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
11 resultados
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- CADAVERIC STUDY ON THE LEARNING CURVE OF THE TWO-APPROACH GANZ PERIACETABULAR OSTEOTOMY(2016) FERRO, Fernando Portilho; EJNISMAN, Leandro; MIYAHARA, Helder Souza; TRINDADE, Christiano Augusto de Castro; FAGA, Antonio; VICENTE, Jose Ricardo NegreirosObjective: The Bernese periacetabular osteotomy (PAO) is a widely used technique for the treatment of non-arthritic, dysplastic, painful hips. It is considered a highly complex procedure with a steep learning curve. In an attempt to minimize complications, a double anterior-posterior approach has been described. We report on our experience while performing this technique on cadaveric hips followed by meticulous dissection to verify possible complications. Methods: We operated on 15 fresh cadaveric hips using a combined posterior Kocher-Langenbeck and an anterior Smith-Petersen approach, without fluoroscopic control. The PAO cuts were performed and the acetabular fragment was mobilized. A meticulous dissection was carried out to verify the precision of the cuts. Results: Complications were observed in seven specimens (46%). They included a posterior column fracture, and posterior and anterior articular fractures. The incidence of complications decreased over time, from 60% in the first five procedures to 20% in the last five procedures. Conclusions: We concluded that PAO using a combined anterior-posterior approach is a reproducible technique that allows all cuts to be done under direct visualization. The steep learning curve described in the classic single incision approach was also observed when using two approaches.
- PUBLICATION RATES OF PAPERS PRESENTED AT THE BRAZILIAN ORTHOPEDIC MEETING(2013) EJNISMAN, Leandro; GOMES, Guilherme Seva; OLIVEIRA, Rafael Garcia de; MALAVOLTA, Eduardo Angeli; GOBBI, Riccardo Gomes; CAMARGO, Olavo Pires deObjective: To quantify the publication rates of the papers presented at the 2007 Brazilian Orthopedics Meeting (Congresso Brasileiro de Ortopedia - CBOT). Methods: Evaluation of the proportion of abstracts submitted by the various orthopedic subspecialties and according to the Brazilian states. Then, a Lilacs and PubMed search was performed in order to determine which presentations generated national or international published papers. Results: Sao Paulo and the Southeast region were responsible for the greatest number of presentations at the congress (54.1% and 68.3% respectively). Shoulder and Elbow were the subspecialty responsible for more presentations (13.8%). Among the 653 studies presented at the congress, 174 (26.6%) were published. Oral presentations obtained a publication rate 3.58 times higher than posters. Conclusion: The CBOT publication rate is lower than 30%. Many of the papers presented at the CBOT does not pass the scrutiny of scientific journals and therefore should not be the only source of scientific update of the participants: Descriptive Epidemiologic.
- 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.
- EPIDEMIOLOGY OF HIP PAIN IN BRAZILIAN BODYBUILDERS(2021) FAGOTTI, Lorenzo; EJNISMAN, Leandro; ALMEIDA-SANTOS, Marcos Antonio; GURGEL, Henrique Melo Campos; MIYAHARA, Helder de Souza; PEDRINELLI, AndreObjective: To determine the frequency of hip pain in competitive bodybuilders over three different bodybuilding competitions. Methods: This study evaluated bodybuilders recruited from three competitions during the year of 2016. All participants provided their informed consent and the study received IRB approval. Training routine, health condition, level of success on competitions, history of hip pain and physical examination of the hip were evaluated. Results: 113 bodybuilders were evaluated, mean age was 30.5 +/- 8.65 years and mean BMI was 25.2 +/- 3.65 kg/m(2). Mean values for hip flexion, adduction, abduction, internal rotation, external rotation and distance between the knee and the table (FABER distance) were 116 +/- 13, 23 +/- 8, 71 +/- 12, 40 +/- 10, 36 +/- 9 and 19 +/- 4, respectively. Eight (7%) participants presented hip pain within the week prior to examination and only 2 (1,7%) presented with anterior impingement sign. None of the athletes who reported hip pain interrupted their physical training or performance. Conclusion: Symptomatic athletes continued their training program under the presence of hip pain. The frequency of hip pain among bodybuilders is high and may be underestimated in this study.
- TWO CLASSIFICATIONS FOR SURGICAL WOUND HEMATOMA AFTER TOTAL HIP REPLACEMENT(2018) FAGOTTI, Lorenzo; EJNISMAN, Leandro; GURGEL, Henrique de Melo Campos; MIYAHARA, Helder de Souza; CROCI, Alberto Tesconi; VICENTE, Jose Ricardo NegreirosObjective: To determine the reliability of two classification methods for wound hematoma after total hip replacement. Methods: This prospective cohort study was conducted on patients who underwent total hip replacement for hip osteoarthritis between May 2014 and April 2015. Epidemiological, surgical, and functional data were assessed. Two experienced hip surgeons evaluated 75 pictures of wounds taken 24 hours after surgery. Both evaluators performed the analysis twice, with a 6-week interval between the two analyses. The subjective classification was divided into four different categories describing the hematoma: absent, mild, moderate, and severe. The objective classification was derived from mathematical calculation of the area of the hematoma using a grid superimposed on a picture of the wound. Results: The subjective classification demonstrated an intra-rater agreement of more than 70%, while kappa values showed poor to moderate inter-rater reliability. The objective classification based on mathematical measurements of the hematoma area was more reliable, with good to excellent intra-and inter-rater reliability. Conclusion: The objective classification demonstrated higher intra-and inter-rater reliability. The classification methods used in this study could serve as a useful instrument for orthopedic surgeons, researchers, and health care providers when assessing wound hematomas after total hip replacement.
- 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.
- THREE-DIMENSIONAL PRINTING IN ORTHOPEDICS : WHERE WE STAND AND WHERE WE ARE HEADING(2021) EJNISMAN, Leandro; HELITO, Camilo Partezani; CAMARGO, Andre Ferrari De Franca; ROCHA, Bruno Aragao; BAPTISTA, Andre Mathias; CAMARGO, Olavo Pires DeThree-dimensional printing is a technology in expansion in the medical field. It also presents many applications in orthopedics. Our review article aims to describe 3D printing, types of 3D printers, and its use in the orthopedic field. 3D models can be created using tomography scans. Those models can then be manipulated, even simulating surgeries. It is possible to print biomodels, which will help us understand deformities and plan surgeries. Orthopedic surgeons must be updated in these disruptive technologies that may help their daily practice. Level of Evidence V, Expert opinion.
- 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.
- BRAZILIAN ORTHOPEDISTS' OPINIONS AND PERCEPTIONS ON FEMOROACETABULAR IMPINGEMENT(2016) EJNISMAN, Leandro; KHAN, Moin; AYENI, Olufemi Roll; BHANDARI, Mohit; MIYAHARA, Helder de Souza; VICENTE, Jose Ricardo NegreirosObjective: To assess the opinion of Brazilian orthopedists surgeons on the diagnosis and treatment of femoroacetabular impingement (FAI). Methods: A questionnaire was sent to several orthopedic societies around the world, including the Sociedade Brasileira de Ortopedia e Traumatologia (SBOT). This questionnaire was sent electronically and included questions on many topics related to FAI. Results: 253 Brazilian orthopedists responded the questionnaire. Sixty-eight point nine percent worked in private practice and 23.1% in academic institutions. Pain during hip rotation was the most important finding in the clinical history according to 81.8% of the respondents and the anterior impingement sign was the most important finding in the physical examination according to 88.2%. Initial treatment was physiotherapy according to 86.2%. Surgical treatment was hip arthroscopy according to 38.8%, and via surgical hip dislocation for 14.7%. Conclusion: Brazilian orthopedists' opinions on FAI are similar to their international colleagues. There is considerable discrepancy in the answers provided, demonstrating a need for future investigation on FAI, in order to institute proper treatment and diagnosis protocols.
- INCISIONAL NEGATIVE-PRESSURE WOUND THERAPY IN REVISION TOTAL HIP ARTHROPLASTY DUE TO INFECTION(2018) MIYAHARA, Helder de Souza; SERZEDELLO, Felipe Ribeiro; EJNISMAN, Leandro; LIMA, Ana Lucia Lei Munhoz; VICENTE, Jost Ricardo Negreiros; HELITO, Camilo PartezaniObjective: To present our institution's experience with negative-pressure wound therapy (NPWT) as an adjuvant in wound healing of patients who have undergone revision total hip arthroplasty (THA) due to septic loosening in the presence of active fistula. Methods: We prospectively assessed patients presenting with THA infection, associated with the presence of fistula, treated with a PICO (R) device for NPWT, in combination with the standard treatment for prosthesis infection in our institution. Resolution of the infectious process and healing of the surgical wound without complications were considered an initial favorable outcome. Results: We assessed 10 patients who used PICO (R) in our department. No complications were identified in association with the use of the NPWT device. The mean follow-up of the patients after use of the device was 12.7 months. Only one patient progressed with fistula reactivation and recurrence of infection. Conclusion: NPWT can be used in wound complications and infection following THA procedures safely and with promising results. Randomized prospective studies should be conducted to confirm its effectiveness.