EDUARDO ANGELI MALAVOLTA
Projetos de Pesquisa
Unidades Organizacionais
Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina
11 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.
- Correlation between the UCLA and Constant-Murley scores in rotator cuff repairs and proximal humeral fractures osteosynthesis(2018) MALAVOLTA, Eduardo Angeli; ASSUNÇÃO, Jorge Henrique; GRACITELLI, Mauro Emilio Conforto; SIMÕES, Pedro Antonio Araújo; SHIDO, Danilo Kenji; FERREIRA NETO, Arnaldo AmadoABSTRACT Objective: To evaluate the correlation between the UCLA and Constant-Murley scores in the surgical treatment of rotator cuff tears and proximal humeral fractures (PHF). Methods: Retrospective study evaluating patients submitted to arthroscopic rotator cuff repair and surgical treatment of PHF with 2-year follow-up. Patients were evaluated by the UCLA and Constant-Murley scores in the preoperative period for the rotator cuff repairs, and 3, 6, 12 and 24 months after surgery for both diagnoses. Pearson's correlation coefficient (r) was calculated to measure the degree of correlation between the two clinical scales. Results: We evaluated 109 patients: 54 with rotator cuff tear and 55 with PHF. Twenty-four months after surgical treatment, the scores according to the UCLA and Constant-Murley scores were 32.6 ± 4.0 and 85.0 ± 12.0 for the rotator cuff tears and 30.3 ± 5.3 and 73.8 ± 13.9 for the PHF, demonstrating significant improvements in both, in relation to the initial evaluation (p < 0.001). The scales demonstrated high correlation (r = 0.88, p < 0.001). The scores obtained in the two scales showed high or very high correlation in all the postoperative clinical evaluations (r = 0.79-0.91, p < 0.001). The correlation was high in the preoperative evaluation (r = 0.73, p < 0.001). Conclusion: The UCLA and Constant-Murley scores presented high or very high correlation in the evaluation of surgical treatment of rotator cuff tears and PHF. The correlation in the preoperative evaluation was high.
- Answer to letter to the editor regarding the article “Asian ethnicity: a risk factor for adhesive capsulitis?”(2019) MALAVOLTA, Eduardo Angeli; GRACITELLI, Mauro Emilio Conforto; ASSUNÇÃO, Jorge Henrique; FERREIRA NETO, Arnaldo Amado
- 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%.
- Septic arthritis of the shoulder and elbow: one decade of epidemiological analysis at a tertiary referral hospital(2018) ASSUNÇÃO, Jorge Henrique; NOFFS, Guilherme Guelfi; MALAVOLTA, Eduardo Angeli; GRACITELLI, Mauro Emilio Conforto; LIMA, Ana Lucia Munhoz; FERREIRA NETO, Arnaldo AmadoABSTRACT Objective: To describe the clinical and epidemiological characteristics of patients with septic arthritis of the shoulder or elbow and to evaluate prognostic factors for complications during treatment. Methods: A retrospective case series was studied with patients treated between 2004 and 2014. The patients' clinical and epidemiological characteristics were collected. The clinical and orthopedic complications were identified and possible prognostic factors were evaluated. Results: Twenty-seven patients were analyzed, 17 with septic arthritis of the shoulder and ten of the elbow. Median age was 46 years (IQR, 24.5; 61). Previous joint disease was observed in nine patients (33%). At least one clinical comorbidity was observed in 23 patients (85%). Staphylococcus aureus was identified in 14 cases (52%). Fourteen patients (52%) had at least one clinical complication and five patients died (19%). Nine patients (33%) had some type of orthopedic complication. The time between onset of symptoms and surgical treatment was longer in patients with orthopedic complications (p = 0.020). Regarding the development of clinical complications, leukocytosis on hospital admission time (p = 0.021) and the presence of clinical morbidities (p = 0.041) were predictive factors. Conclusions: Septic arthritis of the shoulder and elbow primarily affects individuals who are immunocompromised and/or have clinical comorbidities. S. aureus is the most common pathogen in Brazil. Leukocytosis at hospital admission and the presence of clinical comorbidities are factors associated with the presence of clinical complications. Longer time between onset of symptoms and surgical treatment was correlated with orthopedic complications.
- 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.
- Outcomes evaluation of locking plate osteosynthesis in displaced fractures of the proximal humerus(2013) GRACITELL, Mauro Emilio Conforto; LOBO, Frederico Lafraia; FERREIRA, Gustavo Maximiano Aliperti; PALMA, Marcos Vianna da; MALAVOLTA, Eduardo Angeli; BENEGAS, Eduardo; KOJIMA, Kodi Edson; FERREIRA NETO, Arnaldo Amado; SILVA, Jorge dos SantosObjective: To evaluate functional outcomes, radiographic findings and complications of proximal humeral fractures treated with locking plates and to determine prognostic factors for successful clinical outcomes. Methods: Forty patients undergoing internal fixation of fractures of the proximal humerus with the Philos(r) plate were included in the study. The surgeries were performed between 2004 and 2011 and the patients underwent radiographic and clinical evaluation, by Constant -Murley and Dash score. Outcomes were analyzed by use of multivariate regression with several different variables. Results: Patients were on average of 61.8 ± 16.28 years, and most were female (70%). The Constant -Murley score was 72.03 ± 14.01 and Dash score was 24.96 ± 19.99. The postoperative radiographs showed a head-shaft angle of 135.43º± 11.82. Regression analysis showed that the patient's age and the Hertel classification influenced the Constant -Murley scale (p = 0.0049 and 0.012, respectively). Other prognostic criteria such as Neer and AO classification, head-shaft angle, the presence of metaphyseal comminution and extension of the humeral metaphyseal fragment showed no effect on prognosis. Complications occurred in four patients (10%). Conclusion: The fixation with the Philos(r) plate provided good clinical and radiographic results in fractures of the proximal humerus, with a low complication rate. Patient's age and Hertel classification were defined as prognostic factors that led to worse functional outcomes.
- 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.
- Critical analysis of scientific publications of the Revista Brasileira de Ortopedia from 2006 to 2010(2013) MALAVOLTA, Eduardo Angeli; GOBBI, Riccardo Gomes; MANCUSO FILHO, Jose Antonio; DEMANGE, Marco KawamuraOBJECTIVE: Profile analysis of articles from scientific journals is rare in our country. The aim of this study was to perform an analysis of publications of the Revista Brasileira de Ortopedia (RBO), to specify the designs of the studies and their level of evidence. METHODS: All articles published in RBO from January 2006 to December 2010 were classified according to the design of the study. The clinical studies were further stratified according to the level of evidence, in agreement with the norm of the journal. The studies classified as randomized and controlled clinical trials (RCTs) had their quality assessed by the system proposed by Jadad. RESULTS: In this period, there were 376 articles published in RBO. Clinical studies represented most of the papers, with 60.64% of the total. Case series represented 61.4% of the clinical studies. Thirteen RCTs were published, accounting for 3.46% of the total, and 5.7% of the clinical studies. The analysis of the quality of the RCTs showed that 5 (38.46%) were considered high quality, while 8 (61.54%) were of low quality. Among the studies in which the level of evidence does not apply (non-clinical), non-systematic reviews (46 articles) and basic research (40 articles) have prevailed, representing 12.23% and 10.64% respectively of the total. CONCLUSIONS: Case series were the most prevalent (37.23%) studies published in RBO between 2006 and 2010, while RCTs accounted for 3.46% of the articles. The majority of RCTs (61.54%) were considered low quality, and only 1.32% of the clinical studies were classified as level I evidence.
- Asian ethnicity: a risk factor for adhesive capsulitis?(2018) MALAVOLTA, Eduardo Angeli; GRACITELLI, Mauro Emilio Conforto; PINTO, Gustavo de Mello Ribeiro; SILVEIRA, Arthur Zorzi Freire da; ASSUNÇÃO, Jorge Henrique; FERREIRA NETO, Arnaldo AmadoABSTRACT Objective: The aim of this study was to evaluate whether Asian ethnicity is a risk factor for the development of adhesive capsulitis. The secondary aim was to describe the distribution of cases of capsulitis by age group. Methods: A cross-sectional study comparing the rate of adhesive capsulitis in individuals of Asian ethnicity with that of other ethnicities. We excluded patients with fractures and those with symptoms not involving the shoulder. The odds ratio was adjusted for confounding factors by binary logistic regression. Results: A total of 1331 patient records were evaluated and after applying the selection criteria, 814 patients remained. We found 134 cases of adhesive capsulitis (15.6%). The peak of incidence was at 60-64 years in the patients of Asian ethnicity and at 55-59 years in the other patients. The unadjusted odds ratio was 4.2 (CI 95%, 2.4-7.4), while the odds ratio adjusted for sex and diabetes mellitus was 3.6 (CI 95%, 2.0-6.5). Conclusion: Patients of Asian ethnicity showed an independent risk factor for the development of adhesive capsulitis, with an adjusted odds ratio of 3.6. Adhesive capsulitis was more common between 55 and 64 years.