ALBERTO TESCONI CROCI
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Ortopediae Traumatologia, Faculdade de Medicina - Docente
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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- Use of closed suction drainage after primary total hip arthroplasty: a prospective randomized controlled trial(2018) FAGOTTI, Lorenzo; EJNISMAN, Leandro; MIYAHARA, Helder de Souza; GURGEL, Henrique de Melo Campos; CROCI, Alberto Tesconi; VICENTE, Jose Ricardo NegreirosABSTRACT Objective: This study aimed to investigate drain use in a controlled population of patients with hip osteoarthritis undergoing primary total hip arthroplasty. Methods: This prospective controlled trial evaluated 93 patients randomized into two groups: a group that received drains and a group that did not. The patients who were randomized to the drain group used a 3.2 mm drain placed under the fascia that was kept in place for 24 h. Postoperative evaluations were performed after 24 h and then three, six, and 12 weeks after total hip arthroplasty. The primary outcome was perioperative blood loss in both groups 24 h after total hip arthroplasty. The other parameters that were evaluated included mid-thigh circumference, the rate of blood transfusion, hematocrit, inflammatory serum levels, and the Harris Hip Score. Results: The clinical and laboratory data revealed no differences between the study groups with respect to blood loss and need for blood transfusion, duration of hospital stay, reoperation rate, complications, inflammatory serum markers, and the Harris Hip Score. Patients without closed suction drainage reported higher pain levels after 24 h (VAS score 1 vs. 2, p < 0.01). Conclusion: Similar clinical and laboratory outcomes were found in both cohorts.
- Femoroacetabular Impingement and Acetabular Labral Tears - Part 1: Pathophysiology and Biomechanics(2020) EJNISMAN, Leandro; RICIOLI JÚNIOR, Walter; QUEIROZ, Marcelo Cavalheiro; VICENTE, Jose Ricardo Negreiros; CROCI, Alberto Tesconi; POLESELLO, Giancarlo CavalliAbstract Femoroacetabular impingement (FAI) is an important cause of hip pain, and the main etiology of hip osteoarthritis in the young population. Femoroacetabular impingement is characterized by subtle alterations in the anatomy of the acetabulum and proximal femur, which can lead to labrum tearing. The acetabular labrum is essential to the stability of the hip joint. Three types of FAI were described: cam (anespherical femoral head), pincer (acetabular overcoverage) and mixed (characteristics of both cam and pincer). The etiology of FAI is related to genetic and environmental characteristics. Knowledge of this condition is essential to adequately treat patients presenting with hip pain.
- 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.
- Osteonecrosis of the Femoral Head: Update Article(2022) MIYAHARA, Helder de Souza; RANZONI, Lucas Verissimo; EJNISMAN, Leandro; VICENTE, José Ricardo Negreiros; CROCI, Alberto Tesconi; GURGEL, Henrique Melo de CamposAbstract Among the pathologies that affect the hip joint, osteonecrosis of the femoral head (ONFH) is probably the most intriguing and challenging. It consists of a multifactorial disease with a highly-variable spectrum in its clinical presentation. It has a devastating effect, due to disabling painful conditions, both for usual activities and sports. Given the huge range of risk factors, such as prolonged use of corticosteroids (especially in cases of rheumatologic diseases), trauma sequelae, sickle cell anemia, HIV, alcoholism, smoking, blood dyscrasias, and several other diseases that compromise the blood supply to the femoral head, ONFH has a varied clinical presentation and prognosis, which makes it difficult to determine a specific treatment, especially in cases in which chondral involvement has not yet occurred and the hip joint is still preserved. These are the main factors found in the literature that determine the classifications of this pathology. The range of treatments includes several options for cases in which an attempt is made to save the joint: conservative treatment, traditional decompression and/or combined with some type of adjuvant treatment (homologous grafting, synthetic grafting, vascularized grafts, tantalum screws, and bone marrow aspirate injection), and, for cases in which there is already a subchondral fracture and/or collapse of the femoral head and/or a reduction in the joint space, femoral osteotomies or total hip arthroplasty are commonly performed.
- Social profile and cost analysis of deep infection following total hip replacement surgery(2017) FRAZÃO, Vera Lucia; MIYAHARA, Helder de Souza; KIRIHARA, Ricardo Akihiro; LIMA, Ana Lucia Lei Munhoz; CROCI, Alberto Tesconi; VICENTE, José Ricardo NegreirosABSTRACT OBJECTIVE: To characterize the socio-economic and demographic profile of patients undergoing surgery for revision total hip arthroplasty regarding the diagnosis of deep prosthetic infection. METHODS: Twenty patients were retrospectively studied, admitted in the period between 2009 and 2010 by the Hip Surgery Group with the diagnosis of deep prosthetic infection, whose proposed treatment was surgical. This study was carried out in the presence of the patient by completing two forms applied by the social worker of the Group. RESULTS: In a 20-patient sample, 40% were male, 45% were working age, 50% of patients originated from the capital, 85% depended on benefits, 70% were retired, 60% of patients were from this hospital, and 40% were from other services. The average cost of patients to the public system was R$ 55,821.62 per patient and the total spent on treatment of patients in the study exceeded one million Brazilian reals, totalling R$ 1,116,432.40. CONCLUSION: Infection from total hip arthroplasty generates a major expense to the social security system and to the public healthcare system. Physicians must always be alert to the possible risk factors and perioperative care, striving to minimize this complication.
- Are femoroacetabular impingement tomographic angles associated with the histological assessment of labral tears? A cadaveric study(2018) EJNISMAN, Leandro; DOMB, Benjamin G.; SOUZA, Felipe; JUNQUEIRA, Consuelo; VICENTE, Jose Ricardo Negreiros; CROCI, Alberto TesconiPurpose This study sought to investigate the association between tomographic femoroacetabular impingement (FAI) angles and histologically evaluated labral tears. The authors hypothesized that cadavers presenting with cam and pincer morphologies would present a higher prevalence of acetabular labral tears. Methods Twenty fresh cadavers were submitted to computed tomography. Standard FAI angles were measured, including the alpha angle, femoral version, acetabular version, Tonnis angle and center-edge angle. A cam lesion was defined as an alpha angle greater than 50 degrees. A pincer lesion was defined as a center-edge angle greater than 40 degrees, a Tonnis angle less than 0 degrees or acetabular version less than 0 degrees. After dissection, three fragments of each acetabulum, corresponding to the antero-superior, superior and postero-superior acetabular rim, were obtained. These fragments were submitted to routine histological preparation. Each slide was evaluated for possible labral tears. Tears were classified according to their Seldes type. Results The mean age of the cadavers was 50.2 years (SD: 7.4; 13 males). Sixteen (80%) of the cadavers had a cam lesion, and eight cadavers (40%) had a pincer lesion. Histologically, 16 (80%) of the cadavers had a labral tear in at least one region. According to the Seldes classification, 60.7% and 28.6% of these labral tears were type 1 and type 2, respectively. A mixed type of labral tear (10.7%), which represented a new form of Seldes tear, was described. Cadavers with a labral tear had significantly higher alpha angles than other cadavers (53.29 degrees vs 49.33 degrees, p = 0.01). Pincer lesions were not associated with labral tears. We found no association between pincer or cam lesions and Seldes classification. Conclusion Cadavers presenting with higher alpha angles had a higher incidence of labral tears. No association was found between FAI and Seldes classification. Clinical relevance This study demonstrated a high prevalence of FAI abnormalities associated with histological alterations in a cadaveric sample. Joint damage may be present in the early stages of FAI.
- Proposal for a new clinical test for diagnosing lateral hip snapping,(2014) CABRITAA AMORIM, Henrique Antonio Berwanger de; GURGELA, Henrique Melo de Campos; MARQUES, Ricardo; SANTOS, Leandro Emilio Nascimento; VICENTEA, José Ricardo Negreiros; LEONHARDTA, Marcos de Camargo; EJNISMANA, Leandro; CROCI, Alberto TesconiLateral hip snapping is a nosological entity that is often unknown to many orthopedists and even to some hip surgery specialists. It comprises palpable and/or audible snapping on the lateral face of the hip that is sometimes painful, caused by muscle-tendon friction on the greater trochanter during flexion and extension of the coxofemoral joint. In the following, we describe a new test for diagnosing lateral hip snapping, which is eminently clinical.
- Acetabular Component Positioning in Total Hip Arthroplasty With and Without a Computer-Assisted System: A Prospective, Randomized and Controlled Study(2014) GURGEL, Henrique M. C.; CROCI, Alberto T.; CABRITA, Henrique A. B. A.; VICENTE, Jose Ricardo N.; LEONHARDT, Marcos C.; RODRIGUES, Joao CarlosIn a study of the acetabular component in total hip arthroplasty, 20 hips were operated on using imageless navigation and 20 hips were operated on using the conventional method. The correct position of the acetabular component was evaluated with computed tomography, measuring the operative anteversion and the operative inclination and determining the cases inside Lewinnek's safe zone. The results were similar in all the analyses: a mean anteversion of 17.4 degrees in the navigated group and 14.5 degrees in the control group (P = .215); a mean inclination of 41.7 degrees and 42.2 degrees (P = .633); a mean deviation from the desired anteversion (15 degrees) of 5.5 degrees and 6.6 degrees (P = .429); a mean deviation from the desired inclination of 3 degrees and 3.2 degrees = .783); and location inside the safe zone of 90% and 80% (P = .661). The acetabular component position's tomography analyses were similar whether using the imageless navigation or performing it conventionally.
- 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.
- Formation of a pseudotumor in total hip arthroplasty using a tribological metal-polyethylene pair(2015) FAGOTTI, Lorenzo; VICENTE, José Ricardo Negreiros; MIYAHARA, Helder Souza; OLIVEIRA, Pedro Vitoriano de; BERNABÉ, Antônio Carlos; CROCI, Alberto TesconiABSTRACT The aim here was to report a case of a young adult patient who evolved with tumor formation in the left thigh, 14 years after revision surgery on hip arthroplasty. Davies in 2005 made the first description of this disease in patients undergoing metal-on-metal hip arthroplasty. Over the last decade, however, pseudotumors around metal-on-polyethylene surfaces have become more prevalent. Our patient presented with increased volume of the left thigh 8 years after hip arthroplasty revision surgery. Two years before the arising of the tumor in the thigh, a nodule in the inguinal region was investigated to rule out a malignant neoplastic process, but the results were inconclusive. The main preoperative complaints were pain, functional limitation and marked reduction in the range of motion of the left hip. Plain radiographs showed loosening of acetabular and femoral, and a large mass between the muscle planes was revealed through magnetic resonance imaging of the left thigh. The surgical procedure consisted of resection of the lesion and removal of the components through lateral approach. In respect of total hip arthroplasty, pseudotumors are benign neoplasms in which the bearing surface consists of metal-on-metal, but they can also occur in different tribological pairs, as presented in this case.