulder have been reported. What motivated this case report was the unusual location of the anchor, found in the acromioclavicular joint which, to our knowledge, has never been reported so far. A 53-year old male with previous rotator cuff (RC) repair using bioabsorbable suture anchors presented with pain and weakness after 2 years of surgery. A suspicion of retear of the RC led to request of a magnetic resonance image, in which the implant was found located in the acromioclavicular joint. The complications reported with the use of metallic implants around the shoulder led to the development of bioabsorbable anchors. Advantages are their absorption over time, minimizing the risk of migration or interference with revision surgery, less artifacts with magnetic resonance imaging, and tendon-to-bone repair strength similar to metallic anchors. Since the use of bioabsorbable suture anchors is increasing, it is important to know the possible complications associated with these devices.

The first report of the use of allografts in humans dates back to 1881. The first tissue bank of bone grafts was created in 1940 in the United States and the initial clinical results were published in 1942 by Inclan, 1942. Since then a series of regulations and studies has emerged relating to the use of grafts in orthopedic practice19. Currently, tendon allografts are used in knee surgeries, in elbow ligament reconstructions and in revisions of the acromioclavicular joint (Costic et al., 2004).

OBJETIVO: O objetivo deste estudo foi comparar os resultados da cirurgia (reconstrução do ligamento femoropatelar medial; LFPM) com os resultados do tratamento conservador da luxação primária de patela. MÉTODOS: Trinta e nove pacientes (41 joelhos) com luxação de patela foram randomizados em dois grupos (um grupo foi tratado conservadoramente - imobilização e fisioterapia - e o outro cirurgicamente com a reconstrução do LFPM) e foram avaliados com um seguimento mínimo de dois anos. O questionário de Kujala foi aplicado para avaliar dor e qualidade de vida e as recidivas foram avaliadas. Os testes do Qui-quadrado de Pearson e exato de Fisher foram utilizados na avaliação estatística. RESULTADOS: A análise estatística mostrou que a média do escore de Kujala foi significativamente mais baixa no grupo conservador (70,8) quando comparada à média do grupo cirúrgico (88,9), com p = 0,001. O grupo cirúrgico apresentou maior porcentagem de resultados bom/excelente (71,43%) no escore de Kujala quando comparados ao grupo conservador (25%) com p = 0,003. O grupo conservador apresentou um número maior de recorrências (35% dos casos), enquanto que no grupo cirúrgico não houve relatos de recorrências e/ou subluxações. CONCLUSÕES: O tratamento com a reconstrução do ligamento femoropatelar medial com o tendão patelar produziu melhores resultados, com base na análise das recorrências pós-tratamento e nos resultados finais melhores no questionário de Kujala após um seguimento mínimo de dois anos. OBJECTIVE: The aim of this study was to compare the surgical results from reconstruction of the medial patellofemoral ligament (MPFL) with non-operative treatment of primary patellar dislocation. METHODS: Thirty-nine patients (41 knees) with patellar dislocation were randomized into two groups. One group was treated conservatively (immobilization and physiotherapy) and other was treated surgically with reconstruction of the MPFL, and the results were evaluated with a minimum follow-up of two years. The Kujala questionnaire was applied to assess pain and quality of life, and recurrences were evaluated. Pearson's chi-square test and Fisher's exact test were used in the statistical evaluation. RESULTS: The statistical analysis showed that the mean Kujala score was significantly lower in the conservative group (70.8), compared with the mean value in the surgical group (88.9), with p = 0.001. The surgical group presented a higher percentage of "good/excellent" Kujala score results (71.43%) than in the conservative group (25.0%), with p = 0.003. The conservative group presented a greater number of recurrences (35% of the cases), while in the surgical group there were no reports of recurrences and/or subluxation. CONCLUSIONS: Treatment with reconstruction of the medial patellofemoral ligament using the patellar tendon produced better results, based on the analysis of post-treatment recurrences and the better final results from the Kujala questionnaire after a minimum follow-up period of two years.

More than 2 years after undergoing anterior cruciate ligament (ACL) reconstruction, women still present bilateral asymmetries during multijoint movement tasks. Given the well-known ACL-injury gender bias, the goal of this study was to investigate whether males also present such asymmetries more than 2 years after undergoing ACL reconstruction.This study involved 12 participants submitted to ACL reconstruction in the ACL group and 17 healthy participants in the control group. The mean postoperative period was 37 months. The participants executed bilateral countermovement jumps and load squat tasks. The kinematics and ground reaction forces on each lower limb and pelvis were recorded, and used to compute bilateral peak vertical ground reaction forces, peak knee and hip joint powers in the sagittal plane, and the ratio between these powers.For the jump task, the groups had the same performance in the jump height, but for the ACL group the peak knee joint power on the operated side was 13% lower than on the non-operated side (p = 0.02). For the squat task, the hip-knee joint power ratio on the operated side of the ACL group was 31% greater than on the non-operated side (p = 0.02).The ACL group presented a deficit in the operated knee that had its energy generation over time (joint power) partially substituted by the hip joint power of the same side. The fact that, even after more than 2 years following the ACL reconstruction and returning to regular activity, the ACL group still had neuromuscular asymmetries suggests a need for improvement in the ACL reconstruction surgery procedures and/or rehabilitation protocols.

Introdução: A busca por um substituto ósseo que faça prescindível a obtenção de enxerto autólogo é uma necessidade do cirurgião ortopédico. O aspirado de medular óssea possui células tronco do sistema mesenquimal capazes de se diferenciarem em osteoblastos, sendo assim considerado um material osteogênico. O plasma rico em plaquetas possui os chamados fatores plaquetários de crescimento, que possuem a capacidade de promover e estimular a diferenciação de células tronco do sistema mesenquimal em osteoblastos, acelerando o processo de consolidação óssea. Objetivo: O objetivo deste estudo foi avaliar a ocorrência de consolidação e o tempo para tal nas osteotomias de cunha de abertura na tíbia, comparando o enxerto autólogo de ilíaco, ao plasma rico em plaquetas associado a medular óssea. Métodos: Foram estudados 25 pacientes submetidos a osteotomia tibial de cunha de abertura medial. Os pacientes foram divididos em dois grupos, de forma randomizada. O grupo controle formado por 14 pacientes submetidos à osteotomia com a utilização de enxerto autólogo do ilíaco, e o grupo de estudo formado por 11 pacientes submetidos à osteotomia com utilização de um composto de plasma rico em plaquetas e medular óssea. Resultados: Quanto à ocorrência de consolidação da osteotomia, as Introdução: A busca por um substituto ósseo que faça prescindível a obtenção de enxerto autólogo é uma necessidade do cirurgião ortopédico. O aspirado de medular óssea possui células tronco do sistema mesenquimal capazes de se diferenciarem em osteoblastos, sendo assim considerado um material osteogênico. O plasma rico em plaquetas possui os chamados fatores plaquetários de crescimento, que possuem a capacidade de promover e estimular a diferenciação de células tronco do sistema mesenquimal em osteoblastos, acelerando o processo de consolidação óssea. Objetivo: O objetivo deste estudo foi avaliar a ocorrência de consolidação e o tempo para tal nas osteotomias de cunha de abertura na tíbia, comparando o enxerto autólogo de ilíaco, ao plasma rico em plaquetas associado a medular óssea. Métodos: Foram estudados 25 pacientes submetidos a osteotomia tibial de cunha de abertura medial. Os pacientes foram divididos em dois grupos, de forma randomizada. O grupo controle formado por 14 pacientes submetidos à osteotomia com a utilização de enxerto autólogo do ilíaco, e o grupo de estudo formado por 11 pacientes submetidos à osteotomia com utilização de um composto de plasma rico em plaquetas e medular óssea. Resultados: Quanto à ocorrência de consolidação da osteotomia, asIntrodução: A busca por um substituto ósseo que faça prescindível a obtenção de enxerto autólogo é uma necessidade do cirurgião ortopédico. O aspirado de medular óssea possui células tronco do sistema mesenquimal capazes de se diferenciarem em osteoblastos, sendo assim considerado um material osteogênico. O plasma rico em plaquetas possui os chamados fatores plaquetários de crescimento, que possuem a capacidade de promover e estimular a diferenciação de células tronco do sistema mesenquimal em osteoblastos, acelerando o processo de consolidação óssea. Objetivo: O objetivo deste estudo foi avaliar a ocorrência de consolidação e o tempo para tal nas osteotomias de cunha de abertura na tíbia, comparando o enxerto autólogo de ilíaco, ao plasma rico em plaquetas associado a medular óssea. Métodos: Foram estudados 25 pacientes submetidos a osteotomia tibial de cunha de abertura medial. Os pacientes foram divididos em dois grupos, de forma randomizada. O grupo controle formado por 14 pacientes submetidos à osteotomia com a utilização de enxerto autólogo do ilíaco, e o grupo de estudo formado por 11 pacientes submetidos à osteotomia com utilização de um composto de plasma rico em plaquetas e medular óssea. Resultados: Quanto à ocorrência de consolidação da osteotomia, as Introdução: A busca por um substituto ósseo que faça prescindível a obtenção de enxerto autólogo é uma necessidade do cirurgião ortopédico. O aspirado de medular óssea possui células tronco do sistema mesenquimal capazes de se diferenciarem em osteoblastos, sendo assim considerado um material osteogênico. O plasma rico em plaquetas possui os chamados fatores plaquetários de crescimento, que possuem a capacidade de promover e estimular a diferenciação de células tronco do sistema mesenquimal em osteoblastos, acelerando o processo de consolidação óssea. Objetivo: O objetivo deste estudo foi avaliar a ocorrência de consolidação e o tempo para tal nas osteotomias de cunha de abertura na tíbia, comparando o enxerto autólogo de ilíaco, ao plasma rico em plaquetas associado a medular óssea. Métodos: Foram estudados 25 pacientes submetidos a osteotomia tibial de cunha de abertura medial. Os pacientes foram divididos em dois grupos, de forma randomizada. O grupo controle formado por 14 pacientes submetidos à osteotomia com a utilização de enxerto autólogo do ilíaco, e o grupo de estudo formado por 11 pacientes submetidos à osteotomia com utilização de um composto de plasma rico em plaquetas e medular óssea. Resultados: Quanto à ocorrência de consolidação da osteotomia, as Introdução: A busca por um substituto ósseo que faça prescindível a obtenção de enxerto autólogo é uma necessidade do cirurgião ortopédico. O aspirado de medular óssea possui células tronco do sistema mesenquimal capazes de se diferenciarem em osteoblastos, sendo assim considerado um material osteogênico. O plasma rico em plaquetas possui os chamados fatores plaquetários de crescimento, que possuem a capacidade de promover e estimular a diferenciação de células tronco do sistema mesenquimal em osteoblastos, acelerando o processo de consolidação óssea. Objetivo: O objetivo deste estudo foi avaliar a ocorrência de consolidação e o tempo para tal nas osteotomias de cunha de abertura na tíbia, comparando o enxerto autólogo de ilíaco, ao plasma rico em plaquetas associado a medular óssea. Métodos: Foram estudados 25 pacientes submetidos a osteotomia tibial de cunha de abertura medial. Os pacientes foram divididos em dois grupos, de forma randomizada. O grupo controle formado por 14 pacientes submetidos à osteotomia com a utilização de enxerto autólogo do ilíaco, e o grupo de estudo formado por 11 pacientes submetidos à osteotomia com utilização de um composto de plasma rico em plaquetas e medular óssea. Resultados: Quanto à ocorrência de consolidação da osteotomia, as porcentagens de consolidação foram de 100% no grupo Ilíaco e 91% no grupo PRP (p=0,440). Em relação ao tempo para consolidação não se observou diferença entre os grupos (p=0,129). Conclusão: Nas osteotomias proximais por cunha de adição medial a utilização do plasma rico em plaquetas associado ao aspirado de medular óssea foi efetiva no que se refere à ocorrência de consolidação e no tempo necessário para a ocorrência de tal evento, quando estudamos e comparamos este enxerto ao enxerto autólogo do ilíaco Introduction: The search for a bone substitute that makes unnecessary the harvest of autologous bone graft is a necessity of the orthopaedic surgeon. Bone marrow aspirate is rich in mesenquimal stem cells. The bone marrow aspirate contain mesenquimal stem cells that can differenciate in osteoblasts, being considered an osteogenic material. Platelet rich plasma contain several growth factors that have the capacity to promote and stimulate the differenciation of mesenquimal stem cells in osteoblasts improving the bone healing process, in other words platelet rich plasma has osteoinductive property. Objective: The aim of this study was to compare the occurrence of consolidation and the time taken to achieve this in cases of opening wedge osteotomy of the tibia, between autologous iliac grafts and platelet rich plasma with bone marrow aspirate. Methods: Twenty-five patients who underwent opening wedge osteotomy were studied. They were randomly divided into two groups: a control group of 14 patients wich received autologous iliac grafts and a study group of 11 patients wich received a compound of platelet rich plasma and bone marrow aspirate. Results: The consolidation rates achieved were 100% in the iliac group and 91% in the platelet-rich plasma group (p = 0.440). There was no difference in the time taken to achieve consolidation between the groups (p = 0.129). Conclusion: The use of platelet rich plasma with bone marrow aspirate as a bone substitute was shown to be effective in achieving consolidation in tibial osteotomies and in the time necessary to achieve this when compared to autologous iliac graft .

Malleolar fractures are rarely associated with lesions of the adjacent tendons or neurovascular structures. The association of ankle fractures with Achilles tendon rupture is even more infrequent, although both of these injuries are very common in and of themselves. To our knowledge, fracture of the lateral malleolus in association with an acute rupture of the ipsilateral calcaneus tendon has not been previously described. In this article, we describe a female patient who sustained an acute rupture of the Achilles tendon in conjunction with fracture of the ipsilateral lateral malleolus.

OBJETIVO: O presente estudo procurou avaliar a aplicação do plasma rico em plaquetas associado ao aspirado de medular óssea como substituto ósseo ao enxerto autólogo do ilíaco nas osteotomias tibiais proximais de cunha de adição medial (OTCAM). MÉTODOS: Foram estudados 25 pacientes submetidos a OTCAM divididos de forma randomizada em dois grupos, grupo ilíaco, 14 pacientes submetidos a OTCAM nos quais se utilizou o enxerto autólogo do ilíaco para preencher o sitio da osteotomia, grupo PRP, 11 pacientes submetidos a OTCAM nos quais se utilizou um composto formado por plasma rico em plaquetas associado ao aspirado de medular ósseo para preencher o sitio da osteotomia. Foram avaliados o sangramento (variação dos níveis de hemoglobina e hematócrito) e a dor (escala visual analógica -EVA), comparando os grupos em relação a essas variáveis. RESULTADOS: Não foram observadas diferenças entre os grupos no que se refere à variação dos níveis de hemoglobina (p = 0,820) e hematócrito (p = 0,323). Os grupos não foram diferentes em relação à intensidade da dor segundo a EVA (p = 0,538). CONCLUSÃO: O uso do PRP associado ao aspirado de medular óssea nas OTCAM não demonstrou vantagem sobre a utilização do enxerto autólogo do ilíaco no que se refere a dor e sangramento. OBJECTIVE: The present study was performed in order to evaluate the use of platelet rich plasma associated to bone marrow aspirate, substituting autologous iliac bone graft in medial opening wedge osteotomy (OWHTO). METHODS: Twenty-five patients were submitted to tibial opening wedge osteotomy, being divided into two groups. Iliac group: 14 patients submitted to OWHTO, using autologous iliac bone graft to fill the gap. PRP group: 11 patients using platelet rich plasma associated to bone marrow aspirate to fill the gap. We evaluated bleeding (hemoglobin and hematocrit levels) and pain (visual analogic scale-VAS), then we compared the groups regarding these variables. RESULTS: Differences between the groups were not found regarding hemoglobin levels (p=0.820) and hematocrit levels (p=0.323). The groups were not different regarding pain measured with VAS (p=0.538). CONCLUSION: The use of platelet rich plasma associated to bone marrow aspirate in medial opening wedge osteotomy did not offer advantages over autologous iliac bone graft regarding bleeding and pain.

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.

Os autores descrevem caso de paciente do sexo feminino, com 23 anos de idade, submetida à cirurgia do joelho para realinhamento patelar com uso de garrote pneumático e que desenvolveu neurapraxia femoral. Faz-se breve revisão da literatura sobre as vantagens e desvantagens do uso do garrote em cirurgias do joelho e discute-se a necessidade da sua indicação, considerando-se as complicações acarretadas por seu uso incorreto. The authors describe the case of a 27 year-old female patient submitted to knee surgery for patellar realignment with the use of a pneumatic tourniquet, who developed femoral neurapraxia. They make a brief literature review about the advantages and disadvantages of using a tourniquet in knee surgeries, and discuss the need for tourniquet indication considering the complications entailed by the incorrect use of the tourniquet.

Traumatic sternoclavicular dislocation is a rare injury corresponding to less than 5% of all injuries of the scapular belt. It is preferentially treated through reduction of the sternoclavicular joint, symptom relief, a brief period of immobilization and rehabilitation, with the aim of gaining strength and range of motion. In some patients, however, this type of injury may progress with instability and pain, thus causing discomfort and pain. On such occasions, surgical treatment is chosen. The objective of this study was to report the clinical case of a sports player who progressed with chronic traumatic anterior instability of the sternoclavicular joint and underwent reconstruction using the ipsilateral semitendinosus tendon. This was a 16-year-old male patient who was a state-level judo player. Following a fall during a fight, he presented pain, slight deformity and edema in the right sternoclavicular joint, and he underwent conservative treatment for 12 months, without success. In the end, reconstruction of the sternoclavicular joint was carried out using the ipsilateral autologous semitendinosus, with resection of the intra-articular disc and suturing of the costoclavicular ligaments. We have presented a case of dislocation of the sternoclavicular joint in a high-performance judo player who underwent reconstruction using the semitendinosus, with excellent functional results after 1 year of follow-up.

OBJETIVO: O tratamento mais utilizado para o tratamento das infecções profundas nas artroplastias totais do joelho tem sido a revisão em dois tempos. Mesmo seguindo os passos preconizados neste tipo de tratamento, ainda existe a dúvida do período certo para realizar o segundo tempo da revisão sem o risco de colocação de um novo implante em uma área ainda infectada. Nosso trabalho tem como objetivo determinar o valor da cultura obtida por biópsia artroscópica, a fim de determinar o momento adequado para a realização do segundo tempo da revisão e também o tempo adequado para manter o espaçador. MATERIAL E MÉTODOS: Doze pacientes com o diagnóstico de infecção profunda pós-artroplastia total de joelho primária foram submetidos ao protocolo de revisão em dois tempos, e após seis semanas da colocação do espaçador e da antibioticoterapia, o paciente foi submetido à biópsia artroscópica no joelho infectado e através dela foram colhidas amostras para cultura a fim de verificar se o momento era adequado para a realização do segundo tempo da revisão. RESULTADOS: Os resultados das culturas de todos os pacientes submetidos à biópsia artroscópica foram negativos, sendo todos submetidos ao segundo tempo da revisão. Das culturas colhidas durante o implante da nova prótese, onze confirmaram a inexistência de processo infeccioso ativo no sítio cirúrgico; uma cultura foi positiva, sendo isolado neste paciente Staphyloccocus aureus sensível à oxacilina. CONCLUSÃO: Apesar do pequeno número de casos, concluímos que a cultura obtida pela biópsia artroscópica tem valor e mostrou que seis semanas é o tempo adequado para manutenção do espaçador.

As artroplastias totais de joelho apresentaram nas últimas décadas apreciável melhora em relação aos resultados cirúrgicos devido à difusão de técnicas operatórias precisas e ao desenvolvimento de materiais de implante de alta tecnologia. Apesar disso ainda estão sujeitas a complicações, sendo a infecção a mais difícil de ser solucionada. Neste artigo discutimos os fatores de risco para infecção, classificação, condições clínicas e cirúrgicas, assim como métodos diagnósticos. As opções de tratamento incluem supressão com antibióticos, manutenção da prótese, troca imediata ou em dois tempos dos componentes protéticos e os procedimentos de salvação. Além disto, os autores apresentam o protocolo de tratamento utilizado no Instituto de Ortopedia e Traumatologia do Hospital das Clínicas da FMUSP pelo Grupo de Artroplastias. Total knee arthroplasty results have markedly improved during the last decades due to diffusion of accurate surgical techniques and development of high-technology implant materials. However, complications still develop, infection being that of most difficult resolution. Risk factors for infection, classification of infections, clinical and surgical conditions, as well as diagnostic methods are discussed in the present article. Therapeutic options include suppression by antibiotic therapy, maintenance of the prosthesis, immediate or two-step replacement of prosthetic, and salvage procedures. In addition, the authors describe the treatment protocol used by the Arthroplasty Group in the Institute of Orthopedics and Traumatology (I.O.T.) of the Clinics Hospital of the Medical School of the São Paulo University.

With the significant increase in life expectancy for HIV-infected patients in the era of high potency antiretroviral therapy, major metabolic changes have been observed due to the prolonged period of the viral infection and the treatment itself. Osteoarticular changes resulting from these processes are mainly reported in long term HIV-infected patients receiving high potency antiretroviral therapy and include osteopenia/osteoporosis, osteonecrosis, carpal tunnel syndrome and adhesive capsulitis of the shoulder.

Objective: The objective of this study was to describe the methodology of knee rotation analysis using biomechanics laboratory instruments and to present the preliminary results from a comparative study on patients who underwent anterior cruciate ligament (ACL) reconstruction using the double-bundle technique. Methods: The protocol currently used in our laboratory was described. Three-dimensional kinematic analysis was performed and knee rotation amplitude was measured on eight normal patients (control group) and 12 patients who were operated using the double-bundle technique, by means of three tasks in the biomechanics laboratory. Results: No significant differences between operated and non-operated sides were shown in relation to the mean amplitudes of gait, gait with change in direction or gait with change in direction when going down stairs (p > 0.13). Conclusion: The preliminary results did not show any difference in the double-bundle ACL reconstruction technique in relation to the contralateral side and the control group.