RESUMO
BACKGROUND: Reconstructive joint surgery is an indicator of poor prognosis in rheumatoid arthritis (RA). Objectives of this study were to describe the incidence rate of orthopedic and hand surgery indication (OHSI) in an ongoing cohort of Hispanic early RA patients treated according to a T2T strategy and to investigate predictors. METHODS: Through February 2018, the cohort comprised 185 patients recruited from 2004 onwards, with variable follow-up, and rheumatic assessments at fixed intervals that included prospective determination of OHSI. Charts were reviewed by a single data abstractor. OHSI incidence rate was calculated. A case-control study nested within a cohort investigated the predictors; cases (OHSI patients) were paired with controls (1:4) according to age, sex and autoantibodies. A logistic regression model included baseline and cumulative (up to OHSI or equivalent) variables related to disease activity, treatment and to persistence with therapy. The IRB approved the study. RESULTS: Patients from the cohort were predominantly middle-aged (mean ± SD age: 38.5 ± 12.9 years) females (87.6%) with 5.4 ± 2.6 months of disease duration. The cohort contributed to 1538 patient-years of follow-up. Twelve patients received incidental OHSI at a follow-up of 85 ± 44.5 months. The OHSI incident global rate was 8/1000 patient-years. Longer symptom duration at cohort referral (OR: 1.313, 95%CI: 1.02-1.68, p = 0.032) and a higher number of flares/patient (OR: 1.608, 95%CI: 1.05-1.61, p = 0.015) predicted OHSI. OHSI patients had more severe flares than their counterparts, and the opposite figure was true for mild flares. CONCLUSION: Early referral for appropriate management and flare control may prevent OHSI in Hispanic recent-onset RA patients.
Assuntos
Antirreumáticos/uso terapêutico , Artrite Reumatoide/terapia , Procedimentos Ortopédicos/estatística & dados numéricos , Procedimentos de Cirurgia Plástica/estatística & dados numéricos , Encaminhamento e Consulta/estatística & dados numéricos , Adulto , Estudos de Casos e Controles , Feminino , Seguimentos , Articulação da Mão/patologia , Articulação da Mão/cirurgia , Hispânico ou Latino/estatística & dados numéricos , Humanos , Incidência , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Estudos Prospectivos , Índice de Gravidade de Doença , Exacerbação dos Sintomas , Fatores de TempoRESUMO
Introducción: En los últimos años se ha visto un amplio interés renovado en la artroplastía unicompartimental como resolución de la artrosis medial de rodilla debido a las ventajas sobre la prótesis total de rodilla. Métodos: Se realizó un estudio epidemiológico retrospectivo en el cual se estudiaron 25 pacientes consecutivos (30 rodillas) de Enero de 2002 a Septiembre de 2013, sometidos a artroplastía unicompartimental de rodilla con prótesis Oxford fase 3 con el uso de insertos de polietileno con diseño ultracongruente. Con un promedio de seguimiento de 6.1 años (1.1-11.5 años). Se analizaron variables demográficas como peso, talla e índice de masa corporal y variables perioperatorias como valores de hemoglobina, sangrado y tiempo quirúrgico; evaluamos la función pre- y postoperatoria de los pacientes de acuerdo a escalas clínicas y funcionales. Realizamos una evaluación clínica y radiológica del implante revisando la presencia de cambios artrósicos en los compartimentos no intervenidos. Resultados: Se observó una óptima sobrevida del implante. El Knee Score Society clínico mejoró de 61 en el preoperatorio a 84 al momento final del seguimiento obteniendo un 90% de resultados excelentes y buenos. Al final del seguimiento obtuvimos un promedio postquirúrgico de flexión de 120º y con extensión completa. Sólo dos pacientes presentaron resultados satisfactorios por progresión de la artrosis en el compartimento lateral y únicamente un paciente requirió conversión en dos tiempos a prótesis total debido a infección periprotésica. Conclusión: La artroplastía unicompartimental de rodilla es una cirugía menos invasiva con buenos resultados clínicos y funcionales. El éxito del procedimiento se basa en la correcta selección de los pacientes.
Introduction: There has been great renewed interest in the past few years in unicompartmental arthroplasty for medial arthrosis of the knee due to the advantages over total knee replacement. Methods: A retrospective epidemiological study was performed with 25 consecutive patients (30 knees) from January 2002 to September 2013, who underwent unicompartmental knee arthroplasty with a phase 3 Oxford prosthesis using polyethylene inserts with an ultra-congruent design. With an average follow-up of 6.1 years (1.1-11.5 years). The following demographical variables were analyzed: weight, size, body mass index and perioperative variables like hemoglobin, bleeding and surgical time; we evaluated the pre and post-operative function of patients according to clinical and functional scales. We performed a clinical and radiological evaluation of the implant to check for the presence of arthrosis changes in non-intervened compartments. Results: We observed optimal survival of the implant. The clinical Knee Score Society improved from 61 in the pre-op to 84 at the end of the follow-up period, with 90% excellent and good results. At the end of the follow-up the average post-surgical flection was 120º and full extension. Only two patients showed satisfactory results due to progression of the arthrosis in the lateral compartment and only one patient required conversion to total replacement in two surgeries due to a periprosthetic infection. Conclusion: Unicompartmental knee arthroplasty is a less invasive surgery with good clinical and functional results. The success of the procedure is based on the proper selection of patients.
Assuntos
Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Artroplastia do Joelho/métodos , Prótese do Joelho , Osteoartrite do Joelho/cirurgia , Seguimentos , Desenho de Prótese , Estudos Retrospectivos , Fatores de TempoRESUMO
INTRODUCTION: There has been great renewed interest in the past few years in unicompartmental arthroplasty for medial arthrosis of the knee due to the advantages over total knee replacement. METHODS: A retrospective epidemiological study was performed with 25 consecutive patients (30 knees) from January 2002 to September 2013, who underwent unicompartmental knee arthroplasty with a phase 3 Oxford prosthesis using polyethylene inserts with an ultra-congruent design. With an average follow-up of 6.1 years (1.1-11.5 years). The following demographical variables were analyzed: weight, size, body mass index and perioperative variables like hemoglobin, bleeding and surgical time; we evaluated the pre and post-operative function of patients according to clinical and functional scales. We performed a clinical and radiological evaluation of the implant to check for the presence of arthrosis changes in non-intervened compartments. RESULTS: We observed optimal survival of the implant. The clinical Knee Score Society improved from 61 in the pre-op to 84 at the end of the follow-up period, with 90% excellent and good results. At the end of the follow-up the average post-surgical flection was 120 degrees and full extension. Only two patients showed satisfactory results due to progression of the arthrosis in the lateral compartment and only one patient required conversion to total replacement in two surgeries due to a periprosthetic infection. CONCLUSION: Unicompartmental knee arthroplasty is a less invasive surgery with good clinical and functional results. The success of the procedure is based on the proper selection of patients.
Assuntos
Artroplastia do Joelho/métodos , Prótese do Joelho , Osteoartrite do Joelho/cirurgia , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Desenho de Prótese , Estudos Retrospectivos , Fatores de TempoRESUMO
Venous thromboembolic disease (VTED) is a public health problem worldwide. In the United States it causes 2 million annual cases. Its annual incidence is 1-2 cases per 1,000 individuals in the general population. It is a disease frequently associated with life threatening complications and its mortality rate is 1-5% of cases. Due to its high complication rate, its slow recovery, and the need for prolonged disability, it is considered as a high-cost disease. VTED may occur in both surgical and medical patients; the known associated risk factors include prolonged rest, active cancer, congestive heart failure, atrial fibrillation, and stroke, among the major medical conditions. Orthopedic surgery represents the main surgical risk factor for VTED, including mainly hip and knee replacements, as well as polytraumatized patients with severe spinal lesions, and major fractures. VTED may be prevented with the appropriate use of antithrombotics. The participants in this consensus defined thromboprophylaxis as the strategy and actions undertaken to reduce the risk of VTED in patients undergoing high risk orthopedic surgery. The position of the Mexican College of Orthopedics and Traumatology regarding the prevention of VTED in orthopedic surgery is described herein.