Luiz Felipe Morlin Ambra

Resumo: Avaliar a conformidade anatômica de 25 implantes de artroplastia total de joelho (ATJ) à morfologia de joelhos na população brasileira feminina e masculina. Foram analisados 500 exames de ressonância de joelhos de 250 mulheres e 250 homens. As medidas anteroposterior (AP) e mediolateral (ML) dos fêmures, tíbias, e implantes foram tomadas a fim de obter correspondência morfológica. As divergências médias das medidas AP e ML entre as morfologias articulares e os implantes analisados foram as seguintes: fêmures femininos 4,48 mm; fêmures masculinos 4,89 mm; tíbia feminina 3,63 mm; e tíbia masculina 6,11 mm. Os implantes com melhor adaptação AP versus ML foram: Medacta Sphere para o fêmur feminino; Stryker Triathlon para fêmur o masculino; Smith & Nephew Legion para tíbia feminina; e Zimmer Persona para a tíbia masculina. Na comparação da melhor relação de implantes femorais e tibiais para o sexo feminino, observou-se que o United Orthopedic U2 apresentou a melhor pontuação estatística, seguido dos implantes Aesculap Columbus e Smith & Nephew Legion. Para os homens, o melhor escore foi encontrado no Zimmer Persona, Microport Advance e Smith & Nephew Legion. A pior relação feminina foi com o Peter Brehm BPK-S, e a masculina, com o Orthovasive Indus. Os implantes estudados foram satisfatórios para a cobertura óssea articular dos joelhos de brasileiros de ambos os sexos submetidos à ATJ. No entanto, também foram encontrados resultados com diferenças maiores do que 10 mm na maioria dos implantes. Isso ressalta a necessidade de atenção dos cirurgiões para realizar um bom planejamento para a escolha dos implantes. Demonstrou-se que os implantes importados eram mais customizáveis do que os nacionais na população brasileira.

To evaluate the anatomical conformity of 25 total knee arthroplasty (TKA) implants to the knee morphology of the Brazilian female and male population. We analyzed 500 magnetic resonance imaging (MRI) scans of knees from 250 women and 250 men. We collected data on anteroposterior (AP) and mediolateral (ML) measurements of femurs, tibias, and implants to assess their morphological correspondence. The mean AP versus ML divergence between joint morphologies and the implants was as follows: 4.48 mm for female femurs; 4.89 mm for male femurs; 3.63 mm for female tibias; and 6.11 mm for male tibias. The implants with the best AP versus ML adaptation were: Medacta Sphere for female femurs; Stryker Triathlon for male femurs; Smith & Nephew Legion for female tibias; and Zimmer Persona for male tibias. When comparing the best femoral and tibial implant ratios for female subjects, the United Orthopedic U2 presented the best statistical score, followed by the Aesculap Columbus and Smith &Nephew Legion implants. For male patients, the implants with the highest scores were the Zimmer Persona, the Microport Advance, and the Smith & Nephew Legion. The worst ratios were found in the Peter Brehm BPK-S for female individuals and the Orthovasive Indus for male subjects. The implants studied presented satisfactory results for bone coverage of the knees of Brazilian subjects of both genders undergoing TKA. However, we also found differences higher than 10 mm in most implants. This finding highlights that surgeons must carefully plan the TKA during implant selection. Imported implants proved to be more customizable than Brazilian ones in this population.

Objectives: Our aim was to compare the epidemiology of surgically treated fractures during the pandemic period with previous years without the pandemic. Methods: This was a retrospective study with data collection that included patients hospitalized and operated for fractures between March 24th and June 23rd in 2018, 2019 and 2020. Results: A total of 879 patients were registered, resulting in a total of 965 fractures. During the COVID-19 pandemic, 234 patients were registered, representing 26.62% of the total, and in the period before the pandemic, 645 patients were registered, 73.38% of the total. Conclusion: We observed a proportional increase in high-energy trauma in the social isolation period and patient’s average age. The other changes found in the study had no statistical difference. Level of Evidence IV, Case Series.

Purpose: To evaluate the influence of trochlear dysplasia on clinical outcomes after autologous chondrocyte implantation (ACI) for the treatment of large cartilage lesions in the patellofemoral joint (PFJ) with a minimum of 2 years’ follow‐up. Methods: We performed a retrospective review of prospectively collected data of all patients submitted to cartilage repair with ACI for focal cartilage defects in the PFJ by a single surgeon. Patient factors, lesion morphology, and preoperative and postoperative patient‐reported outcome measures including the Knee Injury and Osteoarthritis Score, Lysholm score, Tegner activity level, and International Knee Documentation Committee Subjective Knee Evaluation Form score were collected. Two independent observers assessed preoperative imaging to determine the presence and grade of trochlear dysplasia. Patients were stratified into 2 groups based on the presence or absence of trochlear dysplasia. Patients without trochlear dysplasia served as controls. Patients were matched 1:1 for sex, age, body mass index, lesion size, and location. Results: Forty‐six patients who underwent ACI in the PFJ with a mean follow‐up period of 3.7 ± 1.9 years (range, 2‐9 years) were enrolled in this study (23 in the trochlear dysplasia group vs 23 in the normal trochlea group). The patients’ mean age was 30.1 ± 8.8 years. Patient‐reported outcome measures at final follow‐up did not differ between the 2 groups ( P > .05). No difference in failure rates was seen between the 2 groups (n = 1 [4.3%] vs n = 1 [4.3%], P > .999). Additionally, no difference in clinical outcomes was seen between patients with high‐grade dysplasia (19 patients; Dejour types B‐D) and patients without dysplasia (19 patients) ( P > .05). Conclusions: ACI in the PFJ provides favorable outcomes even in patients with trochlear dysplasia, which are comparable to those in patients with normal trochlear anatomy. Thus, trochlear dysplasia seems to not influence the clinical outcomes of ACI in the PFJ. Level of Evidence: Level III, retrospective comparative trial.