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Abstract(s)
A artrose resulta da senescência e consequente destruição progressiva
dos tecidos que compõem a articulação, em particular a cartilagem, conduzindo
à instalação progressiva de dor, deformação e limitação dos movimentos. A
cartilagem articular perde a sua elasticidade, integridade e consistência, e
consequentemente também, parte ou totalidade da sua capacidade funcional. A
artrose do joelho é denominada por gonartrose.
Por se tratar de um processo degenerativo, é lento e gradual, o que
permite que se possam planear diversas intervenções ao longo da sua
evolução numa tentativa de controlar a sua progressão e sintomatologia.
O tratamento da artrose do joelho é, ao início, essencialmente clinico. O
objetivo é aliviar a dor, sendo para isso usada terapia não farmacológica e
farmacológica. A primeira consiste em terapia física/ocupacional, osteopatia e
acupunctura. Quanto à segunda consiste em terapia oral, através da
administração de glucosamina ou acetaminofeno, anti-inflamatórios não
esteróides ou opióides, terapia tópica com capsaicina, anti-inflamatórios não
esteróides ou lidocaína e terapia intra-articular com a administração de
corticóides ou ácido hialurónico. Logo que o tratamento clinico deixar de ser
eficaz, a cirurgia pode ser encarada. Em artroses pouco avancadas, uma
lavagem articular artroscópica pode permitir "lavar a articulação" e regularizar
pequenas lesões meniscais: a irrigação com o soro fisiológico comporta a
remoção dos restos da cartilagem, fonte de inflamação, e dá frequentemente
um bom alívio, ainda que este temporário (alguns meses ou anos). Mas as duas mais importantes possibilidades terapêuticas cirúrgicas são osteotomia e
prótese do joelho. A osteotomia do joelho corrige o eixo do membro inferior de
forma a equilibrar o peso do doente sobre o compartimento oposto cuja
cartilagem é sã. A prótese total do joelho substitui, em contrapartida, a
cartilagem destruída. Em última instância recorre-se à fusão da articulação do
joelho, cirurgia conhecida por artrodese.
Esta dissertação foi feita com base numa revisão teórica do que se
conhece até hoje sobre as intervenções cirúrgicas no tratamento da gonartrose.
Osteoarthritis results from progressive senescence and consequent destruction of tissues that make up the joint, particularly the cartilage, leading to the progressive pain, deformity and limitation of movement. The articular cartilage loses its elasticity, integrity and consistency, and hence also, some or all of its functional capacity. Osteoarthritis of the knee is called by gonarthrosis. Because it is a degenerative process is slow and gradual, allowing various interventions can be planned along its evolution in an attempt to control its progression and symptomatology. The treatment of osteoarthritis of the knee is at the beginning, primarily clinical. The aim is to relieve pain, being used for this non-pharmacological and pharmacological therapy. The first consists of physical therapy / occupational, osteopathy and acupuncture. The second consists of oral therapy, through administration of glucosamine or acetaminophen, nonsteroidal antiinflammatory drugs or opioids, topical therapy with capsaicin, anti-inflammatory steroids or lidocaine and therapy with intra-articular administration of corticosteroids or hyaluronic acid. Once the clinical treatment no longer effective, surgery may be considered. In osteoarthritis little advanced, an arthroscopic lavage may allow "wash the articulation” and of small meniscal lesions: irrigation with saline solution involves the removal of debris from the cartilage, a source of ignition, and often gives a good relief, although this temporary (few months or years). But the two most important therapeutic options are surgical osteotomy and knee prosthesis. Knee osteotomy corrects the axis of the lower limb in order to balance the patient's weight on the opposite compartment where the cartilage is healthy. Total knee prosthesis replaces, by contrast, the damaged cartilage. Ultimately one relies on the fusion of the knee joint, surgery known as arthrodesis. This thesis was based on a theoretical review of what is known today about the surgical treatment of gonarthrosis.
Osteoarthritis results from progressive senescence and consequent destruction of tissues that make up the joint, particularly the cartilage, leading to the progressive pain, deformity and limitation of movement. The articular cartilage loses its elasticity, integrity and consistency, and hence also, some or all of its functional capacity. Osteoarthritis of the knee is called by gonarthrosis. Because it is a degenerative process is slow and gradual, allowing various interventions can be planned along its evolution in an attempt to control its progression and symptomatology. The treatment of osteoarthritis of the knee is at the beginning, primarily clinical. The aim is to relieve pain, being used for this non-pharmacological and pharmacological therapy. The first consists of physical therapy / occupational, osteopathy and acupuncture. The second consists of oral therapy, through administration of glucosamine or acetaminophen, nonsteroidal antiinflammatory drugs or opioids, topical therapy with capsaicin, anti-inflammatory steroids or lidocaine and therapy with intra-articular administration of corticosteroids or hyaluronic acid. Once the clinical treatment no longer effective, surgery may be considered. In osteoarthritis little advanced, an arthroscopic lavage may allow "wash the articulation” and of small meniscal lesions: irrigation with saline solution involves the removal of debris from the cartilage, a source of ignition, and often gives a good relief, although this temporary (few months or years). But the two most important therapeutic options are surgical osteotomy and knee prosthesis. Knee osteotomy corrects the axis of the lower limb in order to balance the patient's weight on the opposite compartment where the cartilage is healthy. Total knee prosthesis replaces, by contrast, the damaged cartilage. Ultimately one relies on the fusion of the knee joint, surgery known as arthrodesis. This thesis was based on a theoretical review of what is known today about the surgical treatment of gonarthrosis.
Description
Keywords
Gonartrose - Joelho - Tratamento cirúrgico Artroscopia - Joelho Artroplastia - Joelho Biomecânica - Joelho Osteotomia - Joelho
Pedagogical Context
Citation
Publisher
Universidade da Beira Interior