ABSTRACT BACKGROUND: Carpal tunnel syndrome (CTS) is a common condition greatly affects patients’ quality of life and ability to work. Systematic reviews provide useful information for treatment and health decisions. OBJECTIVE: This study aimed to assess the methodological quality of previously published systematic reviews on the treatment of CTS. DESIGN AND SETTING: Overview of systematic reviews conducted at the Brazilian public higher education institution, São Paulo, Brazil METHODS: We searched the MEDLINE and Cochrane Library database for systematic reviews investigating the treatment of CTS in adults. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and measurement tool to assess systematic reviews (AMSTAR) were applied by two independent examiners. RESULTS: Fifty-five studies were included. Considering the stratification within the AMSTAR measurement tool, we found that more than 76% of the analyzed studies were “low” or “very low”. PRISMA scores were higher when meta-analysis was present (15.61 versus 10.40; P = 0.008), while AMSTAR scores were higher when studies performed meta-analysis (8.43 versus 5.59; P = 0.009) or when they included randomized controlled trials (7.95 versus 6.06; P = 0.043). The intra-observer correlation demonstrated perfect agreement (> 0.8), a Spearman’s correlation coefficient of 0.829, and an ICC of0.857. The inter-observer correlation indicated that AMSTAR was more reliable than PRISMA. CONCLUSION: Overall, systematic reviews of the treatment of CTS are of poor quality. Reviews with better-quality conducted meta-analysis and included randomized controlled trials. AMSTAR is a better tool than PRISMA because it has a better performance and should be recommended in future studies. REGISTRATION NUMBER IN PROSPERO: CRD42020172328 (https://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42020172328)

ABSTRACT BACKGROUND: The diagnostic criteria for carpal tunnel syndrome (CTS) lack uniformity. Moreover, because CTS is a syndrome, there is no consensus as to which signs, symptoms, clinical and complementary tests are more reproducible and accurate for use in clinical research. This heterogeneity is reflected in clinical practice. Thus, establishing effective and comparable care protocols is difficult. OBJECTIVE: To identify the diagnostic criteria and outcome measures used in randomized clinical trials (RCTs) on CTS. DESING AND SETTING: Systematic review of randomized clinical trials carried out at the Federal University of São Paulo, São Paulo, Brazil. METHODS: We searched the Cochrane Library, PubMed, and Embase databases for RCTs with surgical intervention for CTS published between 2006 and 2019. Two investigators independently extracted relevant data on diagnosis and outcomes used in these studies. RESULTS: We identified 582 studies and 35 were systematically reviewed. The symptoms, paresthesia in the median nerve territory, nocturnal paresthesia, and special tests were the most widely used clinical diagnostic criteria. The most frequently assessed outcomes were symptoms of paresthesia in the median nerve territory and nocturnal paresthesia. CONCLUSION: The diagnostic criteria and outcome measures used in RCTs about CTS are heterogeneous, rendering comparison of studies difficult. Most studies use unstructured clinical criteria associated with ENMG for diagnosis. The Boston Questionnaire is the most frequently used main instrument to measure outcomes. REGISTRATION: PROSPERO (CRD42020150965- https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=150965).

RESUMO Objetivo: Verificar a prevalência de pacientes vítimas de trauma motociclístico que estavam sob efeito de álcool e drogas. Métodos: Estudo observacional e prospectivo, com pacientes internados na Enfermaria de Ortopedia e Traumatologia do Hospital São Paulo (Unifesp), de março de 2015 a março de 2016. Foram incluídos pacientes de ambos os sexos, idade superior a 18 anos, internados por trauma motociclístico e que necessitavam de tratamento cirúrgico ortopédico. Resultados: Durante a pesquisa, foram internados 282 pacientes, dos quais 23,8% eram vítimas de trauma motociclístico. Desses, 49,3% motociclistas referiram o uso de álcool e drogas previamente ao sinistro, enquanto 50,7% negaram o consumo. Na análise do consumo de álcool e drogas nos pacientes de traumas motociclísticos, foi observado que 65% estavam sob efeito apenas de álcool, 16% estavam sob efeito de álcool e drogas, e 19% sob efeito de drogas ilícitas. Conclusão: A incidência de pacientes que sofreram acidentes motociclísticos sob efeito de álcool e drogas foi de 49,3%. Nível de Evidência IV, Série de Casos Prospectivos.

ABSTRACT Objective: To verify the prevalence of patients who were victims of motorcycle trauma who were under the influence of alcohol and drugs. Methods: The study was observational and prospective, with patients hospitalized to the Orthopedics and Traumatology Ward of Hospital São Paulo (UNIFESP), from March 2015 to March 2016. The study included patients of all genders, over 18 years old, hospitalized due to motorcycle trauma and who needed orthopedic surgical treatment. Results: During the research, 282 patients were hospitalized, of which 23.8% were victims of motorcycle trauma. Of these, 49.3% motorcyclists reported the use of alcohol and drugs before the accident, while 50.7% denied their consumption. In the analysis of alcohol and drug consumption in patients with motorcycle injuries, the results showed that: 65% used only alcohol; 16% used both alcohol and drugs; and 19% used only illicit drugs. Conclusion: The incidence of patients who suffered motorcycle accidents under the influence of alcohol and drugs was 49.3%. Level of Evidence IV, Prospective Case Series.

ABSTRACT BACKGROUND: Carpal tunnel syndrome (CTS) is a common condition greatly affects patients’ quality of life and ability to work. Systematic reviews provide useful information for treatment and health decisions. OBJECTIVE: This study aimed to assess the methodological quality of previously published systematic reviews on the treatment of CTS. DESIGN AND SETTING: Overview of systematic reviews conducted at the Brazilian public higher education institution, São Paulo, Brazil METHODS: We searched the MEDLINE and Cochrane Library database for systematic reviews investigating the treatment of CTS in adults. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and measurement tool to assess systematic reviews (AMSTAR) were applied by two independent examiners. RESULTS: Fifty-five studies were included. Considering the stratification within the AMSTAR measurement tool, we found that more than 76% of the analyzed studies were “low” or “very low”. PRISMA scores were higher when meta-analysis was present (15.61 versus 10.40; P = 0.008), while AMSTAR scores were higher when studies performed meta-analysis (8.43 versus 5.59; P = 0.009) or when they included randomized controlled trials (7.95 versus 6.06; P = 0.043). The intra-observer correlation demonstrated perfect agreement (> 0.8), a Spearman’s correlation coefficient of 0.829, and an ICC of0.857. The inter-observer correlation indicated that AMSTAR was more reliable than PRISMA. CONCLUSION: Overall, systematic reviews of the treatment of CTS are of poor quality. Reviews with better-quality conducted meta-analysis and included randomized controlled trials. AMSTAR is a better tool than PRISMA because it has a better performance and should be recommended in future studies. REGISTRATION NUMBER IN PROSPERO: CRD42020172328 (https://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42020172328)

ABSTRACT BACKGROUND: There are several anesthetic techniques for surgical treatment of carpal tunnel syndrome (CTS). Results from this surgery using the “wide awake local anesthesia no tourniquet” (WALANT) technique have been described. However, there is no conclusive evidence regarding the effectiveness of the WALANT technique, compared with the usual techniques. OBJECTIVE: To evaluate the effectiveness of the WALANT technique, compared with intravenous regional anesthesia (IVRA; Bier’s block), for surgical treatment of CTS. DESIGN AND SETTING: Randomized clinical trial, conducted at Hospital Alvorada Moema and the Discipline of Hand Surgery, Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil. METHODS: Seventy-eight patients were included. The primary outcome was measurement of perioperative pain through a visual analogue scale (VAS). The secondary outcomes were the Boston Questionnaire score, Hospital Anxiety and Depression Scale (HADS) score, need for use of analgesics, operating room times, remission of paresthesia, failures and complications. RESULTS: The WALANT technique (n = 40) proved to be superior to IVRA (n = 38), especially for controlling intraoperative pain (0.11 versus 3.7 cm; P < 0.001) and postoperative pain (0.6 versus 3.9 cm; P < 0.001). Patients spent more time in the operating room in the IVRA group (59.5 versus 46 minutes; P < 0.01) and needed to use more analgesics (10.8 versus 5.7 dipyrone tablets; P = 0.02). Five IVRA procedures failed (5 versus 0; P = 0.06). CONCLUSIONS: The WALANT technique is more effective than IVRA for CTS surgery.

OBJECTIVES: Machinery injuries account for a substantial share of traumatic upper limb injuries (TULIs) affecting young active individuals. This study is based on the hypothesis that there is an important relationship between the improper use of power saws and TULIs. The aim of the study is to assess the prevalence and epidemiology of TULIs caused by power saws and determine the risks related to power saw use. METHODS: A cross-sectional evaluation of medical records from a two-year period was performed. Patients sustaining TULIs related to power saws were analyzed. Data on the epidemiology, site of injury, mechanism of trauma, technical specifications of the tool, cutting material, personal protective equipment, time lost and return to work were obtained. RESULTS: A database search retrieved 193 TULI records, of which 104 were related to power saws. The majority of patients were male (102/104; 98.1%), right-handed (97/104; 93.3%), and manual workers (46/104; 44.2%), with an average age of 46.8 years. The thumb was the most frequently injured site (32/93; 34.4%). Most of the injuries were caused by manual saws (85/104; 81.7%), and masonry saws accounted for 68.2% (58/85) of the cases. Masonry saws improperly used for woodwork resulted in 86.2% (50/58) of the injuries. TULI caused by masonry saws was 5 times higher in manual workers than in other patients. In addition, masonry saws had a risk of kickback 15 times higher than that of other saws, and the risk of injury increased by 5.25 times when the saws were used improperly for wood cutting. CONCLUSIONS: The profile of TULIs related to power saws was demonstrated and was mainly associated with manual saws operated by manual workers that inappropriately used masonry saws for woodworking.

RESUMO Objetivo: Verificar como os cirurgiões da mão conduzem o tratamento da fratura de escafoide e suas complicações. Métodos: Durante o 36° Congresso Brasileiro de Cirurgia da Mão (2016) foram distribuídos 200 questionários. Resultados: Na suspeita da fratura sem confirmação radiográfica, 57% dos cirurgiões solicitam TC ou RM, enquanto 43% optam por imobilização e radiografia seriada. Nas fraturas estáveis, a preferência foi tratamento com gesso. Nas fraturas sem desvio da cintura do escafoide, 33% optam pela fixação percutânea. Nas fraturas desviadas do polo proximal ou da cintura, a opção é o tratamento cirúrgico em 66% e 99,4%. A maioria trata a pseudoartrose da cintura com enxerto não vascularizado. Quando a absorção no foco da pseudoartrose é maior que 4 mm, 50% preferem utilizar enxerto do ilíaco e fixar com parafuso. Nas pseudoartroses do polo proximal, a técnica de Zaidemberg é a preferida por 64%. Os cirurgiões mais experientes têm maior propensão para pedir exames em fraturas ocultas (63,9% versus 47,6%; p = 0,04) e tendem a indicar cirurgia com mais frequência para as fraturas do terço distal (16,4% versus 4,7%; p = 0,02). Conclusões: Forneceu-se panorama das preferências de tratamento para as fraturas do escafoide. Destaca-se maior tendência de cirurgiões mais experientes para solicitação de exames subsidiários para fraturas ocultas e maior indicação cirúrgica para as fraturas do terço distal. Nível de Evidência IV, Estudo transversal tipo survey.

ABSTRACT Objective: To verify how hand surgeons manage scaphoid fractures and their complications. Methods: Two hundred questionnaires were distributed during the 36th Brazilian Hand Surgery Congress (2016). Results: On suspicion of fracture without radiographic confirmation, 57% of surgeons request a CT or MRI scan, while 43% opt for immobilization and consecutive radiographs. In stable fractures the preference was for treatment with plaster cast. In fractures with no scaphoid waist displacement, 33% opt for percutaneous fixation. In displaced waist or proximal pole fractures, 66% and 99.4%, respectively, opted for surgical treatment. Most surgeons treat waist nonunion with a nonvascularized bone graft. When absorption at the site of nonunion is greater than 4 mm, 50% prefer to use iliac graft and screw fixation. In proximal pole nonunion, the Zaidemberg technique is preferred by 64%. More experienced surgeons are more likely to request tests in occult fractures (63.9% versus 47.6%; p=0.04), and tend to recommend surgery for distal third fractures more frequently (16.4% versus 4.7%; p=0.02). Conclusions: We have provided an overview of treatment preferences for scaphoid fractures. It should be noted that more experienced surgeons are more likely to request additional tests for occult fractures and to recommend surgical treatment of distal third fractures. Level of Evidence IV, Cross-sectional survey.

RESUMO Objetivo: Avaliar as tendências no planejamento, diagnóstico e tratamento da síndrome do túnel do carpo (STC) dos cirurgiões brasileiros especialistas em mão. Métodos: Este estudo transversal foi realizado no 36o Congresso Brasileiro de Cirurgia da Mão. Preparamos um questionário sobre as preferências no tratamento de STC, e os cirurgiões especialistas em mão que participaram do congresso foram solicitados a responder os questionários. Foram analisados 174 questionários. Resultados: A eletroneuromiografia é usada pela maioria dos cirurgiões. A tala noturna é a modalidade de tratamento conservador mais usada. Metade dos cirurgiões utiliza antibióticos profiláticos de rotina. A maioria dos entrevistados realiza as cirurgias no centro cirúrgico com internação hospitalar e prefere anestesia regional intravenosa. A maior parte dos cirurgiões emprega a técnica aberta padrão associada à abertura da fáscia antebraquial e não realiza neurólise. Curativos compressivos são habitualmente usados por sete dias. Conclusão: A conduta pré, intra e pós-operatória na STC entre os cirurgiões de mão brasileiros é compatível com a literatura internacional. Entretanto, há necessidade de reflexão e de novos estudos sobre a infiltração local de corticoides, o uso de antibióticos profiláticos, internação hospitalar e tipo de anestesia com o objetivo de proporcionar melhor custo-efetividade ao tratamento cirúrgico da STC. Nível de Evidência V; Opinião do especialista.

ABSTRACT Objective: To evaluate tendencies in the planning, diagnosis, and treatment of carpal tunnel syndrome (CTS) by Brazilian hand surgery specialists. Methods: This cross-sectional study was performed at the 36th Brazilian Hand Surgery Congress. We prepared a questionnaire about preferences in the management of CTS, and board-certified hand surgeons that attended the congress were asked to fill out the questionnaires. A total of 174 questionnaires were analyzed. Results: Electromyography examination is used by most surgeons. Night splinting is the most commonly used conservative treatment option. Half of the surgeons utilized prophylactic antibiotics. Most of the interviewees conduct inpatient surgery in the operating room and prefer intravenous regional anesthesia. Most of surgeons use the standard open technique associated with proximal release of the antebrachial fascia and do not perform neurolysis. Compressive dressings are most commonly used for 7 days. Conclusion: The approach to CTS among Brazilian hand surgeons with regard to pre-, intra-, and post-operatory conduct is consistent with the international literature. However, there is a need to reflect and conduct new studies on non-surgical treatment involving local corticosteroid injection, use of prophylactic antibiotics, hospital admission, and type of anesthesia in order to provide more cost-effective approach to surgical treatment for CTS. Level of Evidence V; Expert opinion.

Nas intervenções cirúrgicas, a randomização e o mascaramento podem ser de difícil aplicabilidade. Nessa situação, os estudos prospectivos e não randomizados (EPNR) podem gerar a melhor evidência disponível. O objetivo deste estudo é avaliar, por meio da escala proposta por Downs & Black, a qualidade dos EPNR publicados em nosso meio e avaliar a reprodutibilidade interobservadores dessa escala. EPNR publicados na Acta Ortopédica Brasileira e Revista Brasileira de Ortopedia até 2011 e anteriores a 2006 foram incluídos e aplicou-se a escala de Downs & Black - de forma independente por dois pesquisadores. Os estudos foram estratificados pelo período de publicação, periódico e tipo de intervenção. Os escores obtidos de Downs & Black foram considerados para a avaliação da reprodutibilidade da escala. Foram considerados 59 estudos, sendo sete excluídos durante as avaliações. Não houve diferenças entre os escores, exceto para o tipo de intervenção, que demonstrou melhor qualidade metodológica para os estudos que envolvem intervenções clínicas (p < 0,001). O índice de correlação intraclasse para o escores de Downs & Black foi de 0,79 (IC95% 0,65-0,88), demonstrando boa reprodutibilidade. EPNR apresentam qualidade metodológica semelhante quando estratificados pelo periódico de publicação e período de publicação. Estudos com intervenções clínicas apresentam melhor qualidade metodológica. A escala de Downs & Black apresenta boa reprodutibilidade interobservadores.

In surgical interventions, randomization and blinding may be difficult to implement. In this situation, non-randomized prospective studies (EPNR) can generate the best evidence. The objective of this study is to evaluate, by means of the scale proposed by Downs & Black, the quality of EPNR published in our country and to assess the interobserver reproducibility of this scale. EPNR published in Acta Ortopedica Brasileira and Revista Brasileira de Ortopedia until 2011 and prior to 2006 were included. Two of us independently applied the Downs & Black scale. The studies were stratified by period of publication, journal and type of intervention. The scores obtained were considered to assess the reliability of the scale and groups comparison. 59 studies were considered, seven excluded during the assessments. There were no differences between the scores, except for the type of intervention, which showed better methodological quality for studies involving clinical interventions (p < 0.001). The correlation coefficient for the Downs & Black score was 0.79 (95% CI 0.65 to 0.88), demonstrating good reliability. EPNR present methodological quality similar when stratified by the periodic publication and publication period. Studies with clinical interventions have better methodological quality. The Downs & Black scale shows good interobserver reproducibility.

CONTEXTO E OBJETIVO Não existe consenso sobre qual é a melhor classificação para as fraturas do rádio distal e os métodos existentes apresentam baixa reprodutibilidade. Este estudo tem como objetivo descrever e avaliar a reprodutibilidade de uma nova classificação (a IDEAL) comparando-a com as classificações mais amplamente utilizadas. TIPO DE ESTUDO E LOCAL Estudo de reprodutibilidade, Disciplina de Cirurgia da Mão, Universidade Federal de São Paulo. MÉTODOS Apresentamos a classificação IDEAL e sua fundamentação teórica baseada em evidências. Sessenta radiografias (anteroposterior e de perfil) de pacientes com fraturas do rádio distal foram classificadas por seis examinadores: um especialista e um residente de cirurgia da mão, um ortopedista, um residente de ortopedia e dois estudantes de medicina. Cada um, independentemente, avaliou as radiografias em três momentos diferentes. Analisamos a concordância intra e interobservador da classificação IDEAL, AO, Frykman e Fernandez, utilizando o kappa (κ) de Cohen (para dois observadores) e κ de Fleiss (para mais de dois observadores). RESULTADOS A concordância demonstrou-se elevada para a classificação IDEAL (κ = 0,771) e moderada para Frykman (κ = 0,556), Fernandez (κ = 0,671) e AO (κ = 0,650). A concordância interobservador foi moderada para a classificação IDEAL (κ = 0,595), mas insatisfatória para Frykman (κ = 0,344), Fernandez (κ = 0,496) e AO (κ = 0,343). CONCLUSÃO A reprodutibilidade da classificação IDEAL se demonstrou superior quando comparada às analisadas neste estudo, tornando a classificação IDEAL adequada para aplicação. Estudos complementares confirmarão se esta classificação é adequada para previsão de terapia e prognóstico.

CONTEXT AND OBJECTIVE There is no consensus concerning which classification for distal radius fractures is best and the existing methods present poor reproducibility. This study aimed to describe and assess the reproducibility of the new IDEAL classification, and to compare it with widely used systems. DESIGN AND SETTING Reproducibility study, Hand Surgery Section, Universidade Federal de São Paulo. METHODS The IDEAL classification and its evidence-based rationale are presented. Sixty radiographs (posteroanterior and lateral) from patients with distal radius fractures were classified by six examiners: a hand surgery specialist, a hand surgery resident, an orthopedic generalist, an orthopedic resident and two medical students. Each of them independently assessed the radiographs at three different times. We compared the intra and interobserver concordance of the IDEAL, AO, Frykman and Fernandez classifications using Cohen's kappa (κ) (for two observers) and Fleiss's κ (for more than two observers). RESULTS The concordance was high for the IDEAL classification (κ = 0.771) and moderate for Frykman (κ = 0.556), Fernandez (κ = 0.671) and AO (κ = 0.650). The interobserver agreement was moderate for the IDEAL classification (κ = 0.595), but unsatisfactory for Frykman (κ = 0.344), Fernandez (κ = 0.496) and AO (κ = 0.343). CONCLUSION The reproducibility of the IDEAL classification was better than that of the other systems analyzed, thus making the IDEAL system suitable for application. Complementary studies will confirm whether this classification system makes adequate predictions for therapy and prognosis.

CONTEXTO E OBJETIVOS A programação de pesquisa em ortopedia deve ser considerada do ponto de vista global. Esforços devem ser planejados como forma de se obter evidência que seja válida para promoção da saúde de alcance mundial. TIPO DE ESTUDO E LOCAL Estudo exploratório conduzido na Universidade Federal de São Paulo (Unifesp), São Paulo, Brasil e na McMaster University, Hamilton, Canadá. MÉTODOS Identificamos e analisamos pesquisas multicênticas/colaborativas realizadas na América Latina, considerando os esforços nos Estados Unidos e Canadá como referência. Para tal, exploramos os aspectos dos dados disponíveis em fontes oficiais e utilizamos os dados provenientes de acidentes de trânsito como modelo de discussão de pesquisas colaborativas nestes países. RESULTADOS A avaliação demonstra uma pequena proporção de estudos colaborativos/multicêntricos em nosso meio. Análise breve demonstrou que existe enorme proporção de mortes devidas a traumas provenientes dos acidentes de trânsito. Dessa forma, parece-nos claro que iniciativas envolvendo estudos colaborativos são importantes para a definição e melhor entendimento do padrão das lesões provenientes de trauma ortopédico e as formas de tratamento. A pesquisa ortopédica pode ser importante ferramenta para aglutinar cirurgiões ortopédicos, pesquisadores e sociedades médicas para uma ação em conjunto. CONCLUSÕES Apontamos algumas diretrizes práticas para iniciativas em pequisas colaborativas e propusemos algumas soluções com um plano de ação resumido para a realização de pesquisa baseada em evidências envolvendo trauma ortopédico.

CONTEXT AND OBJECTIVE Orthopedic research agendas should be considered from a worldwide perspective. Efforts should be planned as the means for obtaining evidence that is valid for health promotion with global outreach. DESIGN AND SETTING Exploratory study conducted at Universidade Federal de São Paulo (Unifesp), São Paulo, Brazil, and McMaster University, Hamilton, Canada. METHODS We identified and analyzed collaborative and multicenter research in Latin America, taking into account American and Canadian efforts as the reference points. We explored aspects of the data available from official sources and used data from traffic accidents as a model for discussing collaborative research in these countries. RESULTS The evaluation showed that the proportion of collaborative and multicenter studies in our setting is small. A brief analysis showed that the death rate due to traffic accidents is very high. Thus, it seems clear to us that initiatives involving collaborative studies are important for defining and better understanding the patterns of injuries resulting from orthopedic trauma and the forms of treatment. Orthopedic research may be an important tool for bringing together orthopedic surgeons, researchers and medical societies for joint action. CONCLUSIONS We have indicated some practical guidelines for initiatives in collaborative research and have proposed some solutions with a summarized plan of action for conducting evidence-based research involving orthopedic trauma.

As endopróteses não convencionais (ENC) são frequentemente utilizadas na ortopedia oncológica. As complicações do procedimento é motivo de pesquisa, pois há a instituição deste em população jovem e com grande potencial de sobrevida. Nós conduzimos uma revisão da literatura com o objetivo de buscar a melhor evidência científica relativa ao tema. A pesquisa englobou as bases: MEDLINE, EMBASE, CINAHL e o Registro Central Cochrane de ensaios clínicos randomizados (ECR), objetivando identificar estudos reportando complicações, e a substituição ou não da superfície articular da patela. Os estudos foram selecionados de acordo com a melhor qualidade metodológica existente para o assunto. Cento e quarenta e seis (146) estudos foram avaliados. Nenhum ERC foi encontrado. Realizamos uma avaliação qualitativa e quantitativa dos trabalhos encontrados (níveis de evidência IV e V). Utilizou-se o teste de U de Mann-Whitney para a análise estatística. Os resultados apontam para a necessidade de produção de novos estudos, para que se possa chegar a uma conclusão mais sólida. Pode-se considerar altas as taxas de complicações pós ENC, a despeito da baixa qualidade dos estudos, conforme demonstra os estudos existentes na literatura.

Non-conventional endoprostheses (NCE) are frequently used in orthopedic oncology. The complications associated with this procedure have prompted research, due to the fact that it is commonly performed on young patients, with a higher survival rate. We conducted a systematic review of the literature, searching for the best scientific evidence on the subject. The research was carried out in the following databases: MEDLINE, EMBASE, CINAHL and the Cochrane Central Register of randomized controlled trials (CCTR), seeking to identify studies that report complications, and compare patellar resurfacing versus retention. The studies were selected according to the best methodological quality that exists for the subject. One hundred and forty six (146) studies were evaluated. No randomized clinical trial was found. We conducted a qualitative and quantitative evaluation of the work found (evidence levels IV and V). We used the Mann-Whitney U test for the statistical analysis. The results indicate a need for further studies that will enable us to reach a more solid conclusion. The rate of complications after NCE can be considered high, despite the low quality of the studies, as demonstrated by the studies that exist in the literature.