LEANDRO EJNISMAN
Projetos de Pesquisa
Unidades Organizacionais
Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina - Médico
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
6 resultados
Resultados de Busca
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- RADIOGRAPHIC EVALUATION OF OSSEOINTEGRATION OF UNCEMENTED TARGOS (R) STEMS. A 5-YEAR FOLLOW-UP(2022) MIYAHARA, Helder de Souza; NARCISO, Jorge Henrique; CORREA, Jose Guilherme Lollo; VICENTE, Jose Ricardo Negreiros; EJNISMAN, Leandro; RUDELLI, Bruno Alves; GURGEL, Henrique de Melo Campos; CROCI, Alberto TesconiIntroduction: 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 (R) collared stems in arthroplasties. Methods: Observational study of 182 total hip arthroplasties performed in 2014 with Targos (R) 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 os-seointegration 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), af-fected side (p=0.459), and degree of Dorr (p=0.857). Conclusion: Targos (R) 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.
- Inter and intra-observer agreement of the 3-dimensional CT based anterior inferior iliac spine classification system shows fair-to-moderate agreement among high volume hip surgeons(2023) EFRIMA, Ben; AMAR, Eyal; ROTMAN, Dani; ELIAS, Avital; EJNISMAN, Leandro; BONIN, Nicolas; ALBAGLI, Assaf; BENADY, Amit; SEGAL, Ortal; RATH, EhudPurpose The purpose of this multicenter, multinational study is to evaluate the agreement level of the Hetsroni's classification system across high-volume hip surgeons who specialize in hip preservation surgeries. Methods Four surgeons from three countries reviewed a digital survey that included 93 3D CT images of the hip from 53 patients. The population was composed of individuals who had undergone a pelvis CT scan in a tertiary hospital between 2000 and 2016. Each rater reviewed the images and classified each image according to AIIS subtype I, II, or III. After a minimum of two months, the raters repeated the survey. The inter-rater and intra-rater agreement was then assessed. The kappa values were calculated to determine variability. Results Inter-rater agreement levels yielded fair agreement for both sessions (Kappa = 0.4, p value < 0.001 in the first and Kappa = 0.27, p value < 0.001 in the second). Inter-rater agreement levels separating non-pathological Type I from pathological Types II and III yielded moderate to fair inter-rater agreement levels (K = 0.47, p value < 0.001 in the first session and k = 0.32, p value < 0.001 in the second). Intra-rater reliability displayed moderate agreement (average K = 0.53). Conclusion The current 3D CT-based AIIS classification system shows fair-to-moderate inter- and intra-rater agreement among high-volume hip surgeons. According to this study, the agreement of the Hetsroni classification system is not able to be sufficiently reproduced. Since accurate classification of the AIIS morphology is imperative in establishing proper treatment for SSI, this classification system there is therefore limited in its clinical value.
- ETHICAL AND LEGAL ASPECTS OF TELEMEDICINE APPLIED IN ORTHOPEDICS(2022) YAMAGUCHI, Fabio Seiji MAzz I.; MIYHARA, Helder De Souza; SILVA, Jorge dos santos; RUDELLI, Bruno alves; EJNISMAN, Leandro; GURGEL, Henrique melo de camposDue to the pandemic of COVID-19, many outpatient services were suspended, affecting hundreds of patients. As a result, several countries were forced to seek strategies to readapt their health systems, one of which was the expansion of telemedicine. Currently, telemedicine is used for several specialties, facilitating the treatment and follow-up of patients who have difficulty accessing it. Tele-orthopedics, telemedicine applied to the orthopedic specialty, allows orthopedic care to be offered to patients regardless of orthopedics presents high patient satisfaction, allowing greater rehabilitation effectiveness after surgery and treatment compliance. There is much information in the current literature about telemedicine's legal and ethical aspects, but it is fragmented. and ethical aspects, emphasizing tele-orthopedics. The ethical principles of autonomy, beneficence, non-maleficence and justice must be respected, as well the privacy and confidentiality during use. Level of Evidence V: Expert Opinion.
- Reproducibility of Digital Planning in Cementless Total Hip Arthroplasty Among Experienced and Novice Surgeons(2023) FABRICIO, Marcelo Zerbetto; RUDELLI, Bruno Alves; MIYAHARA, Helder de Souza; EJNISMAN, Leandro; GURGEL, Henrique de Melo Campos; CROCI, Alberto TesconiAbstract Objective The present study aims to assess the reproducibility of digital planning for cementless total hip arthroplasty (THA) among surgeons with different levels of experience. In addition, it attempts to determine the degree of planning reliability based on a contralateral THA or on a spherical marker positioned at the greater trochanter for calibration. Methods Two evaluators with different experience levels (A1 and A2) performed independently the retrospective digital surgical planning of 64 cementless THAs. Next, we compared the planning with the implants used in the surgery. The reproducibility was excellent when planning and implants were identical; proper in case of a single-unit variation; and inappropriate if there was variation in two or more units. The present analysis also determined the calibration accuracy between the contralateral THA and the spherical marker at the greater trochanter level. Results The present study demonstrated greater success when the most experienced evaluator performed the planning and greater accuracy for the contralateral THA. When splitting the analysis per parameter (contralateral THA or spherical marker), there was a statistical difference only for the planning of A1 and the implants used in the surgery. This difference occurred in the excellent category, with 67.3% for contralateral THA compared with 30.6% for a spherical marker (p < 0.001), and in the inappropriate category, with 7.1% for contralateral THA compared with 30.6% for a spherical marker (p < 0.001). Conclusions Digital planning is more accurate when performed by an experienced evaluator. The contralateral prosthesis head was a better reference than a marker on the greater trochanter.
- FEMORAL HEAD DECOMPRESSION AND GRAFT: TECHNIQUE WITH NEW INSTRUMENTS(2022) MIYAHARA, Helder De Souza; RUDELLI, Bruno Alves; RANZONI, Lucas Verissimo; EJNISMAN, Leandro; VICENTE, Jose Ricardo Negreiros; GURGEL, Henrique Melo De CamposIntroduction: Osteonecrosis of the femoral head (ONFH) is a pathol-ogy that can be treated with many approaches by the hip surgeon. Advanced decompression is a technique that aims to prevent the collapse of the femoral head and the arthrosis process of the joint, a technique already widespread and used by hip surgeons. In this study, we performed the technique with a new retractable blade and a new bone substitute as graft for the femoral head. Objective: To evaluate the technique with new instruments (EasyCore Hip (R)) and a calcium phosphate bone substitute (Graftys (R) HBS). Methods: Patients with osteonecrosis of the femoral head without major degenerative changes, such as femoral head collapse, were selected. Femoral head decompression was performed using the EasyCore Hip (R) retractable blade along with the calcium phosphate bone substitute as graft (Graftys (R) HBS). Results: The instruments proved to be reliable and reproducible, and the bone substitute presented good mechanical resistance, maintaining its temperature during the surgery. The dis-posable retractable blade presents variation in size and angle, which is an advantage in the removal of necrotic bone. However, we must take some precautions in order to achieve a better result. Conclusion: using EasyCore Hip (R) instruments and a calcium phosphate bone substitute (Graftys (R) HBS) is safe; however, some precautions must be taken during the use of the technique.
- Mentorship in Medical Residency in Orthopedics: Evaluation of a Program by Mentors and Mentees(2022) MENDES JÚNIOR, Adriano Fernando; PEREIRA, Gabriel Meireles Azevedo; BUSSIUS, Daniel Teixeira; ORTIZ, Rafael Trevisan; EJNISMAN, LeandroAbstract Objective To demonstrate the degree of recommendation of mentors and mentees regarding a mentorship program, to assess the degree of satisfaction of the participants, and to describes the main characteristics of the meetings in pairs. Materials and Methods A primary, retrospective, analytical study based on answers to the annual evaluation questionnaires of the institutional mentorship program in pairs of the Orthopedics and Traumatology residency from December 2017 to February 2021. Results We compiled 52 responses from 26 mentorship preceptors and 26 mentored residents. The mentees and mentors had average ages of 27 (±1.5) years and 45 (±8.2) years respectively. A total of 96% of the participants recommend the program, and 89% of the mentees reported that the mentors contributed to their personal and professional decision-making process. Conclusion The mentorship program proved to be a highly recommended strategy in medical residency in Orthopedics. Data show that mentors contributed to the mentees' personal and professional decision-making process.