A qualidade de vida dos idosos com coxartrose

Um dos fenómenos marcantes desde os meados do século XX até aos dias de hoje é o processo de envelhecimento das sociedades a nível mundial (Moura, 2006). Envelhecer de forma saudável e com boa qualidade de vida é algo que todas a pessoas desejam, mas muitas vezes o envelhecimento é acompanhado por diferentes tipos de alterações que poderão provocar alterações da qualidade de vida do idoso. A investigação científica acerca da relação entre a qualidade de vida do idoso com coxartrose e o impacto da artroplastia total da anca é ainda um tema recente. Assim esta investigação tem como objetivo avaliar a perceção da qualidade de vida dos idosos com coxartrose, antes da cirurgia da artroplastia total da anca, e avaliar a perceção da qualidade de vida dos idosos após o sexto mês da artroplastia total da anca. Procedeu-se assim a um estudo de natureza descritivo, longitudinal e de abordagem quantitativa, com 35 utentes idosos que foram submetidos a artroplastia total da anca por patologia de coxartrose. Foi utilizado como instrumento de recolha de dados o questionário genérico de qualidade de saúde SF-36 no dia antes da cirurgia e após 6 meses da artroplastia total da anca e um questionário de forma a fazer uma caracterização sócio - demográfica da amostra. Verifica-se que a perceção da qualidade de vida dos idosos com coxartrose, antes da cirurgia da artroplastia total da anca é limitada em várias dimensões como função física desempenho físico, dor corporal, perceção geral de saúde, vitalidade, função social, desempenho emocional, saúde mental e transição de saúde. Após o sexto mês da artroplastia total da anca, a perceção da qualidade de vida dos idosos apresenta-se na maioria dos sujeitos melhorada.

EVIDENCE FOR MECHANICAL STRAINS INFLUENCE IN OSTEOPHYTE DEVELOPMENT

Purpose: Osteophytes are osteo-cartilaginous metaplastic tissue outgrowths of bone capped by cartilage usually found in degenerative and inflammatory joint disease. The presence and degree of maturity of osteophytes, along with joint space narrowing, are the main radiographic criteria for diagnosis and grading osteoarthritis (OA). Although osteophytes are known for being anatomic signs of advanced OA, they can occur in non-symptomatic joints, in joints with no other observable alterations, and in early stage OA. It remains unclear if they develop from molecular, physiological and/or mechanical stimuli. We hypothesized that mechanical strains play a role in osteophyte development. The overall objective of this thesis was to find evidence that osteophytes are influenced by mechanical strains. Methods: The first project was to develop a mechanically-induced osteophyte animal model. One single impact load that was reported to induce moderate joint damage was applied to the periosteum of the rat knee. Animals were sacrificed at four time points to characterize the evolution of damaged tissue and the joint by histology. A second study using human mature hip osteophytes was conducted to evaluate if mature osteophyte presented histological signs of proliferating and developmental processes. The histological characterization of mature osteophyte was used to compare findings of the mechanically-induced osteophyte in the animal model to validate the use of this rodent model in studying some aspect of osteophyte development of human. Lastly, a detailed three-dimensional (3D) radiological morphometric analysis was performed on microscopic computed tomography (µCT) scanned femoral heads collected from total hip arthroplasty patients presenting mature hip osteophytes. Quantitative morphometric measures of osteophytes internal structure was compared to three regions of the femoral head of known quality of organisation and mechanical constraint. Results and Conclusion: Osteophyte can be mechanically induced by a single load impact to the joint periosteum, indicating that a moderate trauma to the periosteal layer of the joint may play a role in osteophyte development. Mature osteophytes have proliferation, developing and remodelling zones and have trabecular structures. Mechanically-induced osteophytes and mature osteophytes presented similar histological composition. Mature osteophytes have organized internal structure. These results provide evidence that mechanical strain can influence osteophyte development.

Dosimetric optimization of CT protocols for the preoperative planning of hip arthroplasty

Radiation dose in x-ray computed tomography (CT) has become a topic of great interest due to the increasing number of CT examinations performed worldwide. In fact, CT scans are responsible of significant doses delivered to the patients, much larger than the doses due to the most common radiographic procedures. This thesis work, carried out at the Laboratory of Medical Technology (LTM) of the Rizzoli Orthopaedic Institute (IOR, Bologna), focuses on two primary objectives: the dosimetric characterization of the tomograph present at the IOR and the optimization of the clinical protocol for hip arthroplasty. In particular, after having verified the reliability of the dose estimates provided by the system, we compared the estimates of the doses delivered to 10 patients undergoing CT examination for the pre-operative planning of hip replacement with the Diagnostic Reference Level (DRL) for an osseous pelvis examination. Out of 10 patients considered, only for 3 of them the doses were lower than the DRL. Therefore, the necessity to optimize the clinical protocol emerged. This optimization was investigated using a human femur from a cadaver. Quantitative analysis and comparison of 3D reconstructions were made, after having performed manual segmentation of the femur from different CT acquisitions. Dosimetric simulations of the CT acquisitions on the femur were also made and associated to the accuracy of the 3D reconstructions, to analyse the optimal combination of CT acquisition parameters. The study showed that protocol optimization both in terms of Hausdorff distance and in terms of effective dose (ED) to the patient may be realized simply by modifying the value of the pitch in the protocol, by choosing between 0.98 and 1.37.

Comparison of the Effects of Electrical Field Stimulation and Low-Level Laser Therapy on Bone Loss in Spinal Cord-Injured Rats

Objective: This study investigated the effects of low-level laser therapy (LLLT) and electrical stimulation (ES) on bone loss in spinal cord-injured rats. Materials and Methods: Thirty-seven male Wistar rats were divided into four groups: standard control group (CG); spinal cord-injured control (SC); spinal cord-injured treated with laser (SCL; GaAlAs, 830 nm, CW, 30mW/cm, 250 J/cm(2)); and spinal cord-injured treated with electrical field stimulation (SCE; 1.5 MHz, 1: 4 duty cycles, 30 mW, 20 min). Biomechanical, densitometric, and morphometric analyses were performed. Results: SC rats showed a significant decrease in bone mass, biomechanical properties, and morphometric parameters (versus CG). SCE rats showed significantly higher values of inner diameter and internal and external areas of tibia diaphyses; and the SCL group showed a trend toward the same result (versus SC). No increase was found in either mechanical or densitometric parameters. Conclusion: We conclude that the mentioned treatments were able to initiate a positive bone-tissue response, maybe through stimulation of osteoblasts, which was able to determine the observed morphometric modifications. However, the evoked tissue response could not determine either biomechanical or densitometric modifications.

The effect of oestrogen and alendronate therapies on postmenopausal bone loss around osseointegrated titanium implants

Objectives This study evaluated the influence of oestrogen deficiency and its therapies on bone tissue around osseointegrated implants. Methods Implants were placed in 66 female rats tibiae. The animals were assigned into five groups: control (CTL), sham, ovariectomy (OVX), oestrogen (EST), and alendronate (ALE). While CTL was sacrificed 60 days after implant placement, other groups were subjected to ovariectomy or sham surgery according to group and euthanized after 90 days. Blood and urine samples were collected at sacrifice day for osteocalcin (OCN) and deoxypyridinoline (DPD) quantification. Densitometry of femur and lumbar vertebrae was performed in order to evaluate rats` skeletal impairment. Non-decalcified sections were referred to fluorescent and light microscopy for analyses of mineral apposition rate (MAR), eroded and osteoclastic surfaces, bone-to-implant contact (BIC), and bone area fraction occupancy (BAFO). Results Results from the OVX group showed significantly lower bone mineral density (BMD), BIC, BAFO, and MAR, while OCN, deoxipiridinoline, eroded surface and ostecoclastic surface were increased compared with the other groups of the study. ALE reduced OCN and DPD concentrations, MAR, osteoclastic and eroded surfaces, and no difference was in BIC and BAFO relative to SHAM. EST and CTL showed similar results to SHAM for measurements. Conclusions Oestrogen deficiency exerted a negative influence on bone tissue around implants, while oestrogen replacement therapy and alendronate were effective against its effects. Although alendronate therapy maintained the quantity of bone around implants, studies evaluating bone turnover kinetics are warranted. To cite this article:Giro G, Coelho PG, Pereira RMR, Jorgetti V, Marcantonio E Jr, Orrico SRP. The effect of oestrogen and alendronate therapies on postmenopausal bone loss around osseointegrated titanium implants.Clin. Oral Impl. Res. 22, 2011; 259-264.doi: 10.1111/j.1600-0501.2010.01989.x.

Down-regulation of expression of osteoblast and osteocyte markers in periodontal tissues associated with the spontaneous alveolar bone loss of interleukin-10 knockout mice

The aim of this study was to unravel the mechanisms by which interleukin (IL)-10, a potent pleiotropic cytokine, modulates alveolar bone homeostasis in C57BL/6 wild-type (WT) and IL-10 knockout (IL-10 KO) mice, evaluated at 8, 24, and 48 wk of age. Interleukin-10 KO mice presented significant alveolar bone loss when compared with WT mice, and this was not associated with changes in leukocyte counts or bacterial load. The levels of expression of messenger RNA (mRNA) for tumor necrosis factor-alpha (TNF-alpha), IL-1 beta, IL-6, transforming growth factor-beta (TGF-beta), receptor activator of nuclear factor kappa B ligand (RANKL), osteoprotegerin (OPG), and matrix metalloproteinase 13 (MMP13) were similar between both strains, whereas a significant decrease of tissue inhibitor of metalloproteinase 1 (TIMP1) mRNA expression was found at 48 wk in IL-10 KO mice. The osteoblast markers core binding factor alpha1 (CBFA1) and type I collagen (COL-I) were expressed at similar levels in both strains, whereas the levels of alkaline phosphatase (ALP) and osteocalcin (OCN), and those of the osteocyte markers phosphate-regulating gene endopeptidases (PHEX) and dentin matrix protein 1 (DMP1) were significantly lower in IL-10 KO mice. Our results demonstrate that the alveolar bone loss in the absence of IL-10 was associated with a reduced expression of osteoblast and osteocyte markers, an effect independent of microbial, inflammatory or bone-resorptive pathways.

The Potential Role of Suppressors of Cytokine Signaling in the Attenuation of Inflammatory Reaction and Alveolar Bone Loss Associated with Apical Periodontitis

Inflammatory cytokines contribute to periapical tissue destruction. Their activity is potentially regulated by suppressors of cytokine signaling (SOCS), which down-regulate signal transduction as part of an inhibitory feedback loop. We investigated the expression of the cytokines tumor necrosis factor alpha (TNF-alpha); interleukin (IL)-10 and RANKL; and SOCS-1, -2, and -3 by real-time polymerase chain reaction in 57 periapical granulomas and 38 healthy periapical tissues. Periapical granulomas exhibited significantly higher SOCS-1, -2, and -3, TNF-alpha, IL-10, and RANKL messenger RNA levels when compared with healthy controls. Significant positive correlations were found between SOCS1 and IL-10 and between SOCS3 and IL-10. Significant inverse correlations were observed between SOCS1 and TNF-alpha, SOCS1 and RANKL, and SOCS3 and TNF-alpha. Increased SOCS-1, -2, and -3 messenger RNA levels in periapical granulomas may be related to the downregulation of inflammatory cytokines in these lesions; therefore, SOCS molecules may play a role in the dynamics of periapical granulomas development. (J Endod 2008;34:1480-1484)

A study compared nine patient-specific indices for musculoskeletal disorders.

BACKGROUND AND OBJECTIVE: Patient-specific quality of life indices show great potential, but certain conceptual and methodological concerns have yet to be fully addressed. The present study reviewed nine patient-specific instruments used in musculoskeletal disorders: the Canadian Occupational Performance Measure (COPM), Juvenile Arthritis Quality of life Questionnaire (JAQQ), McMaster-Toronto Arthritis questionnaire (MACTAR), Measure Yourself Medical Outcome Profile (MYMOP), Patient-Specific Index (PASI) for total hip arthroplasty, Problem Elicitation Technique (PET), Patient Generated Index (PGI) of quality of life, Patient-Specific Functional Scale (PSFS), and Schedule for the Evaluation of Individual Quality of Life (SEIQoL). STUDY DESIGN AND SETTING: Each tool was evaluated for purpose, content validity, face validity, feasibility, psychometric properties, and responsiveness. RESULTS: This critical appraisal revealed important differences in terms of the concept underlying these indices, the domains covered, the item-generation techniques and the scoring (response scale, methods) in each scale. The nine indices would generate different responses and likely scores for the same patient, despite the fact that they all include patient-generated items. CONCLUSION: Although the value of these indices in treatment planning and monitoring at an individual level is strong, more studies are needed to improve our understanding of how to interpret the numeric scores of patient-specific indices at both an individual and a group level.

Medial migration of lag screw after gamma nailing.

Fractures of the proximal femur are common in the elderly population. Intramedullary nailing has become the standard treatment for intertrochanteric fractures although several extramedullary implants (e.g. dynamic hip screw (DHS), blade plate, locking compression plate (LCP), etc.) exist. However, despite this being a very common operation in traumatology, there are numerous associated complications. We report the rare complication of the migration of the medial lag screw into the pelvis at five and a half weeks postoperatively. The implant was removed and replaced by a total hip arthroplasty with simultaneous grafting of the acetabular defect and strapping of the greater trochanter. The evolution was favourable. We also present a review of the literature and analyze our case.

Koiran lonkan nivelrikon hoito sementittömällä ja sementoidulla lonkkaproteesilla : tapausselostus

Summary: Treatment of degenerative joint disease of the hip with uncemented and cemented total hip arthroplasty in a dog : a case report

Évaluation biomécanique de la locomotion à la suite d'une arthroplastie de la hanche

Depuis les dernières années, la prévalence de personnes souffrant de dégénérescence des cartilages articulaires, communément appelée ostéoarthrite (OA), ne cesse d’augmenter. Les douleurs articulaires et les raideurs musculaires associées à cette pathologie mènent à des limitations des capacités fonctionnelles, à une perte de mobilité et d’autonomie affectant grandement la qualité de vie de ces personnes. Afin de soulager les personnes souffrant de cette pathologie, l’arthroplastie de la hanche est une procédure chirurgicale fréquemment utilisée. À la suite de cette chirurgie, une amélioration de la qualité de vie et une reprise des capacités fonctionnelles sont souvent observées. Cependant, comparativement à des sujets sains, la vitesse de marche est diminuée, une faiblesse des muscles abducteurs de la hanche est constatée et des mouvements compensatoires au niveau du tronc sont persistants. L’objectif de cette thèse est d’évaluer le patron locomoteur chez des patients qui subiront une arthroplastie de la hanche. Plus spécifiquement, les adaptations locomotrices pré et post-opératoires seront quantifiées dans le but d’apporter des modifications aux programmes de réhabilitation pour ainsi favoriser un patron locomoteur sans déficit. Afin de répondre à cet objectif, trois études distinctes ont été effectuées. Dans le cadre de la première étude, l’impact de l’implantation d’une prothèse totale de la hanche avec une tête fémorale de large diamètre et une prothèse de resurfaçage a été évalué par rapport aux sujets sains lors de la locomotion. Au cours de cette étude, le contrôle du tronc a été analysé en utilisant la distance entre le centre de masse corporel et le centre articulaire de la hanche opérée. Suite aux résultats obtenus, aucune différence majeure n’existe entre les deux types de prothèses en ce qui a trait au contrôle du tronc et ce, à un an post-opératoire. Lors de la deuxième étude, la symétrie des paramètres biomécaniques des membres inférieurs lors de la locomotion chez des patients ayant bénéficié de l’implantation d’une prothèse de la hanche a été caractérisée suite à un programme d’exercices péri-opératoires (pré et post-opératoire). Lors de cette étude, le programme d’exercices péri-opératoires était complémentaire au protocole de réadaptation du centre hospitalier. D’après les résultats obtenus lors de cette étude exploratoire, ce programme d’exercices péri-opératoires semble permettre d’améliorer la symétrie de la puissance et du travail musculaire au niveau de la hanche, du genou et de la cheville favorisant ainsi un patron de marche avec de minimes compensations. Finalement, dans le cadre de la troisième étude, l’approche prédictive et l’approche fonctionnelle, utilisées pour localiser le centre articulaire de la hanche, ont été comparées aux mesures radiographiques, chez des patients à la suite d’un remplacement articulaire de la hanche. À la suite de cette étude, les résultats démontrent que l’utilisation de l’approche fonctionnelle est plus appropriée chez des patients ayant bénéficié d’une arthroplastie de la hanche. En effet, cette approche individualisée est plus précise ce qui, par conséquent, permettra d’obtenir des résultats de plus grande qualité lors d’analyses biomécaniques de la locomotion.

Simvastatin therapy in cyclosporine A-induced alveolar bone loss in rats

Background and Objective: Cyclosporine A treatment is important in the therapy of a number of medical conditions; however, alveolar bone loss is an important negative side-effect of this drug. As such, we evaluated whether concomitant administration of simvastatin would minimize cyclosporine A-associated alveolar bone loss in rats subjected, or not, to experimental periodontal disease. Material and Methods: Groups of 10 rats each were treated with cyclosporine A (10 mg/kg/day), simvastatin (20 mg/kg/day), cyclosporine A and simvastatin concurrently (cyclosporine A/simvastatin) or vehicle for 30 days. Four other groups of 10 rats each received a cotton ligature around the lower first molar and were treated similarly with cyclosporine A, simvastatin, cyclosporine A/simvastatin or vehicle. Calcium (Ca(2+)), phosphorus and alkaline phosphatase levels were evaluated in serum. Expression levels of interleukin-1 beta, prostaglandin E(2) and inducible nitric oxide synthase were evaluated in the gingivomucosal tissues. Bone volume and numbers of osteoblasts and osteoclasts were also analyzed. Results: Treatment with cyclosporine A in rats, with or without ligature, was associated with bone loss, represented by a lower bone volume and an increase in the number of osteoclasts. Treatment with cyclosporine A was associated with bone resorption, whereas simvastatin treatment improved cyclosporine A-associated alveolar bone loss in all parameters studied. In addition, simvastatin, in the presence of inflammation, can act as an anti-inflammatory agent. Conclusion: This study shows that simvastatin therapy leads to a reversal of the cyclosporine A-induced bone loss, which may be mediated by downregulation of interleukin-1 beta and prostaglandin E(2) production.