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.
- 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.
- 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.
- 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.
- A modified iliofemoral approach to intrapelvic acetabular revision - technical note(2018) VICENTE, José Ricardo Negreiros; MIYAHARA, Helder de Souza; EJNISMAN, Leandro; SOUZA, Bruno de Biase; GURGEL, Henrique Melo; CROCI, Alberto TesconiABSTRACT Among the patterns of acetabular osteolysis associated with acetabular loosening, the authors emphasize the severity of pelvic dissociation and medial segmental losses in which the quadrilateral lamina is severely affected. Such lesions are potentially lethal in cases of large vascular injury. This note aimed to describe a modified iliofemoral approach in cases of massive intrapelvic migration of the acetabular component in patients with total proximity of the iliac vascular bundle and absence of an anatomical demarcation plane between the migrated contents and the iliac bundle. This approach was performed in 12 of 21 patients who had these criteria.
- Translation and validation of the new version of the Knee Society Score - The 2011 KS Score - into Brazilian Portuguese(2017) SILVA, Adriana Lucia Pastore e; CROCI, Alberto Tesconi; GOBBI, Riccardo Gomes; HINCKEL, Betina Bremer; PECORA, José Ricardo; DEMANGE, Marco KawamuraABSTRACT OBJECTIVE: Translation, cultural adaptation, and validation of the new version of the Knee Society Score - The 2011 KS Score - into Brazilian Portuguese and verification of its measurement properties, reproducibility, and validity. In 2012, the new version of the Knee Society Score was developed and validated. This scale comprises four separate subscales: (a) objective knee score (seven items: 100 points); (b) patient satisfaction score (five items: 40 points); (c) patient expectations score (three items: 15 points); and (d) functional activity score (19 items: 100 points). METHOD: A total of 90 patients aged 55-85 years were evaluated in a clinical cross-sectional study. The pre-operative translated version was applied to patients with TKA referral, and the post-operative translated version was applied to patients who underwent TKA. Each patient answered the same questionnaire twice and was evaluated by two experts in orthopedic knee surgery. Evaluations were performed pre-operatively and three, six, or 12 months post-operatively. The reliability of the questionnaire was evaluated using the intraclass correlation coefficient (ICC) between the two applications. Internal consistency was evaluated using Cronbach's alpha. RESULTS: The ICC found no difference between the means of the pre-operative, three-month, and six-month post-operative evaluations between sub-scale items. CONCLUSION: The Brazilian Portuguese version of The 2011 KS Score is a valid and reliable instrument for objective and subjective evaluation of the functionality of Brazilian patients who undergo TKA and revision TKA.
- Clinical and radiographic outcomes of hip resurfacing arthroplasty after eight years - a retrospective study(2018) BESSA, Felipe Spinelli; FUENTES, Ronald Delgadillo; MIYAHARA, Helder de Souza; CROCI, Alberto Tesconi; EJNISMAN, Leandro; VICENTE, José Ricardo NegreirosABSTRACT Objective: To assess the clinical and radiographic outcomes of hip resurfacing arthroplasty for the treatment of hip osteoarthritis. Methods: This study retrospectively assessed 30 patients with hip osteoarthritis who underwent hip resurfacing arthroplasty between 2005 and 2014. Patients of both genders suffering from advanced primary and secondary hip osteoarthritis were included in the study. Data were collected about postoperative complications and the need for revision of the arthroplasty. Antero-posterior pelvis and lateral hip x-rays were performed in order to classify osteolysis according to the Amstutz criteria; the Lequèsne index of severity for osteoarthritis of the hip and the UCLA activity level questionnaires were answered pre- and postoperatively. Results: After a mean follow-up of eight years, a statistically significant improvement was observed between the mean of the outcomes of both scores, when compared pre- and postoperatively (p < 0.001). Nevertheless, there was a high incidence of arthroplasty revision (20%), related to the size of the femoral stem and errors in surgical technique. Conclusion: Using the appropriate technique, hip resurfacing arthroplasty can present good results in well-selected patients.
- 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.
- Total hip arthroplasty using a posterior minimally invasive approach - results after six years(2015) VICENTE, José Ricardo Negreiros; MIYAHARA, Helder Souza; LUZO, Carlos Malheiros; GURGEL, Henrique Melo; CROCI, Alberto TesconiOBJECTIVE: To evaluate the medium-term clinical-functional results (minimum follow-up of six years) from total uncemented hip arthroplasty performed by means of a posterior minimally invasive access, in comparison with the traditional right lateral access. METHODS: In a comparative prospective study, 224 adult patients underwent elective total hip arthroplasty due to a diagnosis of primary or secondary osteoarthrosis. A group of 103 patients with posterior minimally invasive access was compared with a group of 121 patients with the traditional right lateral access. The mean length of follow-up among the patients of this sample was 7.2 years. We evaluated the clinical-functional and radiographic results and occurrences of loosening, along with any complications that occurred, with a minimum follow-up of six years. RESULTS: The clinical-functional analyses before the surgical procedure and six years afterwards were similar in the two groups (p = 0.88 and p = 0.55). One patient in the minimally invasive group underwent revision of the acetabular component and two patients in the control group underwent the same procedure (p = 0.46). The Trendelenburg clinical test, which showed weakness of the hip abductor musculature, was present in five patients operated using the traditional lateral route and absent in all those who underwent the minimally invasive procedure (p = 0.06). There was no difference regarding the radiographic parameters obtained, either in acetabular or in femoral positioning (p = 0.32 and p = 0.58). CONCLUSIONS: The medium-term clinical and radiographic results and the complication rates were similar between the patients who underwent total hip arthroplasty by means of the posterior minimally invasive access and those with the traditional lateral access.
- Fresh osteochondral knee allografts in Brazil with a minimum two-year follow-up(2017) TÍRICO, Luís Eduardo Passarelli; DEMANGE, Marco Kawamura; SANTOS, Luiz Augusto Ubirajara; PÉCORA, José Ricardo; CROCI, Alberto Tesconi; CAMANHO, Gilberto LuísABSTRACT OBJECTIVE: The present study aimed to report the results of the first series of cases of fresh ostechondral allografts in the knee joint in Brazil with a minimum follow-up of two years. METHODS: A protocol of procurement, harvesting, processing, and utilization of fresh osteochondral allografts in the knee joint was established, beginning with legislation modifications, graft harvesting techniques, immediate processing, storage of fresh grafts, and utilization of two surgical techniques of osteochondral transplantation. Eight patients were treated and followed-up for a minimum of two years. RESULTS: Patients were evaluated with subjective IKDC, KOOS, and modified Merle D'Aubigne and Postel questionnaires. Mean subjective IKDC score was 31.99 ± 13.4 preoperative and 81.26 ± 14.7 at the latest follow-up; preoperative KOOS score was 46.8 ± 20.9 and postoperative was 85.24 ± 13.9, indicating a significant improvement over time (p < 0.01). Mean modified Merle D'Aubigne-Postel score was 8.75 ± 2.25, preoperatively, and 16.1 ± 2.59 postoperatively. Friedman test for non-parametric samples demonstrated a significant improvement in postoperative scores (p < 0.01). CONCLUSION: The use of fresh osteochondral allografts in Brazil is a safe procedure, with good clinical results in the short- and medium-term for the treatment of osteochondral lesions greater than 4 cm2 in the knee joint.