ABSTRACT Objective To analyze pain, functional capacity, quality of life, anxiety and depression outcomes in patients undergoing lumbar spine surgery following use of the Second Opinion Program, and to present disagreements regarding diagnoses and therapeutic indications between the first and second opinions. Methods A prospective, observational cohort study with 100 patients enrolled in the Second Opinion Program who underwent lumbar spine surgery. Questionnaires addressing pain intensity, level of disability, quality of life, anxiety and depression were applied prior to and within 1, 3, 6 and 12 months of surgery. Descriptive and comparative statistical analyses were performed. The following clinical outcomes were analyzed: pain intensity, level of disability, quality of life, anxiety, and depression. Results In this sample, 88% and 12% out of 100 patients were submitted to lumbar decompression and arthrodesis, respectively. Patients reported improvements in function, pain intensity, and quality of life factors following surgery and were able to attain the minimal clinically important difference relative to the preoperative period. Agreement between the first and second opinions was observed in 44% of diagnoses, and in 27% of therapeutic indications. Conclusion Patients had favorable postoperative outcomes regarding pain, disability, and quality of life. These findings and the high rates of diagnostic and therapeutic indication disagreements corroborate the need of a second opinion in cases of spine disease with surgical indications.

ABSTRACT Objective To describe the technical specificities and feasibility of simulation of minimally invasive spine surgery in live pigs, as well as similarities and differences in comparison to surgery in humans. Methods A total of 22 Large White class swine models, weighing between 60 and 80kg, were submitted to surgical simulations, performed during theoretical-practical courses for training surgical techniques (microsurgical and endoscopic lumbar decompression; percutaneous pedicular instrumentation; lateral access to the thoracic spine, and anterior and retroperitoneal to the lumbar spine, and management of complications) by 86 spine surgeons. For each surgical technique, porcine anatomy (similarities and differences in relation to human anatomy), access route, and dimensions of the instruments and implants used were evaluated. Thus, the authors describe the feasibility of each operative simulation, as well as suggestions to optimize training. Study results are descriptive, with figures and drawings. Results Neural decompression surgeries (microsurgeries and endoscopic) and pedicular instrumentation presented higher similarities to surgery on humans. On the other hand, intradiscal procedures had limitations due to the narrow disc space in swines. We were able to simulate situations of surgical trauma in surgical complication scenarios, such as cerebrospinal fluid fistulas and excessive bleeding, with comparable realism to surgery on humans. Conclusion A porcine model for simulation of minimally invasive spinal surgical techniques had similarities with surgery on humans, and is therefore feasible for surgeon training.

ABSTRACT Objective Phase 1 clinical trial to determine feasibility, safety, and efficacy of a new advanced cell therapy product for treatment of knee articular cartilage injuries. Methods Three participants with knee focal chondral lesions were included, with no signs of osteoarthritis. Chondrocytes were obtained through knee arthroscopy, cultured in collagen membrane for 3 weeks at the laboratory, subjected to tests to release the cell therapy product, and implanted. All patients underwent a specific 3-month rehabilitation protocol, followed by assessments using functional and imaging scales. The main outcome was the incidence of severe adverse events. Results Three participants were included and completed the 2-year follow-up. There was one severe adverse event, venous thrombosis of distal leg veins, which was no associated with therapy, was treated and left no sequelae. The clinical and radiological scales showed improvement in the three cases. Conclusion The preliminary results, obtained with the described methodology, allow concluding that this product of advanced cell therapy is safe and feasible. ReBEC platform registration number: RBR-6fgy76

ABSTRACT To describe a case of autologous chondrocyte implantation after cell culture contamination by Mycoplasma pneumoniae and the measures taken to successfully complete cell therapy in a patient with focal chondral lesion. A 45-year-old male patient, complaining of chronic pain on the knee and no history of trauma. He had a chondral lesion in the trochlear region of the femur and clinical tests compatible with pain in the anterior compartment of the knee. Conservative treatment failed to alleviate symptoms. Surgical treatment was indicated, but due to the size of the lesion, membrane-assisted autologous chondrocyte implantation was the technique of choice. Cartilage biopsies were collected from the intercondylar region of the distal femur. After isolation, chondrocytes were expanded ex vivo in a trained laboratory, for three weeks, and seeded onto a commercially available collagen membrane prior to implantation in the knee. Two days before surgery, a cell culture sample tested positive for Mycoplasma pneumoniae. The source of contamination was found to be autologous blood serum, extracted from the patient´s peripheral vein, and used to supplement the cell culture medium. After treating the patient with antibiotics, all procedures were repeated and the new final cell product, free from contaminants, was successfully implanted. We discuss the strategies available to deal with this situation, and describe the results of this particular case, which led to modifications in the autologous chondrocyte implant protocol.

Resumo Objetivo Comparar a dor, a função, a qualidade de vida e os eventos adversos da descompressão lombar e da fusão espinhal em pacientes com patologias degenerativas da coluna vertebral que participaram de um programa de segunda opinião para cirurgias de coluna com acompanhamento de 36 meses. Métodos Os dados desta coorte retrospectiva foram obtidos de um sistema de saúde privado entre junho de 2011 e janeiro de 2014. A amostra do estudo foi composta por 71 pacientes encaminhados para cirurgia de coluna lombar. Os desfechos para comparações entre a descompressão lombar e a fusão espinhal foram qualidade de vida (avaliada pelo questionário EuroQoL 5D), dor (medida pela Escala Numérica de Classificação de Dor) e função (avaliada pelo Questionário de Incapacidade de Roland Morris) no início do estudo e aos 12 e 36 meses de acompanhamento pós-cirúrgico. As definições de recuperação foram estabelecidas pela diferença mínima clinicamente importante (DMCI). As diferenças basais entre os grupos foram analisadas por teste t não pareado, e as diferenças nas pontuações dos instrumentos entre os momentos, por modelos mistos generalizados. Os resultados foram apresentados como valores médios ajustados pelos modelos e intervalos de confiança de 95%. Resultados No total, 22 pacientes foram submetidos à artrodese, e 49 pacientes, à descompressão lombar. Quanto às comparações de achados antes e depois das intervenções cirúrgicas, a DMCI foi alcançada em todos os desfechos de qualidade de vida, dor e função nos dois pontos de acompanhamento em relação aos escores basais Em relação às complicações, apenas a descompressão lombar apresentou 4% (n = 3) de taxa cirúrgica de recidiva da hérnia de disco lombar. Conclusão Pacientes com patologias espinhais degenerativas apresentam melhoras nos desfechos de dor, função e qualidade de vida em longo prazo que são clinicamente significativas e independentes da intervenção cirúrgica.

Abstract Objective To compare pain, function, quality of life and adverse events of lumbar decompression and spinal fusion in patients with degenerative spinal pathologies who participated in a second opinion program for spinal surgeries with a 36-month followup. Methods The data for this retrospective cohort were withdrawn from a private healthcare system between June 2011 and January 2014. The study sample consisted of 71 patients with a lumbar spine surgical referral. The outcomes for the comparisons between lumbar decompression and spinal fusion were quality of life (evaluated through the EuroQoL 5D), pain (measured by the Numerical Rating Scale) and function (assessed through the Roland Morris Disability Questionnaire) measured at baseline, and at 12 and 36 months after the surgical procedures. The definitions of recovery were established by the minimal clinically important difference (MCID). The baseline differences between the groups were analyzed by non-paired t-test, and the differences in instrument scores between time points, by generalized mixed models. The results were presented as mean values adjusted by the models and 95% confidence intervals. Results Concerning the surgical techniques, 22 patients were submitted to spinal fusion and 49 patients, to lumbar decompression. As for the comparisons of the findings before and after the surgical interventions, the MCID was achieved in all outcomes regarding quality of life, pain and function at both time points when compared to baseline scores Moreover, concerning the complication rates, only lumbar decompression presented a surgical rate of 4% (n = 3) for recurrence of lumbar disc hernia. Conclusion Patients with degenerative spinal pathologies present improvements in long-term outcomes of pain, function and quality of life which are clinically significant, no matter the surgical intervention.

RESUMO Objetivo: A doença degenerativa da coluna cervical é uma fonte frequente de dor cervical intermitente, na qual os sintomas predominantes são dor axial cervical. As indicações para cirurgia são reservadas para os casos de falha do tratamento conservador ou com sintomas neurológicos progressivos. O objetivo deste estudo foi avaliar os fatores prognósticos dos pacientes submetidos ao tratamento cirúrgico da coluna cervical. Métodos: O estudo avaliou os pacientes submetidos à cirurgia da coluna cervical entre julho de 2011 e novembro de 2015 (n = 58). As variáveis de comparação avaliadas foram tabagismo, hipertensão, diabete, sobrepeso, técnica cirúrgica aplicada e número de níveis de artrodese. O desfecho primário foi definido como dor e os desfechos secundários foram qualidade de vida e disfunção. Resultados: Encontramos diferença estatisticamente significativa entre os escores de dor de base e aos 12 meses após a cirurgia, favorável aos pacientes sem hipertensão arterial sistêmica (p = 0,009) e aos submetidos à discectomia com instrumentação (p = 0,004). Também houve diferença estatisticamente significativa na avaliação da disfunção da coluna cervical: o resultado foi mais favorável para os pacientes sem diagnóstico prévio de hipertensão (p = 0,028) e para os pacientes com IMC menor do que 25 kg/m2(p = 0,005). Não se observou evidência de interação significativa entre os dados avaliados e os resultados do questionário de qualidade de vida. Conclusões: Os pacientes não hipertensos, com índice de massa corpórea menor do que 25 kg/cm2e submetidos à artrodese combinada à discectomia, são os mais beneficiados com o procedimento cirúrgico da doença degenerativa da coluna cervical.

ABSTRACT Objective: Degenerative disease of the cervical spine is a frequent source of intermittent neck pain, where the predominant symptom is axial neck pain. The indications for surgical treatment are reserved for the cases where the conservative treatment has not relieved the symptoms or the patient presents progressive neurological impairment. The objective of this study was to evaluate the prognostic factors involved in patients submitted to surgical treatment of the cervical spine, Methods: The study analyzed data from patients submitted to cervical spine surgery between July 2011 and November 2015 (n= 58). The evaluated data included smoking habits, hypertension, diabetes, overweight, surgical technique, and number of levels of fusion. The primary outcome was defined as pain and the secondary outcomes were quality of life and disability., Results: A statistically significant difference was found between baseline and the 12-month post-operative results regarding pain in favor of non-hypertensive patients (p= 0.009) and discectomy plus instrumentation (, p= 0.004). There was also significant difference between the results of neck disability in favor of non-hypertensive patients (p= 0.028) and patients with body mass index lower than 25, kg/m2 (p= 0.005). There was no significant interaction between any analyzed data and the quality of life score results. Conclusions: Non-hypertensive patients, those with body mass index lower than 25 kg/m2, and those submitted to discectomy combined with arthrodesis of the cervical spine are the most benefited by cervical degenerative disease surgery.

RESUMO Objetivo: Avaliar fatores de crescimento e citocinas em amostras de plasma rico em plaquetas obtidas por três diferentes métodos de centrifugação. Métodos: Foi coletado sangue periférico de seis indivíduos, sem doença hematológica, com idades entre 18 e 68 anos, para obtenção de plasma rico em plaquetas, utilizando o método aberto e sistemas comerciais das empresas Medtronic e Biomet. Os produtos obtidos com os diferentes tipos de centrifugação foram submetidos às análises laboratoriais, incluindo citocinas próinflamatórias e quimiocinas, por meio de ensaios de citometria de fluxo, concentração do fator de crescimento fibroblástico-2 (FGF-2) e fator de crescimento transformador-beta1 (TGF-β1). Resultados: As diferentes centrifugações geraram perfis sistematicamente diferentes referentes ao número de plaquetas e de leucócitos. O sistema da Medtronic originou produto com a maior concentração de plaquetas, e o método aberto com a menor concentração de plaquetas. Os resultados da análise de citocinas demonstraram que os diferentes tipos de centrifugação originaram produtos com elevadas concentrações de interleucina 8 e interleucina 1β. O sistema aberto resultou em produto com elevados níveis de interleucina 6. As demais citocinas e quimiocinas mensuradas foram similares entre os sistemas. O produto obtido com o método aberto apresentou níveis superiores de TGF-β1 em relação aos demais sistemas e reduzidos níveis de FGF-2. Conclusão: Os elementos figurados, fatores de crescimento e citocinas, em amostras de plasma rico em plaquetas, variaram conforme a técnica de centrifugação utilizada.

ABSTRACT Objective: To evaluate growth factors and cytokines in samples of platelet-rich plasma obtained by three different centrifugation methods. Methods: Peripheral blood of six individuals with no hematological diseases, aged 18 to 68 years, was drawn to obtain platelet-rich plasma, using the open method and commercial columns by Medtronic and Biomet. The products obtained with the different types of centrifugation were submitted to laboratory analysis, including pro-inflammatory cytokines and chemokines by flow cytometry assays, the concentration of fibroblast growth factors-2 (FGF-2) and transforming growth factor-beta1 (TGF-β1). Results: The diverse separation methods generated systematically different profiles regarding number of platelets and leukocytes. The Medtronic system yielded a product with the highest concentration of platelets, and the open method, with the lowest concentration of platelets. The results of cytokine analysis showed that the different types of centrifugation yielded products with high concentrations of interleukin 8, interleukin 1β. The open system resulted in a product with high levels of interleukin 6. Other cytokines and chemokines measured were similar between systems. The product obtained with the open method showed higher levels of TGF-β1 in relation to other systems and low FGF-2 levels. Conclusion: The formed elements, growth factors and cytokines in samples of platelet-rich plasma varied according to the centrifugation technique used.

RESUMO Objetivo: Mensurar a reprodutibilidade interobservadores da avaliação radiográfica da instabilidade da coluna lombar. Métodos: Foram realizadas mensurações das radiografias dinâmicas de coluna lombar na incidência em perfil, avaliando-se a translação anterior e a angulação entre os corpos vertebrais. Os exames foram avaliados em workstations da própria instituição, por meio do sistema Vue RIS (PACS) da Carestream Health, versão 11.0.12.14 Inc. 2009©. Resultados: A proporção de concordância em detecção de casos de instabilidade radiográfica entre os observadores variou de 88,1 a 94,4%, e os coeficientes de concordância AC1 estiveram todos acima de 0,8, indicando concordância excelente. Conclusão: A análise interobservadores realizada entre médicos ortopedistas com diferentes níveis de treinamento em radiografias dinâmicas da coluna vertebral obteve elevada reprodutibilidade e concordância. No entanto, alguns fatores, como método manual de aferição e a presença de osteófitos vertebrais, podem ter gerado alguns resultados menos consistentes nessa avaliação comparativa de medidas.

ABSTRACT Objective: To measure the interobserver reproducibility of the radiographic evaluation of lumbar spine instability. Methods: Measurements of the dynamic radiographs of the lumbar spine in lateral view were performed, evaluating the anterior translation and the angulation among the vertebral bodies. The tests were evaluated at workstations of the organization, through the Carestream Health Vue RIS (PACS), version 11.0.12.14 Inc. 2009© system. Results: Agreement in detecting cases of radiographic instability among the observers varied from 88.1 to 94.4%, and the agreement coefficients AC1 were all above 0.8, indicating excellent agreement. Conclusion: The interobserver analysis performed among orthopedic surgeons with different levels of training in dynamic radiographs of the spine obtained high reproducibility and agreement. However, some factors, such as the manual method of measurement and the presence of vertebral osteophytes, might have generated a few less accurate results in this comparative evaluation of measurements.

Resumo O objetivo deste estudo foi avaliar os efeitos da estimulação elétrica neuromuscular em pacientes submetidos à artroplastia total de joelho. Esta foi uma revisão sistemática sem restrição de idioma ou status de publicação. Nossa pesquisa foi realizada na biblioteca Cochrane, MEDLINE, Embase e LILACS. Foram incluídos ensaios clínicos randomizados ou quase-randomizados, avaliando a estimulação elétrica neuromuscular após a artroplastia total de joelho. Quatro estudos com risco de viés moderado e de baixo poder estatístico foram incluídos, totalizando 376 participantes. Não houve diferença estatisticamente significativa na função do joelho, dor e amplitude de movimento durante 12 meses de seguimento. Esta avaliação concluiu que a estimulação elétrica neuromuscular foi menos eficaz do que a reabilitação tradicional na função, força muscular e amplitude de movimento. No entanto, essa técnica é útil para a ativação do quadríceps durante os primeiros dias após a cirurgia.

Abstract The purpose of this study was to evaluate the effects of neuromuscular electrical stimulation in patients submitted to total knee arthroplasty. This was a systematic review with no language or publication status restriction. Our search was made in Cochrane Library, MEDLINE, Embase and LILACS. Randomized or quasi-randomized clinical trials evaluating neuromuscular electrical stimulation after total knee arthroplasty were included. Four studies with moderate risk of bias and low statistical power were included, totalizing 376 participants. There was no statistically significant difference in knee function, pain and range of motion during 12 month follow-up. This review concluded that neuromuscular electrical stimulation was less effective than traditional rehabilitation in function, muscular strength and range of motion. However, this technique was useful for quadriceps activation during the first days after surgery.

RESUMO Objetivo Avaliar tendinopatia do músculo peitoral maior em praticantes de levantamento de peso utilizando ultrassonografia e elastografia. Métodos Participaram do estudo 20 sujeitos, sendo 10 com ruptura do tendão do músculo peitoral maior e 10 como controles. Avaliou-se o tendão músculo peitoral maior contralateral por meio de exames ultrassonográficos e elastografia. O aparelho de ultrassonografia utilizado era de alta resolução, e a avaliação foi realizada no modo B. A avaliação por elastografia foi classificada em três padrões, a saber: (A) se endurecido (mais de 50% de área com coloração azul); (B), se intermediário (mais de 50% verde); e (C), se amolecido (mais de 50% vermelho). Resultados A média de idade da amostra foi 33±5,3 anos. Foi encontrada diferença estatisticamente significante (p=0,0055) quanto à presença de tendinopatia avaliada pela ultrassonografia, pois 80% dos casos apresentaram tendinopatia músculo peitoral maior versus 10% nos pacientes controles. Não foram encontradas diferenças significantes entre os grupos quanto à presença de alteração na elastografia (p=0,1409). Conclusão Os pacientes praticantes de musculação de longa data apresentaram imagem à ultrassonografia com maior tendinopatia em relação aos controles, e não foi obtida significância estatística quanto à elastografia em relação aos controles.

ABSTRACT Objective To evaluate tendinopathy of the pectoralis major muscle in weightlifting athletes using ultrasound and elastography. Methods This study included 20 patients, 10 with rupture of the pectoralis major muscle and 10 control patients. We evaluated pectoralis major muscle contralateral tendon with ultrasonographic and elastography examinations. The ultrasonographic examinations were performed using a high-resolution B mode ultrasound device. The elastography evaluation was classified into three patterns: (A), if stiff (more than 50% area with blue staining); (B), if intermediate (more than 50% green); and (C), if softened (more than 50% red). Results Patients’ mean age was 33±5.3 years. The presence of tendinous injury measured by ultrasound had a significant different (p=0.0055), because 80% of cases had tendinous injury versus 10% in the Control Group. No significant differences were seen between groups related with change in elastography (p=0.1409). Conclusion Long-term bodybuilders had ultrasound image with more tendinous injury than those in Control Group. There was no statistical significance regarding change in tendon elasticity compared with Control Group.

RESUMO Objetivo: Correlacionar dados epidemiológicos, hábitos de vida e fatores psicossociais como preditivos para manifestação clínica de dorsolombalgia em pacientes atendidos no setor de urgências ortopédicas de hospital terciário brasileiro, além de avaliar o interesse em participar de programa hipotético para reabilitação física. Métodos: Trata-se de estudo observacional do tipo transversal. Foram avaliados 210 pacientes provenientes do pronto atendimento de um hospital terciário, com queixa predominante de dor nas costas. Foram utilizados: questionários epidemiológicos do tipo múltipla escolha desenvolvidos para o presente estudo; questionário Oswestry para incapacidade física; e escala Hospital Anxiety and Depression Scale (HAD). As análises dos dados foram realizadas por meio do programa SAS - Statistical Analysis System (SAS Institute, 2001). Os cálculos foram realizados com as funções Proc MEANS e Proc Freq do SAS. Resultados: A média de idade foi de 39,1 anos e não houve predominância entre os gêneros. A atividade laborativa mais frequente foi a administrativa (65,2% dos casos). Observou-se índice de massa corporal médio de 26,0, que indicou sobrepeso. A maioria (83,3%) dos pacientes apresentou baixa incapacidade física (Oswestry de 0 – 40%). O número de visitas nos 6 meses anteriores (p=0,04) e os escores de ansiedade e depressão (p=0,05), isoladamente, tiveram correlação com a incapacidade física. A maioria dos pacientes (77%) aceitaria participar de programa hipotético de reabilitação física para prevenção de dores nas costas. Conclusão: Os pacientes com queixa de dorsolombalgia foram, predominantemente, adultos jovens, sedentários ou hipoativos, com sobrepeso e com queixas recorrentes dos sintomas. A maioria dos participantes apresentou baixa incapacidade física e aceitaria participar de programa hipotético de reabilitação física para a prevenção de dores nas costas.

ABSTRACT Objective: To correlate epidemiological data, lifestyle, and psychosocial factors as predictors for clinical manifestation of back pain in patients treated at the orthopedic emergency unit of a Brazilian tertiary care hospital, and to evaluate their interest in participating in a hypothetical program for physical rehabilitation. Methods: This is an observational cross-sectional study. We evaluated 210 patients from the emergency department of a tertiary hospital with a major complaint of back pain. We used: epidemiological multiple-choice questionnaires developed for this study; Oswestry questionnaire for physical disability; Hospital Anxiety and Depression Scale (HAD) scale. Data analyses were performed using SAS - Statistical Analysis System (SAS Institute, 2001). Measurements were performed with the SAS functions Proc MEANS and Proc Freq. Results: The mean age was 39.1 years and there was no predominance between genders. The usual work activity was administrative (65.2% of cases). The mean body mass index was 26.0, indicating overweight. The majority (83.3%) of patients had low physical disability (Oswestry 0 – 40%). The number of medical visits in the previous 6 months (p=0.04) and the scores of anxiety and depression (p=0.05), independently, were correlated with physical disability. Most patients (77%) would agree to participate in a hypothetical program of physical rehabilitation for prevention of back pain. Conclusion: Patients with back pain complaints were predominantly young adults, sedentary or hypoactive, overweight, and with recurrent complaints of symptoms. Most participants had low levels of physical disability and would accept participation in a hypothetical physical rehabilitation program for the prevention of back pain.

A síndrome do impacto é definida pela colisão dos tendões dos músculos que formam o manguito rotador contra o arco coracoacromial. Vários fatores concorrem para essa doença e são classificados como estruturais ou funcionais. Os primeiros são alterações do arco coracoacromial, úmero, bursa e manguito rotador; os fatores funcionais estão relacionados com o mecanismo de elevação do membro superior, por meio da atividade sincronizada e equilibrada entre o manguito rotador e os músculos da cintura escapular. Os autores relatam aqui, o caso de um lipoma parosteal do úmero proximal, situado entre os ventres musculares do deltoide, redondo menor e infraespinhal ocasionando os sinais clínicos da síndrome do impacto. Trata-se de uma ocorrência rara, caracterizada como uma causa estrutural para o desencadeamento dessa sintomatologia.

The impingement syndrome is defined by the compression of the rotator cuff tendons against the coracoacromial arch. Several factors contribute to this condition and they are classified as structural or functional factors. The former are changes in the coracoacromial arch, proximal humerus, bursa and rotator cuff, and the latter are related to the mechanism of the upper limb by means of synchronized activity and balanced between the rotator cuff and scapular girdle muscles. The authors report here a case of parosteal lipoma of the proximal humerus, located between the muscles deltoid, teres minor and infraspinatus causing clinical signs of impingement. It is a rare occurrence, characterized as a structural cause for the onset of this symptom.

OBJECTIVE: To evaluate the social, economic and health aspects related to former professional soccer players in Brazil. METHODS: This was a cross-sectional study with the participation of 100 male Brazilian former professional soccer players. For characterization of the sample variables such as age, current and past weight, height, BMI (Body Mass Index) and player position were evaluated. In all analyzes it was considered P <0.05. RESULTS: In the group of former players evaluated, 78% were overweight and 4% were considered obese. During their careers, 54% of now ex-soccer players underwent drugs infiltration in the knee. Currently, former athletes presented on average 5.4 points on the VAS pain scale, with 97% of ex-players complaining of knee pain. CONCLUSION: The results of this study show that these individuals had large weight gain after retirement, high frequency of drug injections in the knee during their careers and chronic pain in this joint after retirement. Level of Evidence III, Cross-Sectional Study.

OBJETIVO: Descrever as características epidemiológicas e os eventos adversos dos pacientes submetidos aos procedimentos de artroplastia de quadril e joelho. MÉTODOS: Estudo transversal, com avaliação retrospectiva de prontuários médicos de todas artroplastias de quadril e de joelho realizadas entre janeiro de 2007 e dezembro de 2010, em hospital privado. Foram incluídos pacientes adultos submetidos à artroplastia total do quadril ou do joelho, com anuência dos cirurgiões. Foram excluídos os pacientes com prontuários incompletos ou perdidos na base de dados do hospital. As variáveis categóricas analisadas foram: idade, gênero, tipo de artroplastia (primária ou secundária), tipo de procedimento, tempo de cirurgia, uso de drenos, risco de infecção, adesão ao protocolo para prevenção de trombose venosa profunda e embolia pulmonar, e adesão ao protocolo para prevenção de infecção. Os desfechos avaliados dos pacientes foram eventos adversos ocorridos após a cirurgia. RESULTADOS: Foram incluídos 510 pacientes, sendo 166 hospitalizações para artroplastia do joelho (92 do gênero masculino) e 344 hospitalizações para artroplastia do quadril (176 do gênero feminino). A média da idade dos pacientes foi 71 anos (variação 31 a 99 anos). Os eventos adversos ocorreram em 76 pacientes (14,9%); não foi encontrada correlação entre as variáveis avaliadas e o número de complicações. CONCLUSÃO: Os dados não demonstraram fatores individuais que favorecessem complicações de pacientes submetidos à artroplastia do quadril e joelho; portanto, os cirurgiões têm que considerar administrações profiláticas para evitar complicações.

OBJECTIVE: To describe the epidemiologic characteristics and adverse events of patients submitted to total hip and total knee replacement. METHODS: A cross-sectional study retrospectively assessing medical chart data of all total hip and total knee replacements performed at a private hospital, between January 2007 and December 2010 Patients submitted to total hip and total knee replacement, with consent of surgeons were included. Incomplete records and/or missing data of the hospital database were excluded. The categorical variables analyzed were age, gender, type of arthroplasty (primary or secondary), type of procedure, duration of surgery, use of drains, risk of infection, compliance to protocol for prevention of deep venous thrombosis and embolism pulmonary, and compliance to the protocol for prevention of infection. The outcomes assessed were adverse events after surgery. RESULTS: A total of 510 patients were included; in that, 166 admissions for knee replacements (92 male) and 344 admissions for hip replacements (176 female). The mean age of patients was 71 years (range 31-99 years). Adverse events were reported in 76 patients (14.9%); there was no correlation between assessed variables and number of complications. CONCLUSION: The results showed no individual factors favoring complications in patients submitted to total hip and total knee replacement; hence, surgeons should consider prophylaxis to avoid complications.

OBJETIVO: Comparar o custo estimado do tratamento de patologias da coluna aos verificados para esse tratamento dentro de um centro especializado. MÉTODOS: Foi realizada a avaliação dos custos médios de tratamento de 399 pacientes encaminhados por uma fonte pagadora para avaliação e tratamento no Centro de Referência de Tratamento da Coluna Vertebral do Hospital Israelita Albert Einstein. Todos os pacientes apresentavam indicação de tratamento cirúrgico antes de serem encaminhados para avaliação. Do total de pacientes encaminhados, apenas 54 foram submetidos a tratamento cirúrgico e 112 a tratamento conservador com fisioterapia motora e acupuntura. Os custos dos dois tratamentos foram calculados com base em uma tabela previamente acordada de valores de reembolso para cada etapa do tratamento. RESULTADOS: Os pacientes tratados de forma não cirúrgica apresentaram custo médio de tratamento de R$ 3.245,16, enquanto os pacientes tratados com cirurgia apresentaram custo médio de R$ 36.590,16. O custo total estimado da coorte de pacientes tratados foi de R$ 2.339.326,09, o que representa uma diminuição de 158,5% em relação ao custo total projetado desses mesmos pacientes, caso fosse realizada a indicação inicial de tratamento. CONCLUSÃO: O tratamento realizado dentro de um centro especializado em tratamento de patologias da coluna apresenta, globalmente, custos menores do que os observados regularmente.

OBJECTIVE: To compare the estimated cost of treatment of spinal disorders to those of this treatment in a specialized center. METHODS: An evaluation of average treatment costs of 399 patients referred by a Health Insurance Company for evaluation and treatment at the Spine Treatment Reference Center of Hospital Israelita Albert Einstein. All patients presented with an indication for surgical treatment before being referred for assessment. Of the total number of patients referred, only 54 underwent surgical treatment and 112 received a conservative treatment with motor physical therapy and acupuncture. The costs of both treatments were calculated based on a previously agreed table of values for reimbursement for each phase of treatment. RESULTS: Patients treated non-surgically had an average treatment cost of US$ 1,650.00, while patients treated surgically had an average cost of US$ 18,520.00. The total estimated cost of the cohort of patients treated was US$ 1,184,810.00, which represents a 158.5% decrease relative to the total cost projected for these same patients if the initial type of treatment indicated were performed. CONCLUSION: Treatment carried out within a center specialized in treating spine pathologies has global costs lower than those regularly observed.