Abstract To compare the magnitude of subsidence between single- (SW) and double-wedge (DW) femoral stems in primary total hip arthroplasties (THAs), and to identify factors associated with clinically relevant subsidence. Retrospective cohort study with 82 patients (164 hips) undergoing bilateral THA between 2012 and 2022, each receiving type-I (Corail) and -II (Summit) stems, both manufactured by DePuy Synthes. Subsidence was measured radiographically up to 6 months postoperatively and was considered clinically relevant when greater than 3 mm. Radiographic variables included cortical enlargement index (CEI) and canal fill rate (CFR). Statistical analyses included paired t-test, logistic regression, and Spearman correlation. The mean subsidence was 1.93 ± 1.16 mm in type-I stems and 2.23 ± 1.57 mm in type-II (p = 0.181). Clinically relevant subsidence occurred in 18.2% of type-I stems and 31.7% of type-II (OR = 2.07; p = 0.050). Greater subsidence was observed in the first surgery in bilateral arthroplasties (p = 0.006). There was no significant correlation between subsidence, age, body mass index (BMI), CEI, or CFR. The DW stems were associated with a higher risk of clinically relevant subsidence. In bilateral THA, subsidence is more pronounced at first surgery, with no detectable influence of demographic or radiographic factors.
Resumo A hérnia de disco lombar é uma das principais causas de dor radicular e incapacidade na população adulta, com impacto expressivo no sistema de saúde e na produtividade laboral. O manejo inicial é predominantemente conservador, mas uma parcela dos pacientes pode evoluir com sintomas refratários ou déficit neurológico progressivo, necessitando de intervenção cirúrgica. Ao longo das últimas décadas, técnicas minimamente invasivas, como a cirurgia endoscópica, revolucionaram o tratamento com menor agressão tecidual, recuperação acelerada e menores taxas de complicações. Este artigo revisa a evolução das técnicas cirúrgicas, destacando evidências comparativas entre elas, bem como o papel emergente de novas tecnologias.
Abstract Although early mobilization is essential for functional recovery after phalangeal fractures, many fixation methods still require prolonged immobilization, increasing the risk of joint stiffness. We herein describe a simple, safe, and low-cost technique that combines intramedullary Kirschner wires (K-wires) with external connection, adapted from the Ulson method, which was originally developed for distal radius fractures. The procedure consists of closed reduction under fluoroscopy followed by the insertion of two 1.0-mm intramedullary wires. The external ends of these wires are bent and connected, forming a stable frame that enables immediate mobilization without the need for immobilization. The technique provided stable fixation, reliable bone healing, and early rehabilitation, with a low complication rate. It represents a practical and reproducible option, especially useful in resource-limited settings.
Abstract Lumbar disc herniation is one of the main causes of root pain and disability in the adult population, with a significant impact on the healthcare system and labor productivity. Initial management is predominantly conservative, but a portion of patients may evolve with refractory symptoms or progressive neurological deficit, requiring surgical intervention. Over the past few decades, minimally invasive techniques, such as endoscopic surgery, have revolutionized treatment with less tissue damage, accelerated recovery, and lower complication rates. This article reviews the evolution of surgical techniques, highlighting comparative evidence among them and the emerging role of new technologies.
Abstract To develop a predictive model to estimate complications up to 30 days after total hip arthroplasty (THA), based on clinical and functional variables, aiming at the creation of a practical tool for clinical use. Prospective cohort study conducted in a public referral hospital, with patients undergoing primary and elective THA between November 2021 and April 2022. The sample included 122 patients (mean age: 56 years, 59.8% men). Clinical, sociodemographic, and functional capacity variables were evaluated and estimated by the Duke Activity Status Index (DASI). Outcomes included clinical complications, early readmission, prolonged hospitalization (> 6 days), and intensive care unit (ICU) stay for more than one day. A logistic regression model was used, with performance evaluated by the C-statistic (area under the curve, AUC), and the model was incorporated into an online tool. The most prevalent comorbidities were hypertension (61%), diabetes (23%), and dyslipidemia (15%). Complications within 30 days occurred in 13.1% of patients, with surgical wound infection and anemia being the most common events. Dyslipidemia (odds ratio [OR]: 4.70; p = 0.010), sedentary lifestyle (OR: 4.71; p = 0.026), high ASA classification (OR: 3.67; p = 0.035), and functional capacity < 4 metabolic equivalents of task (METs) (OR: 4.08; p = 0.040) were significant risk factors. The tool is available at https://upneuro.shinyapps.io/atq-pred. Dyslipidemia, sedentary lifestyle, low functional capacity, and high ASA classification were associated with a higher risk of post-THA complications. The preoperative evaluation should include functional and cardiovascular aspects. The model showed good accuracy, and further studies are needed to validate its clinical application. This is a prospective cohort study without a control group aimed at identifying prognostic factors for complications after total hip arthroplasty.
