Epidural analgesia causes a temporary cessation of nerve conduction via administration of low concentration of local anaesthesia, or opioid, into epidural space. The resulting temporary discontinuation of nerve conduction is called central neuroaxial anaesthesia and it facilitates the process of surgical intervention. An epidural catheter is usually inserted during epidural desensitisation. It helps to control the amount of administered anaesthesia and hence to respond to surgery progress, but it also enables to keep the catheter within the epidural space for the following postoperative analgesia, which will promote timely postoperative rehabilitation and pain management.The research project was conducted on basis of quantitative and qualitative investigation. The quantitative research was performed via questionnaires directed at the nursing staff, and the qualitative research took form of semi-structured interviews with patients. The quantitative investigation was conducted in fourteen health care facilities in the Czech Republic. Respondents of the quantitative research were nurses working in orthopaedic departments, multidisciplinary ICU or ARO (Anaesthesiology Resuscitation Dept.), who provided care to patients after TKR or THR with an epidural catheter insitu. Qualitative research respondents were patients hospitalised in orthopaedic departments for TKR or THR, with epidural catheter insitu and who agreed to participate at the interview. Quantitative research data were processed in Excel 2010 and presented in graphs, frequency and contingency tables, whereas the qualitative research data were processed using charts of the Smart Art program. After the agreement with the management of health care facilities, this dissertation will promote education and aid situation improvement. The Standard of Nursing Care Assisting a Patient with Epidural Catheter during Insertion and Care will be an outcome of this project. Moreover, we will design a patient information booklet and a quality of care indicator that will focus on monitoring of complications occurrence such as infections in patients with epidural catheter. The findings may help to design a training course specialised in nursing care provision to those patients and also to provide basis for further research.

A identificação de fatores relacionados à segurança e qualidade das próteses para artroplastia de quadril na visão do ortopedista especialista, bem como a busca e checagem por informações advindas dos instrumentos legais de regulação, tais como localização do Registro do Ministério da Saúde e rótulo de instruções de uso, com exata descrição das características dos dispositivos, a notificação e procura por alertas da Tecnovigilância podem apontar critérios que minimizem a possibilidade de erros e surgimento de eventos adversos na escolha dos implantes para quadril durante o processo de indicação, solicitação, liberação, implantação e utilização do produto. Investigando este contexto, foram entrevistados os membros da Sociedade Brasileira de Quadril, e do retorno das respostas surgiram dados que mostram que 72% dos sujeitos não acreditam que o Registro da ANVISA faça parte de um processo de segurança e qualidade no cadastramento de produtos para saúde no Brasil, e outros 72% desconhecem a ferramenta Tecnovigilância para monitoramento pós-comercialização. Todavia, 94% da amostra refere já ter constatado falha protética ao longo da carreira, outros 94% indicam que a falha ocorreu com próteses nacionais, e que em 60% das ocorrências o fornecedor foi contatado, e não a ANVISA, e em outros 30% das falhas nada foi feito. Estes dados são preocupantes, pois refletem o descompasso entre a Agência Nacional de Saúde e a classe de médicos assistentes no que tange ao monitoramente de tecnologias em saúde, estes por não notificarem os EA (evento adverso) e QT (queixa técnica) ao órgão regulatório, e a Agência que, por conseguinte, não divulga amplamente esta ferramenta a quem de fato deveria ser o alvo de atenção, pois são estes que utilizam, na prática diária, os produtos registrados no Brasil. Na tentativa de facilitar a conferência de dados imprescindíveis relacionados à OPME(órteses, próteses e materiais especiais) entre eles próteses para quadril, elaborou-se uma revista eletrônica intitulada Guia Prático para checagem de questões sobre segurança e qualidade de dispositivos médicos cirúrgicos de acordo com procedimentos da ANVISA. / Identification factors related to safety and quality of prostheses for total hip arthroplasty according to the orthopedic specialists, as well as the search and checking for information from the legal instruments of regulation such as the registry made by the Ministry of Health and corresponding label functioning instructions containing the exact description of the characteristics of the devices, alert notifications for technical surveillance, etc., can lead to criteria that minimize errors and avoid adverse events when choosing hip implants, during the process of request, release, deliver and use of the product. In order to investigate this context, a survey was made by means of a questionnaire where members of the Hip Brazilian Society answered selected questions. Data from answers have shown that 72% of respondents do not believe that the ANVISA (National Health Agency) product registration is part of a safety and quality process for health products in Brazil, and another 72% are unaware of the pos market monitoring tool called Tecnovigilância. However, 94% of the medical doctors state that they already have found prosthetic failure throughout their career, other 94% indicate that the failure occurred with national prostheses, and in 60% of these cases the supplier was contacted and not the ANVISA, and for other 30 % of failures nothing was done. The exposure of these data is worrying since it reflects the gap between ANVISA and the physicians in regard to monitoring health technologies. Also, the doctors do not notify adverse events to the regulatory Agency and the Agency therefore does not disseminate this tool to those who actually should be the focus of attention since they use the products in their daily practice. Finally, in order to facilitate data verification of health products, in special hip phrostheses, a practical electronic guide was developed where questions and doubts about safety and quality of medical devices can be checked according to the ANVISA procedures.

Aseptic loosening due to polyethylene wear presents one of the most frequently occurring joint replacement complications requiring a revision surgery. Numerous scientific works and publications deal with the issue of morphology, determination and distribution of wear particles. Few studies, however, determine reliably amounts of particles in individual periprosthetic zones. The objective of this work was to evaluate the correlation between amounts of wear particles and periprosthetic osteolysis findings. Description of distribution of these particles in the surroundings of joint replacement presented further objectives of the work. Wear particles were isolated from granuloma obtained during revisions of total hip replacements. Amounts of wear particles were determined using IRc. These findings were correlated with X-ray examinations and intraoperative findings. Method of progressive enzymatic degradation of tissue was used in order to describe wear particles distribution in polyethylene granuloma and surrounding periprosthetic tissues. Results showed uneven incidence of wear particles in the surroundings of the total joint replacement. The incidence correlated with X-ray examinations and intraoperative findings. Distribution of particles was described as well as new determination methods and further...

Submitted by Renata Lopes (renatasil82@gmail.com) on 2016-07-14T11:51:08Z No. of bitstreams: 1 elmanodearaujoloures.pdf: 9149491 bytes, checksum: 08630dfeb5037d2bfef775000aee4585 (MD5) / Approved for entry into archive by Diamantino Mayra (mayra.diamantino@ufjf.edu.br) on 2016-07-19T14:30:09Z (GMT) No. of bitstreams: 1 elmanodearaujoloures.pdf: 9149491 bytes, checksum: 08630dfeb5037d2bfef775000aee4585 (MD5) / Made available in DSpace on 2016-07-19T14:30:09Z (GMT). No. of bitstreams: 1 elmanodearaujoloures.pdf: 9149491 bytes, checksum: 08630dfeb5037d2bfef775000aee4585 (MD5) Previous issue date: 2011-10-20 / A artroplastia total do quadril possui uma das melhores relações custo-benefício dentre todas as intervenções realizadas no aparelho locomotor. Grande parte das publicações aborda somente os aspectos técnicos e o desempenho dos implantes e negligencia a repercussão sobre a qualidade de vida e as co-morbidades, tornando a medida correta dos benefícios do tratamento imprecisa. Atualmente, os parâmetros de medição da qualidade de vida associados às escalas funcionais tornaram-se imperativos para uma análise acurada de resultados e fatores influentes. O objetivo principal do estudo foi avaliar a qualidade de vida relacionada à saúde em pacientes afetados por osteoartrose do quadril e tratados por artroplastia total do quadril. Estudou-se prospectivamente uma coorte de 38 pacientes operados em hospital universitário de referência regional acompanhados durante, no mínimo, seis meses até atingirem reabilitação satisfatória. Secundáriamente, avaliou-se o desempenho de curto prazo do componente acetabular MD4® implantado em 35 indivíduos. Os dados foram obtidos por meio da aplicação de quatro instrumentos: 1) questionário para a caracterização sóciodemográfica e clínica da amostra; 2) escala de avaliação funcional do quadril – Harris Hip Score (HHS); 3) instrumento genérico de avaliação da qualidade de vida relacionada à saúde The Medical Outcomes Study 36-item Short-Form Health Survey (SF-36) e 4) questionário de avaliação da satisfação individual com o procedimento. Os resultados dos testes pré e pós-operatórios foram submetidos à análise estatística descritiva e comparados com a literatura. Os resultados pré e pósoperatórios do SF-36 foram capacidade funcional: 13,4-53,7; limitação por aspectos físicos: 9,21-48,0; dor: 23,1-62,6; estado geral de saúde: 54,2-71,3; vitalidade: 40,3- 69,9; aspectos sociais: 40,8-74,3; limitação por aspectos emocionais: 23,7-64,9; saúde mental: 52,6-80,4. O Harris Hip Score variou de 36,1 a 92,1, em média. Todos os resultados foram estatisticamente significantes (p < 0,001). A combinação de duas escalas mostrou-se valiosa na identificação de vieses e conferiu maior confiabilidade na compreensão das diversas variáveis. O estudo demonstra uma significativa melhora na qualidade de vida relacionada à saúde em pacientes afetados por osteoartrose de diferentes etiologias submetidos à artroplastia total do quadril. A avaliação da qualidade de vida não substitui a avaliação clínica provida por instrumentos específicos e pela experiência do cirurgião, mas pode adicionar dados importantes ao valorizar o conjunto de expectativas do paciente perante um tratamento médico e ser considerada um instrumento eficiente na análise de resultados da artroplastia total do quadril. Adicionalmente, o componente acetabular avaliado mostrou estabilidade e indícios de osteointegração em todos os casos, o que pode ser considerado indicativo de bom desempenho a médio prazo do implante. / Total hip replacement is one of the most cost-effective procedures upon the locomotor system. Most of the publications covers only the technical aspects and the performance of implants and neglects the impact on the quality of life and comorbidities, making the correct measurement of a treatment benefits imprecise. Nowadays, the measurement of health-related quality of life associated with functional scales has become imperative for more accurate analysis of results and influencing factors. To assess the health – related quality of life in patients with osteoarthritis and undergoing total hip arthroplasty was the main goal in this study. A cohort of 38 patients from a regional referral teaching hospital was prospectively followed up for at least six months until they have achieved satisfactory rehabilitation. Secondarily, the short-term performance of the MD-4® acetabular component implanted in 35 individuals was evaluated. Data were obtained through the application of four instruments: 1) questionnaire for socio-demographic and clinical characteristics of the sample; 2) functional scale of the hip - Harris Hip Score (HHS); 3) generic instrument for assessing health-related quality of life The Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) and 4) questionnaire assessing individual satisfaction with the procedure. The results pre and postoperatively were analyzed using descriptive statistics and compared with the literature. The SF-36 results pre and post-operative were functional capacity: 13.4 to 53.7, limited by physical aspects: 9.21 to 48.0; pain: 23.1 to 62.6, general health: 54.2 to 71.3; vitality: 40.3 to 69.9; social aspects: from 40.8 to 74.3, limited by emotional aspects: from 23.7 to 64.9; mental health: 52.6 - 80.4. The Harris Hip Score ranged from 36.1 to 92.1 on average. All results were statistically significant (p < 0.001). The combination of two scales showed up to be valuable in bias identification and gave more reliability on the variables understanding. The study reports a significant improvement in health-related quality of life in patients affected by osteoarthritis of many etiologies that underwent total hip replacement. Healthrelated quality of life assessment does not replace clinical evaluation provided by specific instruments and the physician’s experience but can add important data and also can be considered an efficient tool in analyzing outcomes of total hip replacement due to the weight it gives to the patient’s expectations regarding a medical treatment.Additionally , the study showed up evidence of osteointegration and stability of the acetabular cup in all cases, which would be a predictor factor for mid-term survivorship of this acetabular component.

Predložená dizertačná práca sa zaoberá analýzou opotrebenia totálnych bedrových endoprotéz za použitia optických metód. V práci bol predstavený nový prístup hodnotenia objemového úbytku materiálu pomocou 3D optického skeneru. Tento nový prístup je časovo efektívny, poskytuje veľké množstvo snímaných bodov na povrchu implantátu. Množstvo bodov umožňuje presnejšiu rekonštrukciu pôvodnej geometrie a prípadné rekonštrukcie nežiaducich poškodení polyetylénovej vložky pri extrakcii. Predstavené metóda bola validovaná za pomoci štandardizovanej gravimetrickej metódy v súlade s ISO 14242. Následne bol optická skenovacia metóda použitá v troch štúdiách zameraných na analýzu opotrebenia, mechanické zmeny artikulujúceho povrchu a mikroštruktúrne zmeny v dôsledku zlyhania implantátu. Analýza 23 extrahovaných polyetylénových vložiek typ Bicon - plus s rozšíreným použitím v Českej republike poukázala na niektoré problémy spojené so zlyhaním implantátu. Adhezívno - abrazívne opotrebenie bolo identifikované v oblasti penetrácie femurálnej hlavice a následné poškodenia ako delaminácia materiálu , plastické deformácie a pitting boli pozorované v okolí tejto oblasti. Analýza materiálových vlastností poukázala na degradáciu mechanických a chemických vlastností, čo bolo prevažne závislé od rozsahu opotrebenia implantátu. U implantátov boli pozorované výrazné plastické deformácie , nárast oxidačného indexu a nižší pomer tvrdosti voči modulu elasticity, v porovnaní s novými vzorkami. Tečenie materiálu a plastické deformácie, ktoré vykazovali všetky extrahované vzorky boli analyzované v závere predloženej dizertačnej práce, na základe testov na nových implantátoch v zábehovom cykle. Cieľom práce je uviesť nový prístup analýzy opotrebenia polyetylénových vložiek za pomoci optických skenovacích metód a preukázať jeho použiteľnosť na analýze súboru extrahovaných implantátov. Výsledky získané pomocou tejto metódy sa ukázali ako vhodné a môžu viesť k lepšiemu pochopeniu procesov opotrebenia a zlyhávania implantátov.

This master's thesis deals with stress-strain analysis of hip joint after total hip replacement. These stress-strain states are compared between four variable stems. A research study of available literature is presented with the focus on finite element analysis of hip joints. Basics of hip's joint anatomy is described along with total endoprostheses' variants and properties. Computational modeling was chosen as a solution method using finite element analysis. The solution was executed using ANSYS software. For each stem there was created a computational model which consists of several submodels such as model of geometry, material, contacts and loading. The assesed variables were total hip displacement, contact pressure between the head and liner, stress on each stem and strain on femur. The evaluation of femur's bone tissue was accomplished on basis of Frost's mechanostat in seven Gruen zones.

This work analyzes problems of friction and lubrication of total hip replacement (THR). At first, experimental study of friction coefficient under various conditions was conducted using hip joint simulator based on principle of pendulum. After that, lubrication film development was observed, using colorimetric interferometry with head from THR and glass cup with respect of geometry and clearance to cups made originally for THR. With respect to research study [25] it was found that increasing contact conformity leads to increased film thickness. Also protein adsorption on articulating surfaces was observed. Thanks to adsorption 80 nm film thickness was measured even if relative surface speed was zero. Furthermore protein aggregation was observed on the border of contact zone, similar aggregations were observed by Myant et al. [29] or Vrbka et al. [25]. These aggregations are formed when lubricant is under shear stress and it can positively affect film thickness. If the relative motion of articulating surfaces is not sufficient, the protein layer can`t be refreshed enough and film thickness start decreasing. Coefficient of friction 0,13 was measured when lubricating film development was observed. Close to this value are material combinations metal on polyethylene and metal on metal.

Dizertační práce se zabývá mechanismy mazání v náhradách kyčelního kloubu. Byla provedena systematická studie formování proteinového filmu při zahrnutí různých materiálů a provozních podmínek. Hlavní pozornost je přitom věnována roli jednotlivých proteinů obsažených v synoviální kapalině při současné přítomnosti dalších proteinů. Jelikož metody aplikované v předchozích studiích neumožňovaly separovat jednotlivé složky maziva, byla vyvinuta optická měřící metoda na principu fluorescenční mikroskopie. Z důvodu verifikace metody byly provedeny dvě nezávislé studie zaměřené na měření tloušťky mazacího filmu a dělení maziva na výstupu mazaného kontaktu. Z důvodu určitých limitací fluorescenční mikroskopie byla dále využita i metoda optické interferometrie, jejíž využití je ilustrováno ve studii zabývající se formováním mazacího filmu v náhradách kyčelního klubu při uvažování reálné konformity třecích povrchů. Závěrečná část práce představuje nový metodologický přístup založený na in situ pozorování kontaktní oblasti umožňující popsat roli jednotlivých proteinů ve vztahu k vývoji tloušťky mazacího filmu. Práce obsahuje originální výsledky, které přináší nové poznání v oblasti biotribologie náhrad kyčelního kloubu vedoucí k dalšímu vývoji implantátů při snaze zabránit jejich selhání v důsledku omezené životnosti.

Die Zielsetzung dieser Arbeit besteht darin zu prüfen, ob die Luxationsrate bei Hochrisikopatienten durch den Einsatz von 40-mm- und 44-mm-Köpfen im Vergleich zu Patienten mit maximal 36-mm-Köpfen reduziert werden kann. Hierzu wurden die im Zeitraum von September 2009 bis Mai 2014 hüftendoprothetisch versorgten Patienten mit einem erhöhten Luxationsrisiko erfasst und die Verläufe auf Luxationen überprüft. Zur Risikobewertung diente eine eigens entwickelte Klassifikation. Des Weiteren erfolgte die Analyse der postoperativen Verläufe, der Röntgenbilder und eines Telefoninterviews in den Fällen, in denen Köpfe ≥ 40 mm zum Einsatz kamen. Im Untersuchungszeitraum wurden 288 Hüftendoprotheseneingriffe mit erhöhtem Luxationsrisiko durchgeführt. Bei 278 HTEP-Implantationen erfolgte der Einsatz von Gelenkköpfen ≤ 36 mm. In dieser Gruppe betrug die Luxationsrate 15,1% (n=42). Bei 10 Patienten wurden 40-mm- oder 44-mm-Gelenkköpfe eingesetzt. In diesen Fällen wurde das Luxationsrisiko entsprechend der vorgeschlagenen Klassifikation mit 3A (hoch) bis 4B (sehr hoch) bewertet. Bei einem mittleren Follow up von 22,8 Monaten wurde bei diesen Patienten keine Luxation festgestellt. Die mit 40-mm- sowie 44-mm-Köpfen erzielten Ergebnisse und die aktuelle Literatur sprechen für eine wesentlich höhere Gelenkstabilität und eine deutlich verminderte Luxationsneigung größerer Köpfe. Deren Einsatz ist daher gegenwärtig bei Risiko-patienten gerechtfertigt, sofern dieser in Abhängigkeit vom Pfannenaußendurch-messer konstruktiv möglich ist. In der weiteren Entwicklung der Hüftendoprothetik sollte die Verwendung größerer Köpfe angestrebt werden.:Inhaltsverzeichnis Bibliographische Beschreibung Abkürzungsverzeichnis 1. Einleitung 1.1 Bedeutung der Hüftendoprothetik 1.2 Hüftendoprothesenluxation 1.2.1 Definition und Häufigkeit 1.2.2 Ursachen 1.2.3 Einteilung und Klassifikation 1.2.4 Risikofaktoren 1.2.5 Beurteilung des Luxationsrisikos bei hüftendoprothetischen Eingriffen 1.2.6 Ursachen des luxations-mindernden Effektes großer Köpfe 1.2.7 Vorgehen nach Luxation 1.2.7.1 Diagnostik 1.2.7.2 Therapie 1.3 Zielsetzung der Arbeit 2. Publikation 3. Zusammenfassung 4. Literaturverzeichnis 5. Tabellenverzeichnis 6. Abbildungsverzeichnis 7. Erklärung über die eigenständige Abfassung der Arbeit 8. Lebenslauf und wissenschaftlicher Werdegang 9. Danksagung 10. Anlagen Anlage 1 - Dokumentationsbogen Patienten mit Großköpfen Anlage 2 - Telefoninterviewbogen zu 40/44mm Köpfen

Among other factors, optimism has been shown to significantly influence the course of some diseases (cancer, HIV, coronary heart disease). This study investigated whether optimism of a patient before a total hip replacement can predict the functionality of the lower limbs 3 and 6 months after surgery. A total of 325 patients took part in the study (age: 58.7 years; w: 55%). The functionality was measured with the Western Ontario and McMaster Universities arthrosis index, and optimism with the Life Orientation Test. To analyse the influences of age, gender and optimism, general linear models were calculated. In optimistic patients, functionality improved significantly over time. The study showed a clear influence of dispositional optimism on the recovery after total hip replacement in the first 3 months after surgery.