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ABSTRACT Objective: To identify the patient profile that obtains better clinical and quality of life improvement after lumbar spinal stenosis surgery, comparing the results in the pre and postoperative periods. Methods: Thirty-seven patients with lumbar spine stenosis submitted to surgery were prospectively evaluated. Through the 36-Item Short Form General Health Survey (SF-36) questionnaire we performed a preoperative analysis to identify morbidities and social security benefit earning. The SF-36 is a subjective postoperative questionnaire to assess surgical success six months after the surgery. Results: There were unfavorable outcomes in patients who received social security benefits and in those who had morbidities. According to the SF-36 score, the surgical result is better when the patient is non-smoker (p=0.05), non-hypertense (p=0.040), non-diabetic (p =0.010) or non sedentary (p=0.019), respectively on mental health, pain, social aspects and general health domains. Conclusion: The patient profiles that best benefit from the surgery are those who do not have morbidities and had no social security benefit. Evidence Level II, Prospective Study.

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ABSTRACT Objective: To analyze the impact of a physiotherapy protocol in maximum inspiratory and expiratory pressure in patients with adolescent idiopathic scoliosis (AIS) by manovacuometry. AIS may change the respiratory dynamics and the performance of inspiratory and expiratory muscles, affecting ventilatory capacity. Methods: Patients with AIS aged 10 to 20 years old were randomly assigned to receive an aerobic exercise-training program or no treatment. They were evaluated for respiratory muscle strength before and after the treatment period by means of manovacuometry, thorax and spine radiographs. Physical therapy exercising protocol comprised three weekly sessions including stretching and aerobic exercises during four months. Results: Forty five patients received physical therapy and 45 patients received no treatment (control group). The mean maximum inspiratory pressure (Pimax) was -52.13 cm H20 and the maximum expiratory pressure (Pemax) was 62.38 cm H20. There was a significant increase of Pimax and Pemax (p=0,000) in the group receiving physical therapy. There were no drop-outs and no adverse events in this study. Respiratory muscle strength, scoliosis and kyphosis degrees were not statistically correlated. Conclusion: Exercising is beneficial to patients with AIS, who have shown significant increases in respiratory muscle strength after physical therapy. There was no correlation between respiratory pressure and spine deformity. Level of Evidence I, High quality randomized trial.

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ABSTRACT Objective: To assess socio-demographic characteristics of patients undergoing total knee arthroplasty (TKA) in a public university hospital, evaluating the outcome infection and associated factors. Method: A retrospective study was carried out with 78 patients undergoing TKA, from 2013 to 2014. The socio-demographic and clinical characteristics of the patients were collected. Comparison between infected and non-infected patients was performed to find out which variables were possibly associated to this complication. Result: Of 81 arthroplasties performed, patients were older (mean age 64 years), women (79%), with primary osteoarthritis as main etiology (87.6%) and most had comorbidities (82.7%). Infection occurred in 16% of patients, and this outcome associated with age older than 65 years (p=0.023) and the occurrence of deep vein thrombosis (p=0.027). Conclusion: Patients undergoing TKA are mostly elderly women with primary osteoarthritis in the knee and comorbidities who developed infection in 16% of cases. More studies need to be conducted aimed at creating specific protocols in order to improve the quality of clinical practice. Level of Evidence III, Retrospective Comparative Study.

Resumo em Inglês:

ABSTRACT Objective: To determine whether the second-generation constrained condylar prosthesis provided satisfactory results in revision total knee arthroplasty. Methods: A series of 41 cases of revision total knee arthroplasty using the second-generation constrained condylar knee prosthesis was reviewed. The series comprised 7 men and 34 women with a mean age of 73.2 years. The original diagnosis was predominantly osteoarthritis. The most common reason for revision surgery was aseptic loosening. The mean interval between the primary and revision surgeries was 66.4 months. The mean follow-up period was 49.4 months. Results: The mean Knee Society knee score improved from 43.8 to 82.9 after revision surgery, the mean Knee Society function score improved from 37.1 to 79.2; the range of motion improved from 95.6° to 105.6° and the radiological femorotibial alignment improved from 181.4° (varus 6.4°) to 174.9° (valgus 0.1°), on average (p<0.001 at all items). Conclusion: Revision total knee arthroplasty with the use of the second-generation constrained condylar knee prosthesis yielded reproducible clinical success. Level of Evidence IV, Case series.

Resumo em Inglês:

ABSTRACT Objective: To evaluate the intra-observer reproducibility of Schatzker classification for tibial plateau fractures through smartphone applications. Methods: Radiographs were evaluated in two incidences (anteroposterior and profile) and CT slices (axial, sagittal and coronal) of 37 patients with tibial plateau fracture. Two evaluators, knee surgery experts, classified the cases by viewing the images of the isolated radiographs and then X-rays associated with CT slices in four different stages via smartphones and then presential assessment. Data were statistically analyzed with the Kappa coefficient (k). Results: There was intra-observer agreement by comparing the two methods of evaluation: display or via smartphone, and the analysis made showed statistical significance. Conclusion: The use of smartphones did not affect the reliability of Schatzker classification. Level of Evidence III, Diagnostic Study - Investigating a Diagnostic Test.

Resumo em Inglês:

ABSTRACT Objective: To evaluate the knowledge on developmental dysplasia of the hip (DDH) by professionals involved in its diagnosis. Methods: This is a cross-sectional study using questionnaires to assess the knowledge about DDH. Orthopedic surgeons and pediatricians, residents and medical students from a tertiary teaching hospital were included in the study. Results: We evaluated 142 medical students, eight orthopedic residents, ten pediatric residents, seven pediatricians, and nine orthopedic surgeons; 50% declared not having examined any DDH case in the last year and only three had diagnosed more than 10 cases during their career. Regarding self-assessed knowledge (0-10), the average score was 4.25 [n=186; SD=2.43]. Nineteen percent of the participants ignored semiological tests and 26.1% of pediatricians (specialists and residents), were unaware of how to perform them. The most acknowledged and neglected risk factor was pelvic presentation (68%) and CMT (9.3%), respectively. None of the participants were able to identify all the risk factors. The average number of risk factors identified was two (n=186; SD=1.58). Forty seven point three percent of the participants failed to recognize the time of birth as the ideal moment for diagnosis; 17% reported it was after the first month. Regarding neglected severe DDH, 45.3% failed to recognize its natural history. Conclusion: Knowledge on DDH among health professionals who are involved in screening is flawed. Level of Evidence IV, Developing a Decision Model.

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ABSTRACT Objective: To evaluate the Magnetic Resonance Imaging (MRI) findings and their validity in patients with ischiofemoral impingement syndrome (IFI) . Methods: We retrospectively analyzed 55 hips. MRI findings of 30 hips were consistent with IFI syndrome. Twenty five hips had no MRI findings consistent with IFI syndrome. We compared the ischiofemoral space (IFS), quadratus femoris space (QFS), ischial angle (IA) and femoral neck angle (FNA) between the age and gender matched groups. We also analyzed edema, fatty replacement and partial or total rupture of quadratus femoris muscle. Mann Whitney U test was used to compare the data. Results: We observed atrophy in eight, fatty replacement also in eight and edema in all of the quadratus femoris muscle. QFS (p<0.001) and IFS (p<0.001) were significantly lower in patients as compared to the control group. IA (p=0.012) and FNA (p=0.010) values were significantly higher in patients compared with the control group. Conclusion: MRI findings of IFI include narrowing of QFS and IFS and increase in IA and FNA. This condition should be kept in mind for patients with hip pain. Level of Evidence III, Retrospective Study.

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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.

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ABSTRACT Objective: To assess the adequacy to the Brazilian population of orthopedic implants used for treatment of proximal femoral fractures. Methods: The neck-shaft angle of the femur of 101 patients was measured in anteroposterior pelvis radiographs and these measurements were correlated to gender, age, height, weight and ethnicity. In addition, we compared the values of the neck -shaft angle with the angulation of the main implants available in the Brazilian market for the treatment of transtrochanteric fractures. Results: Of the 101 measurements, an average of 130.9±6.7° was obtained, ranging from 112° to 150°. Correlating these measurements with epidemiological variables, only age was statistically significant. Conclusion: Most of the analyzed population presented anatomical characteristics that allow the proper use of these implants to treat transtrochanteric fractures, as indicated from the analysis of neck-shaft angles. Nonetheless, 4% of individuals did not fit this pattern and would have required alternative implants. Level of Evidence III, Study of nonconsecutive patients; without consistently applied reference ''gold'' standard.

Resumo em Inglês:

ABSTRACT Objective: To evaluate the prevalence of temporomandibular dysfunction (TMD) and its association with perceived stress and common mental disorder (CMD) in academic students. Methods: This is s transversal observational study conducted at Universidade de Minas Gerais, Divinópolis Unit, in health science courses. To investigate the prevalence of TMD, the anamnestic index by Fonseca was used. Stress was assessed by the perceived stress scale, translated and adapted for the Brazilian population in 2006. To track CMD, we used the Self-Reporting Questionnaire (SRQ-20). Data were analyzed using SPSS version 13.0, adopting a 5% significance level. Results: The prevalence of TMD in the sample was 71.9%, distributed as follows: Light TMD (50.0%), moderate (16.4%) and severe (5.5%), being more frequent among women (76.4%). Common mental disorders were present in 29.9% of participants. The average perceived stress was 30.9. Conclusion: The results of this study allow us to conclude that there is a statistically significant correlation between TMD and variables such as parafunctional habits, perceived stress and CMD. Level of Evidence II, Development of diagnostic criteria on consecutive patients (with universally applied reference "gold" standard).