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Brazil is still a developing and unequal nation,
where some regions stand a high level of
development while others remain very poor.
There is a large percentage of young people in
the population, although a progressive aging is
shown by demographic data.
During the 1990’s, there was an increase on the
number of knee replacement surgeries done in
the country, no longer limited to few specialized
university centers. Knee surgeons in Brazil
indicate knee replacement on patients over
sixty, but a great number refuse to undergo
arthroplasty even on patients with more
advanced age and great functional limitations.
Most of these patients would only submit to
surgery when the pain is extreme, restricting
them to short distance walks.
Knee replacement on young people are
indicated mostly in cases of trauma sequelae,
common in Brazil due to a large number of
traffic accidents (especially with motorcycles),
or in cases of rheumatic diseases sequelae,
especially rheumatoid arthritis or gouty arthritis
and systemic lupus erythematosus.
There is a different approach when it comes to
the care and attention given to the patient when
performing knee arthroplasty in each of those
two situations, and the expectations on the
surgery outcome are also different.
In general, patients with severe sequelae of
trauma have stiffness of the knee. When
undergoing knee arthroplasty, these patients
have improvements from the functional point
of view even with relatively small improvement
of the mobility.
Patients with sequelae due to trauma need
special care regarding the surgical incision.
There has to be a careful evaluation on factors
such as the presence of scars due to soft tissue
trauma or to previous surgeries, as well as the
adherence of the skin to deep layers. In spite of
the severe deformities or bone loss that would
justify the indication
of arthroplasty, some patients can be frustrated
with the functional outcome, even if the surgeon
is able to achieve a reasonable result. These
patients expect to have a completely new knee
and often overload excessively their prosthesis,
limiting its survivorship.
Regarding to rheumatic patients, the indication
for arthroplasty occurs in cases that show
extensive impairment of joint function by
disease severity or lack of proper medical
treatment. The most common rheumatic disease
is rheumatoid arthritis, but there are also cases
of systematic lupus erythematosus and gouty
arthritis. Most of these patients chronically use
immunosuppressive drugs, which make them
Knee arthroplasty
in young patients.
Brazilian Experience
J.-R. Pécora