RESUMO

Objective To evaluate the clinical and radiographic results and survival of the acetabular revision surgery of total hip arthroplasty with cemented implant without the use of reinforcement ring, associated with structural homologous bone grafting. Methods A total of 40 patients (44 hips) operated from 1995 to 2015 were retrospectively analyzed. Radiographs were evaluated according to the classification of the acetabular bone defect, graft shape, and the presence of osseointegration. Cases were considered as failures when the migration of the implant was > 5 mm in any direction, and/or the progression of radiolucency lines around the acetabular component were > 2 mm. We verified the association of radiographic findings with cases of failure using statistical tests and analyzed survival using the Kaplan-Meier curve. Results Of the 44 hips, 45.5% of the acetabular defects were Paprosky type 3A and 50% were 3B. In 65% of the hips, the graft configuration was classified as Prieto type 1 and in 31% as type 2. No radiographic evidence of osseointegration was observed in 13.6% of the cases. We observed 9 (20.5%) reconstruction failures. A correlation was observed between reconstruction failure and the absence of radiographic signs of graft osseointegration. Conclusion We observed good clinic and radiographic results, with survival of 79.54% in a mean follow-up of 9.65 years. Also, there was an association between absence of radiographic signs of osseointegration of the structural graft and failure in this series of patients with large bone defects. The failures did not correlate with the severity of the acetabular bone defect, thickness, or graft configuration.

RESUMO

Abstract Objective To evaluate the clinical and radiographic results and survival of the acetabular revision surgery of total hip arthroplasty with cemented implant without the use of reinforcement ring, associated with structural homologous bone grafting. Methods A total of 40 patients (44 hips) operated from 1995 to 2015 were retrospectively analyzed. Radiographs were evaluated according to the classification of the acetabular bone defect, graft shape, and the presence of osseointegration. Cases were considered as failures when the migration of the implant was > 5 mm in any direction, and/or the progression of radiolucency lines around the acetabular component were > 2 mm. We verified the association of radiographic findings with cases of failure using statistical tests and analyzed survival using the Kaplan-Meier curve. Results Of the 44 hips, 45.5% of the acetabular defects were Paprosky type 3A and 50% were 3B. In 65% of the hips, the graft configuration was classified as Prieto type 1 and in 31% as type 2. No radiographic evidence of osseointegration was observed in 13.6% of the cases. We observed 9 (20.5%) reconstruction failures. A correlation was observed between reconstruction failure and the absence of radiographic signs of graft osseointegration. Conclusion We observed good clinic and radiographic results, with survival of 79.54% in a mean follow-up of 9.65 years. Also, there was an association between absence of radiographic signs of osseointegration of the structural graft and failure in this series of patients with large bone defects. The failures did not correlate with the severity of the acetabular bone defect, thickness, or graft configuration.

Resumo Objetivo Avaliarosresultadosclínicos, radiográficos e a sobrevida da cirurgia de revisão acetabular de artroplastia total de quadril com implante cimentado sem uso de anel de reforço, associado à enxertia óssea homóloga estrutural. Métodos Um total de 40 pacientes (44 quadris) operados de 1995 a 2015 foram analisados retrospectivamente. As radiografias foram avaliadas de acordo com a classificação do defeito ósseo acetabular, o formato do enxerto e à presença de osteointegração. Foram considerados casos de insucesso a migração do implante > 5 mm em qualquer direção e/ou a progressão de linhas de radioluscência em torno do componente acetabular > 2mm. Verificamos a associação dos achados radiográficos com os casos de falha utilizando testes estatísticos e analisamos a sobrevida utilizando a curva de Kaplan-Meier. Resultados Dos 44 quadris, 45,5% dos defeitos acetabulares eram Paprosky tipo 3A e 50%, 3B. Em 65% dos quadris, a configuração do enxerto foi classificada como tipo 1 de Prieto e em 31% como tipo 2. Não foi observada evidência radiográfica de osteointe-gração em 13,6% dos casos. Observamos 9 (20,5%) falhas de reconstrução. Foi observada correlação entre falha da reconstrução com a ausência de sinais radiográficos de osteointegração do enxerto. Conclusão Observamos bons resultados clínicos e radiográficos, com sobrevida de 79,54% em seguimento médio de 9,65 anos. Também houve associação entre ausência de sinais radiográficos de osteointegração do enxerto estrutural e falha nesta série de pacientes com grandes defeitos ósseos. As falhas não se correlacionaram com a severidade do defeito ósseo acetabular, espessura ou configuraçãodoenxerto.

Assuntos

RESUMO

BACKGROUND: In our country, transplantation centers differ in the age limit for allogeneic hematopoietic transplantation (ALOHT). In our program, transplants with age- adjusted conditioning are performed in patients until 70 years old. Currently more than 60% of ALOHT reported to the Center for International Bone Marrow Transplantation Research (CIBMTR) are performed in patients older than 40 years. AIM: To report our experience with ALOHT in acute myelogenous leukemia (AML), analyzing patient age at transplantation in different periods and transplant results in different age groups. MATERIAL AND METHODS: A retrospective analysis of the database of adult hematopoietic transplants in AML patients was performed. Demographic data, disease characteristics, transplant data, survival and relapse times, and mortality were collected. RESULTS: In our program, 1030 transplants were performed in adults and 119 ALOHT were performed in AML patients, between 1990 and 2020. The median age of patients in all periods was 41 years, (range 16-69). The median age was 33 and 45 years, in the periods 1990-2000 and 2000-2020 respectively (p < 0.01). Seventy-eight patients received myeloablative conditioning (median age 44 years) and 41 reduced intensity conditioning (median age 53 years). Five-year overall survival was 44.6% (confidence intervals (CI) 41-48). Non relapse mortality of all periods was 19% (CI 17 - 40%) and relapse rate was 17 % (CI 16-22). No difference in five years overall survival among patients younger than 40, 41 to 50 and over 51 years was observed. Conclusions: Overall Survival, non-relapse mortality and relapse rate were similar in younger and older patients in our program and similar to those previously reported in other centers.

Assuntos

RESUMO

Purpose: To investigate the efficacy of allogeneic mesenchymal stem-cells and autologous mononuclear cells to promote sensorimotor recovery and tissue rescue. Methods: Female rabbits were submitted to the epidural balloon inflation method and the intravenous cells administrations were made after 8 hours or seven days after injury induction. Sensorimotor evaluation of the hindlimbs was performed, and the euthanasia was made thirty days after the treatment. Spinal cords were stained with hematoxylin and eosin. Results: Both therapies given 8 hours after the injury promoted the sensorimotor recovery after a week. Only the group treated after a week with mononuclear cells showed no significant recovery at post-injury day 14. In the days 21 and 28, all treatments promoted significant recovery. Histopathological analysis showed no difference among the experimental groups. Our results showed that both bone marrow-derived cell types promoted significant sensorimotor recovery after injury, and the treatment made at least a week after injury is efficient. Conclusion: The possibilities of therapy with bone marrow-derived cells are large, increasing the therapeutic arsenal for the treatment of spinal cord injury.(AU)

Assuntos

RESUMO

Abstract Purpose: To investigate the efficacy of allogeneic mesenchymal stem-cells and autologous mononuclear cells to promote sensorimotor recovery and tissue rescue. Methods: Female rabbits were submitted to the epidural balloon inflation method and the intravenous cells administrations were made after 8 hours or seven days after injury induction. Sensorimotor evaluation of the hindlimbs was performed, and the euthanasia was made thirty days after the treatment. Spinal cords were stained with hematoxylin and eosin. Results: Both therapies given 8 hours after the injury promoted the sensorimotor recovery after a week. Only the group treated after a week with mononuclear cells showed no significant recovery at post-injury day 14. In the days 21 and 28, all treatments promoted significant recovery. Histopathological analysis showed no difference among the experimental groups. Our results showed that both bone marrow-derived cell types promoted significant sensorimotor recovery after injury, and the treatment made at least a week after injury is efficient. Conclusion: The possibilities of therapy with bone marrow-derived cells are large, increasing the therapeutic arsenal for the treatment of spinal cord injury.

Assuntos

RESUMO

OBJECTIVES: The purpose of this study was to compare union rates for isolated subtalar arthrodesis with and without the use of bone grafts or bone graft substitutes. METHODS: We retrospectively reviewed 135 subtalar fusions with a mean follow-up of 18 ± 14 months. The standard approach was used for all surgeries. Graft materials included b-tricalcium phosphate, demineralized bone matrix, iliac crest autograft and allograft, and allograft cancellous chips. Successful subtalar fusion was determined clinically and radiographically. RESULTS: There was an 88% (37/42) union rate without graft use and an 83% (78/93) union rate with bone graft use. Odds ratio of union for graft versus no graft was 0.703 (95% CI, 0.237-2.08). The average time to union in the graft group was 3 ± 0.73 months and 3 ± 0.86 in the non-graft group, with no statistically significant difference detected (p = 0.56). CONCLUSION: Graft use did not improve union rates for subtalar arthrodesis. Level of Evidence IV, Case Series.

OBJETIVOS: O propósito deste estudo foi comparar as taxas de união de artrodese subtalar isolada com e sem uso de enxertos ósseos ou seus substitutos. MÉTODOS: Revisamos retrospectivamente 135 fusões subtalares com seguimento médio de 18 ± 14 meses. A via de acesso padrão foi utilizada em todas as cirurgias. Os enxertos utilizados incluíram fosfato b-tricálcico, matriz óssea desmineralizada, autoenxerto e aloenxertos da crista ilíaca e aloenxerto de lascas de osso trabecular. A fusão subtalar bem-sucedida foi determinada clínica e radiograficamente. RESULTADOS: Verificou-se uma taxa de união de 88% (37/42) sem uso de enxerto e de 83% (78/93) com enxerto ósseo. A análise da razão de chances (odds ratio) de união óssea para enxerto e não enxerto foi 0,703 (IC 95%, 0,237-2,08). O tempo médio de união no grupo com enxerto foi de 3 ± 0,73 meses e 3 ± 0,86 no grupo sem enxerto, sem detecção de diferença estatisticamente significante (p = 0,56). CONCLUSÃO: O uso de enxerto não melhorou as taxas de união na artrodese subtalar. Nível de Evidência IV, Série de Casos.

RESUMO

ABSTRACT Objectives: The purpose of this study was to compare union rates for isolated subtalar arthrodesis with and without the use of bone grafts or bone graft substitutes. Methods: We retrospectively reviewed 135 subtalar fusions with a mean follow-up of 18 ± 14 months. The standard approach was used for all surgeries. Graft materials included b-tricalcium phosphate, demineralized bone matrix, iliac crest autograft and allograft, and allograft cancellous chips. Successful subtalar fusion was determined clinically and radiographically. Results: There was an 88% (37/42) union rate without graft use and an 83% (78/93) union rate with bone graft use. Odds ratio of union for graft versus no graft was 0.703 (95% CI, 0.237-2.08). The average time to union in the graft group was 3 ± 0.73 months and 3 ± 0.86 in the non-graft group, with no statistically significant difference detected (p = 0.56). Conclusion: Graft use did not improve union rates for subtalar arthrodesis. Level of Evidence IV, Case Series.

RESUMO Objetivos: O propósito deste estudo foi comparar as taxas de união de artrodese subtalar isolada com e sem uso de enxertos ósseos ou seus substitutos. Métodos: Revisamos retrospectivamente 135 fusões subtalares com seguimento médio de 18 ± 14 meses. A via de acesso padrão foi utilizada em todas as cirurgias. Os enxertos utilizados incluíram fosfato b-tricálcico, matriz óssea desmineralizada, autoenxerto e aloenxertos da crista ilíaca e aloenxerto de lascas de osso trabecular. A fusão subtalar bem-sucedida foi determinada clínica e radiograficamente. Resultados: Verificou-se uma taxa de união de 88% (37/42) sem uso de enxerto e de 83% (78/93) com enxerto ósseo. A análise da razão de chances (odds ratio) de união óssea para enxerto e não enxerto foi 0,703 (IC 95%, 0,237-2,08). O tempo médio de união no grupo com enxerto foi de 3 ± 0,73 meses e 3 ± 0,86 no grupo sem enxerto, sem detecção de diferença estatisticamente significante (p = 0,56). Conclusão: O uso de enxerto não melhorou as taxas de união na artrodese subtalar. Nível de Evidência IV, Série de Casos.

RESUMO

Abstract Acquired Cystic Kidney Disease (ACKD) is regarded as a common late condition of end stage renal damage and expresses its most important features when associated with long term hemodialysis. ACKD is also widely known as a premalignant lesion. Its occurrence in chronically rejected renal allografts is rare and its frequency and behavior in this setting are not well known. Herein we report a case of ACKD in a long standing nonfunctional allograft (215 months) which is not associated with malignancy and briefly review the related literature.

Resumo A doença renal cística adquirida (ACKD) é considerada uma condição tardia relacionada à doença renal crônica terminal e manifesta-se de modo mais evidente no contexto de hemodiálise de longo prazo. ACKD é amplamente reconhecida como lesão pré-maligna. Sua ocorrência em enxertos renais cronicamente rejeitados é rara, de modo que a frequência e o comportamento da entidade nesse cenário não estão bem documentados. Relatamos a ocorrência de ACKD em um aloenxerto renal não funcionante sem malignidade após 215 meses de transplante e brevemente revisamos a literatura relacionada.

Assuntos

RESUMO

Bone replacement materials have been widely used to reconstruct atrophic jawbones. Based on previous reports demonstrating the presence of viable cells in bone blocks even after processing by musculoskeletal tissue banks for orthopedic use, the aim of this study was to evaluate the presence of cells in bone blocks from three Brazilian tissue banks for maxillary reconstructions. All samples were processed by the respective tissue banks, according to the guidelines of the Brazilian National Sanitary Surveillance Agency. Three samples were removed from each block for subsequent histological processing and stained using hematoxylin & eosin. Further evaluation included section staining by the Feulgen method and ultrastructural analysis using scanning electron microscopy (SEM). Light microscopy images from all bone samples showed presence of osteocyte-like cells in all groups and intense Feulgen staining, demonstrating presence of DNA in bone even after tissue processing. The ultrastructural analysis showed red blood cells in lacunae within the bone tissue. In conclusion, despite bone tissue processing by the musculoskeletal tissue banks, cells may be found within the bone used for allogeneic grafts.

Resumo Substitutos ósseos têm sido amplamente utilizados para reconstrução de ossos maxilares atróficos. Uma vez que relatos anteriores demonstram a existência de células viáveis em blocos ósseos após processamento pelos bancos de tecidos músculo-esqueléticos para uso ortopédico, o objetivo deste trabalho foi avaliar a presença de células provenientes de três bancos de tecidos músculo-esqueléticos do Brasil. Todas as amostras foram processadas pelos respectivos bancos seguindo as normas da Agência Nacional de Vigilância Sanitária brasileira. Foi realizada a retirada de 3 amostras de cada bloco, que foram destinadas para processamento histológico e subsequente coloração por hematoxilina e eosina e Feugen e análise ultra-estrutural através de microscopia eletrônica de varredura (MEV). As imagens de microscopia de luz de todos os fragmentos de enxertos ósseos mostraram presença de células do tipo osteócito em todos os grupos avaliados, bem como intensa coloração por Feulgen, demonstrando a presença de DNA nos ossos mesmo após o processamento realizado. As análises ultraestruturais evidenciaram a presença de hemácias nas lacunas do tecido ósseo. Conclui-se que mesmo após os processamentos realizados pelos bancos de tecidos músculo-esqueléticos é possível encontrar células nos ossos utilizados para enxertia alógena.

Assuntos

RESUMO

OBJECTIVE: The present study aimed to report the results of the first series of cases of fresh ostechondral allografts in the knee joint in Brazil with a minimum follow-up of two years. METHODS: A protocol of procurement, harvesting, processing, and utilization of fresh osteochondral allografts in the knee joint was established, beginning with legislation modifications, graft harvesting techniques, immediate processing, storage of fresh grafts, and utilization of two surgical techniques of osteochondral transplantation. Eight patients were treated and followed-up for a minimum of two years. RESULTS: Patients were evaluated with subjective IKDC, KOOS, and modified Merle D'Aubigne and Postel questionnaires. Mean subjective IKDC score was 31.99 ± 13.4 preoperative and 81.26 ± 14.7 at the latest follow-up; preoperative KOOS score was 46.8 ± 20.9 and postoperative was 85.24 ± 13.9, indicating a significant improvement over time (p < 0.01). Mean modified Merle D'Aubigne-Postel score was 8.75 ± 2.25, preoperatively, and 16.1 ± 2.59 postoperatively. Friedman test for non-parametric samples demonstrated a significant improvement in postoperative scores (p < 0.01). CONCLUSION: The use of fresh osteochondral allografts in Brazil is a safe procedure, with good clinical results in the short- and medium-term for the treatment of osteochondral lesions greater than 4 cm2 in the knee joint.

OBJETIVO: Relatar os resultados dos primeiros casos de transplante osteocondral a fresco na articulação do joelho no Brasil com um mínimo de seguimento de dois anos. MÉTODOS: Foi feito um protocolo de captação, processamento e uso de transplantes osteocondrais a fresco na articulação do joelho. Iniciou-se com modificações na legislação vigente, técnicas de captação de enxertos, processamento imediato, armazenamento a fresco dos enxertos e uso de duas técnicas cirúrgicas de transplante osteocondral. Oito pacientes foram transplantados e acompanhados com mínimo de dois anos de seguimento. RESULTADOS: Os pacientes foram avaliados por meio dos questionários do International Knee Documentation Committee (IKDC) subjetivo, Knee Injury and Osteoarthritis Outcome Score (KOOS) e índice de Merle D'Aubigne e Postel modificado. A média da pontuação da escala IKDC subjetiva pré-operatória foi de 31,99 ± 13,4 e de 81,26 ± 14,7 no pós-operatório e da escala KOOS pré-operatória foi de 46,8 ± 20,9 e de 85,24 ± 13,9 no pós-operatório, com melhoria significativa ao longo do tempo (p < 0,01). A média da pontuação pelo índice de Merle D'Aubigne e Postel modificado foi de 8,75 ± 2,25 no pré-operatório e de 16,1 ± 2,59 no pós-operatório. O resultado do teste de Friedman para amostras não paramétricas demonstrou melhoria significativa ao longo do tempo (p < 0,01). CONCLUSÕES: O transplante osteocondral a fresco no Brasil é um procedimento seguro, com bons resultados clínicos em curto e médio prazo para o tratamento de lesões osteocondrais maiores do que 4 cm2 na articulação do joelho.