MARCIA UCHOA DE REZENDE
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
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- Effect of postoperative use of nasal oxygen catheter supplementation in wound healing following total knee arthroplasty(2014) HELITO, Camilo Partezani; JUNQUEIRA, Jader Joel Machado; GOBBI, Ricardo Gomes; ANGELINI, Fabio Janson; REZENDE, Marcia Uchoa; TIRICO, Luis Eduardo Passarelli; DEMANGE, Marco Kawamura; ALBUQUERQUE, Roberto Freire da Mota e; PECORA, Jose Ricardo; CAMANHO, Gilberto LuisOBJECTIVES: Healing is an event that is fundamental to the success of total knee arthroplasty. The aims of the present study were to compare the rates of complications related to wound healing between two groups of volunteers submitted to total knee arthroplasty and to evaluate the effects of postoperative oxygen supplementation by means of a nasal catheter. METHOD: A total of 109 patients who underwent total knee arthroplasty were randomized into two groups, namely, groups that did and did not receive postoperative oxygen supplementation via a nasal catheter. The surgical wound was monitored every day during the hospital stay and on the 7th, 14th, 21st, 30th and 42nd postoperative days. Characteristics related to healing were observed, including hyperemia, dehiscence, necrosis, phlyctenules and deep and superficial infection. RESULTS: There were no cases of deep infection. Hyperemia was statistically correlated with the total number of complications in the groups, with oxygen demonstrated to be a protective factor against hyperemia. Approximately 30% of the patients who exhibited hyperemia had other complications, independent of oxygen supplementation. CONCLUSION: Oxygen supplementation following total knee arthroplasty was shown to be effective in diminishing hyperemia around the operative wound. The development of hyperemia was a precursor to other complications, irrespective of whether oxygen supplementation was used.
- SCHOOLING OF THE PATIENTS AND CLINICAL APLICATION OF QUESTIONNAIRES IN OSTEOARTHITIS(2014) CAMPOS, Gustavo Constantino de; KOHARA, Marcelo Tomio; REZENDE, Marcia Uchoa; SANTANA, Olga Fugiko Magashima; MOREIRA, Merilu Marins; CAMARGO, Olavo Pires deObjective: To evaluate the consistency of the questionnaires (WOMAC, Lequesne, VAS, SF 36-PCS and SF 36-MCS) when applied in patients with osteoarthritis of the knees (KOA) verifying if age and level of education interfere with the completion of the questionnaires. Method: One hundred and two patients with KOA answered WOMAC, LESQUESNE, VAS and SF-36 questionnaires and provided data correlated with age and education. The internal consistency of the WOMAC questionnaire was verified with Cronbach's alpha. Pearson's correlations between the questionnaires, age and educational level was performed. Results: Mean age was 65 years old. Schooling averaged 7.94 years; WOMAC 47.95; VAS 63.57; Lequesne 12.29; PCS and MCS 31.91 43.68. Cronbach's alpha for WOMAC 0.9. Education did not affect WOMAC response (r=-0.182, p = 0.067) and MCS (r=0.021 / p=0.835), but showed weak but significant correlation with VAS (r=-0.264 / p=0.007), Lequesne (r=0.277, p=0.005) and PCS (r=0.309/ p=0.002). Age showed significant direct correlation only with PCS (r=0.205, p=0.039). Conclusion: The level of education does not interfere with the completion of WOMAC but may interfere with completing VAS, Lequesne and physical component of SF-36.
- VISCOSUPPLEMENTATION IN PATIENTS WITH HEMOPHILIC ARTHROPATHY(2013) ZELADA, Flavio; ALMEIDA, Adriano Marques de; PAILO, Alexandre Felicio; BOLLIGER NETO, Raul; OKAZAKI, Erica; REZENDE, Marcia Uchoa deObjective: To assess whether viscosupplementation with hyaluronic acid in patients with severe hemophilic arthropathy associated with triamcinolone after washing with saline improves joint pain, stiffness, function and quality of life. Methods: Eleven patients with hemophilic arthritis of the knee with and without involvement of other joints (elbows and ankles) underwent joint lavage with saline and subsequent injection of Hylan and triamcinolone in all affected joints. The patients answered the algo-functional (Lequesne and WOMAC), visual analog scale for pain (VAS) and SF-36 (quality of life) questionnaires preoperatively, and at one and three months postoperatively. Results: Pain (VAS and WOMAC pain) and stiffness (WOMAC stiffness) did not show significant improvement (p = 0.3, p = 0.2, p = 0.1, respectively). However function had significant improvement given by WOMAC total and function (averaging 11 points, p = 0.04 and p = 0.001). There was no significant variation in scores in Lequesne's questionnaire (p = 0.1), yet both mental and physical components of SF-36 presented clinically relevant and significant improvements (p = 0.002). Conclusion: Joint lavage with saline followed by injection of corticosteroids and Hylan is effective in the treatment of hemophilic arthropathy, functionally and in quality of life. Level of Evidence IV, Case series.
- THE NATURAL HISTORY OF THE ANTERIOR KNEE INSTABILITY BY STRESS RADIOGRAPHY(2014) REZENDE, Marcia Uchoa de; HERNANDEZ, Arnaldo Jose; CAMANHO, Gilberto LuisObjective: To analyze the anteroposterior displacement of the knee by means of stress radiography in individuals with unilateral anterior knee instability and relate to time of instability. Methods: Sixty individuals with intact knees (control group) and 125 patients with unilateral anterior instability (AI group) agreed to participate in the study. Gender, age, weight, height, age at injury, time between injury and testing, and surgical findings are studied. Both groups are submitted to anterior and posterior stress radiographies of both knees. Anterior (ADD) and posterior displacement difference (PDD) were calculated between sides. Results: In the control group ADD and PDD are in average, zero, whereas in the AI group ADD averaged 9.8mm and PDD, 1.92mm. Gender, age, weight, height, age at trauma and presence of menisci's lesions do not intervene in the values of ADD and PDD. Meniscal injuries increase with time. ADD and PDD do not relate with the presence or absence of associated menisci's lesions. The ADD and the PDD are related to each other and increase with time. Conclusion: There is a permanent anterior subluxation of the injured knee that is related to the amount of anterior displacement that increases with time. Level of Evidence III, Study Types Case-control study.
article Transplante autólogo de condrócitos(2011) BARRETO, Ronald Bispo; PECORA, Jose Ricardo; GOBBI, Riccardo Gomes; REZENDE, Marcia Uchoa de; CAMANHO, Gilberto LuisThis literature review article describes the autologous chondrocyte implantation (ACI) process - its stages, clinical indications, surgical technique, laboratory protocol, rehabilitation and clinical outcomes. Since 1994, when the ACI was described for the first time, the procedure has improved to become one of the most important surgical alternatives for the treatment of chondral lesions of the knee.- Development of a Fresh Osteochondral Allograft Program Outside North America(2016) TIRICO, Luis Eduardo Passarelli; DEMANGE, Marco Kawamura; SANTOS, Luiz Augusto Ubirajara; REZENDE, Marcia Uchoa de; HELITO, Camilo Partezani; GOBBI, Riccardo Gomes; PECORA, Jose Ricardo; CROCI, Alberto Tesconi; BUGBEE, William DickObjective. To standardize and to develop a fresh osteochondral allograft protocol of procurement, processing and surgical utilization in Brazil. This study describes the steps recommended to make fresh osteochondral allografts a viable treatment option in a country without previous fresh allograft availability. Design. The process involves regulatory process modification, developing and establishing procurement, and processing and surgical protocols. Results. Legislation: Fresh osteochondral allografts were not feasible in Brazil until 2009 because the law prohibited preservation of fresh grafts at tissue banks. We approved an amendment that made it legal to preserve fresh grafts for 30 days from 2 degrees C to 6 degrees C in tissue banks. Procurement: We changed the protocol of procurement to decrease tissue contamination. All tissues were procured in an operating room. Processing: Processing of the grafts took place within 12 hours of tissue recovery. A serum-free culture media with antibiotics was developed to store the grafts. Surgeries: We have performed 8 fresh osteochondral allografts on 8 knees obtaining grafts from 5 donors. Mean preoperative International Knee Documentation Committee (IKDC) score was 31.99 +/- 13.4, improving to 81.26 +/- 14.7 at an average of 24 months' follow-up. Preoperative Knee Injury and Oseoarthritis Outcome Score (KOOS) score was 46.8 +/- 20.9 and rose to 85.24 +/- 13.9 after 24 months. Mean preoperative Merle D'Aubigne-Postel score was 8.75 +/- 2.25 rising to 16.1 +/- 2.59 at 24 months' follow-up. Conclusion. To our knowledge, this is the first report of fresh osteochondral allograft transplantation in South America. We believe that this experience may be of value for physicians in countries that are trying to establish an osteochondral allograft transplant program.
- Adding triamcinolone to viscosupplementation: one year outcome of randomized trial(2014) CAMPOS, Gustavo Constantino; HISSADOMI, Marcelo Issao; FRUCCHI, Renato; PASQUALIN, Thiago; REZENDE, Marcia Uchôa deOBJECTIVE: This is an extended follow-up of a randomized controlled trial to evaluate if the addition of triamcinolone to viscosupplementation could alter one-year pain and function of viscosupplementation alone. This is a Level I Therapeutic study (See Guidelines for Authors for a complete description of levels of evidence). METHODS: In a previously reported study we prospectively enrolled 104 patients with knee osteoarthritis and randomized them to receive either a single intra-articular injection (6 mL) of hylan GF-20 (Group viscosupplementation [Group VS]), or a single intra-articular injection of hylan GF-20 (6 mL) and 1 mL (20 mg) of triamcinolone hexacetonide (Group VS + T). Visual Analogue Scale, WOMACTM, and Lequesne questionnaires were completed at baseline, at weeks 1, 4, 12, 24. At the one-year follow-up point, all patients were recruited and reassessed. RESULTS: At one year, the effects of treatment observed in the previous periods were present, with no differences between groups; only the Group receiving hylan + triamcinolone hexacetonide still showed a difference from baseline in the Visual Analogue Scale questionnaire. CONCLUSIONS: The addition of triamcinolone hexacetonide improves first-week symptoms and functional scores of viscosupplementation and does not alter its adverse effects. There might be benefits for the one-year pain results.
- INTENSITY, DURATION AND TYPE OF PHYSICAL ACTIVITY REQUIRED TO IMPROVE FUNCTION IN KNEE OSTEOARTHRITIS(2017) KIRIHARA, Ricardo Akihiro; CATELAN, Fellipe Bravim; FARIAS, Fabiane Elize Sabino de; SILVA, Cleidneia Aparecida Clemente da; CERNIGOY, Claudia Helena de Azevedo; REZENDE, Marcia Uchoa deObjective: To evaluate the effects of physical activity intensity, type and duration in patients with knee osteoarthritis (KOA). Methods: A retrospective study of 195 KOA patients who were followed for two years after receiving educational material about KOA with or without attending classes. The patients were evaluated at baseline and 24 months. At the evaluations, the patients answered questionnaires pertaining to pain and function (WOMAC, Lequesne, VAS and SF-36); reported the intensity, duration and type of exercise performed per week; and performed the Timed Up & Go (TUG) and Five Times Sit-to-Stand (FTSST) tests. Results: Increased age affected improvements in the TUG results (p=0.017). The type, intensity and duration of physical activity did not correlate with pain, function or quality of life improvements (p>0.05), but the TUG results were on average 4 seconds faster among the patients who practiced intense physical activity and/or exercised for more than 180 minutes per week and/or performed isolated weight training or swam compared with those who remained sedentary after 2 years (p=0.01; p<0.001; p=0.01; p=0.04, respectively). Conclusions: Patients with KOA should aim for intense physical activity and/or more than 180 minutes of exercise per week and/or weight training (bodybuilding) for relevant pain reduction and functional improvement.
- BRAZILIAN CONSENSUS STATEMENT ON VISCOSUPPLEMENTATION OF THE HIP (COBRAVI-Q)(2022) SOUSA, Eduardo Branco De; HAMDAN, Paulo Cesar; MENEGASSI, Zartur Jose Barcelos; ALCHAAR, Adrieni Antunes Do Amaral; TIEPPO, Antonio Martins; SOUZA, Caio Goncalves De; PINHEIRO, Carlos Bruno Reis; ALMEIDA, Cyro Scala De; ROCHA, Eduardo De Melo Carvalho; CUNHA, Fabiano Goncalves; PACHECO, Ivan; REZENDE, Marcia Uchoa De; SOUZA, Marcio Passini Goncalves De; SILVA, Marcos Britto Da; CAMPOS, Gustavo Constantino DeObjective: The Brazilian Consensus on Hip Viscosupplementation aims to generate a referential and consensual source from the theoretical knowledge and clinical experience of specialists in the field. Methods: A multidisciplinary panel was formed with 15 specialists (sports medicine, orthopedists, physiatrists and rheumatologists), based on clinical and academic experience in the use of viscosupplementation of the hip. 12 statements were prepared, discussed and voted. Each panelist gave a value between 0 and 10 on a Likert scale, specifying their level of agreement with the statement. Results: The panel reached a consensus on several aspects of viscosupplementation of the hip, with emphasis on the following statements: best indication is for mild to moderate hip arthrosis; it may be indicated in severe osteoarthritis; results may vary according to the characteristics of the viscosupplement used; Viscosupplementation should not be performed as an isolated procedure, but in conjunction with other rehabilitation and pharmacological measures; best injection technique should be based on anatomical references coupled with imaging guidance; it is a cost-effective procedure. Conclusion: Viscosupplementation is a safe and effective therapy for hip osteoarthritis, even in severe cases. Guided injection is recommended.
- BRAZILIAN CONSENSUS STATEMENT ON VISCOSUPPLEMENTATION OF THE KNEE (COBRAVI)(2019) CAMPOS, Gustavo Constantino de; SOUSA, Eduardo Branco de; HAMDAN, Paulo Cesar; ALMEIDA JUNIOR, Cyro Scala de; TIEPPO, Antonio Martins; REZENDE, Marcia Uchoa de; ALCHAAR, Adrieni Antunes do Amaral; PINHEIRO, Carlos Bruno; ROCHA, Eduardo de Melo Carvalho; CUNHA, Fabiano Gocalves; PACHECO, Ivan; VIEIRA, Mario Sergio Rossi; ANTONIO, Silvio Figueira; MENEGASSI, Zartur Jose BarcelosObjective: The aim of this consensus statement on viscosupplementation is to serve as a reference document based on relevant literature and clinical experience in the treatment of knee osteoarthritis using an intra-articular injection of hyaluronic acid, covering key aspects such as clinical indications, effectiveness, and tolerability. Methods: A multidisciplinary panel including two sports medicine physicians, six orthopedists, four physiatrists, and two rheumatologists were selected based on their clinical and academic experience of viscosupplementation. Sixteen statements were prepared and discussed, after which a vote was held. Each member of the panel gave a score between 0 and 10 on a Likert scale, specifying their level of agreement with the statement. Results: The panel reached a consensus on several issues. Specifically, the panel agreed that the best indication is for mild to moderate knee arthrosis; prior or concomitant use of intraarticular triamcinolone hexacetonide may optimize the effect of hyaluronic acid; viscosupplementation should not be performed as an isolated procedure but in conjunction with other rehabilitative and pharmacological measures; viscosupplementation has analgesic, anti-inflammatory, and chondroprotective effects; and viscosupplementation is cost-effective. Conclusion: This consensus statement provides clear information and guidance for both individuals and payers.