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      RADIOGRAPHIC EVALUATION OF OSSEOINTEGRATION OF UNCEMENTED TARGOS® STEMS. A 5-YEAR FOLLOW-UP Translated title: AVALIAÇÃO RADIOGRÁFICA DA OSSEOINTEGRAÇÃO DE HASTES NÃO CIMENTADAS TARGOS®. UM SEGUIMENTO DE 5 ANOS

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          ABSTRACT

          Introduction

          Total hip arthroplasty is a widespread treatment and is considered the gold standard in cases of hip osteoarthritis, with high rates of success in improving pain and function when well performed. After five years of follow-up, this study evaluates the osseointegration of uncemented Targos® collared stems in arthroplasties.

          Methods

          Observational study of 182 total hip arthroplasties performed in 2014 with Targos® cementless collared femoral stems (Lepine). Bone quality was assessed according to the Dorr scale and osseointegration according to the Engh score.

          Results

          The overall mean age was 56.5 years, consisting of 104 men (57.1%) and 103 women (56.6%). The osseointegration rate of the stems (total Engh>0) was 100%. There was no statistical difference between groups concerning age (p=0.262), gender (p=0.463), primary diagnosis (p=0.585), affected side (p=0.459), and degree of Dorr (p=0.857).

          Conclusion

          Targos® cementless collared femoral stems showed excellent osseointegration in all patients evaluated, regardless of age, gender, and preoperative bone quality. Moreover, spot welds observed on preoperative radiographs have the best association with implant osseointegration. Level of evidence IV, case series .

          RESUMO

          Introdução

          A artroplastia total do quadril é um tratamento amplamente difundido, sendo considerado padrão ouro nos casos de osteoartrose do quadril, com altos índices de sucesso na melhora da dor e função, quando bem realizada. Este estudo avalia a presença de osseointegração de hastes com colar não cimentadas Targos® em artroplastias após cinco anos de seguimento.

          Métodos

          Estudo observacional com 182 artroplastias totais de quadril realizadas em 2014 com com hastes femorais com colar não cimentadas Targos® (Lepine). A qualidade óssea foi avaliada de acordo com a escala de Dorr e a osseointegração de acordo com o escore de Engh.

          Resultados

          A média geral de idade foi de 56,5 anos, sendo 104 homens (57,1%) e 103 mulheres (56,6%). A taxa de osseointegração das hastes (Engh total>0) foi de 100%. Não houve diferença estatística nos grupos quanto à idade (p=0,262), sexo (p=0,463), diagnóstico primário (p=0,585), lado acometido (p=0,459) e grau de Dorr (p=0,857).

          Conclusão

          As hastes femorais com colar não cimentadas Targos® apresentaram excelente osseointegração em todos os pacientes avaliados, independentemente da idade, sexo e qualidade óssea pré-operatória. Além disso, a presença de “spot welds” observados nas radiografias pré-operatórias tem a melhor associação com a osseointegração do implante. Nível de evidência IV, case series .

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          Most cited references25

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          OARSI recommendations for the management of hip and knee osteoarthritis, Part II: OARSI evidence-based, expert consensus guidelines.

          To develop concise, patient-focussed, up to date, evidence-based, expert consensus recommendations for the management of hip and knee osteoarthritis (OA), which are adaptable and designed to assist physicians and allied health care professionals in general and specialist practise throughout the world. Sixteen experts from four medical disciplines (primary care, rheumatology, orthopaedics and evidence-based medicine), two continents and six countries (USA, UK, France, Netherlands, Sweden and Canada) formed the guidelines development team. A systematic review of existing guidelines for the management of hip and knee OA published between 1945 and January 2006 was undertaken using the validated appraisal of guidelines research and evaluation (AGREE) instrument. A core set of management modalities was generated based on the agreement between guidelines. Evidence before 2002 was based on a systematic review conducted by European League Against Rheumatism and evidence after 2002 was updated using MEDLINE, EMBASE, CINAHL, AMED, the Cochrane Library and HTA reports. The quality of evidence was evaluated, and where possible, effect size (ES), number needed to treat, relative risk or odds ratio and cost per quality-adjusted life years gained were estimated. Consensus recommendations were produced following a Delphi exercise and the strength of recommendation (SOR) for propositions relating to each modality was determined using a visual analogue scale. Twenty-three treatment guidelines for the management of hip and knee OA were identified from the literature search, including six opinion-based, five evidence-based and 12 based on both expert opinion and research evidence. Twenty out of 51 treatment modalities addressed by these guidelines were universally recommended. ES for pain relief varied from treatment to treatment. Overall there was no statistically significant difference between non-pharmacological therapies [0.25, 95% confidence interval (CI) 0.16, 0.34] and pharmacological therapies (ES=0.39, 95% CI 0.31, 0.47). Following feedback from Osteoarthritis Research International members on the draft guidelines and six Delphi rounds consensus was reached on 25 carefully worded recommendations. Optimal management of patients with OA hip or knee requires a combination of non-pharmacological and pharmacological modalities of therapy. Recommendations cover the use of 12 non-pharmacological modalities: education and self-management, regular telephone contact, referral to a physical therapist, aerobic, muscle strengthening and water-based exercises, weight reduction, walking aids, knee braces, footwear and insoles, thermal modalities, transcutaneous electrical nerve stimulation and acupuncture. Eight recommendations cover pharmacological modalities of treatment including acetaminophen, cyclooxygenase-2 (COX-2) non-selective and selective oral non-steroidal anti-inflammatory drugs (NSAIDs), topical NSAIDs and capsaicin, intra-articular injections of corticosteroids and hyaluronates, glucosamine and/or chondroitin sulphate for symptom relief; glucosamine sulphate, chondroitin sulphate and diacerein for possible structure-modifying effects and the use of opioid analgesics for the treatment of refractory pain. There are recommendations covering five surgical modalities: total joint replacements, unicompartmental knee replacement, osteotomy and joint preserving surgical procedures; joint lavage and arthroscopic debridement in knee OA, and joint fusion as a salvage procedure when joint replacement had failed. Strengths of recommendation and 95% CIs are provided. Twenty-five carefully worded recommendations have been generated based on a critical appraisal of existing guidelines, a systematic review of research evidence and the consensus opinions of an international, multidisciplinary group of experts. The recommendations may be adapted for use in different countries or regions according to the availability of treatment modalities and SOR for each modality of therapy. These recommendations will be revised regularly following systematic review of new research evidence as this becomes available.
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            The operation of the century: total hip replacement.

            In the 1960s, total hip replacement revolutionised management of elderly patients crippled with arthritis, with very good long-term results. Today, young patients present for hip-replacement surgery hoping to restore their quality of life, which typically includes physically demanding activities. Advances in bioengineering technology have driven development of hip prostheses. Both cemented and uncemented hips can provide durable fixation. Better materials and design have allowed use of large-bore bearings, which provide an increased range of motion with enhanced stability and very low wear. Minimally invasive surgery limits soft-tissue damage and facilitates accelerated discharge and rehabilitation. Short-term objectives must not compromise long-term performance. Computer-assisted surgery will contribute to reproducible and accurate placement of implants. Universal economic constraints in healthcare services dictate that further developments in total hip replacement will be governed by their cost-effectiveness.
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              Bone cement implantation syndrome.

              Bone cement implantation syndrome (BCIS) is poorly understood. It is an important cause of intraoperative mortality and morbidity in patients undergoing cemented hip arthroplasty and may also be seen in the postoperative period in a milder form causing hypoxia and confusion. Hip arthroplasty is becoming more common in an ageing population. The older patient may have co-existing pathologies which can increase the likelihood of developing BCIS. This article reviews the definition, incidence, clinical features, risk factors, aetiology, pathophysiology, risk reduction, and management of BCIS. It is possible to identify high risk groups of patients in which avoidable morbidity and mortality may be minimized by surgical selection for uncemented arthroplasty. Invasive anaesthetic monitoring should be considered during cemented arthroplasty in high risk patients.
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                Author and article information

                Contributors
                Role: were the main contributors in writing the manuscript
                Role: evaluated the data from the statistical analysis
                Role: were the main contributors in writing the manuscript
                Role: performed the surgery, followed the patients and gathered clinical data
                Role: performed the surgery, followed the patients and gathered clinical data
                Role: performed the surgery, followed the patients and gathered clinical data
                Role: performed the bibliographic research, revised the manuscript and contributed to the intellectual concept of the study
                Journal
                Acta Ortop Bras
                Acta Ortop Bras
                aop
                Acta Ortopedica Brasileira
                ATHA EDITORA
                1413-7852
                1809-4406
                02 December 2022
                2022
                : 30
                : spe2
                : e250098
                Affiliations
                [1 ]Universidade de São Paulo, Medical School, Orthopedics and Traumatology Institute, São Paulo, SP, Brazil.
                Author notes
                Correspondence: Helder de Souza Miyahara, São Paulo, Brasil Rua Ovídeo Pires de Campos, 333 Cerqueira César. helder_miyahara@ 123456hotmail.com

                All authors declare no potential conflict of interest related to this article.

                AUTHORS’ CONTRIBUTION: Each author contributed individually and significantly to the development of the manuscript.

                Author information
                http://orcid.org/0000-0002-2532-2685
                http://orcid.org/0000-0003-0548-836X
                http://orcid.org/0000-0002-7010-1101
                http://orcid.org/0000-0003-3528-9249
                http://orcid.org/0000-0002-9866-1960
                http://orcid.org/0000-0002-0780-6811
                http://orcid.org/0000-0002-2005-0553
                http://orcid.org/0000-0003-3047-2757
                Article
                00206
                10.1590/1413-785220223002e250098
                9721410
                36506860
                93a34240-3f4b-4551-a24d-7dd4afb6b4e2

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 20 March 2021
                : 18 June 2021
                Page count
                Figures: 0, Tables: 4, Equations: 0, References: 25
                Categories
                Original Article
                Orthopedic Trauma

                hip arthroplasty,osseointegration,femur,osteoar­thritis, hip,artroplastia de quadril,osseointegração,fêmur,osteoartrite do quadril

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