EDUARDO ANGELI MALAVOLTA
Projetos de Pesquisa
Unidades Organizacionais
Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina
14 resultados
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- Outcome assessment in the treatment of rotator cuff tear: what is utilized in Brazil?(2017) ASSUNÇÃO, Jorge Henrique; MALAVOLTA, Eduardo Angeli; DOMINGUES, Vitor Rodrigues; GRACITELLI, Mauro Emilio Conforto; FERREIRA NETO, Arnaldo AmadoABSTRACT This review evaluated the outcomes used in clinical studies involving rotator cuff tear published in the last decade in the two leading Brazilian orthopedic journals. A literature review was performed using the journals Revista Brasileira de Ortopedia and Acta Ortopédica Brasileira. It included all original clinical articles describing at least one outcome measured before or after any clinical or surgical intervention related to rotator cuff tear, published between 2006 and 2015. The authors evaluated range of motion, muscle strength, patient satisfaction, and tendon integrity and functional outcomes scores. There were 25 clinical studies published about rotator cuff in the two principal Brazilian orthopedic journals in the last decade, 20 case series (80%), one case-control (4%), and four cohorts (16%). Objective measures such as muscle strength, patient satisfaction, and evaluation of tendon integrity were little used. Range of motion measurements were performed in 52% of the articles. Evaluations of muscle strength and patient satisfaction were reported by 28% and 16% of the studies, respectively. Only 28% of the articles evaluated tendon integrity after surgery. Of these, 16% did so by magnetic resonance imaging and 12% by , ultrasonography. The most used scale was the UCLA, present in 92% of the articles, while the Constant-Murley appeared in 20%. Scales deemed reliable, with high internal consistency and good responsiveness, were rarely used.
- Reverse shoulder arthroplasty: clinical results and quality of life evaluation(2017) FERREIRA NETO, Arnaldo Amado; MALAVOLTA, Eduardo Angeli; ASSUNÇÃO, Jorge Henrique; TRINDADE, Evelinda Marramon; GRACITELLI, Mauro Emilio ConfortoABSTRACT OBJECTIVE: To evaluate the clinical and radiological results and the impact on quality of life of the reverse shoulder arthroplasty. METHODS: Retrospective case series evaluating 13 patients undergoing reverse shoulder arthroplasty with at least two years of clinical follow-up. Clinical evaluation was performed before and after surgery with the ASES and VAS scales and hand-mouth, hand-neck, and hand-head functional tests. Quality of life was measured with the SF-12 questionnaire. The rate of complications and radiographic postoperative findings were recorded. RESULTS: The patients improved from 23.1 ± 15 to 82.7 ± 15 according to ASES scale (p < 0.001). The physical component of the SF-12 increased from 31.7 ± 6.9 to 47.1 ± 8.6 (p < 0.001), while the emotional increased from 48 ± 12.3 to 55.5 ± 7.5 (p = 0.061). The pain reduced from 7.9 to 1 according to the VAS (p = 0.002). The performance on the hand-mouth, hand-neck, and hand-head functional tests showed significant improvement (p = 0.039, p < 0.001 and p < 0.001, respectively). Complications occurred in 15% of patients and notching, in 31%. CONCLUSION: Reverse shoulder arthroplasty led to a significant clinical improvement according to the ASES and VAS scales. The quality of life has improved according to the physical aspect of the SF-12, and showed a trend of improvement in the emotional aspect. The complication rate was 15%, and notching occurred in 31%.
- Tomographic evaluation of Hill-Sachs lesions: is there a correlation between different methods of measurement?(2017) ASSUNCAO, Jorge Henrique; GRACITELLI, Mauro Emilio Conforto; BORGO, Gustavo Dias; MALAVOLTA, Eduardo Angeli; BORDALO-RODRIGUES, Marcelo; FERREIRA NETO, Arnaldo AmadoBackground Several methods are currently available to evaluate and quantify the glenoid or humeral bone loss; however, none is universally accepted, particularly in the case of Hill-Sachs (HS) lesions. Purpose To establish whether there is correlation among different methods of measuring HS lesions, and to investigate the correlation between glenoid bone loss and the various HS lesion measurements and to assess the inter-observer reliability of such measurements. Material and Methods We assessed computed tomography (CT) or arthro-CT scans taken from individuals with recurrent anterior glenohumeral dislocation. The scans were independently assessed by two examiners. The parameters assessed were as follows: HS lesion width and depth on the axial and coronal planes, articular arc loss on the axial plane, and percentage of glenoid bone loss on the sagittal plane. Results Scans from 50 shoulders were assessed. The percentage of articular arc loss and HS lesion width on the axial plane were the only measurements that exhibited strong correlation (r=0.83; P<0.001). The values of the correlation coefficient corresponding to HS lesion depth on the coronal plane were the lowest. Most of the measurements exhibited moderate correlation. The inter-examiner reliability was good relative to all measurements except for HS lesion width and depth on the coronal plane, for which it was moderate. Conclusion The measurements of articular arc loss and HS lesion width on the axial plane exhibited strong correlation. The inter-examiner reliability relative to articular arc loss, HS lesion width and depth on the axial plane, and glenoid bone loss was good.
- Intraobserver and interobserver agreement in the classification and treatment of proximal humeral fractures(2017) GRACITELLI, Mauro E. C.; DOTTA, Thiago A. G.; ASSUNCAO, Jorge H.; MALAVOLTA, Eduardo A.; ANDRADE-SILVA, Fernando B.; KOJIMA, Kodi E.; FERREIRA NETO, Arnaldo A.Background: There is controversy surrounding the reliability of radiographic measurements and existing classifications for proximal humeral fractures. Methods: Ten orthopedists, divided into 2 groups by length of experience, evaluated radiographs in 3 views from 40 proximal humeral fractures. We evaluated 11 radiographic criteria (including the Neer and pathomorphologic classifications, head-shaft angle, displacement of the humeral shaft, and lesser and greater tuberosities) and treatment indication. We also analyzed the criteria that most influenced the choice of treatment. Results: Interobserver reliability was substantial for the presence of fracture of the greater tuberosity (kappa = 0.749) and medial metaphyseal comminution (kappa = 0.627) and moderate for the pathomorphologic classification (kappa = 0.504), displacement of the greater tuberosity (kappa = 0.422), and treatment decision (kappa = 0.565). Intraobserver reliability was substantial for treatment indication (kappa = 0.620) and presence of displacement of the fracture of the greater tuberosity (kappa = 0.627 and 0.611) and moderate for the Neer (kappa = 0.490) and pathomorphologic (kappa = 0.607) classifications. The results were influenced by the observer's experience. The surgical indication was influenced by the pathomorphologic classification in 50% of the evaluators (odds ratio, 4.85; range, 3.30-8.65). Conclusion: The pathomorphologic classification has higher reliability than the Neer classification and was the factor that most influenced the surgical decision. The determination of the presence of fracture and displacement of the greater tuberosity and medial metaphyseal comminution is reliable with the use of simple radiographs, and the results were influenced by the observer's experience. Level of evidence: Basic Science Study; Validation of Classification System (C) 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. All rights reserved.
- Ultrasound evaluation of the rotator cuff after osteosynthesis of proximal humeral fractures with locking intramedullary nail(2017) GRACITELLI, Mauro Emilio Conforto; MALAVOLTA, Eduardo Angeli; ASSUNÇÃO, Jorge Henrique; MATSUMURA, Bruno Akio; KOJIMA, Kodi Edson; FERREIRA NETO, Arnaldo AmadoABSTRACT Objective: To evaluate supraspinatus tendon integrity with ultrasound (US) in patients submitted to proximal humeral fracture (PHF) fixation with a locking intramedullary nail., Methods: Thirty-one patients with PHF treated with curvilinear locking intramedullary nail, aged between 50 and 85 years, were assessed by US at six months postoperatively and clinically at six and 12 months postoperatively. The primary aim was supraspinatus tendon integrity, evaluated by US at six months postoperatively. Secondary aims included the Constant-Murley, DASH score, and visual analog pain scores, as well as complications and reoperation rates. Results: Full-thickness rotator cuff ruptures were observed in four patients (13%), supraspinatus ruptures in three cases (10%), and subscapularis ruptures in one case (3%). Partial ruptures were diagnosed in 10 cases (32%). The results using the Constant-Murley score at 12 months were 71.3 ± 15.2 points for the entire series, with 73.2 ± 16.1 points for patients without rotator cuff ruptures and 68.7 ± 14.1 points for those with partial or complete ruptures, without a statistically significant difference (p= 0.336). Complications, exclusively for rotator cuff ruptures, were observed in nine patients (29%). Conclusion: A high rate of rotator cuff ruptures was demonstrated, with partial ruptures in 32% of cases and full-thickness ruptures in 13%. However, clinical results are satisfactory, and are not influenced by the presence of rotator cuff ruptures.
- MULTIFOCAL OSTEONECROSIS SECONDARY TO OCCUPATIONAL EXPOSURE TO ALUMINUM(2017) ASSUNCAO, Jorge Henrique; MALAVOLTA, Eduardo Angeli; GRACITELLI, Mauro Emilio Conforto; FILIPPI, Renee Zon; FERREIRA NETO, Arnaldo AmadoMultifocal osteonecrosis is a rare disease; chronic use of corticosteroids is considered the main risk factor. Patients with chronic renal failure can develop aluminum toxicity, which can lead to osteomalacia and encephalopathy. An association between osteonecrosis and aluminum toxicity has been reported among patients with dialytic renal insufficiency. Occupational exposure to aluminum rarely causes lung disease and no cases of bone lesions resulting from exposure to this metal have been reported. In this manuscript, we describe a novel case of a patient with multifocal osteonecrosis associated with chronic occupational exposure to aluminum.
- Impact of proximal humerus version on neck-shaft angle: A clinical study(2017) ASSUNCAO, J. H.; MALAVOLTA, E. A.; BERALDO, R. A.; GRACITELLI, M. E. C.; BORDALO-RODRIGUES, M.; FERREIRA NETO, A. A.Background Two recent experimental studies evaluated the influence of shoulder rotation on neck-shaft angle, with conflicting results. However, there have been no clinical studies of whether this angle varies in different shoulder positions. The present study aimed to determine whether shoulder rotation affects neck-shaft angle on standard radiographs in patients with complaints of shoulder pain. Hypothesis Shoulder rotation does not affect neck-shaft angle. Materials and methods A prospective study was conducted in selected patients with shoulder pain. Three true anterior-posterior radiographic views were obtained: in neutral rotation, 30° external rotation, and internal rotation with patient's arm in a sling. The X-rays were evaluated by three shoulder and elbow surgeons. Inter- and intra-observer reliability was evaluated by Intraclass Correlation Coefficient (ICC). Results Neck-shaft angle on true AP view did not differ between neutral rotation and 30° external rotation: 132° ± 6° and 130° ± 9°, respectively (P > 0.999). In internal rotation with the hand resting on the abdomen, neck-shaft angle was 145° ± 6°: i.e., significantly different (P < 0.001) to the other two positions. Intra- and inter-observer correlation demonstrated excellent reliability. Conclusions Radiographic neck-shaft angle was significantly different in internal rotation with the patient's arm in a sling, compared with views in neutral or 30° external rotation. Intra- and inter-observer correlation showed excellent reliability. Level of evidence II Comparative prospective study. © 2017 Elsevier Masson SAS
- Locking intramedullary nails versus locking plates for the treatment of proximal humerus fractures(2017) GRACITELLI, Mauro E. C.; MALAVOLTA, Eduardo A.; ASSUNCAO, Jorge H.; FERREIRA NETO, Arnaldo A.; SILVA, Jorge S.; HERNANDEZ, Arnaldo JoseIntroduction: Proximal humerus fractures (PHF) are common fractures and are the third most common type of fractures among older adults. The most commonly used implants include the locking plate and the locking intramedullary nail. Areas covered: The aim of this study is to perform a literature review of biomechanical and clinical studies that compare the locking plate and intramedullary nail for PHF osteosynthesis. Expert commentary: Twelve clinical studies and seven biomechanical studies were identified that met this criterion. The findings of this review showed that intramedullary nailing and locking plate fixation yielded similar functional results, but with contrasting complication rates. The biomechanical studies showed controversial results, with most of the studies demonstrating better biomechanical properties for the intramedullary nail. Different types of intramedullary nail for PHF have different characteristics, with curvilinear nails presenting a higher risk of complications.
- Rotator cuff repair in the Brazilian Unified Health System: Brazilian trends from 2003 to 2015(2017) MALAVOLTA, Eduardo Angeli; ASSUNÇÃO, Jorge Henrique; BERALDO, Rodrigo Alves; PINTO, Gustavo de Mello Ribeiro; GRACITELLI, Mauro Emilio Conforto; FERREIRA NETO, Arnaldo AmadoABSTRACT OBJECTIVE: To assess the historical trend of rotator cuff repairs in Brazil between 2003 and 2015, using the database of the Brazilian Unified Health System's (Sistema Único de Saúde [SUS]) Department of Informatics (DataSUS). METHODS: Historical series using DataSUS. Surgeries performed between 2003 and 2015 were included and data relating to cuff tear repair were assessed, including decompression procedures were included. The numerator was the total number of rotator cuff repair and the denominator, the total population of the assessed locality. Population data were based on information from the Instituto Brasileiro de Geografia e Estatística (IBGE). RESULTS: During the period, 50,207 surgeries were performed. The rate was presented as number of procedures per 100,000 inhabitants, and increased from 0.83 to 2.81, a growth of 238%. In 2015, the South region had the highest rate, 6.32, followed by the Southeast, 3.62, while the North had the lowest rate, 0.13. The growing trend can be observed in the Southeast, South, and Midwest, while the rate is stable in the North and Northeast. CONCLUSION: The rate of rotator cuff repairs in Brazil performed through the SUS increased from 0.83 to 2.81 between 2003 and 2015, representing a growth of 238%, but remains lower than that of developed countries. A trend of growth can be observed in the Southeast, South, and Midwest, while the rate is stable in the North and Northeast.
- Clinical outcomes of arthroscopic rotator cuff repair: correlation between the University of California, Los Angeles (UCLA) and American Shoulder and Elbow Surgeons (ASES) scores(2017) ASSUNCAO, Jorge H.; MALAVOLTA, Eduardo A.; GRACITELLI, Mauro E. C.; HIRAGA, Dalton Y.; SILVA, Flavio R. da; FERREIRA NETO, Arnaldo A.Background: There are more than 40 outcome scores for evaluating shoulder pain and function. Some studies have correlated the results obtained using different scales, but none has compared the results obtained by the University of California, Los Angeles (UCLA) and American Shoulder and Elbow Surgeons (ASES) scores. Methods: We performed a retrospective study to evaluate patients who underwent arthroscopic rotator cuff repair with 2 years' follow-up. The patients were evaluated by the UCLA and ASES scores preoperatively and at 6, 12, and 24 months after surgery. The Pearson correlation coefficient (r) was calculated to measure the degree of correlation between the 2 outcome scores. Results: We evaluated 143 patients. At 24 months postoperatively, the UCLAandASES scores were 30.4 +/- 5.8 and 81.2 +/- 20.8, respectively (P < .001). The UCLAand ASES scores showed a very high correlation (r = 0.91, P < .001). In all the postoperative clinical evaluations, the scores obtained from the 2 scales were highly or very highly correlated (r = 0.87-0.92, P < .001). For the preoperative scores, the correlation was moderate (r = 0.67, P < .001). Conclusion: The UCLA and ASES scores presented a very high correlation in the evaluation of surgical treatment of rotator cuff tear. In the preoperative period, the correlation was moderate. (C) 2017ournal of Shoulder and Elbow Surgery Board of Trustees. All rights reserved.