Resumo O impacto femoroacetabular (IFA) é uma importante causa de dor no quadril, e a principal etiologia da osteoartrose do quadril no jovem. O IFA é caracterizado por alterações sutis da anatomia do acetábulo e do fêmur proximal que podem causar lesões do complexo condrolabial. O lábio é uma estrutura fibrocartilaginosa essencial na estabilidade articular. Três tipos de IFA são descritos: came (onde há uma anesfericidade da cabeça femoral), pincer (onde há uma sobrecobertura acetabular) e misto (que apresenta características de ambos). A etiologia do IFA está relacionada com características genéticas e ambientais. O conhecimento desta doença e sua fisiopatologia é essencial para o tratamento de pacientes que apresentam dor no quadril.

Abstract Femoroacetabular impingement (FAI) is an important cause of hip pain, and the main etiology of hip osteoarthritis in the young population. Femoroacetabular impingement is characterized by subtle alterations in the anatomy of the acetabulum and proximal femur, which can lead to labrum tearing. The acetabular labrum is essential to the stability of the hip joint. Three types of FAI were described: cam (anespherical femoral head), pincer (acetabular overcoverage) and mixed (characteristics of both cam and pincer). The etiology of FAI is related to genetic and environmental characteristics. Knowledge of this condition is essential to adequately treat patients presenting with hip pain.

RESUMO Objetivo: Investigar o uso de drenos em uma população controlada de pacientes com osteoartrose do quadril submetidos a artroplastia total de quadril primária. Métodos: Este estudo prospectivo controlado avaliou 93 pacientes randomizados em dois grupos: um grupo no qual se usaram drenos e um grupo no qual não se usaram drenos. Os pacientes randomizados para o grupo com drenos usaram dreno de 3,2 mm, colocado sob a fáscia e mantido por 24 horas. As avaliações pós-operatórias foram feitas após 24 horas e três, seis e 12 semanas após a artroplastia total de quadril. O desfecho primário foi perda sanguínea perioperatória em ambos os grupos 24 horas após a artroplastia total de quadril. Os demais parâmetros avaliados foram circunferência do meio da coxa, taxa de transfusão de sangue, hematócrito, níveis séricos inflamatórios e Harris Hip Score. Resultados: Os dados clínicos e laboratoriais não indicaram diferenças entre os grupos de estudo quanto à perda de sangue e necessidade de transfusão de sangue, tempo de internação hospitalar, taxa de reoperação, complicações, marcadores séricos inflamatórios e Harris Hip Score. Os pacientes que não usaram drenos de sucção fechada relataram maiores níveis de dor após 24 horas (EVA 1 vs. 2, p < 0,01). Conclusão: Encontramos resultados clínicos e laboratoriais semelhantes em ambas as coortes.

ABSTRACT Objective: This study aimed to investigate drain use in a controlled population of patients with hip osteoarthritis undergoing primary total hip arthroplasty. Methods: This prospective controlled trial evaluated 93 patients randomized into two groups: a group that received drains and a group that did not. The patients who were randomized to the drain group used a 3.2 mm drain placed under the fascia that was kept in place for 24 h. Postoperative evaluations were performed after 24 h and then three, six, and 12 weeks after total hip arthroplasty. The primary outcome was perioperative blood loss in both groups 24 h after total hip arthroplasty. The other parameters that were evaluated included mid-thigh circumference, the rate of blood transfusion, hematocrit, inflammatory serum levels, and the Harris Hip Score. Results: The clinical and laboratory data revealed no differences between the study groups with respect to blood loss and need for blood transfusion, duration of hospital stay, reoperation rate, complications, inflammatory serum markers, and the Harris Hip Score. Patients without closed suction drainage reported higher pain levels after 24 h (VAS score 1 vs. 2, p < 0.01). Conclusion: Similar clinical and laboratory outcomes were found in both cohorts.

RESUMO Objetivo: Determinar a confiabilidade de dois métodos de classificação dos hematomas de ferida cirúrgica após artroplastia total do quadril. Métodos: Este estudo prospectivo de coorte foi conduzido em pacientes com osteoartrose do quadril submetidos à artroplastia total do quadril entre maio de 2014 e abril de 2015. Foram analisados dados epidemiológicos, cirúrgicos e funcionais. Dois experientes cirurgiões de quadril avaliaram 75 fotografias de feridas obtidas 24 horas após a cirurgia. Ambos os avaliadores analisaram as fotografias duas vezes, em intervalo de seis semanas. A classificação subjetiva consistiu em quatro categorias descrevendo o hematoma: ausente, leve, moderado e grave. A classificação objetiva foi obtida pelo cálculo matemático da área do hematoma, sobrepondo-se uma retícula a cada fotografia de ferida. Resultados: A classificação subjetiva mostrou concordância intra-avaliador de mais de 70%, enquanto que os valores de kappa mostraram concordância inter-avaliador baixa a moderada. A classificação objetiva baseada em cálculo matemático da área do hematoma foi mais confiável, com excelente concordância intra e inter- avaliador. Conclusão: A classificação objetiva demonstrou melhor concordância intra e inter-avaliador. Os métodos de classificação usados neste estudo podem ser um instrumento útil para cirurgiões ortopedistas, pesquisadores e profissionais de saúde para avaliar hematomas de feridas cirúrgicas após artroplastia total de quadril. Nível de Evidência II; Desenvolvimento de critérios diagnósticos em pacientes consecutivos (com padrão de referência "ouro" aplicado).

ABSTRACT Objective: To determine the reliability of two classification methods for wound hematoma after total hip replacement. Methods: This prospective cohort study was conducted on patients who underwent total hip replacement for hip osteoarthritis between May 2014 and April 2015. Epidemiological, surgical, and functional data were assessed. Two experienced hip surgeons evaluated 75 pictures of wounds taken 24 hours after surgery. Both evaluators performed the analysis twice, with a 6-week interval between the two analyses. The subjective classification was divided into four different categories describing the hematoma: absent, mild, moderate, and severe. The objective classification was derived from mathematical calculation of the area of the hematoma using a grid superimposed on a picture of the wound. Results: The subjective classification demonstrated an intra-rater agreement of more than 70%, while kappa values showed poor to moderate inter-rater reliability. The objective classification based on mathematical measurements of the hematoma area was more reliable, with good to excellent intra- and inter-rater reliability. Conclusion: The objective classification demonstrated higher intra- and inter-rater reliability. The classification methods used in this study could serve as a useful instrument for orthopedic surgeons, researchers, and health care providers when assessing wound hematomas after total hip replacement. Level of Evidence II; Development of diagnostic criteria on consecutive patients (with universally applied reference ‘‘gold’’ standard).

ABSTRACT Objective: To assess the opinion of Brazilian orthopedists surgeons on the diagnosis and treatment of femoroacetabular impingement (FAI). Methods: A questionnaire was sent to several orthopedic societies around the world, including the Sociedade Brasileira de Ortopedia e Traumatologia (SBOT). This questionnaire was sent electronically and included questions on many topics related to FAI. Results: 253 Brazilian orthopedists responded the questionnaire. Sixty-eight point nine percent worked in private practice and 23.1% in academic institutions. Pain during hip rotation was the most important finding in the clinical history according to 81.8% of the respondents and the anterior impingement sign was the most important finding in the physical examination according to 88.2%. Initial treatment was physiotherapy according to 86.2%. Surgical treatment was hip arthroscopy according to 38.8%, and via surgical hip dislocation for 14.7%. Conclusion: Brazilian orthopedists' opinions on FAI are similar to their international colleagues. There is considerable discrepancy in the answers provided, demonstrating a need for future investigation on FAI, in order to institute proper treatment and diagnosis protocols. Level of Evidence V. Expert Opinion.

OBJECTIVE: To establish the risk factors for joint infection by oxacillin-resistant Staphylococcus aureus (MRSA) using clinical and epidemiological data. METHODS: All septic arthritis cases of the knee and hip diagnosed and treated in our institution from 2006 to 2012 were evaluated retrospectively. Only patients with cultures identified as microbial agents were included in the study. The clinical and epidemiological characteristics of the patients were analyzed, seeking the differences between populations affected by MRSA and oxacillin-sensitive Staphylococcus aureus (MSSA). RESULTS: S. aureus was isolated in thirty-five patients (46.0%) in our total sample, 25 in the knee and 10 in the hip. Of these 35 patients, 22 presented with MSSA and 13 presented with MRSA. Provenance from a health service-related environment, as described by the Centers for Disease Control and Prevention, was the only variable associated with oxacillin-resistant strains of this bacterium (p = 0.001). CONCLUSION: Provenance from a health service-related environment was associated with a higher incidence of MRSA-related septic arthritis, suggesting that this agent should be considered in the initial choice of antibiotic treatment. Previous surgeries of the knee or affected limb and the absence of leukocytes might also be related to infection with this agent.

AIMS: Our primary aimwas to evaluate whether there is really less bleeding in patients for whom the minimally invasive posterior approach is used in comparison with the direct lateral approachfor primary total hip arthroplasty. Our secondary aim was to evaluate the clinical functional results after six months as well as the postoperative radiographic result. METHODS: In a comparative non-random prospective study, 76 adult patients underwent elective total hip arthroplasty using one of two approaches. The minimally invasive posterior approach (34 cases; mini-incision group) was compared with the standard direct lateral approach (42 cases; control group). RESULTS: Lower total estimated bleeding (means of 1083.5 ml versus 1682.3 ml; p < 0.001) and lower intraoperative bleeding (means of 745.6 ml versus 1282.8 ml; p < 0.001) were found in the mini-incision group. There was, however, no difference in the volume of blood drained after the operation (means of 340 ml and 399 ml; p = 0.77). There was also a difference between the two groups regarding the need for allogenic transfusion (8.8% in the mini-incision group versus 28.6%, p = 0.02). We observed a better clinical result in the mini-incision group (p = 0.002) despite the lack of difference between the two groups in relation to the radiographic result. DISCUSSION: Our results draw attention to the possibility that other authors may have underestimated blood losses when using minimally invasive approaches. CONCLUSION: The minimally invasive approach gave rise to a positive final impression with regard to lower blood loss.