Um novo estudo de pesquisadores do Hospital for Special Surgery (HSS) avaliou as tendências no uso da artroplastia total do joelho (ATJ) em pacientes menores de 21 anos nos Estados Unidos.
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Domínio Público
De acordo com Cynthia A. Kahlenberg, MD, MPH, cirurgiã ortopédica do HSS e coautora do estudo, a ATJ raramente é realizada em pacientes com menos de 21 anos, mas pode ser realizada nessa população devido a condições como artrite inflamatória ou artrite idiopática juvenil. artrite (AIJ), tumores malignos ou não malignos ou trauma. No entanto, o número de pacientes com menos de 21 anos submetidos a ATJ nos EUA é desconhecido. Em um dos maiores estudos dos EUA de um registro institucional de artroplastia, apenas 19 ATJs foram realizadas em pacientes com menos de 21 anos de aproximadamente 30.000 ATJs primárias com mais de 34 anos – a maioria das quais para AIJ.
Os pesquisadores analisaram retrospectivamente o Kids' Inpatient Database (KID), uma amostra nacional ponderada de todas as internações hospitalares de pacientes com menos de 21 anos em aproximadamente 4.200 hospitais em 46 estados. Os pesquisadores usaram os códigos da Classificação Internacional de Doenças, Nona Revisão (CID-9) e CID-10 para identificar pacientes submetidos à ATJ de 2000 a 2016 e determinar o diagnóstico primário. Estatísticas descritivas, como médias e porcentagens, juntamente com seus intervalos de confiança de 95% (IC de 95%), foram calculadas usando os pesos amostrais apropriados, conforme recomendado pela Agência de Pesquisa e Qualidade em Saúde para uso com o conjunto de dados KID.
O número total ponderado de ATJs realizadas em pacientes com menos de 21 anos de 2000-2016 foi de 1.331; o número de ATJs realizadas por ano nessa faixa etária manteve-se relativamente estável. A idade média dos pacientes submetidos à ATJ foi de 14,8 anos (IC 95%, 14,4-15,2); 48,8% da coorte era do sexo feminino. Entre os pacientes com tumor, uma proporção maior foi identificada como hispânica (22,1%) ou outra raça (12,6%) em comparação com a coorte não tumoral; 70,3% das ATJs foram realizadas para diagnóstico primário de tumor; e o número de ATJs para tumores malignos aumentou ligeiramente durante o período de estudo. Em contraste, o uso de ATJ para artrite inflamatória/AIJ diminuiu mais de 70% durante o período do estudo, provavelmente devido a melhorias no tratamento médico de pacientes com artrite inflamatória/AIJ.
"Este foi um dos primeiros estudos a analisar em profundidade a ATJ nesta população muito jovem", disse o Dr. Kahlenberg. "Nosso estudo foi capaz de confirmar que os tumores foram o motivo mais comum para artroplastia do joelho nesta população".
"Acho que a maior vantagem como reumatologista é que estamos fazendo um bom trabalho tratando esses pacientes e, ao longo dos anos, os tratamentos para artrite inflamatória estão realmente funcionando bem nessa população jovem", disse Bella Mehta, MBBS, MS , reumatologista do HSS e autor sênior do estudo.