ObjectiveTo review the literature on quality of life among patients who underwent total knee arthroplasty (TKA) and assess the impact of various associated factors.Methodsthis was a systematic review of the literature in the Medline, Embase, Lilacs and SciELO databases, using the terms: TKA (total knee arthroplasty); TKR (total knee replacement); quality of life; and outcomes. There were no restrictions regarding study design.Results31 articles addressing this topic using various quality-of-life evaluation protocols were selected. SF-36/SF-12, WOMAC and Oxford were the ones most frequently used. The studies made it possible to define that TKA is capable of making an overall improvement in patients’ quality of life. Pain and function are among the most important predictors of improvement in quality of life, even when function remains inferior to that of healthy patients.ConclusionThe factors associated negatively were obesity, advanced age, comorbidities, persistence of pain after the procedure and a lengthy wait for surgery.

r e v b r a s o r t o p . 2 0 1 4;4 9(5):520-527 w w w . r b o . o r g . b r Artigo OriginalQualidade de vida após artroplastia total do joelho: revisão sistemática ଝ

PurposeTo analyze the location of the femoral tunnel by three-dimensional computed tomography (3D CT) of the lateral condyle in patients who underwent arthroscopic single-bundle anterior cruciate ligament (ACL) reconstruction, performed using a modified transtibial technique, and to compare the results with data from the literature.Materials and MethodsSeventeen patients with ACL lesions underwent modified transtibial ACL reconstruction. Postoperatively, 3D CT examinations were performed and the images were analyzed by the quadrant system described by Bernard and Hertel to define the femoral tunnel coordinates.ResultsThe mean value of femoral tunnel location coordinates was 37.1±5.9 in the horizontal plane and 23.9±7.5 in the vertical plane. Compared with other studies using the transtibial or transportal technique, femoral positioning was improved in the vertical plane. The outside-in technique provided the best results both in the vertical and horizontal planes.ConclusionsThe modified transtibial technique was not effective for systematically anatomic femoral tunnel positioning; however, it was relatively better than the conventional transtibial technique.

The aim of this study was to describe the number and regional distribution of hospital admission authorization (AIH), hospitalization costs, average length of stay (LOS), and mortality rates related to primary total knee arthroplasty (TKA) procedures funded by the Brazilian Public Health Unic System (SUS) from 2012 to 2021. A cross-sectional descriptive study on the number and regional distribution of AIH, hospitalization costs, average LOS, and mortality rates related to primary TKA procedures funded by the SUS from 2012 to 2021 was done. As results, 65,602 AIH were released in the evaluated period; in 2020 and 2021 there was a sharp decrease of procedures, probably due to the COVID-19 pandemic. The total value spent in the evaluated period was of 271,297,010.60 BRL. The average LOS was of 4.15 days. The absolute number of deaths was of 103, with 0.16% of mortality rate. It was concluded that the number and regional distribution of AIH was of 37,370 (57%) to the Southeast; 18,907 (29%) to the South, 5,250 (8%) to the Northeast; 2,758 (4%) to the Midwest and 1,317 (2%) to the North, totaling 65,602 admissions, with a total expenditure of 271,297,010.60 BRL (156,252,541.60 BRL in Southeast, 77,150,946.31 BRL in South, 21,194,955.07 BRL in Northeast, 12,077,393.69 BRL in Midwest and 4,621,173.96 BRL in North). The average LOS (in days) was of 4.15 (4.15 in Southeast; 3.83 in South; 4.6 in Northeast; 4.81 in Midwest; and, 5.71 in North). The mortality rate was of 0.16% (Southeast=0,14%; South=0,1%; Northeast=0,16%; Midwest=0,17%; and North=0,14%).

Spinal anesthesia for knee arthroscopy is a well-documented and safe procedure. However, some complications and higher costs have been reported. Also, many orthopaedic surgeons are reluctant to use local anesthesia for fear of having to convert to general anesthesia due to inadequate pain control. The purpose of this study is to compare local with spinal anesthesia in two groups of patients submitted to knee arthroscopy. Sixty-five patients were divided in two groups; based on the anesthesia method used, and submitted to the same surgical routine and postoperative analgesia protocol. They were evaluated for analgesia, level of postoperative pain, and level of satisfaction with the type of anesthetic. The two groups did not present any significant differences in relation to perioperative analgesia and pain on the first postoperative day, neither was there any difference in relation to emotional state. However, there was a significant difference in terms of acceptance of the procedure; 100% said they would accept the procedure again in the local anesthesia group, compared with 60.5% in the spinal anesthesia group; also, 100% in the local anesthesia group said they felt encouraged by the type of anesthesia, compared with 67.7% in the spinal anesthesia group. We can conclude that local anesthesia is similar to spinal anesthesia in almost all the aspects investigated, except in terms of acceptance and patients’ level of satisfaction with the procedure. Local anesthesia can be a good alternative to spinal anesthesia, especially in outpatient departments, or when patients have restrictions to traditional models of anesthesia.