BRUNO ALVES RUDELLI
Índice h a partir de 2011
3
Projetos de Pesquisa
Unidades Organizacionais
Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina
8 resultados
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- RADIOGRAPHIC EVALUATION OF OSSEOINTEGRATION OF UNCEMENTED TARGOS (R) STEMS. A 5-YEAR FOLLOW-UP(2022) MIYAHARA, Helder de Souza; NARCISO, Jorge Henrique; CORREA, Jose Guilherme Lollo; VICENTE, Jose Ricardo Negreiros; EJNISMAN, Leandro; RUDELLI, Bruno Alves; GURGEL, Henrique de Melo Campos; CROCI, Alberto TesconiIntroduction: Total hip arthroplasty is a widespread treatment and is considered the gold standard in cases of hip osteoarthritis, with high rates of success in improving pain and function when well performed. After five years of follow-up, this study evaluates the osseointegration of uncemented Targos (R) collared stems in arthroplasties. Methods: Observational study of 182 total hip arthroplasties performed in 2014 with Targos (R) cementless collared femoral stems (Lepine). Bone quality was assessed according to the Dorr scale and osseointegration according to the Engh score. Results: The overall mean age was 56.5 years, consisting of 104 men (57.1%) and 103 women (56.6%). The os-seointegration rate of the stems (total Engh>0) was 100%. There was no statistical difference between groups concerning age (p=0.262), gender (p=0.463), primary diagnosis (p=0.585), af-fected side (p=0.459), and degree of Dorr (p=0.857). Conclusion: Targos (R) cementless collared femoral stems showed excellent osseointegration in all patients evaluated, regardless of age, gender, and preoperative bone quality. Moreover, spot welds observed on preoperative radiographs have the best association with implant osseointegration. Level of evidence IV, case series.
- ETHICAL AND LEGAL ASPECTS OF TELEMEDICINE APPLIED IN ORTHOPEDICS(2022) YAMAGUCHI, Fabio Seiji MAzz I.; MIYHARA, Helder De Souza; SILVA, Jorge dos santos; RUDELLI, Bruno alves; EJNISMAN, Leandro; GURGEL, Henrique melo de camposDue to the pandemic of COVID-19, many outpatient services were suspended, affecting hundreds of patients. As a result, several countries were forced to seek strategies to readapt their health systems, one of which was the expansion of telemedicine. Currently, telemedicine is used for several specialties, facilitating the treatment and follow-up of patients who have difficulty accessing it. Tele-orthopedics, telemedicine applied to the orthopedic specialty, allows orthopedic care to be offered to patients regardless of orthopedics presents high patient satisfaction, allowing greater rehabilitation effectiveness after surgery and treatment compliance. There is much information in the current literature about telemedicine's legal and ethical aspects, but it is fragmented. and ethical aspects, emphasizing tele-orthopedics. The ethical principles of autonomy, beneficence, non-maleficence and justice must be respected, as well the privacy and confidentiality during use. Level of Evidence V: Expert Opinion.
- Bacteria drug resistance profile affects knee and hip periprosthetic joint infection outcome with debridement, antibiotics and implant retention(2020) RUDELLI, Bruno Alves; GIGLIO, Pedro Nogueira; CARVALHO, Vladimir Cordeiro de; PECORA, Jose Ricardo; GURGEL, Henrique Melo Campos; GOBBI, Ricardo Gomes; VICENTE, Jose Riccardo Negreiros; LIMA, Ana Lucia Lei Munhoz; HELITO, Camilo PartezaniBackground Evaluate the effect of bacteria drug resistance profile on the success rates of debridement, antibiotics and implant retention. Methods All early acute periprosthetic infections in hip and knee arthroplasties treated with DAIR at our institution over the period from 2011 to 2015 were retrospectively analyzed. The success rate was evaluated according to the type of organism identified in culture: multidrug-sensitive (MSB), methicillin-resistantStaphylococcus aureus(MRSA), multidrug-resistant Gram-negative bacteria (MRB) and according to other risk factors for treatment failure. The data were analyzed using univariate and multivariate statistics. Results Fifty-seven patients were analyzed; there were 37 in the multidrug-sensitive bacteria (MSB) group, 11 in the methicillin-resistantStaphylococcus aureus(MRSA) group and 9 in the other multidrug-resistant Gram-negative bacteria (MRB) group. There was a statistically significant difference (p < 0.05) in the treatment failure rate among the three groups: 8.3% for the MSB group, 18.2% for the MRSA group and 55.6% for the MRB group (p = 0.005). Among the other risk factors for treatment failure, the presence of inflammatory arthritis presented a failure rate of 45.1 (p < 0.05). Conclusion DAIR showed a good success rate in cases of early acute infection by multidrug-sensitive bacteria. In the presence of infection by multidrug-resistant bacteria or association with rheumatic diseases the treatment failure rate was higher and other surgical options should be considered in this specific population. The MRSA group showed intermediate results between MSB and MRB and should be carefully evaluated.
- Accidents due to falls from roof slabs(2013) RUDELLI, Bruno Alves; SILVA, Marcelo Valerio Alabarce da; AKKARI, Miguel; SANTILI, ClaudioCONTEXT AND OBJECTIVE Falls from the roof slabs of houses are accidents of high potential severity that occur in large Brazilian cities and often affect children and adolescents. The aims of this study were to characterize the factors that predispose towards this type of fall involving children and adolescents, quantify the severity of associated lesions and suggest preventive measures. DESIGN AND SETTING Descriptive observational prospective longitudinal study in two hospitals in the metropolitan region of São Paulo. METHODS Data were collected from 29 cases of falls from roof slabs involving children and adolescents between October 2008 and October 2009. RESULTS Cases involving males were more prevalent, accounting for 84%. The predominant age group was schoolchildren (7 to 12 years old; 44%). Leisure activities were most frequently being practiced on the roof slab at the time of the fall (86%), and flying a kite was the most prevalent game (37.9%). In 72% of the cases, the children were unaccompanied by an adult responsible for them. Severe conditions such as multiple trauma and traumatic brain injuries resulted from 79% of the accidents. CONCLUSION Falls from roof slabs are accidents of high potential severity, and preventive measures aimed towards informing parents and guardians about the dangers and risk factors associated with this type of accident are needed, along with physical protective measures, such as low walls around the slab and gates with locks to restrict free access to these places.
- Experimental study of histological changes in vascular loops according to the duration of the postoperative period: Application in reconstructive microsurgery(2017) PAULOS, Renata Gregorio; RUDELLI, Bruno Alves; FILIPPE, Renee Zon; SANTOS, Gustavo Bispo dos; HERRERA, Ana Abarca; RIBEIRO, Andre Araujo; REZENDE, Marcelo Rosa de; HSIANG-WEI, Teng; MATTAR- JR., RamesOBJECTIVES: To analyze the histological changes observed in venous grafts subjected to arterial blood flow as a function of the duration of the postoperative period to optimize their use in free flap reconstructions. METHOD: Twenty-five rats (7 females and 18 males) underwent surgery. Surgeries were performed on one animal per week. Five weeks after the first surgery, the same five animals were subjected to an additional surgery to assess the presence or absence of blood flow through the vascular loop, and samples were collected for histological analysis. This cycle was performed five times. RESULTS: Of the rats euthanized four to five weeks after the first surgery, no blood flow was observed through the graft in 80% of the cases. In the group euthanized three weeks after the first surgery, no blood flow was observed in 20% of the cases. In the groups euthanized one to two weeks after the first surgery, blood flow through the vascular loop was observed in all animals. Moreover, intimal proliferation tended to increase with the duration of the postoperative period. Two weeks after surgery, intimal proliferation increased slightly, whereas strong intimal proliferation was observed in all rats evaluated five weeks after surgery. CONCLUSION: Intimal proliferation was the most significant change noted in venous grafts as a function of the duration of the postoperative period and was directly correlated with graft occlusion. In cases in which vascular loops are required during free flap reconstruction, both procedures should preferably be performed during the same surgery.
- 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.
- Femoroacetabular Impingement and Acetabular Labral Tears – Part 2: Clinical Diagnosis, Physical Examination and Imaging(2020) POLESELLO, Giancarlo Cavalli; EISJMAN, Leandro; QUEIROZ, Marcelo C.; RUDELLI, Bruno Alves; RUDELLI, Marco; RICIOLI JUNIOR, WalterAbstract The clinical diagnosis of femoral acetabular impingement (FAI) continues to evolve as the understanding of normal and pathological hips progresses. Femoral acetabular impingement is currently defined as a syndrome in which the diagnosis consists of the combination of a previously-obtained comprehensive clinical history, followed by a consistent and standardized physical examination with specific orthopedic maneuvers. Additionally, radiographic and tomographic examinations are used for the morphological evaluation of the hip, and to ascertain the existence of sequelae of childhood hip diseases and the presence of osteoarthritis. The understanding of the femoral and acetabular morphologies and versions associated with images of labral and osteochondral lesions obtained through magnetic resonance imaging (MRI) contributes to the confirmation of this syndrome in symptomatic patients, and helps in the exclusion of differential diagnoses such as iliopsoas tendon snaps, subspine impingement, ischiofemoral impingement, and other hip joint pathologies.
- FEMORAL HEAD DECOMPRESSION AND GRAFT: TECHNIQUE WITH NEW INSTRUMENTS(2022) MIYAHARA, Helder De Souza; RUDELLI, Bruno Alves; RANZONI, Lucas Verissimo; EJNISMAN, Leandro; VICENTE, Jose Ricardo Negreiros; GURGEL, Henrique Melo De CamposIntroduction: Osteonecrosis of the femoral head (ONFH) is a pathol-ogy that can be treated with many approaches by the hip surgeon. Advanced decompression is a technique that aims to prevent the collapse of the femoral head and the arthrosis process of the joint, a technique already widespread and used by hip surgeons. In this study, we performed the technique with a new retractable blade and a new bone substitute as graft for the femoral head. Objective: To evaluate the technique with new instruments (EasyCore Hip (R)) and a calcium phosphate bone substitute (Graftys (R) HBS). Methods: Patients with osteonecrosis of the femoral head without major degenerative changes, such as femoral head collapse, were selected. Femoral head decompression was performed using the EasyCore Hip (R) retractable blade along with the calcium phosphate bone substitute as graft (Graftys (R) HBS). Results: The instruments proved to be reliable and reproducible, and the bone substitute presented good mechanical resistance, maintaining its temperature during the surgery. The dis-posable retractable blade presents variation in size and angle, which is an advantage in the removal of necrotic bone. However, we must take some precautions in order to achieve a better result. Conclusion: using EasyCore Hip (R) instruments and a calcium phosphate bone substitute (Graftys (R) HBS) is safe; however, some precautions must be taken during the use of the technique.