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Les transfusions sanguines sont fréquemment employées pour corriger l’anémie secondaire à une arthroplastie de la hanche ou du genou. Il n’y a cependant pas consensus sur les indications de transfuser. La tendance actuelle est d’utiliser une stratégie transfusionnelle restrictive (soit un seuil de 75-80 g/L d’hémoglobine) mais les conséquences d’une telle pratique sur la récupération fonctionnelle et la qualité de vie des patients sont mal connues. Dans un premier temps, nous avons caractérisé la pratique transfusionnelle au Centre hospitalier de l’Université de Montréal (CHUM). Notre hypothèse était que, devant l’imprécision des recommandations, la pratique transfusionnelle serait variable. Une étude rétrospective de 701 dossiers de patients ayant subi une arthroplastie de la hanche ou du genou a été réalisée. Nous avons observé que les transfusions étaient utilisées de la même façon dans les trois hôpitaux et que les médecins basaient leur décision de transfuser principalement sur un seul chiffre, la concentration d’hémoglobine, adoptant une stratégie restrictive. Soixante-six pourcent des patients avaient une concentration d’hémoglobine inférieure à 100 g/L au départ de l’hôpital. Dans un deuxième temps, nous avons évalué l’impact de cette anémie postopératoire sur la récupération fonctionnelle et la qualité de vie des patients. Notre hypothèse était qu’il existe une concentration d’hémoglobine en dessous de laquelle celles-ci sont atteintes. Une étude de cohorte prospective et observationnelle a été menée chez 305 patients regroupés selon leur concentration d’hémoglobine postopératoire. Les groupes d’hémoglobine (≤ 80, 81-90, 91-100 et > 100 g/L) étaient similaires dans l’évolution de la distance de marche en six minutes, de l’évaluation de l’effort fourni, de la force de préhension et des scores de qualité de vie. L’anémie modérée n’est donc pas associée à une atteinte de la récupération fonctionnelle et de la qualité de vie à court terme. D’autres études devront déterminer les conséquences à long terme d’une stratégie transfusionnelle restrictive sur ces patients. / Red blood cell transfusions are frequently used to treat anemia after total hip or knee arthroplasties. The indications for transfusions remain unclear despite published guidelines. Clinicians have adopted a restrictive transfusion threshold (75-80 g/L) but the consequences of such a strategy on functional outcome and quality of life are not known. First, we characterized the transfusion practice inside the Centre hospitalier de l’Université de Montréal (CHUM). Our hypothesis was that transfusion practice varies inside the CHUM due to uncertainty. A retrospective study of 701 charts of patients operated for a hip or knee arthroplasty was conducted. We observed that there was no difference among hospitals regarding the way transfusions are used and that physicians mainly based their decision to transfuse on a single variable, the hemoglobin concentration, adopting a restrictive transfusion strategy. Sixty-six percent of patients had a hemoglobin concentration under 100 g/L after surgery. Second, we evaluated the impact of this postoperative anemia on functional outcome and quality of life. We hypothesized that a threshold hemoglobin concentration exists below which these become impaired. A prospective, observational cohort study was conducted in 305 patients categorized in groups according to their postoperative hemoglobin concentration. Hemoglobin groups (≤ 80, 81-90, 91-100 and > 100 g/L) were similar in the evolution of the distance walked in six minutes, perception of effort, maximal dominant hand strength and quality of life scores. Thus, moderate anemia is not associated with an impaired functional recovery or quality of life early after hip and knee arthroplasties. Further studies will be required to determine the long-term consequences of a restrictive transfusion strategy in these patients.

La révision d’arthroplastie de la hanche en cas d’important déficit osseux acétabulaire peut être difficile. Les reconstructions avec cupule de très grand diamètre ou cupule « jumbo » (≥ 62 mm chez la femme et ≥ 66 mm chez l’homme) sont une option thérapeutique. Nous voulions évaluer la préservation et la restauration du centre de rotation de la hanche reconstruite en la comparant au coté controlatéral sain ou selon les critères de Pierchon et al. Nous voulions également évaluer la stabilité du montage à un suivi d’au moins 2 ans. Il s’agissait de 53 cas consécutifs de révision acétabulaire pour descellement non septique avec implantation d’une cupule jumbo sans ciment à l’Hôpital Maisonneuve-Rosemont. Le déficit osseux évalué selon la classification de Paprosky et al. Les cupules implantées avaient un diamètre moyen de 66 mm (62-81) chez les femmes et 68 mm (66-75) chez les hommes. L’allogreffe osseuse morcelée et massive était utilisée dans 34 et dans 14 cas respectivement. La cupule a été positionnée avec un angle d’inclinaison moyen de 41.3° (26.0-53.0). Le centre de rotation de la hanche reconstruite a été jugé satisfaisant dans 78% de cas sur l'axe médiolatéral, 71% sur l'axe craniopodal et amélioré dans 27% dans cet axe. Au recul moyen radiologique de 84.0 mois (24.0-236.4) et clinique de 91.8 mois (24.0 – 241.8): 6 cas étaient décédés, 3 perdus au suivi. On a observé le descellement radiologique dans un 1 cas, la luxation récidivante dans 5 cas et l’infection dans 4 cas. Le retrait de la cupule a été effectué dans 2 cas pour infection. L’ostéointégration des greffons osseux était complète dans tous les cas sauf 3. Les scores cliniques étaient pour le HHS de 82 +/-17, le WOMAC de 86 +/- 14 et le SF-12 physique de 46 +/- 12 et mental 53 +/-13. La cupule jumbo peut être considérée comme un moyen fiable pour gérer le déficit osseux dans les révisions acétabulaires. Elle permet de conserver ou d’améliorer la position du centre de rotation physiologique de la hanche. La fixation sans ciment favorise l’ostéointégration de la cupule et permet une stabilité à moyen terme. Le taux de complications est comparable ou inférieur à d'autres procédures de reconstruction. / Acetabular implant revision with large bone defects, can be challenging. One of the reconstruction options is a large outer diameter cup or “jumbo cup” (≥62 mm in women and ≥66 mm in men). We hypothesized that cementless jumbo cups is a reliable technique to preserve or reconstruct hip center of rotation. We also evaluated stability at least 2 two years follow up. Fifty-three consecutive non septic loosening acetabular arthroplasty revisions at Hopital Maisonneuve-Rosemont where a cementless jumbo cup was used were assessed. Bone defect was evaluated according to Paprosky classification. Mean implanted component size was 66 mm (62-81) in women and 68 mm (66-75) in men. Cancelous bone chips allograft was used in 34 cases and bulk bone allograft in 14. Immediate postoperative AP view showed a mean abduction cup angle of 41.3° (26.0-53.0). Hip centre were found at satisfy position in 78% on mediolateral axis, in 71% on craniopodal axis and it was improved in 27% in this late axis. At the mean follow up of 84.0 months (24.0-236.4) radiologically and 91.8 months (24.0-241.8) clinically: 6 patients were died and 3 were lost of follow up. Complications were: dislocation in 5 cases (4 revisions with constrained liner), infection in 4 cases (2 treated conservatively and 2 revised in 2 times procedure) and radiographic loosening in 1 case. Bone graft integration was completed in all except in 3 cases. Clinically, the mean HHS was 82% +/- 17, WOMAC 86 +/- 14, physical SF-12 46 +/- 12 and mentally SF-12 53 +/- 13. Jumbo cups appear as a reliable procedure to manage bone loss in acetabular revision. It allows conservation or improvement of physiologic hip center. Also, cementless fixation promote bone integration. with subsequent cup stabilitity. The complication rate is comparable or may be less than others reconstruction procedures .

This project attempts to quantify the integrity of the fixation of total hip arthro- T plasties (THAs) by observing vibration signal features. The aim of this thesis is, therefore, to find the signal differences between firm and loose prosthesis. These difference will be expressed in different transformed domains with the expectation that a certain domain will provide superior results. Once the signal differences have been determined they will be examined for their ability to quantify the looseness. Initially, a new definition of progressive, femoral component loosening was created, based on the application of mechanical fit, involving four general conditions. In order of increasing looseness the conditions (with their equivalent engineering associations) are listed as, firm (adherence), firm (interference), micro-loose (transition) and macro-loose (clearance). These conditions were then used to aid in the development and evaluation of a simple mathematical model based on an ordinary differential equation. Several possible parameters well suited to quantification such as gap displacement, cement/interface stiffness and apparent mass were the identified from the model. In addition, the development of this model provided a solution to the problem of unifying early and late loosening mentioned in the literature by Li et al. in 1995 and 1996. This unification permitted early (micro loose) and late (macro loose) loosening to be quantified, if necessary, with the same parameter. The quantification problem was posed as a detection problem by utilising a varying amplitude input. A set of detection techniques were developed to detect the quantity of a critical value, in this case a force. The detection techniques include deviation measures of the instantaneous frequency of the impulse response of the system (accuracy of 100%), linearity of the systems response to Gaussian input (total accuracy of 97.9% over all realisations) and observed resonant frequency linearity with respect to displacement magnitude (accuracy of 100%). Note, that as these techniques were developed with the model in mind their simulated performance was, therefore, considerably high. This critical value found by the detector was then fed into the model and a quantified output was calculated. The quantification techniques using the critical value approach include, ramped amplitude input resonant analysis (experimental accuracy of 94%) and ramped amplitude input stochastic analysis (experimental accuracy of 90%). These techniques were based on analysing the response of the system in the time-frequency domain and with respect to its short-time statistical moments to a ramping amplitude input force, respectively. In addition, other mechanically sound forms of analysis, were then applied to the output of the nonlinear model with the aim of quantifying the looseness or the integrity of fixation of the THA. The cement/interface stiffness and apparent mass techniques, inspired by the work of Chung et.al. in 1979, attempt to assess the integrity of fixation of the THA by tracking the mechanical behaviour of the components of the THA, using the frequency and magnitude of the raw transducer data. This technique has been developed fron the theory of Chung etal but with a differing perspective and provides accuracies of 82% in experimentation and 71% in simulation for the apparent mass and interface stiffness techniques, respectively. Theses techniques do not quantify all forms of clinical loosening, as clinical loosening can exist in many different forms, but they do quantify mechanical loosening or the mechanical functionality of the femoral component through related parameters that observe reduction in mechanical mass, stiffness and the amount of rattle generated by a select ghap betweent he bone/cement or prosthesis/cement interface. This form of mechanical loosening in currently extremely difficult to detect using radiographs. It is envisaged that a vibration test be used in conjunction with radiographs to provide a more complete picture of the integrity of fixation of the THA.

La pose d’une prothèse totale de genou (PTG) se fait selon la technique d’alignement mécanique (AM) qui corrige les déformations constitutionnelles du membre pour créer un membre rectiligne. La survie à long terme des implants est excellente mais les résultats fonctionnels sont décevants avec notamment de nombreux symptômes résiduels. Une nouvelle technique chirurgicale, l’alignement cinématique (AC), vise à rétablir l’anatomie constitutionnelle pré-arthrosique du genou, et permet une amélioration des résultats fonctionnels des PTG. Cette technique est actuellement réalisée avec des implants destinés à un positionnement mécanique, et qui ont un design trochléen ne reproduisant pas l'anatomie trochléaire native. Ceci pourrait affecter la biomécanique de l’articulation patello-fémorale et donc rendre les résultats fonctionnels des PTG cinématiques non optimal. Ce travail vise à démontrer 1) les limitations de la technique mécanique, 2) la fiabilité de la technique cinématique pour le positionnement de l’implant fémoral, et 3) que les implants actuels ne permettent pas une restauration de l’anatomie trochléenne des patients. / The conventional technique for TKA, namely mechanical alignment (MA), does not preserve the constitutional limb anatomy but systematically creates a straight limb. Excellent long-term implant survivorship has been reported, but functional outcomes are disappointing. To solve this problem, an alternative technique for TKA, namely kinematic alignment (KA), has recently been promoted and aims at restoring the constitutional (pre-arthritic) knee anatomy and laxity. Mid-term outcomes have shown excellent functional outcomes with this new KA technique. However, KA technique is currently done with TKA implants designed to be mechanically inserted. Their trochlea design does not reproduce the native trochlear anatomy, which could lead to increased rate of patellar complications with KA TKA. This work aims at demonstrating technical limitations of MA technique, good reproducibility of KA technique, and inappropriateness of current implant to restore patient trochlea anatomy.

No description available.

Submitted by Simone Souza (simonecgsouza@hotmail.com) on 2017-09-20T14:37:32Z No. of bitstreams: 1 DISS_2014_Miguel Aprelino Alito.pdf: 4695957 bytes, checksum: 0f8d53c15612c14ec0bd4276f60d6c20 (MD5) / Approved for entry into archive by Jordan (jordanbiblio@gmail.com) on 2017-09-26T12:50:06Z (GMT) No. of bitstreams: 1 DISS_2014_Miguel Aprelino Alito.pdf: 4695957 bytes, checksum: 0f8d53c15612c14ec0bd4276f60d6c20 (MD5) / Made available in DSpace on 2017-09-26T12:50:06Z (GMT). No. of bitstreams: 1 DISS_2014_Miguel Aprelino Alito.pdf: 4695957 bytes, checksum: 0f8d53c15612c14ec0bd4276f60d6c20 (MD5) Previous issue date: 2014-08-25 / Introdução: Protocolos multimodais, quando empregados, melhoram variáveis clínicas perioperatórias e pós-operatórias. Existe pouca informação sobre abreviação do jejum préoperatório com oferta de líquidos claros enriquecidos com carboidratos e imunomoduladores em operações ortopédicas. O projeto ACERTO (ACEleração da Recuperação Total pósoperatória) é baseado em um programa europeu já existente (ERAS) e fundamentado no paradigma da medicina baseada em evidências. É antes de tudo um programa educativo. Objetivos: Avaliar variáveis clínicas, bioquímicas inflamatórias e segurança de um protocolo multimodal em pacientes submetidos à cirurgia de artroplastia total do quadril, utilizando-se técnica cimentada em fêmur e sem cimento no acetábulo (artroplastia total de quadril tipo híbrida). Métodos: Estudo prospectivo com 32 pacientes (16 do sexo masculino, com idade média de 58 anos variando de 26 a 85 anos) randomizados em dois grupos: 17 pacientes (Grupo ACERTO) submetidos a jejum abreviado com oferta de maltodextrina a 12,5%, 2h antes da indução anestésica e uso de dieta imunomoduladora por cinco dias previamente a cirurgia; 15 pacientes (Grupo CONTROLE) submetidos a jejum de 8 horas sem terapia nutricional préoperatória. Foram avaliados clinicamente broncoaspiração na indução anestésica e tempo de internação e em exames laboratoriais os níveis de hemoglobina (HB), velocidade de hemossedimentação (VHS) e proteína C reativa (PCR) no pré-operatório e com 48h de pósoperatório. Resultados: Não ocorreram óbitos, infecções, luxações da prótese, necessidade de reoperação, ou transfusões sanguíneas. Nenhum caso de broncoaspiração ocorreu na indução anestésica. Pacientes do Grupo ACERTO apresentaram, em média, dois dias a menos de internação hospitalar (P < 0,01). A taxa de HB foi similar entre os grupos no pré e pósoperatório. Valores de VHS se mantiveram semelhantes entre os grupos no pós-operatório (p = 0,09), mas a PCR foi maior no grupo CONTROLE no pós-operatório (p = 0,01). Conclusão: Abreviação do jejum pré-operatório com oferta de carboidratos na artroplastia total de quadril é segura, podendo ser praticada. O protocolo investigado como um todo diminuiu o tempo de internação hospitalar e valores de PCR no pós-operatório. / Introduction: Multimodal protocols, when used, enhance several perioperative clinical variables. Limited information is available about the reduction of preoperative fasting with administration of clear liquids enriched with carbohydrate and immunomodulators in orthopedic surgeries. The ACERTO (Accelerated Postoperative Total Recovery) is based on an existing European program (ERAS) and based on the paradigm of evidence-based medicine. It is an educational program. Objectives: To evaluate clinical, biochemical inflammatory variables and safety of the method, shortening up the fast with drink containing carbohydrates and use of immunomodulatory diet in patients undergoing surgery for total hip arthroplasty using cementless technique on the femur and the acetabulum without cement (total hip arthroplasty hybrid type). Methods: A prospective study of 32 patients (16 males, with a mean age of 58 years ranging de 26 to 85 years) were randomized into two groups: 17 patients (Group ACERTO) undergoing abbreviated to offer 12,5% maltodextrin fasting, 2h before induction of anesthesia and use of immunomodulatory diet for five days prior to surgery; 15 patients (Group CONTROL) fasted for 8 hours without preoperative nutritional therapy. Clinically aspiration during induction of anesthesia and hospitalization time and in laboratory tests the levels of hemoglobin (Hb), erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) preoperatively and 48 hours postoperatively were evaluated. Results: There were no deaths, infections, dislocations of the prosthesis, reoperation, or blood transfusions. No cases of aspiration occurred during anesthetic induction. Group ACERTO patients had, on average, two days less hospitalization (P < 0,01). Results of hemoglobin did not differ among groups in preoperative and postoperative. VHS values remained similar between groups postoperatively (p = 0,09), but CRP was higher in the control group postoperatively (p = 0,01). Conclusion: Preoperative fasting abbreviation with of carbohydrates in total hip arthroplasty is safe and may be practiced. The protocol investigated as a whole, decreased hospital stay and CRP levels postoperatively.

The thesis describes the anatomical study, which has been taken place at Orthopedic Clinic of the 1st Faculty of Medicine, Motol University Hospital and at Institute of Anatomy 1st Faculty of Medicine, Charles University in Prague from 2002 till 2009. The study was focused on the area of the upper part of the humerus in order to measure spatial relationships among anatomical structures, especially attachments of rotator cuff muscles to optimize implantation arthroplasty of shoulder joint. Clinico-anatomical study, which results were published in 2010, was also based at measuring angular relations of structures proximal humerus. The proximal humerus was marked by 29 points on the cortical bone, which defined the position of the medial margin of the greater tubercle, the lateral margin of the lesser tubercle, bicipital groove, the crest of greater tubercle and to define position of the proximal humeral metaphyseal axis and anatomical neck. Measurements were carried out in the transversal planes and the measurement method was developed on the reconstruction and the spatial definition of basic axes (axis of humeral head and axis of proximal humeral shaft) with the optimized number of reference points of anatomical neck and cortical bone of proximal humeral shaft. Angles between the axis of the head...

Introduction: Osteoarthrosis (OA) of the knee is a degenerative and chronic disease that promotes intense pain and often compromises the elderly population. With the severity of OA and the lack of success of conventional methods, Total Knee Arthroplasty (KTA) has been the most frequently used treatment, however, in some patients pain persists. Therefore, to better understand the pain, it is necessary to use somatosensory and functional tests. Objective: To evaluate the Pressure Pain Threshold (LDP) of patients with OA and submitted to TKA, as well as to analyze the association of pain intensity with functional factors. Methods: A case-control study was carried out on 40 subjects, selected for convenience at the Specialized Center for Orthopedics and Trauma (CEOT), divided into two groups: TKA group consisting of 20 patients operated on, being evaluated in three phases: preoperative , six and 12 months; and the control group comprised of 20 healthy, asymptomatic, paired subjects by sex and age, evaluated in a single moment. The LDP was performed through the digital pressure algometer. The intensity of pain was measured on the numerical scale from 0 to 10, the muscular strength assessed by the digital manual dynamometer. Range of motion obtained by the fleximeter. Static balance measured by the baropodometer and the speed test used to measure gait speed. Results: It presented statistical difference between the control group and TKA in all peripatellar and tibial points (P) (p <0.002). P4, P5, P5, P6, P8 and P9 (p <0.05), and six and 12 months were significant at P4, P5, P6, P8 and P9 (p <0.05) and Preoperative period and 12 months in P9 (p <0.05). In the comparison between the P at each stage of the evaluation, only significant changes were observed between P3 and P6 (p <0.05), P4 and P6 (p <0.005). Correlations of moderate to strong and inversely proportional between pain in movement and flexor strength (r = - 0.46), knee extensors (r = -0.49), hip abductors (r = -0.59) And gait velocity (r = -0.6), in the preoperative phase. Conclusion: In the preoperative phase there was lower LDP, due to central and peripheral sensitization due to OA chronicity. At six months post-operatively, he found a decrease in pain, which could be related to the efficacy of TKA and rehabilitation. Similar to the pre-surgical phase, at 12 months, LDP decreased, which may be linked to the central pain sensitization mechanism, contributing negatively to the decline in muscle strength and gait velocity. / Introdução: A osteoartrose (OA) do joelho é uma doença degenerativa, crônica que promove dor intensa e frequentemente compromete a população idosa. Com a gravidade da OA e a falta de sucesso dos métodos convencionais, a Artroplastia Total do Joelho (ATJ) tem sido o tratamento cirúrgico mais utilizado, para melhora da função biomecânica e da qualidade de vida. No entanto, alguns pacientes, apresentam a persistência de dor. Portanto, para melhor compreensão do quadro álgico torna-se necessário a utilização de testes somatossensoriais e funcionais. Objetivo: Avaliar o Limiar de Dor por Pressão (LDP) dos pacientes com OA e submetidos à ATJ, bem como analisar a associação da intensidade de dor com os fatores funcionais. Métodos: Estudo caso-controle, participaram 40 sujeitos, selecionados por conveniência no Centro de Especialidade em Ortopedia e Trauma (CEOT), divididos em dois grupos: grupo ATJ formado por 20 pacientes operados, sendo avaliados em três fases: pré-operatória, seis e 12 meses; e o grupo controle formado por 20 sujeitos saudáveis, assintomáticos, pareados por sexo e idade, avaliados em um único momento. O LDP foi realizado pelo algômetro de pressão digital e aplicado perpendicularmente a pele em seis pontos peripatelares (P1, P2, P3, P4, P5 e P6) e três pontos tibiais (P7, P8 e P9). A intensidade de dor foi mensurada na escala numérica de zero a 10. A força muscular avaliada pelo dinamômetro manual digital. A amplitude de movimento obtida pelo flexímetro. Equilíbrio estático mensurado pelo baropodômetro e utilizado o speed test para medir a velocidade da marcha. Resultados: O grupo controle apresentou maior LDP, com diferença estatística, comparado ao grupo ATJ em todos os pontos (P) peripatelares e tibiais (p< 0,002). Na fase pré-operatória houve menor LDP em relação a fase de seis meses nos P3, P4, P5, P6, P8 e P9 (p<0,05). Aos 12 meses ocorreu uma redução do LDP nos P4, P5, P6, P8 e P9 (p<0,05) quando relacionado a fase de seis meses. Na comparação entre os P em cada fase da avaliação, observou que somente na fase pré-operatória, o LDP foi menor no P6 em relação aos P3 e P4 (p<0,005). Foram encontradas correlações de moderada a forte, e inversamente proporcional, entre dor em movimento e força dos flexores (r = -0,46), extensores do joelho (r = -0,49), abdutores do quadril (r = -0,59) e velocidade da marcha (r = -0,6), na fase pré-operatória. Conclusão: Na fase pré-operatória houve menor LDP, provavelmente, em virtude da cronicidade da OA e consequentemente da sensibilização central e periférica. Aos seis meses de pós-operatório, encontrou redução do quadro álgico, podendo relacionar à eficácia da ATJ e da reabilitação. Semelhante à fase pré-cirúrgica, aos 12 meses, o LDP diminuiu, possivelmente estando atrelado ao mecanismo de sensibilização central de dor, contribuindo negativamente para o declínio da força muscular e da velocidade média da marcha.

OBJETIVO: Avaliar o padrão de degeneração histológica do ligamento cruzado posterior (LCP) em pacientes com artrose submetidos à artroplastia total de joelho com prótese com substituição do ligamento cruzado posterior (LCP). A degeneração histológica foi classificada em leve, moderada e grave. Os achados histológicos foram correlacionados com dados clínicos, radiográficos e do transoperatório (presença ou ausência do ligamento cruzado anterior) com a finalidade de aferir se estes parâmetros seriam capazes de predizer o grau de degeneração histológica do LCP em pacientes com gonartrose. MÉTODOS: foram avaliados 89 ligamentos cruzados posterior de 85 pacientes com idade média de 69,79 anos, sendo 69 do sexo feminino, 16 do masculino. O LCP foi corado em hematoxilina-eosina e Tricrômio de Gomori e classificado quanto ao comprometimento histológico em leve, moderado e grave. A degeneração histológica foi correlacionada aos parâmetros idade, artrose radiográfica classificada por Ahlbäck (grau I ao V), eixo radiográfico tíbio-femoral (varo, neutro e valgo), e estado do ligamento cruzado anterior (LCA), presença ou ausência.Os achados histológicos de hipercelularidade, infiltração linfocitária crônica, proliferação vascular; presença de cistos; clones de condrócitos; degenerações colágena, fibrinóide, cartilaginosa ,gordurosa e mucoide foram correlacionados com o grau de degeneração do LCP e ao estado de conservação do LCA. RESULTADO: Não foram identificadas relações entre o grau de degeneração histológica do LCP e faixa etária (abaixo ou acima de 70 anos), sexo, classificação radiográfica de Ahlbäck e presença ou ausência do LCA. Os achados histológicos de degeneração fibrinóide, proliferação vascular e presença de cistos estiveram estatisticamente relacionados à degeneração histológica grave do LCP. CONCLUSÃO: Os parâmetros clínicos e radiográficos não foram capazes de predizer o grau de degeneração histológica do LCP .Os achados histológicos de degeneração fibrinóide, proliferação vascular e presença de cistos caracterizaram a degeneração histológica grave do LCP / OBJECTIVE: Evaluate the histologic degeneration pattern of the posterior cruciate ligament (PCL) in osteoarthrosis patients submitted to total knee replacement with a cruciate substituting prosthesis. The histologic degeneration was classified in mild, moderate and severe. The histologic pattern was related to clinical, per-operatory (presence or absence of anterior cruciate ligament) and radiographic parameters with the aim to settle if these parameters would be reliable to predict the PCL degeneration grade. METHODS: 89 PCLs from 85 patients, 16 men, 69 women, mean age 69, 79 years old. PCL was stained with hematoxylin and eosin and trichromium of Gomori. The PCL histologic degeneration was graded from normal-minimum to severe. The histologic PCL degeneration pattern was related to age, radiographic arthrosis classification (Ahlbäck - grades I to V), knee radiographic axis (varus, neutral, valgus) and to the ACL status (presence or absence).The histologic findings of hipercellularity, chronic lymphocit infiltration, neoangiogenesis, cysts, collagen degeneration (deg), fibrinoid deg, mucoid deg., cartilaginous, deg., fat deg. and condrocyte clones were related to the grade of PCL degeneration and to ACL status. RESULTS: There was no correlation of histologic degeneration to sex or age (above or below 70 years), arthrosis radiographic classification (Ahlbäck) and presence or absence of ACL. The histological findings of fibrinoid degeneration, vascular proliferation and cysts were statistically related to severe histologic LCP degeneration. CONCLUSION: The parameters studied were not capable of predicting the grade of LCP degeneration. The histological findings of fibrinoid degeneration, vascular proliferation and cysts were characteristic of severe PCL histologic degeneration