RICCARDO GOMES GOBBI
Projetos de Pesquisa
Unidades Organizacionais
Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina
LIM/41 - Laboratório de Investigação Médica do Sistema Músculoesquelético, Hospital das Clínicas, Faculdade de Medicina
LIM/41 - Laboratório de Investigação Médica do Sistema Músculoesquelético, Hospital das Clínicas, Faculdade de Medicina
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- Valor da avaliação radiográfica pré-operatória dos defeitos ósseos no joelho nas revisões de artroplastia(2012) IAMAGUCHI, Mauricio Masasi; HELITO, Camilo Partezani; GOBBI, Riccardo Gomes; DEMANGE, Marco Kawamura; TIRICO, Luiz Eduardo Passarelli; PECORA, Jose Ricardo; CAMANHO, Gilberto LuisOBJECTIVE: To evaluate the value of preoperative radiographic evaluations for total knee arthroplasty (TKA) revision. METHODS: Thirty-one knees that were operated between 2006 and 2008, in a consecutive series of cases of TKA revision surgery were analyzed retrospectively. THE FOLLOWING CRITERIA WERE EVALUATED: number of wedges or structured bone grafts used for filling the bone defects; locations of the wedges and bone grafts used; and mean thickness of the polyethylene used. The AORI classification was previously established based on preoperative radiographs, using preestablished criteria. After the analysis, the knees were divided into four groups (I, IIA, IIB and III). RESULTS: The mean number of wedges or grafts used in each knee progressively increased among the groups (group I: 1.33; group IIA: 2; group IIB: 4.33; and group III: 4.83) (P = 0.0012). The commonest locations were medial in the tibia and posteromedial in the femur. There were no statistically significant differences in the thickness of the polyethylene used. CONCLUSION: The AORI classification for bone defects in the knee, based on preoperative radiographs, showed a correlation with increasing need to use wedges and/or structured grafts in TKA revisions. However, up to 46% of the knees in groups I and IIA presented bone defects of up to 5 mm that were not diagnosed by means of preoperative radiographs.
- Study on implant stability in cementless total knee arthroplasty(2012) TIRICO, Luis Eduardo Passarelli; PASQUALIN, Thiago; PECORA, Jose Otavio; GOBBI, Riccardo Gomes; PECORA, Jose Ricardo; DEMANGE, Marco KawamuraObjetives: Determine the stability of tibial and femoral components of 20 cementless knee arthroplasties with rotating platform. Methods: The 20 patients (20 knees) underwent an analysis of dynamic radiographs with an image amplifier and maneuvers of varus and valgus which were compared to static frontal and lateral radiographs of the knees and analyzed by two experienced surgeons in a double-blind way. Results: We could observe in this study that both methods showed very similar results for the stability of the tibial and femoral components (p<0.001) using the Kappa method for comparison. Conclusion: The tibial component was more unstable in relation to the femoral component in both static and dynamic studies. Level of Evidence IV, Case Series.
- Judet quadricepsplasty in the treatment of posttraumatic knee rigidity: Long-term outcomes of 45 cases(2012) OLIVEIRA, Vitor G.; D'ELIA, Luis Fernando; TIRICO, Luis Eduardo Passarelli; GOBBI, Riccardo Gomes; PECORA, Jose Ricardo; CAMANHO, Gilberto L.; ANGELINI, Fabio Janson; DEMANGE, Marco K.BACKGROUND: Posttraumatic knee stiffness is a very debilitating condition. Judet's quadricepsplasty technique has been used for more than 50 years. However, few reports of quadricepsplasty results exist in the literature. METHODS: We report the results of 45 cases of posttraumatic arthrofibrosis of the knee treated with Judet's quadricepsplasty. The results of the procedure were analyzed by measuring the degrees of flexion of the operated knees at different time points (before, immediately after, and late postoperatively). RESULTS: The degree of flexion increased from 33.6 degrees (range, 5-80 degrees) preoperatively to 105 degrees (range, 45-160 degrees) immediately after surgery, followed by a slight fall in the range of motion (ROM) in the late postoperative period, which reached an average of 84.8 degrees. There was no significant correlation between knee strength and the patient's gender, but there was a slight trend of lower strength with age. Although Judet's quadricepsplasty technique dates from more than 50 years ago, it still provides good outcomes in the treatment of rigid knees of various etiologies. In general, all cases showed the same pattern of a small decrease in the ROM in the late postoperative period. CONCLUSION: Judet's quadricepsplasty can increase the ROM of rigid knees. The ROM obtained with the surgery persists long term. (J Trauma. 2012; 72: E77-E80.
- Translation and Validation of the Knee Society Score : KSS for Brazilian Portuguese(2012) SILVA, Adriana Lucia Pastore e; DEMANGE, Marco Kawamura; GOBBI, Riccardo Gomes; SILVA, Tania Fernanda Cardoso da; PECORA, Jose Ricardo; CROCI, Alberto TesconiObjective: To translate, culturally adapt and validate the ""Knee Society Score""(KSS) for the Portuguese language and determine its measurement properties, reproducibility and validity. Method: We analyzed 70 patients of both sexes, aged between 55 and 85 years, in a cross-sectional clinical trial, with diagnosis of primary osteoarthritis,undergoing total knee arthroplasty surgery. We assessed the patients with the English version of the KSS questionnaire and after 30 minutes with the Portuguese version of the KSS questionnaire, done by a different evaluator. All the patients were assessed preoperatively, and again at three, and six months postoperatively. Results: There was no statistical difference, using Cronbach's alpha index and the Bland-Altman graphical analysis, for the knees core during the preoperative period (p=1), and at three months (p=0.991) and six months postoperatively (p=0.985). There was no statistical difference for knee function score for all three periods (p=1.0). Conclusion: The Brazilian version of the Knee Society Score is easy to apply, as well providing as a valid and reliable instrument for measuring the knee score and function of Brazilian patients undergoing TKA. Level of Evidence: Level I - Diagnostic Studies Investigating a Diagnostic Test- Testing of previously developed diagnostic criteria on consecutive patients (with universally applied 'gold' reference standard).
- Dor na ponta da haste após revisão de artroplastia total de joelho(2012) ALBINO, Rômulo Ballarin; SANTOS, Lívia Souza; GOBBI, Riccardo Gomes; IAMAGUCHI, Maurício; DEMANGE, Marco Kawamura; TIRICO, Luis Eduardo; PÉCORA, José RicardoOBJECTIVE: To correlate parameters of implants with incidence of pain. METHODS: 32 knees (31 patients) operated on between 2006 to 2008 in a serie of cases of TKA revision surgery were monitored for evidence of pain at the tip of the stem.In all we used uncemented stem Scorpio TS Total Knee® Revision System (Stryker®). Criteria assessed: pain in the leg or thigh without other causes, diameter and length of the nail; position of the rod in the medullary canal, intramedullary canal diameter. RESULTS: Mean age was 66.7 years and mean follow-up was 2.6 years.21,87% of patients reported leg pain, 9.37% thigh pain. The group of pacients with leg pain presented with shaft diameter 14.7 mm, length 80 mm in 71.42% and 155 mm in 28,58%, stem diameter/ intramedullary canal diameter average relation of 0,76, 42.8% had stem malalignment. The group without leg pain presented with shaft diameter 15.2 mm, length 80 mm in 68% and 155 mm in 32%, diameters average relation of 0.80, 20.8% had stem malalignment. The group with thigh pain presented with shaft diameter 18.3 mm, length 80 mm in 66.67% and 155 mm in 33,33%,diameters average relation of 0.75, 0% had stem malalignment The group without thigh pain presented with shaft diameter 16.56 mm, length 80 mm in 70.37% and 155 mm in 29,63%, diameters average relation of 0.79, 14,2% had stem malalignment. CONCLUSION: There was no association between the assessed criteria and pain in the tip of the stem.
- Necrose avascular da cabeça femoral em pacientes HIV positivos: resultados iniciais do tratamento cirúrgico por substituição articular cerâmica-cerâmica(2012) CABRITA, Henrique Amorim; SANTOS, Alexandre Leme de Godoy; GOBBI, Riccardo Gomes; LIMA, Ana Lúcia Munhoz; OLIVEIRA, Priscila Rosalba; EJNISMAN, Leandro; GURGEL, Henrique Melo Campos; UIP, David; CAMANHO, Gilberto LuisOBJECTIVES: To evaluate the initial functional results and early complication rate of ceramic-ceramic total hip replacements among patients living with HIV who presented osteonecrosis of the femoral head. METHOD: Twelve HIV-positive patients with a diagnosis of osteonecrosis of the incongruent femoral head were evaluated using clinical and laboratory criteria and the WOMAC functional scale before and after treatment with joint replacement. RESULTS: We observed that 83.3% of the subjects were taking protease inhibitors, 75% had dyslipidemia and 66.6% had lipodystrophy syndrome. The improvement over the evolution of the WOMAC score was statistically significant at six and twelve months after the operation, in comparison with the preoperative score. We did not observe complications secondary to this procedure. CONCLUSION: Total hip arthroplasty with a ceramic-ceramic implant for treating avascular necrosis of the hip is an appropriate surgical option for this portion of the population. It provides a significant initial functional improvement and a low early complication rate.
- Método de ensaio biomecânico para análise da isometricidade na reconstrução do ligamento patelofemoral medial(2012) SADIGURSKY, David; GOBBI, Riccardo Gomes; PEREIRA, César Augusto Martins; PÉCORA, José Ricardo; CAMANHO, Gilberto LuisOBJECTIVE: To present a biomechanical device for evaluating medial patellofemoral ligament (MPFL) reconstruction and its isometricity. METHODS: An accessible biomechanical method that allowed application of physiological and non-physiological forces to the knee using a mechanical arm and application of weights and counterweights was developed, so as to enable many different evaluations and have a very accurate measurement system for distances between different structures, for analysis on experiments. This article describes the assembly of this system, and suggests some practical applications. Six cadaver knees were studied. The knees were prepared in a testing machine developed at the Biomechanics Laboratory of IOT-HCFMUSP, which allowed dynamic evaluation of patellar behavior, with quantification of patellar lateralization between 0° and 120°. The differences between the distances found with and without load applied to the patella were grouped according to the graft fixation angle (0°, 30°, 60° or 90°) and knee position (intact, damaged or reconstructed). RESULTS: There was a tendency for smaller lateral displacement to occur at fixation angles greater than 30 degrees of flexion, especially between the angles of 45° and 60° degrees of flexion, after the reconstruction. For the other angles, there was no statistical significance. CONCLUSION: The method developed is a useful tool for studies on the patellofemoral joint and the MPFL, and has a very accurate measurement system for distances between different structures. It can be used in institutions with fewer resources available.