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Cardiovascular

Coxartrose

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Caso clínico do Sr. Gregório Alves

Um doente do sexo masculino, com 66 anos, apresenta-se na consulta devido a uma dor no joelho direito com 2 anos de evolução, refratária a um tratamento médico. Tal dor está a ter um impacto severo na sua qualidade de vida.
No exame físico, queixa-se de dores graves na mobilização ativa, o joelho está rígido e com crepitações. O raio-X mostra estreitamento do espaço articular, esclerose subcondral, e osteófitos marginais.

Objectivos de aprendizagem

  • Avaliação da progressão da gonartrose
  • Tratamento de acordo com a avaliação clínica e radiológica

Fases

  1. Encaminhamento do tratamento cirúrgico

Principais fármacos

  • Medicamentos sintomáticos de ação lenta para OA (SYSADOAs)
  • Paracetamol
  • Anti-inflamatórios não esteróides (AINEs)
  • Corticosteróides
  • Duloxetina
  • Opiáceos

Referências

  • Brown GA. AAOS clinical practice guideline: treatment of osteoarthritis of the knee: evidence-based guideline, 2nd edition. J Am Acad Orthop Surg. 2013;21(9):577–9.
  • McGrory BJ, Weber KL, Jevsevar DS, Sevarino K. Surgical management of osteoarthritis of the knee: Evidence-based guideline: Evidence-based guideline. J Am Acad Orthop Surg. 2016;24(8):e87-93.
  • Bannuru RR, Osani MC, Vaysbrot EE, Arden NK, Bennell K, Bierma-Zeinstra SMA, et al. OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthritis Cartilage. 2019;27(11):1578–89.
  • Miller LE, Fredericson M, Altman RD. Hyaluronic acid injections or oral nonsteroidal anti-inflammatory drugs for knee osteoarthritis: Systematic review and meta-analysis of randomized trials. Orthop J Sports Med. 2020;8(1):232596711989790.
  • Brignardello-Petersen R, Guyatt GH, Buchbinder R, Poolman RW, Schandelmaier S, Chang Y, et al. Knee arthroscopy versus conservative management in patients with degenerative knee disease: a systematic review. BMJ Open. 2017;7(5):e016114.
  • Palmer JS, Monk AP, Hopewell S, Bayliss LE, Jackson W, Beard DJ, et al. Surgical interventions for symptomatic mild to moderate knee osteoarthritis. Cochrane Database Syst Rev. 2019;7:CD012128.
  • Odgaard A, Madsen F, Kristensen PW, Kappel A, Fabrin J. The Mark Coventry award: Patellofemoral arthroplasty results in better range of movement and early patient-reported outcomes than TKA: Patellofemoral arthroplasty results in better range of movement and early patient-reported outcomes than TKA. Clin Orthop Relat Res. 2018;476(1):87–100.
  • Newman JM, Sodhi N, Dekis JC, Khlopas A, Piuzzi NS, Sultan AA, et al. Survivorship and functional outcomes of cementless versus cemented total knee arthroplasty: A meta-analysis. J Knee Surg. 2020;33(3):270–8.
  • Coory JA, Tan KG, Whitehouse SL, Hatton A, Graves SE, Crawford RW. The outcome of total knee arthroplasty with and without patellar resurfacing up to 17 years: A report from the Australian orthopaedic association national joint replacement registry. J Arthroplasty. 2020;35(1):132–8.
  • Büttner M, Mayer AM, Büchler B, Betz U, Drees P, Susanne S. Economic analyses of fast-track total hip and knee arthroplasty: a systematic review. Eur J Orthop Surg Traumatol. 2020;30(1):67–74.
  • Ripollés-Melchor J, Abad-Motos A, Díez-Remesal Y, Aseguinolaza-Pagola M, Padin-Barreiro L, Sánchez-Martín R, et al. Association between use of Enhanced Recovery After Surgery protocol and postoperative complications in total hip and knee arthroplasty in the postoperative outcomes within Enhanced Recovery After Surgery protocol in elective total hip and knee arthroplasty study (POWER2). JAMA Surg. 2020;155(4):e196024.

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