artroplastia total do joelho - dr. cláudio gholmia
DESCRIPTION
Nessa aula, o dr. Claudio Ghomia da Clínica Uniort faz o estudo de caso de dois pacientes que se submeteram ao procedimento de Artroplastia Total do Joelho (ATJ).TRANSCRIPT
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Gender™ FLEXPrótese de Joelho
Zimmer
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Conflito de Interesses
• Medsíntese (Zimmer, GmbH)• Tellus (Zimmer, USA)• MB Osteo (Aesculap, GmbH)• Oskar Skin (Depuy, USA)• Tecnimed (Implantcast GmbH)
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POR QUÊ?
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Porque homens e mulheres são diferentes.
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CT 3D
Comparando fêmures masculino e feminino de mesma dimensão A/P 1
FÊMUR FEMININO•Formato mais trapezoidal•Perfil mais fino
Mahfouz M, Booth R Jr, Argenson, J, Merkl, BC, Abdel Fatah EE, Kuhn MJ. Analysis of variation of adult femora using sex specific statistical atlases. Presented at: Computer Methods in Biomechanics and Biomedical Engineering Conference; 2006.
FÊMUR FEMININO
FÊMUR MASCULINO
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TRÓCLEA PROFUNDA
Hofmann A, Tkach T, Evanich C, Camargo M, Zhang Y. Patellar Component Medialization in Total Knee Arthroplasty. The Journal of Arthroplasty. No.2 1997 , Vol 12
TRÓCLEA PROFUNDA
•Normaliza o mecanismo da patela•Aumenta o ADM
TRÓCLEA COM 3 GRAUS MAIOR
MENOR RESSEÇÃO
MENOS DOR
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PATELLAR TRACKS
• Aglietti P, Insall JN, Cerulli G. Patellar pain and incongruence. I: Measurements of incongruence. Clin Orthop. 1983;176:217-224. • Hsu RWW, Himeno S, Coventry MB, Chao EYS. Normal axial alignment of the lower extremity and load bearing distribution at the knee, Clin Orthop. 1990;255:215-227.• Woodland LH, Francis RS. Parameters and comparisons of the quadriceps angle of college-aged men and women in the supine and standing positions. American Journal of Sports Medicine.
1992;20:208-211.
ÂNGULO Q MAIOR
GSF MENOR
GSM GSF
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PLANALTO TIBIAL ASSIMÉTRICO
• Smith, Hofmann 1991; Krug 1993.
•TÍBIA HUMANA É 4,5MM MENOR NO LADO LATERAL
•GSF E GSM COM INSERT TIBIAL ASSIMÉTRICO
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DESENHO ALTA FLEXÃO
• Argenson JN, Komistek RD, Mahfouz M, Walker SA, Aubaniac JM, Dennis DA. A high flexion total knee arthroplasty design replicates healthy knee motion. Clin Orthop. 2004;428:174-179
• Bellemans J, Banks S, Victor J, Vandenneucker H, Moemans A. Fluoroscopic analysis of the kinematics of deep flexion in total knee arthroplasty: influence of posterior condylar offset. Journal of Bone Joint Surgery. (Br). 2002.
•FLEXÃO DE ATÉ 155°
•MAIOR ÁREA DE CONTATO
•REDUZ O POTENCIAL DE IMPACTO FEMORAL
Maior área de contato
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HIGHLY CROSSLINKED POLYETHILENE
• Laurent MP, et al.: High cycle wear of highly crosslinked UHMWPE tibial articular surfaces evaluated in a knee wear simulator. Soc. of Biomaterials 28th Annual Mtg Transactions, 712, 2002.• Yao JQ, Gsell R, Laurent MP et al.: Improved delamination resistance of melt-annealed electronbeam irradiated highly crosslinked UHMWPE knee inserts. Society for Biomaterials 28th Annual
Meeting Transactions, 60, 2002.• Gsell R, Yao JQ, Laurent MP, Crowninshield RD: Improved oxidation resistance of highly crosslinked UHMWPE for total knee arthroplasty. Society for Biomaterials 27th Annual Meeting Transactions,
84, 2001.• Yao JQ, Laurent MP, Johnson TS, et al.: Backside wear of conventional and high crosslinked UHMWPE tibial inserts as tested in knee wear simulator. Society for Biomaterials 29th Annual Meeting
Transactions, 609, 2003.• Maher SA, Furman BD, Wright TM: Reduced fracture toughness of enhanced cross-linked polyethylene is not associated with increased wear damage. Society for Biomaterials 28th Annual Meeting
Transaction, 542, 2002.
•MINIMIZA RADICAIS LIVRES
•RESISTÊNCIA À OXIDAÇÃO
•RESISTÊNCIA À DELAMINAÇÃO
•REDUZ SIGNIFICAMENTE O DESGASTE
Desg
ast
e
mm
3/M
c
Policonvenciona
l
Poli Higly
Crosslinked
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SUCESSO
Paciente
Pós-op
ProcedimPrótese
• TEORIA DOS 4 P´s
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PROCEDIMENTOS MIS
Menor incisão
Menor perda
sanguín.
Menos dor
Menor tempo
hospital
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CASOS CLÍNICOS
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CASO 1
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CASO 1 – NYM – sexo masc. - 53 anos Geno Varo - Artrite Reumatóide
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CASO 1 – NYM – sexo masc. - 53 anos Geno Varo - Artrite Reumatóide
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CASO 1 – Pós-operatório Imediato
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CASO 1 – Pós-operatório Imediato
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CASO 1 – 60 dias Pós-operatório
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CASO 1 – 60 dias Pós-operatório
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CASO 1 – NYM – R-X 19-03-2014
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CASO 1 – NYM – R-X 19-03-2014
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CASO 2
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CASO 2 – JBT – SEXO FEM. – 81 ANOSGENO VARO BILATERAL / ESQUERDO
FRENTE
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CASO 2 – JBT – SEXO FEM. – 81 ANOSGENO VARO BILATERAL / ESQUERDO
PERFIL
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CASO 2 – JBT – SEXO FEM. – 81 ANOSGENO VARO BILATERAL / FRENTE
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CASO 2 – JBT – SEXO FEM. – 81 ANOSGENO VARO BILATERAL / FRENTE
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CASO 2 – JBT – SEXO FEM. – 81 ANOSGENO VARO BILATERAL / DIREITO FRENTE
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CASO 2 – JBT – SEXO FEM. – 81 ANOSGENO VARO BILATERAL / DIREITO PERFIL
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CASO 2 – JBT – SEXO FEM. – 81 ANOSGENO VARO BILATERAL / PÓS-OPERATÓRIO
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CASO 2 – JBT – SEXO FEM. – 81 ANOSESQUERDO / PERFIL
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CASO 2 – JBT – SEXO FEM. – 81 ANOSDIREITO / PERFIL
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CASO 2 – JBT – SEXO FEM. – 81 ANOSPÓS-OPERATÓRIO
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CASO 2 – JBT – SEXO FEM. – 81 ANOSPÓS-OPERATÓRIO
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CASO 2 – JBT – SEXO FEM. – 81 ANOSPÓS-OPERATÓRIO
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CASO 2 – JBT – SEXO FEM. – 81 ANOSPÓS-OPERATÓRIO
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CASO 2 – JBT – SEXO FEM. – 81 ANOSPÓS-OPERATÓRIO
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OBRIGADO
AGRADECIMENTO ESPECIAL A ZIMMER INSTITUTE QUE GENTILMENTE CEDEU IMAGENS E MATERIAIS PARA CONSTRUÇÃO DESSA APRESENTAÇÃO.