FERNANDO PORTILHO FERRO
Projetos de Pesquisa
Unidades Organizacionais
LIM/41 - Laboratório de Investigação Médica do Sistema Músculoesquelético, Hospital das Clínicas, Faculdade de Medicina
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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.
- Multiple deep tissue cultures in primary total hip arthroplasty: prognostic value for periprosthetic infection(2022) FERRO, Fernando P.; BESSA, Felipe S.; MIYAHARA, Helder; EJNISMAN, Leandro; VICENTE, Jose R. N.; CROCI, Alberto T.Background: The risk of infection after total hip replacement (THR) is significant, with negative impact on quality of life and high costs. Bacteria can contaminate the surgical site despite aseptic techniques; however, there is debate regarding the benefit of identifying bacteria during the primary procedure. Although taking multiple samples for culture is a well-established practice in revision arthroplasty, doing so in primary cases remains controversial. We aimed to investigate whether there is a prognostic value in the culture of samples taken during primary THR, seeking a correlation between the positivity of the cultures and subsequent prosthetic joint infection (PJI). Methods: Deep samples (capsule, femoral and acetabular bone) were collected from 426 patients undergoing elective primary THR. Follow-up was at least 3 years. Microbiological profiles of cultures were analysed. Patient data were reviewed for the identification of risk factors presumably associated with a higher risk of PJI. Results: 54 surgeries (12.6%) had positive cultures. 16 cases (3.8%) developed infection, of which 5 had a positive culture in the primary surgery. Infection rate was 9.3% in patients with positive culture and 3% in those with negative culture (p < 0.05), with an odds ratio of 3.34 (95% CI, 1.09-10.24). Patients with previous hip surgery had an infection rate of 8.5%, compared to 2.9% in patients with no previous surgery (p < 0.05). Conclusions: Routinely harvesting microbiologic samples in primary THR is not justified, as it has no consequence in clinical decision for most patients. It might be recommended in selected cases that are suspected to be at high risk for infection, especially previously operated patients (conversion arthroplasty).
- Arthroscopic bullet removal from the hip joint and concurrent treatment of associated full-thickness chondral defects: A case report(2019) FERRO, Fernando P.; BESSA, Felipe S.; EJNISMAN, Leandro; GURGEL, Henrique M. C.; CROCI, Alberto T.; VICENTE, Jose R. N.The diagnosis of a bullet inside the hip joint is a rare finding. The usual method to treat this condition has been open surgery, with its associated complications and morbidity. The arthroscopic approach has been increasingly utilized for the diagnosis and treatment of several hip conditions, and the number of indications for this technique has been steadily rising. We report the case of a 35-year-old man who suffered a gunshot wound and was operated on for abdominal perforation. He later presented with groin pain that worsened with weight-bearing on his right leg and then underwent arthroscopic removal of a bullet located inside his right hip joint. After a 2-year follow-up, the patient had an excellent clinical outcome, with no radiologic signs of arthritis. The removal of an intra-articular projectile is necessary to avoid complications such as synovitis, osteoarthritis, septic arthritis, and saturnism. The best access to the hip joint remains a topic of debate. Arthroscopy has the advantage of less soft-tissue damage and quicker recovery. The treatment of associated chondral lesions can be done with several techniques, including microfracture, autologous chondrocyte implantation, mosaicplasty, and fresh osteochondral allograft transplantation. There is no consensus as to the best course of treatment for associated chondral lesions in such cases. Hip arthroscopy can be a safe and effective technique for the removal of intra-articular bullets in the hip.
- Traumatic spondylolisthesis of the axis: epidemiology, management and outcome(2012) FERRO, Fernando Portilho; BORGO, Gustavo Dias; LETAIF, Olavo Biraghi; CRISTANTE, Alexandre Fogaca; MARCON, Raphael Martus; LUTAKA, Alexandre SadaoObjective: To evaluate cases of traumatic spondylolisthesis of the axis and describe them in relation to epidemiology, classification, neurological deficit, healing time and treatment method. Method: A retrospective analysis of the medical records of patients treated between 2002 and 2010 at IOT-FMUSP. Inclusion criteria: pars interarticularis fracture of C2. Results: 68% were male patients, with a mean age of 39.1 years. We used the classification by Effendi, modified by Levine-Edwards. Type I fractures were observed in five patients (31.2%) and type II in eight patients (50%). Only three patients (18%) had type IIa fracture. There were no cases of type III. Mechanism: Eight car accidents and four falls. Other mechanisms: being run over, and diving accidents. Treatment with halo traction was used in eleven patients, using minerva cast and halo-cast. Healing time: 3.6 months. Follow-up time: 9.6 months. Discussion: In general, hangman fracture has a good prognosis, which is confirmed by our results. There was no need for surgery in any of the cases. The incidence of neurological deficit is low. No patient had unstable fracture (type III). Conclusion: This paper suggests that traumatic spondylolisthesis of the axis continues to be an injury that is successfully treated by conservative treatment in most cases. Level of Evidence IV, Case series.