Resumo Objetivo Determinar a prevalência da morfologia de impacto femoroacetabular (MIFA), tipo cam ou pincer, por ressonância magnética (RM) em jogadores de futebol entre 13e 18 anos e assintomáticos, bem como avaliar a possível correlação entre as alterações observadas na RM e os achados do exame clínico. Métodos Foram analisados 112 quadris de 56 jogadores (média de 15,3 anos). As imagens foram examinadas por dois radiologistas musculoesqueléticos, com o objetivo de identificar sinais de MIFA. A deformidade (impacto) do tipo cam foi diagnosticada quando o ângulo alfa ≥ 55° ou desvio entre a cabeça e o colo femoral < 7 mm. A deformidade (impacto) do tipo pincer foi diagnosticada quando o ângulo centro-borda (ACB) ≥ 35° ou o índice acetabular ≤ 0°. Outras alterações características de MIFA foram observadas na RM. A amplitude de movimento (ADM) dos quadris foi determinada a partir de um exame clínico. Além disso, foram feitos testes específicos para impactos anterolaterais e posteroinferiores. Resultados A prevalência de achados de RM consistentes com MIFA nessa população foi de 84,8% (95/112). O ângulo alfa foi ≥ 55° em 77,7% (87/112) dos quadris, enquanto o ACB apresentou alterações em 10,7% (12/112) dos quadris. Observou-se uma alta prevalência de achados qualitativos de RM consistentes com MIFA, inclusive perda de esfericidade da cabeça femoral (77%), elevação óssea (44%), edema femoral (21%) e osteíte acetabular (9%). O teste de impacto anterior foi positivo em 15% dos quadris avaliados. Conclusão Os exames de RM indicaram uma alta prevalência de MIFA entre jogadores de futebol juvenil. Nessa população, não houve correlação entre os achados do exame físico e a evidência de MIFA observada na RM.

Abstract Objective To determine the prevalence of femoroacetabular impingement morphology (FAIM), cam- or pincer-type, by magnetic resonance imaging (MRI) in asymptomatic adolescent soccer players, and to evaluate the possible correlation between alterations on MRI and clinical examination findings. Methods A cross-sectional study was conducted to determine the prevalence of FAIM in asymptomatic youth soccer players aged 13-18 years. A total of 112 hips in 56 players (mean age 15.3 years) were evaluated by MRI. Images were examined by two musculoskeletal radiologists for signs of FAIM. Cam-type (impingement) deformity was diagnosed by alpha angle ≥55° or head-neck offset <7 mm. Pincer-type (impingement) deformity was diagnosed by center-edge angle (CEA) ≥35° or acetabular index ≤0°. Other MRI changes, characteristic of FAIM, were observed. Clinical examination was performed to determine the range of motion (ROM) of the hips. In addition, specific tests for anterolateral and posteroinferior impingement were performed. Results The prevalence of MRI findings consistent with FAIM among this young population was 84.8% (95/112). The alpha angle was ≥55° in 77.7% (87/112) of hips, while the CEA was altered in 10.7% (12/112) of hips. Qualitative MRI findings consistent with FAIM were highly prevalent, and included loss of sphericity of the femoral head (77%), osseous bump (44%), femoral neck edema (21%), and acetabular osteitis (9%). The anterior impingement test was positive in 15% of the hips evaluated. Conclusion Youth soccer players have a high prevalence of FAIM as diagnosed by MRI. There is no correlation between physical examination findings and MRI evidence of FAIM in this population.

ABSTRACTTotal hip arthroplasty (THA) is one of the most cost-effective hip surgeries among orthopedic procedures. We conducted an extensive literature review with 5,394 papers regarding survival rates after THA. We searched PubMed, Embase and the Cochrane library from January 1st, 1970 to July 31th, 2014 looking for all citations about total hip arthroplasty with a long term follow-up (longer than 10 years). The criteria were rigorous: no loss of follow-up, and follow-up more than 10 years. The authors should have known the complete history of patients (whether the patient is alive or dead). Considering the criteria, we found only 15 papers. To evaluate the relationship between follow-up and survival, a linear regression analysis was applied. Considering the papers analysed, and applying the search criteria, we obtained a mean age for the patients above 57.5 years. The chance of survival at 15 years was 57.6%, at 20 years it was 34.6% and at 25 years it is only 11.6%. The relationship between follow-up and survival was significantly linear (p <0.001). Only 11.6% of patients undergoing THA will be still alive 25 years after the surgical procedure. Level of Evidence I, Prognostic Study.

ABSTRACTOBJECTIVE: The purpose of this study was to evaluate the performance of valgus intertrochanteric osteotomy in femoral neck non-union.METHODS: Forty-two patients with femoral neck fractures with non-union treated using Pauwels' intertrochanteric osteotomy were reviewed. Demographics, time elapsed between fracture and surgery, follow--up, osteosynthesis used, Garden's classification, limb shortening, and x-rays were evaluated.RESULTS: Twenty-two men and 20 women were reviewed. The youngest patient was 18 years old and the oldest 65 years old, with a mean age of 42.4 years (±11.2). The minimum follow-up was 2 years, with a mean of 10.2 years. The average time elapsed between initial fracture and osteotomy was 6.5 months. Twel-ve cases were neglected femoral neck fractures. Nineteen patients were classified as Garden III, and 23 patients as Garden IV. After valgus osteotomy, non-union healing was observed in 38 patients (38/42; 90.4%). Healing of thirty-seven cases of pseudoarthrosis were obtained after the first-attempt osteotomy, and one case required two operations for healing. The osteotomy failed in four cases. Conside-ring the healed osteotomies, good to excellent functional results were achieved in 80.9% (34/42) of the patients. Total hip replacement was subsequently performed in 14.2% (6/42) of the patients for unfavoura-ble outcomes (two for cutting out, two for osteonecrosis, and two for osteoarthritis).CONCLUSIONS: Valgus intertrochanteric osteotomy has a high success rate in archiving healing in femoral neck non-union with good functional results. It is a biological and effective method. Level of Evidence IV, Therapeutic Study.

Objective:To evaluate the bleeding of the femoral head on hip osteoarthritis in patients who underwent total hip arthroplasty.Methods:One hundred and three hips affected by primary hip osteoarthritis were evaluated. After surgical dislocation, the femoral head was divided into four quadrants, and micro perforations were made in order to observe and assess the presence of bleeding, as early type (EB), late type (LB) or without bleeding (WB).Results:We observed early bleeding (EB) in the upper quadrant in 16 hips (15.5%), late bleeding in 14 hips (13.6%) and no bleeding (WB) in 73 hips (70.9%). The anterior quadrant showed EB in 24 hips (23.3%), LB in 7 hips (6.8%) and WB in 72 hips (69.9%). The lower quadrant presented EB in 40 hips (38.8%), LB 14 hips (13.6%) and WB in 49 hips (47.6%). The posterior quadrant showed EB in 39 hips (37.9%), LB 19 hips (18.4%) and WB in 45 hips (43.7%). Comparing BMI and gender, we found no association between these parameters (p> 0.05).Conclusions:The inferior and posterior quadrant had the highest bleeding levels, following the path of the medial circumflex artery. Level of Evidence III, Therapeutic Study.

Objetiuo:Investigar o efeito da artroplastia total do quadril (ATQ) no índice de massa corporal em relação ao pré e ao pós-operatório.Métodos:Foram analisados retrospectivamente 100 pacientes submetidos à ATQ. Os pacientes foram estratificados pelo índice de massa corporal (IMC), conforme proposto pela Organização Mundial de Saúde (OMS).Resultados:Foram observados 48 pacientes do sexo masculino e 52 do feminino. A média de idade foi de 63,8 ± 13,5 anos. O seguimento médio foi de 24,6 ± 0,6 meses. Os homens apresentaram IMC pré-operatório médio de 28,4 ±3,6 kg/m2 e as mulheres, de 27,5 ±5,0 kg/m2. O IMC médio pós-operatório foi 28,9±0,7kg/m2 para os homens e 27,8±0,7kg/m2 para as mulheres. Ocorreu uma média de aumento geral do IMC em 0,4kg/m2. O IMC aumentou em pacientes com peso normal e com sobrepeso, mas diminuiu levemente em pacientes com obesidade. A maioria dos pacientes (73%) permaneceu com o IMC inalterado.Conclusão:A melhoria da mobilidade obtida com a ATQ não promoveu uma redução das medidas antropométricas na maioria dos pacientes.

Objective:To investigate the effect of total hip arthroplasty (THA) on body mass index (BMI), from before to after the operation.Methods:100 patients who underwent THA were retrospectively analyzed. They were stratified according to BMI, as proposed by the World Health Organization (WHO).Results:There were 48 male patients and 52 female patients. Their mean age was 63.8 ± 13.5 years. The mean follow-up was 24.6 ± 0.6 months. The men had a mean preoperative BMI of 28.4± 3.6kg/m2 and the women, 27.5 ±5.0kg/m2. The mean postoperative BMI was 28.9 ±0.7kg/m2 for the men and 27.8 ± 0.7 kg/m2 for the women. There was a general mean increase in BMI of 0.4kg/m2. The BMI increased both in patients with normal weight and in those who were overweight, but it decreased slightly in patients who were obese. BMI remained unchanged in the majority of the patients (73%).Conclusion:The improvement in mobility achieved through THA did not promote any reduction in anthropometric measurements in the majority of the patients.

OBJETIVO: fazer um estudo epidemiológico da bursite trocantérica no momento da feitura da artroplastia total do quadril (ATQ).MÉTODOS: foram avaliados 62 pacientes, sequenciais, submetidos à ATQ por osteoartrose, sem história prévia de bursite trocantérica. As bursas foram coletadas e avaliadas histologicamente.RESULTADOS: foram observados 35 pacientes do sexo feminino (56,5%) e 27 do masculino (43,5%), com média de 65 anos (+/-11). A bursite trocantérica foi confirmada histologicamente em nove (14,5%), seis do sexo feminino (66,7%) e três (33,3%) do masculino.CONCLUSÕES: das bursas analisadas, 14,5% apresentaram inflamação no momento da feitura da ATQ primária por osteoartrose. A maioria das bursites foi detectada nas pacientes femininas.

OBJECTIVE: this was an epidemiological study on trochanteric bursitis at the time of performing total hip arthroplasty.METHODS: sixty-two sequential patients who underwent total hip arthroplasty due to osteoarthrosis, without any previous history of trochanteric bursitis, were evaluated. The bursas were collected and evaluated histologically.RESULTS: there were 35 female patients (56.5%) and 27 male patients (43.5%), with a mean age of 65 years (±11). Trochanteric bursitis was conformed histologically in nine patients (14.5%), of whom six were female (66.7%) and three were male (33.3%).CONCLUSIONS: 14.5% of the bursas analyzed presented inflammation at the time that the primary total hip arthroplasty due to osteoarthrosis was performed, and the majority of the cases of bursitis were detected in female patients.

Objetivo: verificar se a curva laboratorial hemática deve ser o único preditor de transfusão sanguínea pós-operatória em artroplastia total de quadril (ATQ). Métodos: amostras laboratoriais sanguíneas de 78 pacientes consecutivos submetidos à ATQ foram analisadas em cinco em períodos distintos (um pré-operatório e quatro pós-operatórios). Verificou-se a contagem de hemoglobina, hematócrito e plaquetas desses pacientes. Foram analisadas características antropométricas e comportamentais e comorbidades referentes à amostra, para verificação de fatores de risco associados à prática transfusional. Os indivíduos do estudo foram divididos em dois grupos: aqueles que receberam transfusão sanguínea foram alocados no Grupo 1 (G1) e os que não a receberam, no Grupo 2 (G2). As condutas transfusionais respaldaram-se dos critérios da Academia Americana de Anestesiologia e da Sociedade Britânica de Hematologia. Resultados: receberam transfusão de hemoderivados 27 (34,6%) pacientes. As análises das curvas de hemoglobina, hematócrito e plaquetas entre o G1 e o G2 nas cinco visitas distintas foram similares (p > 0,05). Todos os fatores de risco analisados, com exceção da etnia, não apresentaram repercussões nos índice de transfusão em suas análises com valor p > 0,05. A soma das comorbidades clínicas associadas aos pacientes no G1 foi mediana de 3 (IC 95% 2,29-3,40), enquanto no G2 a mediana foi 2 (IC 95% 1,90-2,61) com valor p = 0,09. Conclusão: a curva hemática apresenta confiabilidade limitada quando usada como parâmetro exclusivo e absoluto. A existência de pacientes tolerantes às variações da curva hematimétrica pressupõe que as suas avaliações de caráter clínico, funcional e de comorbidades sejam parâmetros que devam influenciar na decisão do uso de hemoderivados.

Objective: to determine whether the laboratory hematic curve must be the single predictor of postoperative blood transfusion in total hip arthroplasty. Methods: the laboratory blood samples of 78 consecutive patients undergoing total hip arthroplasty was analyzed during five distinct moments: one preoperative and four postoperative. There was a count of hemoglobin, hematocrit and platelets of the patients samples. Other catalogued variables ascertain possible risk factors related to transfusional practice. They characterized the anthropometric, behavioral and co morbidities data in this population. The study subjects were divided and categorized into two groups: those who received blood transfusion during or after surgery (Group 1, G1), and those who did not accomplish blood transfusion (Group 2, G2). Transfusion rules were lead by guidelines of American Academy of Anesthesiology and the British Society of Hematology. Results: a total of 27 (34.6%) patients received blood transfusions. The curves of hemoglobin, hematocrit and platelet transfusions between G1 and G2 were similar (p > 0.05). None of the analyzed risk factors modified the rate of transfusion rate in their analysis with p value > 0.05, except the race. The sum of clinical co morbidities associated with patients in G1 was a median of 3 (95% CI 2.29-3.40), while in G2 the median was 2 (95% CI 1.90-2.61) with p = 0.09. Conclusion: the curve in red blood cells has limited reliability when used as sole parameter. The existence of tolerant patients hematimetric curve variations assumes that their assessments of clinical, functional evaluation and co-morbidities are parameters that should influence the decision to transfusion red blood cells.

A artroplastia total do quadril tem sido indicada cada vez mais em pacientes mais jovens e ativos, além de haver uma natural e crescente demanda do procedimento em função do aumento da expectativa de vida dos pacientes. Os altos custos da cirurgia e as controvérsias da performance dos implantes fazem deste assunto objeto de constantes pesquisas na busca de novos materiais com melhores resistências ao desgaste e biocompatibilidade. O presente artigo abrange um estudo de revisão das novas superfícies em artroplastia total do quadril.

Total hip arthroplasty is being increasingly indicated for younger and more active patients, in addition to a naturally growing demand for the procedure because of increasing life expectancy among patients. The high costs of this surgery and the controversies regarding implant performance have made this topic the subject of constant research, seeking new materials with better resistance to wear and better biocompatibility. The present article provides a review of new surfaces in total hip arthroplasty.

OBJETIVO: Medir o volume ocupado pelos dispositivos de fixação interna mais difundidos para o tratamento das fraturas de colo femoral, usando como aproximação os primeiros 30, 40 e 50mm de cada parafuso. O estudo visa observar qual desses implantes causa menor agressão óssea. MÉTODOS: Foram avaliados cinco modelos de parafusos canulados e quatro modelos de parafusos deslizantes (DHS) encontrados no mercado nacional através de diferença de volume por deslocamento de água. RESULTADOS: A fixação com dois parafusos canulados apresentou volume significativamente menor do que com DHS nas inserções de 30, 40 e 50mm (p=0,01, 0,012 e 0,013, respectivamente), a fixação com três parafusos não apresentou significância estatística (p=0,123, 0,08 e 0,381, respectivamente) e a fixação com quatro parafusos canulados apresenta volumes maiores que o DHS (p=0,072, 0,161 e 0,033). CONCLUSÕES: A fixação da cabeça femoral com dois parafusos canulados ocupa menor volume quando comparada ao DHS com diferença estatisticamente significativa. A maioria das outras combinações de parafusos não atingiram significância estatística, apesar de a fixação com quatro parafusos canulados apresentar, em média, volumes maiores que o ocupado pelo DHS.

OBJECTIVE: The objective of this paper is to measure the volume occupied by the most widely used internal fixation devices for treating femoral neck fractures, using the first 30, 40 and 50 mm of insertion of each screw as an approximation. The study aimed to observe which of these implants caused least bone aggression. METHODS: Five types of cannulated screws and four types of dy namic hip screws (DHS) available on the Brazilian market were evaluated in terms of volume differences through water displace ment. RESULTS: Fixation with two cannulated screws presented significantly less volume than shown by DHS, for insertions of 30, 40 and 50 mm (p=0.01, 0.012 and 0.013, respectively), fixa tion with three screws did not show any statistically significant difference (p= 0.123, 0.08 and 0.381, respectively) and fixa tion with four cannulated screws presented larger volumes than shown by DHS (p=0.072, 0.161 and 0.033). CONCLUSIONS: Fixa tion of the femoral neck with two cannulated screws occupied less volume than DHS, with a statistically significant difference. The majority of screw combinations did not reach statistical significance, although fixation with four cannulated screws pre sented larger volumes on average than those occupied by DHS.