RESUMO

Abstract Objective Hip osteoarthritis (HO) causes pain and deranges functioning. Surgical treatment is the preferred approach in severe cases, but clinical comorbidities, age and the long waiting list may compromise quality of life. This study aimed to describe the results of acupuncture for the control pain and improvement of functioning in subjects with HO. Method Twelve severe HO patients were treated with ten weekly sessions of a standardized acupuncture point protocol. Pain intensity was assessed with the Visual Analog Pain Scale (VAS) and quality of life with WOMAC Index. Results Pain intensity (VAS) reduced from 75.8 ± 18.8 mm to 20.0 ± 22.6 mm after 10 acupuncture sessions and 48.3 ± 26.6mm in the follow-up (ANOVA F = 7.99; p < 0.001). WOMAC Index values reduced from 74.7 ± 12.7 to 45.7 ± 22.1 and 54.6 ± 22.9 at the same timepoints. Conclusion Acupuncture is an effective conservative rehabilitation strategy to reduce pain and improve quality of life in subjects with severe HO.

Resumo Objetivo A osteoartrite (OA) de quadril causa dor e perda da funcionalidade. O tratamento cirúrgico é a procedimento de escolha nos casos graves, mas as comorbidades clínicas, a idade e a longa lista de espera podem comprometer a qualidade de vida. Este estudo teve como objetivo descrever os resultados da acupuntura no controle da dor e melhora da funcionalidade em indivíduos com OA de quadril. Método Doze pacientes com OA de quadril grave foram tratados com dez sessões semanais de um protocolo padronizado de pontos de acupuntura. A intensidade da dor foi avaliada pela Escala Visual Analógica de Dor (EVA) e a qualidade de vida pelo Índice WOMAC. Resultados A intensidade da dor (EVA) reduziu de 75,8 ± 18,8mm para 20,0 ± 22,6mm após 10 sessões de acupuntura e 48,3 ± 26,6mm no período de seguimento (ANOVA F = 7,99; p < 0,001). Os valores do Índice WOMAC reduziram de 74,7 ± 12,7 para 45,7 ± 22,1 e 54,6 ± 22,9 nos mesmos momentos. Conclusão A acupuntura é uma estratégia de reabilitação conservadora eficaz para reduzir a dor e melhorar a qualidade de vida em indivíduos com OA de quadril grave.

Assuntos

RESUMO

Total hip arthroplasty is a successful procedure with high rates of functional satisfaction and pain relief. A large number of patients with bilateral hip pathology will require both hip joint replacement, from there born the inquietude to knowing benefits and disadvantage of bilateral simultaneous hip arthroplasty. We present a female patient case who developed bilateral hip osteoarthritis secondary to development dysplasia of the hip which was surgically managed with bilateral arthroplasty at one time. We show a follow-up report of the case and a review of the literature to know the main advantages of this new current of hip arthroplasty in patients with bilateral hip pathology

Assuntos

RESUMO

Ante un escenario clínico de coxalgia por artrosis de cadera se planteó la necesidad de conocer los tratamientos con-servadores más seguros y efectivos para el manejo del dolor. El tratamiento de la artrosis requiere un enfoque integral e individualizado en función de las preferencias del paciente para lograr el máximo beneficio clínico. Existen numerosas estrategias útiles para el manejo del dolor en pacientes con artrosis de cadera siendo fuertemente recomendados de inicio la actividad física, los antiinflamatorios no esteroideos (AINE) orales y en ciertos casos los corticoides intraarticulares, tramadol o duloxetina, siempre asociado con la actividad física. Los ejercicios más recomendados son los aeróbicos y el Tai Chi o yoga. (AU)

Faced with a clinical scenario of coxalgia due to hip osteoarthritis, the need to know the safest and most effective conservative treatments for pain management arose. The treatment of osteoarthritis requires a comprehensive and individualised approach based on the patient's preferences to achieve maximum clinical benefit. There are numerous useful strategies for pain management in patients with hip osteoarthritis being strongly recommended from the beginning such as physical activity, oral non-steroidal anti-inflammatory drugs (NSAID) and in certain cases intra-articular corticosteroids, tramadol or duloxetine, always associated with physical activity. The most recommended exercises are aerobics and Tai Chi or yoga. (AU)

Assuntos

RESUMO

Generar recomendaciones basadas en la mejor evidencia disponible acerca del tratamiento de personas de 55 años y más con artrosis de cadera y/o rodilla, leve o moderada.

Assuntos

RESUMO

OBJECTIVE: (i) To develop quality-of-care indicators suitable for evaluation of care for knee and hip osteoarthritis (KHOA) at the primary care level using data from the electronic health records (EHRs) and (ii) to evaluate the quality of care that patients with KHOA receive at family medicine clinics (FMCs). DESIGN: (i) Development of indicators following the RAND-UCLA method. (ii) A cross-sectional analysis of quality-of-care provided for patients with osteoarthritis. SETTING: Four FMCs in Mexico City. PARTICIPANTS: Knee and hip osteoarthritis patients, older than 19 years. SOURCE OF THE INFORMATION: 2009 EHR data. MAIN OUTCOME MEASURES: Quality of care was evaluated using six indicators developed in the first stage of this study. RESULTS: The quality of care evaluation identified that 26.1% of patients were advised in regard to physical exercise, and weight loss was encouraged in 19.7%. Only 5% of patients received acetaminophen as an initial oral analgesic; 54% of patients at risk for gastrointestinal complications received gastroprotective medicines. On average, the percentage of recommended care received was lower for patients who attended only one visit with family physician (17.6%) and higher for those with >3 visits (41.9%). CONCLUSION: The quality of osteoarthritis care at FMCs in Mexico is suboptimal relative to the standards of care and requires continuous evaluation and implementation of improvement strategies.

Assuntos

RESUMO

OBJECTIVE: To evaluate the implementability of the "2008 Mexican Clinical Practice Guideline for the management of hip and knee osteoarthritis at the primary level of care" within primary healthcare of three Mexican regions using the Guideline Implementability Appraisal methodology version 2 (GLIA.v2). METHODS: Six family physicians, representing the South, North, and Central Mexico, and one Mexican physiatrist evaluated the 45 recommendations stated by the Mexican guideline. The GLIA.v2 methodology includes the execution of qualitative and semi-quantitative techniques. RESULTS: Reviewers' agreement was between moderate to near complete in most cases. Sixty-nine percent of the recommendations were considered difficult to implement within clinical practice. Eight recommendations did not have an appropriate format. Only 6 recommendations were judged as able to be consistently applied to clinical practice. Barriers related to the context of one or more institutions/regions were identified in 25 recommendations. These barriers are related to health providers/patients' beliefs, processes of care within each institution, and availability of some treatments recommended by the guideline. CONCLUSIONS: The guideline presented problems of conciseness and clarity that negatively affect its application within the Mexican primary healthcare context. We identified individual, organizational and system characteristics, which are common to the 3 institutions/regions studied and constitute barriers for implementing the guideline to clinical practice. It is recommended that the 2008-Mexican-CPG-OA be thoroughly revised and restructured to improve the clarity of the actions implied by each recommendation. We propose some strategies to accomplish this and to overcome some of the identified regional/institutional barriers.

Assuntos

Assuntos

RESUMO

El objetivo del presente trabajo es hacer una revisión bibliográfica sobre los estudios y publicaciones más relevantes sobre la Osteoartritis (OA) de Cadera, su implicancia a nivel nacional, sus tratamientos Kinésicos convencionales, la Terapia Manual Ortopédica (TMO), y proponer esta última como complemento terapéutico para el tratamiento de todos nuestros pacientes con OA de cadera. La incidencia de esta patología es generalmente mayor en las mujeres, siendo la máxima incidencia entre los 65 y 74 años con una prevalencia aproximada de 13,5 casos por cada 1.000 personas por año, que va en aumento constante con la edad. A nivel nacional, un 3.8 por ciento de la población adulta refiere padecer de OA, observándose una frecuencia más alta en mujeres, tendencia que aumenta con la edad. Cabe destacar que la OA de cadera es la segunda enfermedad reumática más frecuente e invalidante después de la OA de rodilla, por lo tanto, el tratamiento precoz es la estrategia más importante para mejorar la calidad de vida del afectado y evitar su rápido deterioro que inminentemente conlleva a la discapacidad y finalmente a la cirugía artroplástica. La TMO, es una herramienta terapéutica no invasiva que incluye un conjunto de técnicas que se basan en la evaluación y tratamiento de las disfunciones articulares y de tejidos blandos, teniendo como principal método de ejecución la movilización articular.

The objetive of this study is to make a bibliographic review on the most relevant studies and publications about Osteoarthritis of the hip (OA), its relevance on national level, its conventional Physical Therapy treatments and Orthopaedic Manual Therapy (OMT), and to suggest this last one as therapeutic complement to the treatment of all our patients with Osteoarthrtis of the hip. The impact in this pathology was generalyy bigger on women, the higher impac was between 65 and 74 years with an estimated frequency of 13,5 cases each 1.000 people by year, with a constant increase related to age. On national level, a 3,8 percent of the adult population suffer from OA, with a higher frequency on women, that increases with age. It is important to emphasize that OA of the hip is the second rheumatic illness after OA of the knee. Therefore, an early treatment is the most important strategy to improve people's life quality andt to avoid its quick damage that leads to disability and finally to an arthroplastic surgery. OMT, it is a therapeutic non invasive tool that includes a group of techniques that are based on evaluation and treatment of joint dysfunction and soft tissues, having as a main purpose method the joint movement.

Assuntos

RESUMO

El pellizcamiento fémoroacetabular (PFA) es un sindrome clínico reconocido como fuente de dolor mecánico de cadera y artrosis primaria temprana que se presenta frecuentemente en pacientes jóvenes. El tratamiento de esta patología se encuentra enfocado al manejo sintomático, corrección de las alteraciones óseas asociadas, y la prevención de la eventual progresión a la degeneración osteoarticular. El manejo médico se plantea como una primera opción terapéutica para el alivio sintomático. La infiltración articular es una opción diagnóstica y de tratamiento mínimamente invasiva. Finalmente diversas opciones quirúrgicas han sido desarrolladas para la corrección y reparación de las alteraciones morfológicas. Tradicionalmente se ha manejado de forma segura y efectiva con la luxación controlada de cadera logrando resultados promisorios a corto y mediano plazo. Técnicas artroscópicas menos invasivas son cada vez más utilizadas buscando obtener resultados comparables a la técnica abierta.

The femoroacetabular impingement (FAI), it is a clinical syndrome recognized as source of hip mechanic pain and early osteoarthritis (OA). This pathology is frequent in young patients. Treatment is focused in a symptomatic relief, correction of osseous abnormalities and the prevention of the eventual progression to osteoarticular degeneration. Non invasive medical treatment has been proposed for the symptomatic management. Joint infiltration is a diagnostic and minimally invasive treatment option. Finally multiple surgical options have been developed for the correction and repair of morphologic abnormalities. Traditionally, FAI has been managed safely and effectively by hip dislocation and had promising early and midterm results. Less invasive arthroscopic techniques are now being used to an increasing extent in order to emulate the results of the open technique.

Assuntos

RESUMO

La importancia de la Artrosis u Osteoartritis (OA), radica en su alta frecuencia, las molestias que ocasiona a quienes la padecen y el importante deterioro funcional que suele asociarse al compromiso de rodillas y/o caderas. La Artrosis u Osteoartritis (OA), es la enfermedad articular más frecuente. Su frecuencia va aumentando con la edad, y en los mayores de 60 años se estima que más del 80 por ciento presenta alteraciones radiológicas de OA en al menos una articulación. Es difícil realizar comparaciones directas entre diferentes estudios epidemiológicos, ya que en general difieren en la metodología empleada. El diagnóstico radiológico se ha considerado como el patrón de referencia para estudios epidemiológicos de OA, pero los altos costos hacen que los estudios poblacionales, particularmente en Latinoamérica, sean escasos. Estudios más recientes emplean estrategias que apuntan a evaluar sólo a los que son sintomáticos. La prevalencia de la osteoartritis aumenta con la edad. En estudios de necropsias la OA es casi universal en mayores de 65 años. Un estudio Holandés, usando diagnóstico radiológico, realizado en 6.585 individuos, elegidos de manera aleatoria de la población general, demostró una prevalencia creciente con la edad, especialmente en las mujeres. Los datos a nivel mundial son escasos. En OA de caderas, se han reportado valores de 47 hasta 88 casos por 100.000 habitantes, mientras que para la rodilla se han estimado incidencias entre 164 y 240/100.000.

Assuntos