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[PMID]:28470462
[Au] Autor:Grundei H; Timmermann A
[Ad] Endereço:Fa. Eska Orthopaedic Handels GmbH, Osterweide 2c, 23562, Lübeck, Deutschland. info@eskaorthopaedic.de.
[Ti] Título:[Connecting adapter for coupling exoprostheses to endoshafts : Demands on orthopedic technicians with respect to planning and application].
[Ti] Título:Anschlussadapter zur Ankopplung der Exoprothese an den Endostiel : Anforderungen an den Orthopädietechniker hinsichtlich Planung und Anwendung..
[So] Source:Unfallchirurg;120(5):378-384, 2017 May.
[Is] ISSN:1433-044X
[Cp] País de publicação:Germany
[La] Idioma:ger
[Ab] Resumo:INTRODUCTION: Transcutaneous, bone anchored prostheses have proved to be an alternative for amputees. In addition to the safe osseointegration of the implant, the correct prosthetic alignment is also important. Therefore, the interaction between prosthesis components and the prosthesis wearer is significant and the role of the certified prosthetist should not be underestimated. AIM: The aim of treatment is the best possible compensation of disability after limb loss with increase of physical abilities and comfort of the prosthesis wearer by means of bone anchored prosthesis. METHOD: Endoprosthesis inserted by the surgeon carrying out both surgery with the implant and a double-cone and 6 weeks later the exoprosthesis is fitted by the certified prosthetist orthotist (CPO). Mounting the external adaptors, assembly of the prosthesis. RESULTS: The long-term results with cementless implants and more than 35 years experience are presented. Clinical experience with the endo-exo prosthesis since 1999. A total of 135 patients treated after transfemoral amputation, 8 of them bilateral, 8 out of 135 were transtibial amputees and 1 of them bilateral. A total of 85% were amputated as a consequence of trauma and 12 out of 135 had a full range of motion at the beginning of the prosthetic work following osseointegration. In other cases, a hip flexion contracture between 3 and 12 ° had to be considered by corresponding posterior displacement adaptors. CONCLUSION: Bone anchored prostheses influence the skeleton and joints in a more direct way. This fact requires specific prosthetic measures concerning the connection between the endo-implant and the exoprosthesis. Therefore, specially matched adaptors and the prosthetic alignment are the focus of interest. Prostheses connected to an osseointegrated implant have many biomechanical advantages compared to socket-guided prostheses. Because the quality of rehabilitation is clearly affected by the prosthetic alignment, it has to be carried out extremely carefully and precisely if the prosthesis is connected to an osseointegrated implant. According to the survey, none of the prosthesis wearers wanted to return to a socket-guided prosthesis.
[Mh] Termos MeSH primário: Cotos de Amputação/cirurgia
Amputação/reabilitação
Artroplastia de Substituição/instrumentação
Membros Artificiais
Exoesqueleto Energizado
Prótese Articular
Perna (Membro)/cirurgia
[Mh] Termos MeSH secundário: Artroplastia de Substituição/métodos
Terapia Combinada/instrumentação
Terapia Combinada/métodos
Seres Humanos
Osseointegração
Desenho de Prótese
Estudos Retrospectivos
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180306
[Lr] Data última revisão:
180306
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170505
[St] Status:MEDLINE
[do] DOI:10.1007/s00113-017-0351-0


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[PMID]:29385156
[Au] Autor:Lu CH; Chung CH; Lee CH; Hsieh CH; Hung YJ; Lin FH; Tsao CH; Hsieh PS; Chien WC
[Ad] Endereço:Department of Internal Medicine, Division of Endocrinology and Metabolism, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC.
[Ti] Título:Combination COX-2 inhibitor and metformin attenuate rate of joint replacement in osteoarthritis with diabetes: A nationwide, retrospective, matched-cohort study in Taiwan.
[So] Source:PLoS One;13(1):e0191242, 2018.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Osteoarthritis (OA) is the most common form of arthritis associated with an increased prevalence of type 2 diabetes mellitus (T2DM), however their impact on decreasing joint replacement surgery has yet to be elucidated. This study aimed to investigate if the combination of COX-2 inhibitor and metformin therapy in OA with T2DM were associated with lower the rate of joint replacement surgery than COX-2 inhibitor alone. METHODS: In total, 968 subjects with OA and T2DM under COX-2 inhibitor and metformin therapy (case group) between 1 January to 31 December 2000 were selected from the National Health Insurance Research Database of Taiwan, along with 1936 patients were the 1:2 gender-, age-, and index year-controls matched without metformin therapy (control group) in this study. Cox proportional hazards analysis was used to compare the rate of receiving joint replacement surgery during 10 years of follow-up. RESULTS: At the end of follow-up, 438 of all enrolled subjects (15.08%) had received the joint replacement surgery, including 124 in the case group (12.81%) and 314 in the control group (16.22%). The case group tended to be associated with lower rate of receiving the joint replacement surgery at the end of follow-up than the control group (p = 0.003). Cox proportional hazards regression (HR) analysis revealed that study subjects under combination therapy with metformin had lower rate of joint replacement surgery (adjusted HR 0.742 (95% CI = 0.601-0.915, p = 0.005)). In the subgroups, study subjects in the combination metformin therapy who were female, good adherence (>80%), lived in the highest urbanization levels of residence, treatment in the hospital center and lower monthly insurance premiums were associated with a lower risk of joint replacement surgery than those without. CONCLUSIONS: Patients who have OA and T2DM receiving combination COX-2 inhibitors and metformin therapy associated with lower joint replacement surgery rates than those without and this may be attributable to combination therapy much more decrease pro-inflammatory factors associated than those without metformin therapy.
[Mh] Termos MeSH primário: Artroplastia de Substituição
Inibidores de Ciclo-Oxigenase 2/administração & dosagem
Diabetes Mellitus Tipo 2/complicações
Diabetes Mellitus Tipo 2/tratamento farmacológico
Hipoglicemiantes/administração & dosagem
Metformina/administração & dosagem
Osteoartrite/complicações
Osteoartrite/tratamento farmacológico
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Artroplastia de Substituição/estatística & dados numéricos
Estudos de Coortes
Quimioterapia Combinada
Feminino
Seres Humanos
Masculino
Meia-Idade
Osteoartrite/cirurgia
Modelos de Riscos Proporcionais
Estudos Retrospectivos
Taiwan
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Nm] Nome de substância:
0 (Cyclooxygenase 2 Inhibitors); 0 (Hypoglycemic Agents); 9100L32L2N (Metformin)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180222
[Lr] Data última revisão:
180222
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180201
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0191242


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[PMID]:28449888
[Au] Autor:Roehrs TA; Roth T
[Ad] Endereço:Sleep Disorders and Research Center, Henry Ford Hospital (performance site), Detroit, MI, United States; Department of Psychiatry and Behavioral Neurosciences, Wayne State University, SOM, Detroit, MI, United States. Electronic address: troehrs1@hfhs.org.
[Ti] Título:Increasing presurgery sleep reduces postsurgery pain and analgesic use following joint replacement: a feasibility study.
[So] Source:Sleep Med;33:109-113, 2017 May.
[Is] ISSN:1878-5506
[Cp] País de publicação:Netherlands
[La] Idioma:eng
[Ab] Resumo:STUDY OBJECTIVES: To determine whether presurgery sleep extension in short-sleeping volunteers scheduled for total knee/hip replacement surgery would reduce postsurgery pain and analgesic use. METHODS: Eighteen short sleepers, defined by sleep times below the national mean (ie, ≤7 h) nightly, were randomized to one week of a 2-h nightly extension of their time in bed (EXT) or maintenance of their habitual time in bed (HAB) prior to knee or hip replacement surgery. Compliance was monitored by wrist actigraphy. Outcomes were the postsurgery daily dose of opiates (converted to morphine milligram equivalents) and the daily pain ratings (acquired 3-4 times across the day) on a 0-10 rating scale (0 = no pain to 10 = worst pain experienced) over the three to four day inpatient recovery. RESULTS: On a diary before the presurgery time in bed (TIB) manipulation, there were no significant differences in reported nightly sleep times between those randomized to the EXT group [6.0 (±0.78) h] and the HAB group [6.5 (±0.50) h]. During the one-week presurgery TIB manipulation, three participants failed to extend their TIB. Among those extending TIB (n = 7), compared to the HAB group, the EXT group spent significantly more nightly TIB (8.0 vs. 6.9 h, p < 0.05), which resulted in 1 h of more sleep (6.8 vs. 5.8 h, p < 0.04). On the three- to four-day postsurgery inpatient recovery, the EXT group reported significantly less average daily pain (4.4 vs. 5.6, p < 0.04) and less daily morphine milligram equivalent intake (20.3 vs. 38.6 mg, p < 0.02) than those by the HAB group. CONCLUSIONS: In this feasibility study, we found that a presurgery extended TIB and associated increase in sleep time in short-sleeping patients scheduled for undergoing joint replacement results in reduced postsurgery pain ratings and opiate use.
[Mh] Termos MeSH primário: Analgésicos Opioides/administração & dosagem
Analgésicos/administração & dosagem
Artroplastia de Substituição/efeitos adversos
Repouso em Cama/métodos
Dor Pós-Operatória/tratamento farmacológico
Sono/fisiologia
[Mh] Termos MeSH secundário: Actigrafia/métodos
Idoso
Analgésicos/uso terapêutico
Analgésicos Opioides/uso terapêutico
Estudos de Viabilidade
Feminino
Seres Humanos
Masculino
Meia-Idade
Dor Pós-Operatória/classificação
Dor Pós-Operatória/epidemiologia
Dor Pós-Operatória/prevenção & controle
Período Pré-Operatório
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Analgesics); 0 (Analgesics, Opioid)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180216
[Lr] Data última revisão:
180216
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170429
[St] Status:MEDLINE


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[PMID]:29369186
[Au] Autor:Gao X; Yang Y; Liu H; Meng Y; Zeng J; Wu T; Hong Y
[Ad] Endereço:Department of Orthopedics, West China Hospital, Sichuan University.
[Ti] Título:Cervical disc arthroplasty with Prestige-LP for the treatment of contiguous 2-level cervical degenerative disc disease: 5-year follow-up results.
[So] Source:Medicine (Baltimore);97(4):e9671, 2018 Jan.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:The objective of this study is to present the long-term results and to evaluate the safety and effectiveness of the Prestige-LP cervical disc replacement in treatment of patients with symptomatic 2-level cervical degenerative disc disease.Twenty-four patients with 48 Prestige-LP disc were analyzed before surgery and at 1 week, 3 months, 6 months, 12 months, 24 months, and 60 months after surgery. Clinical assessments included 36-Short Form (SF-36), Japanese Orthopedic Assessment (JOA), visual analog scale (VAS), and Neck Disability Index (NDI) scores. Radiographic assessments included cervical lordosis (CL), disc height (DH), range of motion (ROM) of the total cervical spine, functional spinal unit (FSU) as well as upper and lower operated segment. Complications at the 5-year follow-up were collected as well.Mean follow-up period was 64.22 months. There was clinical improvement in terms of SF-36, JOA, NDI, and VAS from the preoperative to the final follow-up (P < .05). Overall, ROM of the total cervical spine, FSU, and upper and lower operated segment were maintained during the follow-up. Statistically significant (P < .05) improvements in the trend of CL and DH were noted at the follow-up. Eight patients were observed an appearance of heterotopic ossification at the 5-year follow-up, with 6 patients appeared at Class II and 2 patients at Class III. Adjacent segment degeneration assessed by radiographic evidence was found in 2 patients.Two-level cervical disc arthroplasty with Prestige-LP showed significant improvement in clinical outcomes at 5 years. It not only effectively preserves the motion of both total cervical spine and operated segments, but also restores normal CL and DH up to 5 years postoperation.
[Mh] Termos MeSH primário: Artroplastia de Substituição/instrumentação
Vértebras Cervicais/cirurgia
Degeneração do Disco Intervertebral/cirurgia
Prótese Articular
[Mh] Termos MeSH secundário: Adulto
Artroplastia de Substituição/métodos
Vértebras Cervicais/fisiopatologia
Avaliação da Deficiência
Feminino
Seguimentos
Seres Humanos
Degeneração do Disco Intervertebral/fisiopatologia
Masculino
Meia-Idade
Medição da Dor
Dor Pós-Operatória/etiologia
Período Pós-Operatório
Amplitude de Movimento Articular
Fatores de Tempo
Resultado do Tratamento
[Pt] Tipo de publicação:EVALUATION STUDIES; JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180208
[Lr] Data última revisão:
180208
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180126
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009671


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[PMID]:29189623
[Au] Autor:Denny DL; Lindseth G
[Ad] Endereço:Dawn L. Denny, PhD, RN, ONC, Assistant Professor, College of Nursing and Professional Disciplines, University of North Dakota, Grand Forks, ND. Glenda Lindseth, PhD, RN, FADA, FAAN, Professor, College of Nursing and Professional Disciplines, University of North Dakota, Grand Forks.
[Ti] Título:Preoperative Risk Factors for Subsyndromal Delirium in Older Adults Who Undergo Joint Replacement Surgery.
[So] Source:Orthop Nurs;36(6):402-411, 2017 Nov/Dec.
[Is] ISSN:1542-538X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Older adults with subsyndromal delirium have similar risks for adverse outcomes following joint replacement surgery as those who suffer from delirium. PURPOSE: This study examined relationships among subsyndromal delirium and select preoperative risk factors in older adults following major orthopaedic surgery. METHODS: Delirium assessments of a sample of 62 adults 65 years of age or older were completed on postoperative Days 1, 2, and 3 following joint replacement surgery. Data were analyzed for relationships among delirium symptoms and the following preoperative risk factors: increased comorbidity burden, cognitive impairment, fall history, and preoperative fasting time. RESULTS: Postoperative subsyndromal delirium occurred in 68% of study participants. A recent fall history and a longer preoperative fasting time were associated with delirium symptoms (p ≤ .05). CONCLUSIONS: Older adults with a recent history of falls within the past 6 months or a longer duration of preoperative fasting time may be at higher risk for delirium symptoms following joint replacement surgery.
[Mh] Termos MeSH primário: Artroplastia de Substituição/métodos
Comorbidade
Delírio/diagnóstico
Complicações Pós-Operatórias
[Mh] Termos MeSH secundário: Acidentes por Quedas/prevenção & controle
Idoso
Feminino
Seres Humanos
Masculino
Estudos Prospectivos
Fatores de Risco
Fatores de Tempo
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180205
[Lr] Data última revisão:
180205
[Sb] Subgrupo de revista:N
[Da] Data de entrada para processamento:171201
[St] Status:MEDLINE
[do] DOI:10.1097/NOR.0000000000000401


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[PMID]:29232073
[Au] Autor:Centers for Medicare & Medicaid Services (CMS), HHS.
[Ti] Título:Medicare Program; Cancellation of Advancing Care Coordination Through Episode Payment and Cardiac Rehabilitation Incentive Payment Models; Changes to Comprehensive Care for Joint Replacement Payment Model: Extreme and Uncontrollable Circumstances Policy for the Comprehensive Care for Joint Replacement Payment Model. Final rule; interim final rule with comment period.
[So] Source:Fed Regist;82(230):57066-104, 2017 Dec 01.
[Is] ISSN:0097-6326
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:This final rule cancels the Episode Payment Models (EPMs) and Cardiac Rehabilitation (CR) Incentive Payment Model and rescinds the regulations governing these models. It also implements certain revisions to the Comprehensive Care for Joint Replacement (CJR) model, including: Giving certain hospitals selected for participation in the CJR model a one-time option to choose whether to continue their participation in the model; technical refinements and clarifications for certain payment, reconciliation and quality provisions; and a change to increase the pool of eligible clinicians that qualify as affiliated practitioners under the Advanced Alternative Payment Model (Advanced APM) track. An interim final rule with comment period is being issued in conjunction with this final rule in order to address the need for a policy to provide some flexibility in the determination of episode costs for providers located in areas impacted by extreme and uncontrollable circumstances.
[Mh] Termos MeSH primário: Artroplastia de Substituição/economia
Reabilitação Cardíaca/economia
Reembolso de Seguro de Saúde/economia
Medicare/economia
Mecanismo de Reembolso/economia
Reembolso de Incentivo/economia
[Mh] Termos MeSH secundário: Cuidado Periódico
Seres Humanos
Reembolso de Seguro de Saúde/legislação & jurisprudência
Medicare/legislação & jurisprudência
Mecanismo de Reembolso/legislação & jurisprudência
Reembolso de Incentivo/legislação & jurisprudência
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180105
[Lr] Data última revisão:
180105
[Sb] Subgrupo de revista:T
[Da] Data de entrada para processamento:171213
[St] Status:MEDLINE


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[PMID]:29257013
[Au] Autor:Lee YS; Koo KH; Kim HJ; Tian S; Kim TY; Maltenfort MG; Chen AF
[Ad] Endereço:Department of Orthopedic Surgery, Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania.
[Ti] Título:Synovial Fluid Biomarkers for the Diagnosis of Periprosthetic Joint Infection: A Systematic Review and Meta-Analysis.
[So] Source:J Bone Joint Surg Am;99(24):2077-2084, 2017 Dec 20.
[Is] ISSN:1535-1386
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: The search for a single standard reference test for determining periprosthetic joint infection (PJI) through analysis of synovial fluid has yielded numerous biomarkers as potential candidates. The purpose of the present systematic review and meta-analysis was to evaluate the diagnostic accuracy of synovial fluid biomarkers and to determine which test has the highest diagnostic odds ratio (DOR) for the diagnosis of PJI. METHODS: An online literature search of the MEDLINE, Embase, and Cochrane databases identified 33 articles reporting a total of 13 major parameters for diagnosing PJI through analysis of synovial fluid. Each of the included articles was independently analyzed for risk of bias and for concerns regarding applicability utilizing the QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies-2) tool. The mada (meta-analysis of diagnostic accuracy) tool was used to generate forest plots for sensitivity, specificity, and the log of the DOR, as well as summary statistics. RESULTS: In this analysis, 13 index tests (leukocyte count; measurement of the percentage of polymorphonucleocytes [PMN%] and the levels of C-reactive protein [CRP], α-defensin, leukocyte esterase [LE], interleukin [IL]-6, IL-8, IL-10, IL-1ß, vascular endothelial growth factor [VEGF], and granulocyte-colony stimulating factor [G-CSF]; culture; and polymerase chain reaction [PCR] analysis) were evaluated on the basis of ≥2 articles. Of these tests, 8 (leukocyte count, PMN%, CRP, α-defensin, LE, IL-6, IL-8, and culture) were appropriate for pooled analysis. The overall sensitivity of these 8 markers was 0.85, and all but culture showed a sensitivity of ≥0.8. All markers showed a specificity of ≥0.9. Of the 8 tests, measurement of the α-defensin level showed the highest log DOR. CONCLUSIONS: Synovial fluid leukocyte count, PMN%, CRP, α-defensin, LE, IL-6, and IL-8 all demonstrated high sensitivity for diagnosing PJI, with α-defensin being the best synovial marker based on the highest log DOR. However, other synovial fluid tests that demonstrate good diagnostic performance can also be used in combination for the diagnosis of PJI. LEVEL OF EVIDENCE: Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
[Mh] Termos MeSH primário: Artroplastia de Substituição/efeitos adversos
Infecções Relacionadas à Prótese/diagnóstico
Líquido Sinovial/metabolismo
alfa-Defensinas/metabolismo
[Mh] Termos MeSH secundário: Artroplastia de Substituição/métodos
Biomarcadores/análise
Proteína C-Reativa/metabolismo
Feminino
Seres Humanos
Masculino
Sensibilidade e Especificidade
Fator A de Crescimento do Endotélio Vascular/metabolismo
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; REVIEW
[Nm] Nome de substância:
0 (Biomarkers); 0 (Vascular Endothelial Growth Factor A); 0 (alpha-Defensins); 9007-41-4 (C-Reactive Protein)
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171227
[Lr] Data última revisão:
171227
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171220
[St] Status:MEDLINE
[do] DOI:10.2106/JBJS.17.00123


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[PMID]:28448387
[Au] Autor:Navathe AS; Liao JM; Emanuel EJ
[Ad] Endereço:Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
[Ti] Título:Volume Increases and Shared Decision-making in Joint Replacement Bundles.
[So] Source:Ann Surg;267(1):35-36, 2018 Jan.
[Is] ISSN:1528-1140
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Artroplastia de Substituição
Tomada de Decisões
Participação do Paciente/estatística & dados numéricos
Padrões de Prática Médica/utilização
[Mh] Termos MeSH secundário: Seres Humanos
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171227
[Lr] Data última revisão:
171227
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170428
[St] Status:MEDLINE
[do] DOI:10.1097/SLA.0000000000002283


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[PMID]:28455729
[Au] Autor:Haskell A
[Ad] Endereço:Department of Orthopaedic Surgery, Palo Alto Medical Foundation, 301 Industrial Road, San Carlos, CA, 94070, USA. haskela@pamf.org.
[Ti] Título:CORR Insights : Can a Three-component Prosthesis be Used for Conversion of Painful Ankle Arthrodesis to Total Ankle Replacement?
[So] Source:Clin Orthop Relat Res;475(9):2295-2297, 2017 09.
[Is] ISSN:1528-1132
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Tornozelo/cirurgia
Artroplastia de Substituição do Tornozelo
[Mh] Termos MeSH secundário: Articulação do Tornozelo/cirurgia
Artrodese
Artroplastia de Substituição
Seres Humanos
Prótese Articular
[Pt] Tipo de publicação:JOURNAL ARTICLE; COMMENT
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171128
[Lr] Data última revisão:
171128
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170430
[St] Status:MEDLINE
[do] DOI:10.1007/s11999-017-5372-z


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[PMID]:29068934
[Au] Autor:Giacalone F; di Summa PG; Fenoglio A; Sard A; Dutto E; Ferrero M; Bertolini M; Garcia-Elias M
[Ad] Endereço:Turin, Italy; Lausanne, Switzerland; and Barcelona, Spain From the Department of Hand Surgery, CTO-Maria Adelaide Trauma and Orthopaedic Hospital; the Department of Plastic, Reconstructive, and Hand Surgery, Centre Hospitalier Universitaire Vaudois; and the Institut Kaplan.
[Ti] Título:Resurfacing Capitate Pyrocarbon Implant versus Proximal Row Carpectomy Alone: A Comparative Study to Evaluate the Role of Capitate Prosthetic Resurfacing in Advanced Carpal Collapse.
[So] Source:Plast Reconstr Surg;140(5):962-970, 2017 Nov.
[Is] ISSN:1529-4242
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: The Resurfacing Capitate Pyrocarbon Implant associated with proximal row carpectomy has been used to treat symptomatic advanced carpal collapse, widening the indications of proximal row carpectomy to patients with capitate head arthritis. The authors retrospectively compared their case series of implant versus carpectomy alone, analyzing whether prosthetic implant outcomes could be similar to those of proximal row carpectomy even with a higher stage of osteoarthritis. METHODS: Fifty-seven patients who underwent surgery for wrist osteoarthritis (minimum follow-up, 2 years) were selected retrospectively. Twenty-five patients (scapholunate advanced collapse/scaphoid nonunion advanced collapse stage III to IV and Kienböck disease stage IV) underwent proximal row carpectomy plus Resurfacing Capitate Pyrocarbon Implant (group A); 32 patients (scapholunate advanced collapse/scaphoid nonunion advanced collapse stage I to II and Kienböck disease stage III) underwent carpectomy alone (group B). Mean follow-up was 33 months. Patients were evaluated clinically and radiographically. Patient-Rated Wrist Evaluation and Disabilities of the Arm, Shoulder, and Hand questionnaire scores were assessed. RESULTS: Group A showed consistent pain relief (visual analogue scale score of 2), while preserving wrist mobility (flexion, 27 degrees; extension, 33 degrees) and grip strength (54 percent compared with the contralateral side). Average Disabilities of the Arm, Shoulder, and Hand questionnaire score was 20, and average Patient-Rated Wrist Evaluation score was 28. No statistically significant difference was observed between groups for all outcomes, except for better extension (p < 0.05) in group B. CONCLUSIONS: Even starting from a higher grade of osteoarthritis, Resurfacing Capitate Pyrocarbon Implant plus proximal row carpectomy showed satisfying results, compared with those obtained with just carpectomy. Data show that indications for proximal row carpectomy can be widened by using the implant, without worsening outcomes. The implant could be a useful alternative to more aggressive salvage procedures in case of capitate head and lunate fossa osteoarthritis involvement. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
[Mh] Termos MeSH primário: Artroplastia de Substituição/métodos
Carbono
Ossos do Carpo/cirurgia
Prótese Articular
Osteoartrite/cirurgia
Articulação do Punho/cirurgia
[Mh] Termos MeSH secundário: Adulto
Idoso
Idoso de 80 Anos ou mais
Artroplastia de Substituição/instrumentação
Ossos do Carpo/diagnóstico por imagem
Ossos do Carpo/patologia
Feminino
Seguimentos
Seres Humanos
Masculino
Meia-Idade
Osteoartrite/diagnóstico por imagem
Osteoartrite/patologia
Radiografia
Estudos Retrospectivos
[Pt] Tipo de publicação:COMPARATIVE STUDY; EVALUATION STUDIES; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (pyrolytic carbon); 7440-44-0 (Carbon)
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171109
[Lr] Data última revisão:
171109
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171026
[St] Status:MEDLINE
[do] DOI:10.1097/PRS.0000000000003759



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