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CC BY-NC-ND 4.0 · Rev Bras Ortop (Sao Paulo) 2020; 55(01): 040-047
DOI: 10.1055/s-0039-1700815
Artigo Original
Sociedade Brasileira de Ortopedia e Traumatologia. Published by Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil

Artrodese versus artroplastia da primeira articulação metatarsofalângica no tratamento do hallux rigidus – Estudo comparativo de pacientes selecionados apropriadamente[∗]

Article in several languages: português | English
Marta Santos Silva
1   Departamento de Ortopedia, Centro Hospitalar do Porto, Hospital de Santo António, Porto, Portugal
,
Ricardo Rodrigues-Pinto 
1   Departamento de Ortopedia, Centro Hospitalar do Porto, Hospital de Santo António, Porto, Portugal
2   Instituto de Ciências Biomédicas Abel Salazar, Porto, Portugal
3   Trofa Saúde Hospital Privado de Alfena, Alfena, Portugal
4   Trofa Saúde Hospital Privado Braga Centro, Braga, Portugal
,
Luís H. Barros
1   Departamento de Ortopedia, Centro Hospitalar do Porto, Hospital de Santo António, Porto, Portugal
,
Arnaldo Sousa
1   Departamento de Ortopedia, Centro Hospitalar do Porto, Hospital de Santo António, Porto, Portugal
,
José Muras
3   Trofa Saúde Hospital Privado de Alfena, Alfena, Portugal
4   Trofa Saúde Hospital Privado Braga Centro, Braga, Portugal
5   Centro Hospitalar Póvoa de Varzim/ Vila do Conde, Largo da Misericórdia, Póvoa de Varzim, Portugal
› Author Affiliations
Further Information

Publication History

12 July 2018

04 December 2018

Publication Date:
02 March 2020 (online)

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Resumo

Objetivo Historicamente, os resultados da artroplastia da primeira articulação metatarsofalângica (1MTP) eram relativamente ruins; no entanto, melhorias na compreensão da biomecânica normal do pé, nos materiais e no design dos implantes, tornam a artroplastia um tratamento aceitável em pacientes selecionados. O presente estudo pretendeu comparar os resultados clínicos e radiográficos da artrodese com os da artroplastia da 1MTP no tratamento de hallux rigidus e apresentar um racional para seleção de pacientes para artroplastia.

Métodos Um total de 36 pacientes (38 pés) com hallux rigidus operados (12 artrodeses e 26 artroplastias) foram prospectivamente incluídos. A dor foi avaliada com recurso à escala visual analógica (VAS) e o resultado funcional usando a escala American Orthopaedic Foot and Ankle Society Hallux Metatarsophalangeal-Interphalangeal (AOFAS-HMI). As complicações e os resultados radiográficos foram também registrados e a taxa de sobrevida calculada para os dois procedimentos.

Resultados Todos os pacientes referiram uma melhoria significativa na dor e nos resultados funcionais após a cirurgia. Os pacientes submetidos a artroplastia tiveram melhor resultado funcional na escala AOFAS-HMI (89,7 versus 65.7 pontos; p < 0.001) e melhor alívio da dor (VAS 1,6 versus 3,9 pontos; p = 0,002) quando comparados com os doentes submetidos a artrodese. Registrou-se um caso de infecção no grupo da artroplastia e 2 casos de pseudoartrose no grupo da artrodese.

Conclusão A artrodese permite alívio da dor e resultados satisfatórios, mas altera a biomecânica da marcha. Tal como a artrodese, a artroplastia melhora a dor significativamente, sendo uma alternativa mais fisiológica para preservar a biomecânica do pé. Apesar dos dois tratamentos terem bons resultados clínicos, em pacientes selecionados, a artroplastia teve melhores resultados clínicos e menor taxa de revisão.

Palavras-chave

hallux rigidus - artroplastia - artrodese - estudo comparativo - artroplastia de substituição

∗ Estudo conduzido no Departamento de Ortopedia, Centro Hospitalar do Porto, Hospital de Santo António, Porto, Portugal.


 

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