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Sato VN, Moriwaki TL, do Amaral E Castro A, da Rocha Correa Fernandes A, Guimaraes JB. Capsular and retinaculum thickening in type II mucopolysaccharidosis: a novel MRI finding. Skeletal Radiol 2024; 53:1211-1217. [PMID: 37930378 DOI: 10.1007/s00256-023-04499-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 10/22/2023] [Accepted: 10/23/2023] [Indexed: 11/07/2023]
Abstract
Mucopolysaccharidoses (MPS) are a group of inherited lysosomal storage diseases caused by a deficiency of glycosaminoglycan (GAG) catalytic enzymes, resulting in an accumulation of unprocessed or partly degraded GAGs in different tissues, including bones and joints. Notably, skeletal and joint abnormalities may be the first complaint that prompts patients to seek medical attention, especially in the milder forms of the disease. To our knowledge, there are no prior imaging reports that have documented capsuloligamentous thickening in patients with MPS on MRI. In this study, we present four cases of patients with clinically and genetically confirmed diagnosis of type II MPS, encompassing seven MRI examination of different joints, including cervical spine, hip, wrist, knee, and shoulder. All of the patients were male, aged between 14 and 35 years, and exhibited varying degrees of joint stiffness in the clinical examination and carpal tunnel syndrome in cases of the wrist joint was affected. None of the patients had a history of surgical procedures on the affected joint, other metabolic or deposit diseases, or sports activity practice. The MRI revealed significant capsuloligamentous and retinaculum thickening, up to eight times greater than the normal capsular thickness reported in the literature.
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Affiliation(s)
- Vitor Neves Sato
- Department of Radiology, Escola Paulista de Medicina/Universidade Federal de São Paulo (UNIFESP), Rua Napoleão de Barros, 800 - Vila Clementino, São Paulo, SP, 04024-002, Brazil.
- Division of Musculoskeletal Radiology, Diagnóstico das Américas (DASA), São Paulo, SP, Brazil.
- Department of Radiology, Hospital Do Coração (HCor) and Teleimagem, São Paulo, SP, Brazil.
| | - Tatiane Lumi Moriwaki
- Department of Radiology, Escola Paulista de Medicina/Universidade Federal de São Paulo (UNIFESP), Rua Napoleão de Barros, 800 - Vila Clementino, São Paulo, SP, 04024-002, Brazil
- Division of Musculoskeletal Radiology, Diagnóstico das Américas (DASA), São Paulo, SP, Brazil
| | - Adham do Amaral E Castro
- Department of Radiology, Escola Paulista de Medicina/Universidade Federal de São Paulo (UNIFESP), Rua Napoleão de Barros, 800 - Vila Clementino, São Paulo, SP, 04024-002, Brazil
- Department of Radiology, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Artur da Rocha Correa Fernandes
- Department of Radiology, Escola Paulista de Medicina/Universidade Federal de São Paulo (UNIFESP), Rua Napoleão de Barros, 800 - Vila Clementino, São Paulo, SP, 04024-002, Brazil
- Radiology Department - Grupo de Radiologia e Diagnóstico por Imagem da Rede D'or, São Paulo, SP, Brazil
| | - Julio Brandao Guimaraes
- Department of Radiology, Escola Paulista de Medicina/Universidade Federal de São Paulo (UNIFESP), Rua Napoleão de Barros, 800 - Vila Clementino, São Paulo, SP, 04024-002, Brazil
- Department of Musculoskeletal Radiology, Fleury Medicina E Saúde, São Paulo, SP, Brazil
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Yılmaz E, Kaya Z, Satış H, Yazol M, Kirkiz S, Koçak Ü. The role of rheumatologist in the assessment of hemophilic arthropathy using head-us in patients with hemophilia. Int J Rheum Dis 2024; 27:e15138. [PMID: 38576103 DOI: 10.1111/1756-185x.15138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 02/29/2024] [Accepted: 03/15/2024] [Indexed: 04/06/2024]
Affiliation(s)
- Emine Yılmaz
- Department of Pediatric Hematology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Zühre Kaya
- Department of Pediatric Hematology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Hasan Satış
- Department of Rheumatology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Merve Yazol
- Department of Radiology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Serap Kirkiz
- Department of Pediatric Hematology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Ülker Koçak
- Department of Pediatric Hematology, Gazi University Faculty of Medicine, Ankara, Turkey
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Schneider AM, Rice SJ, Lancaster N, McGraw M, Farid Y, Finn HA. Low-Dose Irradiation and Rotating-Hinge Revision for the Treatment of Severe Idiopathic Arthrofibrosis Following Total Knee Arthroplasty: A Review of 60 Patients With a Mean 6-Year Follow-Up. J Arthroplasty 2024; 39:1075-1082. [PMID: 37863275 DOI: 10.1016/j.arth.2023.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 09/26/2023] [Accepted: 10/02/2023] [Indexed: 10/22/2023] Open
Abstract
BACKGROUND Severe idiopathic arthrofibrosis after total knee arthroplasty (TKA) is a challenging problem to treat. Low-dose irradiation may decrease fibro-osseous proliferation, while rotating-hinge (RH) revision allows for distal femur shortening and collateral ligament sacrifice. This study reports the clinical outcomes and implant survivorship in patients treated with low-dose irradiation and RH revision for severe idiopathic arthrofibrosis following TKA. METHODS A retrospective review was performed on 60 consecutive patients. Patients who had greater than 80° arc of knee motion or less than 15° flexion contracture were excluded. Mean follow-up was 6 years (range, 2 to 14). Kaplan-Meier survivorship analyses were performed, and logistic regressions were used to determine associations between preoperative patient characteristics and clinical outcomes. RESULTS Median flexion contracture and median terminal flexion at presentation were 20 and 70°, respectively; at final follow-up, 59 of 60 patients (98%) had ≤10° flexion contracture and 49 of 60 patients (82%) had ≥90° of flexion. The 10-year survivorship free from reoperation for any reason, revision for any reason, and revision for aseptic loosening were 63, 87, and 97%, respectively. There were 27% percent of patients who underwent a manipulation under anesthesia postoperatively, which was the most common reason for return to the operating room. A greater number of prior surgeries was significantly associated with worse range of motion at the final follow-up (P = .004). There were no known radiation-associated complications. CONCLUSIONS Patients with severe idiopathic arthrofibrosis following TKA treated with low-dose irradiation and RH revision maintained a gain in knee range of motion of 60° with reliable flexion contracture correction at a mean 6-year follow-up. A manipulation under anesthesia was common in the postoperative period. Survivorship free from revision for aseptic loosening was excellent at 10 years.
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Affiliation(s)
- Andrew M Schneider
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri
| | - Steven J Rice
- Department of Orthopaedic Surgery, University of Chicago, Chicago, Illinois
| | - Neil Lancaster
- Department of Orthopaedic Surgery, Franciscan Health, Olympia Fields, Illinois
| | - Michael McGraw
- Department of Orthopaedic Surgery, Franciscan Health, Olympia Fields, Illinois
| | - Yasser Farid
- Department of Orthopaedic Surgery, University of Illinois at Chicago, Chicago, Illinois
| | - Henry A Finn
- Department of Orthopaedic Surgery, University of Chicago, Chicago, Illinois
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Marquez-Lara A, Padget W, Wall EJ, Parikh SN. Manipulation Under Anesthesia is Safe and Effective for Management of Early Postoperative Knee Arthrofibrosis in Adolescent Patients. J Pediatr Orthop 2024; 44:e84-e90. [PMID: 37937395 DOI: 10.1097/bpo.0000000000002562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
BACKGROUND Management of postoperative knee arthrofibrosis can be challenging and the preferred time for intervention remains controversial. The purpose of this study is to evaluate the safety and efficacy of early (<3 mo postoperatively) manipulation under anesthesia (MUA) for the treatment of knee arthrofibrosis in adolescent patients. We hypothesized that early MUA could restore normal knee motion with a low complication rate and without the need for more invasive intervention. METHODS In a retrospective review, 57 patients who underwent MUA for postoperative knee arthrofibrosis were identified. The time between the index surgery and MUA as well as changes in range of motion (ROM) before and after MUA were analyzed. Descriptive statistics with median and interquartile range were used to analyze this non-parametric study cohort. Repeated measures ANOVA was performed to assess improvement in ROM over time. A P value <0.05 denoted statistical significance. RESULTS The median age of the cohort at time of MUA was 14.5 years [interquartile range (IQR) 12.9 to 17.6)]. 54.4% were male. Median time to MUA was 64 days (IQR 52 to 79) after index surgery. ROM before MUA was 90.0 degrees (IQR 75 to 100), which improved to 130 degrees (120 to 135) after MUA. At final median follow-up of 8.9 months (IQR 5.1 to 16.1), mean ROM was 133 degrees (130 to 140). There were no iatrogenic fractures or physeal separations associated with MUA. 12.3% (n=7/57) failed MUA either due to the need for subsequent repeat MUA (n=2), need for lysis of adhesions (n=3) or need for surgery after MUA (n=2). Those who failed early MUA and required subsequent procedures had ROM >120 degrees at final follow-up. CONCLUSIONS Postoperative knee arthrofibrosis can be safely and effectively treated with early (<3 mo postoperative) MUA. There were no iatrogenic fractures or physeal separations during MUA. Patients who had recurrence of motion deficits after early MUA and required further intervention, regained satisfactory knee motion at final follow-up. Although further research is warranted to better characterize risk factors for knee arthrofibrosis in adolescent patients, early recognition and MUA is a safe and effective treatment for arthrofibrosis to help patients regain full ROM without invasive intervention. LEVEL OF EVIDENCE Therapeutic Study - Level IV.
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Affiliation(s)
| | | | - Eric J Wall
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Shital N Parikh
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH
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Rodriguez-Merchan EC. Ankle arthrodesis and total ankle replacement in patients with congenital bleeding disorders suffering from severe ankle arthropathy. Expert Rev Hematol 2024; 17:1-8. [PMID: 38131332 DOI: 10.1080/17474086.2023.2299301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 12/21/2023] [Indexed: 12/23/2023]
Abstract
INTRODUCTION In patients with congenital bleeding disorders suffering from severe ankle arthropathy, when conservative treatment and joint-preserving surgical techniques fail, there are two possible non-joint-preserving options: ankle arthrodesis (AA) and total ankle replacement (TAR). AREAS COVERED The scope and aim of this article was to analyze the current role of AA and TAR in patients with congenital bleeding disorders suffering from severe ankle arthropathy. EXPERT OPINION In patients with congenital bleeding disorders, both TAR and AA provide good results, mainly in terms of pain relief, although they are not exempt from complications (between 0% and 33% in TAR and between 5% and 23.5% in AA). The current controversy about which of the two surgical techniques, TAR or AA, gives better results, the current literature is not able to resolve it in patients with congenital bleeding disorders. While this question is being answered, my opinion regarding patients with congenital bleeding disorders is that the age of the patient must be taken into account. Given known prosthetic survival rates, the older the patient, the more we might be inclined to indicate TAR. Conversely, AA may be more appropriate for relatively young patients.
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Ramos MS, Pasqualini I, Surace PA, Molloy RM, Deren ME, Piuzzi NS. Arthrofibrosis After Total Knee Arthroplasty: A Critical Analysis Review. JBJS Rev 2023; 11:01874474-202312000-00001. [PMID: 38079496 DOI: 10.2106/jbjs.rvw.23.00140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
» Arthrofibrosis after total knee arthroplasty (TKA) is the new formation of excessive scar tissue that results in limited ROM, pain, and functional deficits.» The diagnosis of arthrofibrosis is based on the patient's history, clinical examination, absence of alternative diagnoses from diagnostic testing, and operative findings. Imaging is helpful in ruling out specific causes of stiffness after TKA. A biopsy is not indicated, and no biomarkers of arthrofibrosis exist.» Arthrofibrosis pathophysiology is multifactorial and related to aberrant activation and proliferation of myofibroblasts that primarily deposit type I collagen in response to a proinflammatory environment. Transforming growth factor-beta signaling is the best established pathway involved in arthrofibrosis after TKA.» Management includes both nonoperative and operative modalities. Physical therapy is most used while revision arthroplasty is typically reserved as a last resort. Additional investigation into specific pathophysiologic mechanisms can better inform targeted therapeutics.
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Affiliation(s)
- Michael S Ramos
- Department of Orthopaedic Surgery, Orthopaedic and Rheumatologic Institute, Cleveland Clinic Foundation, Cleveland, Ohio
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Fu H, Peacock C, Wang C, Kader D, Clement N, Asopa V, Sochart D. The effect of HIV prevalence, CD4 counts and disease severity on the outcome of total knee arthroplasty for haemophilic arthropathy: a systematic review and meta-analysis. Eur J Orthop Surg Traumatol 2023; 33:3235-3254. [PMID: 37212914 DOI: 10.1007/s00590-023-03586-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 05/10/2023] [Indexed: 05/23/2023]
Abstract
PURPOSE End-stage knee arthropathy is a recognised complication of haemophilia. It is often treated by total knee arthroplasty (TKA), which is more technically challenging in patients with haemophilia (PwH). It remains unclear what factors may predict implant survivorship and deep infection rate. Therefore, we systematically review the evidence regarding TKA survivorship and infection in PwH, compared to the general population, and determine the important factors influencing survivorship, particularly HIV and CD4 + count. METHODS A systematic literature review was conducted using MEDLINE, EMBASE, and PubMed for studies reporting Kaplan-Meier survivorship for TKA in PwH (PROSPERO CRD42021284644). Meta-analysis was performed for survivorship, and the results compared to < 55-year-olds from the National Joint Registry (NJR). Meta-regression was performed to determine the impact of relevant variables on 10-year survivorship, with a sub-analysis focusing on HIV. RESULTS Twenty-one studies were reviewed, totalling 1338 TKAs (average age 39 years). Implant survivorship for PwH at 5, 10, and 15 years was 94%, 86%, and 76% respectively. NJR-reported survivorship for males < 55 years was 94%, 90%, and 86%. Survivorship improved over time (1973-2018), and correlated inversely with HIV prevalence. Infection rate was 5%, compared to 0.5-1% in the NJR. Infection was not significantly increased with higher HIV prevalence, and CD4 + count had no effect. Complications were inconsistently reported. CONCLUSION Survivorship was similar at 5 years but declined thereafter, and infection rate was six-fold higher. HIV was related to worse survivorship, but not increased infection. Meta-analysis was limited by inconsistent reporting, and standardised reporting is required in future studies.
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Affiliation(s)
- Howell Fu
- Academic Surgical Unit, South West London Elective Orthopaedic Centre, Epsom General Hospital, Dorking Road, Epsom, KT18 7EG, UK.
| | - Christian Peacock
- Academic Surgical Unit, South West London Elective Orthopaedic Centre, Epsom General Hospital, Dorking Road, Epsom, KT18 7EG, UK
| | - Chao Wang
- Faculty of Health, Science, Social Care and Education, Kingston University, Kingston Hill, Kingston upon Thames, Surrey, KT2 7LB, UK
| | - Deiary Kader
- Academic Surgical Unit, South West London Elective Orthopaedic Centre, Epsom General Hospital, Dorking Road, Epsom, KT18 7EG, UK
| | - Nick Clement
- Academic Surgical Unit, South West London Elective Orthopaedic Centre, Epsom General Hospital, Dorking Road, Epsom, KT18 7EG, UK
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, 51 Little France Cres, Old Dalkeith Rd, Edinburgh, EH16 4SA, UK
| | - Vipin Asopa
- Academic Surgical Unit, South West London Elective Orthopaedic Centre, Epsom General Hospital, Dorking Road, Epsom, KT18 7EG, UK
| | - David Sochart
- Academic Surgical Unit, South West London Elective Orthopaedic Centre, Epsom General Hospital, Dorking Road, Epsom, KT18 7EG, UK
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Chen X, Huang HQ, Duan XJ. Arthroscopic treatment of ankle impingement syndrome. Chin J Traumatol 2023; 26:311-316. [PMID: 37852876 PMCID: PMC10755808 DOI: 10.1016/j.cjtee.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 09/20/2023] [Accepted: 09/27/2023] [Indexed: 10/20/2023] Open
Abstract
Arthroscopic treatment of ankle impingement syndrome (AIS) is a minimally invasive surgical procedure used to address symptoms caused by impingement in the ankle joint. This syndrome occurs when there is abnormal contact between certain bones or soft tissues in the ankle, leading to pain, swelling, or limited range of motion. Traditionally, open surgery was the standard approach for treating AIS. However, with advancements in technology and surgical techniques, arthroscopic treatment has become a preferred method for many patients and surgeons. With improved visualization and precise treatment of the arthroscopy, patients can experience reduced pain and improved functionality, allowing them to return to their daily activities sooner. In this paper, we reviewed the application and clinical efficacy the of arthroscopic approach for treating AIS, hoping to provide a reference for its future promotion.
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Affiliation(s)
- Xin Chen
- Center for Joint Surgery, Southwest Hospital, Third Military University (Amy Medical University), Chongqing, 400038, China
| | - He-Qin Huang
- Department of Nuclear Medicine, Southwest Hospital, Third Military University (Amy Medical University), Chongqing, 400038, China
| | - Xiao-Jun Duan
- Center for Joint Surgery, Southwest Hospital, Third Military University (Amy Medical University), Chongqing, 400038, China.
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Moura CA, Fonseca V, Alves EM, Silva de Oliveira I, Santiago MB. Clinical disease activity index applicability in lupus arthropathy: Unraveling underdiagnosed joint activity. Lupus 2023; 32:1402-1408. [PMID: 37844912 DOI: 10.1177/09612033231206454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2023]
Abstract
INTRODUCTION Lupus arthropathy (LA) ranges from arthralgia and non-deforming arthritis to severe forms such as Jaccoud-type deformities and mutilating arthritis. Considering the evolving concept of LA, measuring arthritis activity in lupus patients may require a more practical and sensitive tool other than the classical composite scores. METHODS In this cross-sectional study, we evaluated the articular pattern of a sample of SLE patients which were divided into those that scored in articular domain on Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) and those with activity arthritis using the Clinical Disease Activity Index (CDAI). After all, we analyzed the association between CDAI and arthritis by SLEDAI-2K as well as its association with the presence or not of Jaccoud-type arthropathy (JA). RESULTS A total of 127 patients with SLE were evaluated. According to SLEDAI-2K, 17 (13.4%) patients have scored in its joint criteria and 32 patients (25.19%) were considered to have some articular activity by CDAI. A total of 16 patients (50%) who scored some activity on CDAI did not score in articular domain of SLEDAI-2K. Also, the presence of Jaccoud-type arthropathy was significantly associated with arthritis activity according to the CDAI score (p = .014) but not with SLEDAI-2K joint criteria (p = .524). CONCLUSION The CDAI was not directly associated with the presence of arthritis by the joint criteria of SLEDAI-2K and the presence of JA was significantly associated with the CDAI but not with arthritis at SLEDAI-2K.
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Affiliation(s)
- Carlos Antonio Moura
- Department of Internal Medicine, Sister Dulce's Social Works, Santo Antonio's Hospital, Salvador, Brazil
- Department of Medicine, Bahiana - School of Medicine and Public Health, Salvador, Brazil
| | - Vanessa Fonseca
- Department of Medicine, Bahiana - School of Medicine and Public Health, Salvador, Brazil
| | - Eneida M Alves
- Department of Medicine, Bahiana - School of Medicine and Public Health, Salvador, Brazil
| | | | - Mittermayer B Santiago
- Department of Medicine, Bahiana - School of Medicine and Public Health, Salvador, Brazil
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Keller DM, Saad BN, Hong IS, Gencarelli P, Tang A, Jankowski JM, Liporace FA, Yoon RS. Comparison of Outcomes After Reverse Total Shoulder Arthroplasty in Patients With Proximal Humerus Fractures Versus Rotator Cuff Arthropathy. J Am Acad Orthop Surg Glob Res Rev 2023; 7:01979360-202310000-00006. [PMID: 37856701 PMCID: PMC10589608 DOI: 10.5435/jaaosglobal-d-23-00160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 09/01/2023] [Indexed: 10/21/2023]
Abstract
INTRODUCTION Indications for reverse total shoulder arthroplasty (rTSA) has expanded to encompass complex proximal humerus fractures (PHFs) in recent years. The purpose of this study was to report and assess whether PHF patients treated with rTSA could achieve similar functional outcomes and short-term survivorship to patients who underwent rTSA for rotator cuff arthropathy (RTCA). METHODS All consecutive patients with a preoperative diagnosis of PHF or RTCA, 18 years or older, treated with rTSA at a single academic institution between 2018 and 2020 with a minimum 2-year follow-up were retrospectively reviewed. Primary outcomes were survivorship defined as revision surgery or implant failure analyzed using the Kaplan-Meier survival curve, and functional outcomes, which included Quick Disabilities of the Arm, Shoulder, and Hand, and range of motion (ROM) were compared at multiple follow-up time points up to 2 years. Secondary outcomes were patient demographics, comorbidities, surgical data, length of hospital stay, and discharge disposition. RESULTS A total of 48 patients were included: 21 patients (44%) were diagnosed with PHF and 27 patients (56%) had RTCA. The Kaplan-Meier survival rate estimates at 3 years were 90.5% in the PHF group and 85.2% in the RTCA group. No differences in revision surgery rates between the two groups (P = 0.68) or survivorship (P = 0.63) were found. ROM was significantly lower at subsequent follow-up time points in multiple planes (P < 0.05). A greater proportion of patients in the PHF group received cement for humeral implant fixation compared with the RTCA group (48% versus 7%, P = 0.002). The mean length of hospital stay was longer in PHF patients compared with RTCA patients (2.9 ± 3.8 days versus 1.6 ± 1.8 days, P = 0.13), and a significantly lower proportion of PHF patients were discharged home (67% versus 96%, P = 0.015). CONCLUSION The rTSA implant survivorship at 3 years for both PHF and RTCA patients show comparable results. At the 2-year follow-up, RTCA patients treated with rTSA were found to have better ROM compared with PHF patients.
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Affiliation(s)
- David M. Keller
- From the Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center/Jersey City Medical Center–RWJBarnabas Health, Livingston, NJ/Jersey City, NJ
| | - Bishoy N. Saad
- From the Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center/Jersey City Medical Center–RWJBarnabas Health, Livingston, NJ/Jersey City, NJ
| | - Ian S. Hong
- From the Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center/Jersey City Medical Center–RWJBarnabas Health, Livingston, NJ/Jersey City, NJ
| | - Pasquale Gencarelli
- From the Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center/Jersey City Medical Center–RWJBarnabas Health, Livingston, NJ/Jersey City, NJ
| | - Alex Tang
- From the Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center/Jersey City Medical Center–RWJBarnabas Health, Livingston, NJ/Jersey City, NJ
| | - Jaclyn M. Jankowski
- From the Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center/Jersey City Medical Center–RWJBarnabas Health, Livingston, NJ/Jersey City, NJ
| | - Frank A. Liporace
- From the Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center/Jersey City Medical Center–RWJBarnabas Health, Livingston, NJ/Jersey City, NJ
| | - Richard S. Yoon
- From the Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center/Jersey City Medical Center–RWJBarnabas Health, Livingston, NJ/Jersey City, NJ
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Lamba A, Holliday CL, Marigi EM, Reinholz AK, Wilbur RR, Song BM, Hevesi M, Krych AJ, Stuart MJ, Levy BA. Arthroscopic Lysis of Adhesions for Arthrofibrosis After Anterior Cruciate Ligament Reconstruction. Am J Sports Med 2023; 51:3149-3153. [PMID: 37724743 DOI: 10.1177/03635465231195366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
BACKGROUND Arthrofibrosis (AF) after anterior cruciate ligament reconstruction (ACLR) remains a challenge. There is a paucity of data on arthroscopic interventions for AF after ACLR. PURPOSE To (1) describe the patient, injury, and surgical characteristics and patient-reported outcomes (PROs) of those requiring an arthroscopic intervention for loss of motion after ACLR and (2) compare outcomes between patients undergoing an early intervention (within 3 months) versus those undergoing a late intervention (after 3 months). STUDY DESIGN Case series; Level of evidence, 4. METHODS Patients with a history of ACLR and a subsequent operative procedure for postoperative AF at a single institution between 2000 and 2018 were retrospectively identified. Arthroscopic interventions included lysis of adhesions, capsular release with or without manipulation under anesthesia, and excision of cyclops lesions. Patients were excluded if they had a knee dislocation or multiple-ligament injury, a periarticular fracture, or less than 2-year follow-up from the arthroscopic intervention. PROs including the Tegner activity score, visual analog scale pain score, and International Knee Documentation Committee score as well as knee range of motion (ROM) were recorded. RESULTS A total of 40 patients were included with a mean age of 27.2 years (range, 11.0-63.8 years) at surgery and a mean follow-up of 10.0 years (range, 2.9-20.7 years). The mean preoperative flexion and extension were 102° (range, 40°-150°) and 8° (range, 0°-25°), respectively. The mean postoperative flexion and extension were 131° (range, 110° to 150°) and 0° (range, -10° to 5°), respectively. After the arthroscopic intervention, the mean ROM improved from 94° (range, 40°-140°) preoperatively to 131° (range, 107°-152°) at final follow-up (P < .001), and the visual analog scale pain score improved from 3.0 preoperatively to 1.2 postoperatively (P = .001). Overall, 13 patients (32.5%) underwent an intervention within 3 months and 27 (67.5%) after 3 months. The early intervention group had a higher postoperative International Knee Documentation Committee score compared with the late intervention group (86.8 vs 71.7, respectively; P = .035). CONCLUSION An arthroscopic intervention for AF after ACLR successfully improved knee ROM and pain. Patients who underwent either early or late surgery obtained satisfactory motion and function, although improved PROs were observed when the intervention occurred within 3 months of the primary procedure.
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Affiliation(s)
- Abhinav Lamba
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Charles L Holliday
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Erick M Marigi
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Anna K Reinholz
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Ryan R Wilbur
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Bryant M Song
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Mario Hevesi
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Aaron J Krych
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Michael J Stuart
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Bruce A Levy
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA
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12
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Calori S, Comisi C, Mascio A, Fulchignoni C, Pataia E, Maccauro G, Greco T, Perisano C. Overview of Ankle Arthropathy in Hereditary Hemochromatosis. Med Sci (Basel) 2023; 11:51. [PMID: 37606430 PMCID: PMC10443289 DOI: 10.3390/medsci11030051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 08/11/2023] [Accepted: 08/14/2023] [Indexed: 08/23/2023] Open
Abstract
Hereditary hemochromatosis (HH) is an autosomal recessive bleeding disorder characterized by tissue overload of iron. Clinical systemic manifestations in HH include liver disease, cardiomyopathy, skin pigmentation, diabetes mellitus, erectile dysfunction, hypothyroidism, and arthropathy. Arthropathy with joint pain is frequently reported at diagnosis and mainly involves the metacarpophalangeal and ankle joints, and more rarely, the hip and knee. Symptoms in ankle joints are in most cases non-specific, and they can range from pain and swelling of the ankle to deformities and joint destruction. Furthermore, the main radiological signs do not differ from those of primary osteoarthritis (OA). Limited data are available in the literature regarding treatment; surgery seems to be the gold standard for ankle arthropathy in HH. Pharmacological treatments used to maintain iron homeostasis can also be undertaken to prevent the arthropathy, but conclusive data are not yet available. This review aimed to assess the ankle arthropathy in the context of HH, including all its aspects: epidemiology, physiopathology, clinical and imaging presentation, and all the treatments available to the current state of knowledge.
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Loret A, Jacob C, Mammou S, Bigot A, Blasco H, Audemard-Verger A, Schwartz IV, Mulleman D, Maillot F. Joint manifestations revealing inborn metabolic diseases in adults: a narrative review. Orphanet J Rare Dis 2023; 18:239. [PMID: 37563694 PMCID: PMC10416490 DOI: 10.1186/s13023-023-02810-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 07/06/2023] [Indexed: 08/12/2023] Open
Abstract
Inborn metabolic diseases (IMD) are rare conditions that can be diagnosed during adulthood. Patients with IMD may have joint symptoms and the challenge is to establish an early diagnosis in order to institute appropriate treatment and prevent irreversible damage. This review describes the joint manifestations of IMD that may be encountered in adults. The clinical settings considered were arthralgia and joint stiffness as well as arthritis. Unspecific arthralgias are often the first symptoms of hereditary hemochromatosis, chronic low back pain may reveal an intervertebral disc calcification in relation with alkaptonuria, and progressive joint stiffness may correspond to a mucopolysaccharidosis or mucolipidosis. Gaucher disease is initially revealed by painful acute attacks mimicking joint pain described as "bone crises". Some IMD may induce microcrystalline arthropathy. Beyond classical gout, there are also gouts in connection with purine metabolism disorders known as "enzymopathic gouts". Pyrophosphate arthropathy can also be part of the clinical spectrum of Gitelman syndrome or hypophosphatasia. Oxalate crystals arthritis can reveal a primary hyperoxaluria. Destructive arthritis may be indicative of Wilson's disease. Non-destructive arthritis may be seen in mevalonate kinase deficiency and familial hypercholesterolemia.
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Affiliation(s)
- Amaury Loret
- Department of Internal Medicine, University Hospital of Tours, Tours, France.
- Department of Rheumatology, University Hospital of Tours, Tours, France.
- Department of Internal Medicine, Hôpital Bretonneau, 2 Boulevard Tonnellé, CHRU de Tours, Tours cedex, 37044, France.
| | - Claire Jacob
- Department of Internal Medicine, University Hospital of Tours, Tours, France
| | - Saloua Mammou
- Department of Rheumatology, University Hospital of Tours, Tours, France
| | - Adrien Bigot
- Department of Internal Medicine, University Hospital of Tours, Tours, France
| | - Hélène Blasco
- Biochemistry laboratory, University Hospital of Tours, Tours, France
- UMR INSERM 1253, Tours, France
- Reference center for inherited metabolic diseases, Tours, France
| | | | - Ida Vd Schwartz
- Medical Genetics Service/Genetics Department, Hospital de Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre - RS, Brazil
| | - Denis Mulleman
- Department of Rheumatology, University Hospital of Tours, Tours, France
| | - François Maillot
- Department of Internal Medicine, University Hospital of Tours, Tours, France
- UMR INSERM 1253, Tours, France
- Reference center for inherited metabolic diseases, Tours, France
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14
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Rodriguez-Merchan EC. The role of intraarticular injections of hyaluronic acid in joint pain relief in hemophilic arthropathy. Expert Rev Hematol 2023; 16:811-817. [PMID: 37837349 DOI: 10.1080/17474086.2023.2271660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 10/12/2023] [Indexed: 10/16/2023]
Abstract
INTRODUCTION Chronic pain in hemophilic patients is due to joint degeneration associated with hemophilic arthropathy. In addition to appropriate hematological treatment (primary prophylaxis), pharmacologic management and Physical Medicine and Rehabilitation should be indicated. When such measures are not sufficient, intraarticular injections (IAIs) of hyaluronic acid (HyA) may be considered. AREAS COVERED In order to determine whether IAIs of HyA are effective in terms of pain relief in individuals with painful moderate hemophilic arthropathy, a PubMed and Cochrane Library search using 'hemophilia hyaluronic acid' as keywords was performed on 18 July 2023. EXPERT OPINION In a study of individuals with hemophilic arthropathy (elbows, knees and ankles), 91% of them improved pain after a mean follow-up of 6 years. In another study of individuals with knee arthropathy, after a 7-year follow-up 82% reported an improvement in pain. As for hemophilic ankle arthropathy, in a study 67% of patients showed relief of joint pain at 6-month follow-up. Although the literature on the subject is very heterogeneous and difficult to interpret, it appears that IAIs of HyA can relieve the joint pain of painful moderate hemophilic arthropathy for months. Moreover, the IAIs can be repeated every 6-12 months.
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Civino A, Bovis F, Ponzano M, Alighieri G, Prete E, Sorrentino S, Magni-Manzoni S, Vinti L, Romano M, Santoro N, Filocamo G, Belotti T, Santarelli F, Gorio C, Cattalini M, Stabile G, Conter V, Rondelli R, Pession A, Ravelli A. Development and Initial Validation of the ONCOREUM Score to Differentiate Childhood Cancer with Arthropathy from Juvenile Idiopathic Arthritis. J Pediatr 2023; 253:219-224.e3. [PMID: 36202241 DOI: 10.1016/j.jpeds.2022.09.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 09/24/2022] [Accepted: 09/28/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To develop and validate a weighted score, the ONCOREUM score, that aids physicians in differentiation of cancer with arthropathy from juvenile idiopathic arthritis (JIA). STUDY DESIGN Data were extracted from the ONCOREUM Study, a multicenter, cross-sectional investigation aimed at comparing children with cancer and arthropathy to children with JIA. Three statistical approaches were applied to develop the ONCOREUM score and assess the role of each variable in the diagnosis of cancer with arthropathy, including 2 approaches based on multivariable stepwise selection (models 1 and 2) and 1 approach on a Bayesian model averaging method (model 3). The β coefficients estimated in the models were used to assign score points. Considering that not missing a child with cancer is a mandatory clinical objective, discriminating performance was assessed by fixing sensitivity at 100%. Score performance was evaluated in both developmental and validation samples (representing 80% and 20% of the study population, respectively). RESULTS Patients with cancer and arthropathy (49 with solid tumors and 46 with hematologic malignancies without peripheral blasts) and 677 patients with JIA were included. The highest area under the receiver operating characteristic (ROC) curve (AUC) in the validation data set was yielded by model 1, which was selected to constitute the ONCOREUM score. The score ranged from -18 to 21.8, and the optimal cutoff obtained through ROC analysis was -6. The sensitivity, specificity, and AUC of the cutoff in the validation sample were 100%, 70%, and 0.85, respectively. CONCLUSIONS The ONCOREUM score is a powerful and easily applicable tool that may facilitate early differentiation of malignancies with articular complaints from JIA.
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Affiliation(s)
- Adele Civino
- Pediatric Rheumatology and Immunology, Hospital "Vito Fazzi", Lecce, Italy.
| | - Francesca Bovis
- Department of Health Sciences, Section of Biostatistics, University of Genova, Italy
| | - Marta Ponzano
- Department of Health Sciences, Section of Biostatistics, University of Genova, Italy
| | - Giovanni Alighieri
- Neonatology and Neonatal Intensive Care Unit, Hospital "A. Perrino", Brindisi, Italy
| | - Eleonora Prete
- Department of Hematology and Bone Marrow Transplant, Hospital "Card. G. Panico", Tricase, Italy
| | - Stefania Sorrentino
- Department of Paediatric Haemato-Oncology, Scientific Institute for Research, Hospitalization and Healthcare (IRCCS) Giannina Gaslini Institute, Genoa, Italy
| | | | - Luciana Vinti
- Department of Pediatric Hemato-Oncology, IRCCS Bambino Gesù, Rome, Italy
| | - Micol Romano
- Paediatric Rheumatology, Hospital and Orthopaedic Trauma Centre "G. Pini", Milan, Italy
| | - Nicola Santoro
- Department of Pediatric Oncology and Hematology, University "Aldo Moro" Bari, Italy
| | - Giovanni Filocamo
- Pediatric Rheumatology, IRCCS Ca' Granda Maggiore Hospital, Milan, Italy
| | - Tamara Belotti
- Pediatric Oncology and Haematology Unit, IRCCS, University of Bologna, Italy
| | - Francesca Santarelli
- Division of Pediatric Immunology and Rheumatology, Department of Public Health and Pediatrics, "Regina Margherita" Children Hospital, University of Turin, Italy
| | - Chiara Gorio
- Pediatric Oncohematology and Bone Marrow Transplant Unit, University of Brescia and "Spedali Civili", Brescia, Italy
| | - Marco Cattalini
- Pediatric Clinic, University of Brescia and "Spedali Civili", Brescia, Italy
| | - Giulia Stabile
- CINECA Interuniversity Consortium, Casalecchio di Reno, Italy
| | - Valentino Conter
- Pediatric Hematology-Oncology Unit, University of Milano-Bicocca, Monza, Italy
| | - Roberto Rondelli
- Pediatric Oncology and Haematology Unit, IRCCS, University of Bologna, Italy
| | - Andrea Pession
- Pediatric Unit, IRCCS S.Orsola-Malpighi Hospital, University of Bologna, Italy
| | - Angelo Ravelli
- Scientific Director, Giannina Gaslini Institute, Genoa, Italy; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics and Maternal-Infantile Sciences (DiNOGMI), University of Genoa, Italy
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Chin B, Wee I, Syn NL, O'Neill GK, Yap ES, Koh PL. Surgery for chronic arthropathy in people with haemophilia. Cochrane Database Syst Rev 2022; 11:CD013634. [PMID: 36448638 PMCID: PMC9710191 DOI: 10.1002/14651858.cd013634.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
BACKGROUND Chronic arthropathy is a potentially debilitating complication for people with haemophilia - a genetic, X-linked, recessive bleeding disorder, characterised by the absence or deficiency of a clotting factor protein. Staging classifications, such as the Arnold-Hilgartner classification for haemophilic arthropathy of the knee, radiologically reflect the extent of knee joint destruction with underlying chronic synovitis. Management of this highly morbid disease process involves intensive prophylactic measures, and chemical or radioisotope synovectomy in its early stages. However, failure of non-surgical therapy in people with progression of chronic arthropathy often prompts surgical management, including synovectomy, joint debridement, arthrodesis, and arthroplasty, depending on the type of joint and extent of the damage. To date, management of people with mild to moderate chronic arthropathy from haemophilia remains controversial; there is no agreed standard treatment. Thus, the benefits and disadvantages of non-surgical and surgical management of mild to moderate chronic arthropathy in people with haemophilia needs to be systematically reviewed. OBJECTIVES: To assess the efficacy and safety of surgery for mild to moderate chronic arthropathy in people with haemophilia A or B. SEARCH METHODS We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group's Coagulopathies Trials Register, CENTRAL, MEDLINE, Embase, CINAHL, and two trial registers to August 2022. We also handsearched relevant journals and conference abstract books. SELECTION CRITERIA Randomized controlled trials (RCTs) and quasi-RCTs comparing surgery and non-surgical interventions, for any joint with chronic arthropathy, in people with haemophilia, who were at least 12 years old. DATA COLLECTION AND ANALYSIS The review authors did not identify any trials to include in this review. MAIN RESULTS The review authors did not identify any trials to include in this review. AUTHORS' CONCLUSIONS The review authors did not identify any trials to include in this review. Due to a lack of research in this particular area, we plan to update the literature search every two years, and will update review if any new evidence is reported. There is a need for a well-designed RCT that assesses the safety and efficacy of surgical versus non-surgical interventions for chronic arthropathy in people with haemophilia.
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Affiliation(s)
- Brian Chin
- Department of Orthopaedic Surgery, National University Health System, Singapore, Singapore
| | - Ian Wee
- Department of Haematology-Oncology, National University Cancer Institute, Singapore, Singapore
| | - Nicholas Lx Syn
- Department of Haematology-Oncology, National University Cancer Institute, Singapore, Singapore
| | - Gavin K O'Neill
- Department of Orthopaedic Surgery, National University Health System, Singapore, Singapore
| | - Eng Soo Yap
- Department of Laboratory Medicine, National University Hospital, Singapore, Singapore
| | - Pei Lin Koh
- Department of Paediatrics, National University Health System, Singapore, Singapore
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Jenkins D, Phalke S, Bell R, Lessard S, Gupta S, Youssef M, Tam K, Nocon A, Rivera-Correa J, Wright T, Sculco T, Otero M, Pernis AB, Sculco P. Adaptive immune responses in patients requiring revision after total knee arthroplasty. J Orthop Res 2022; 41:984-993. [PMID: 36121317 DOI: 10.1002/jor.25445] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 08/25/2022] [Accepted: 09/14/2022] [Indexed: 02/04/2023]
Abstract
Dissatisfaction occurs in nearly 20% of patients after total knee arthroplasty (TKA); however, there remains only limited understanding of the biologic mechanisms that may contribute to suboptimal postoperative outcomes requiring revision surgery. Expansion of effector T and B cells, could promote an abnormal healing response via local or peripheral immune system mechanisms and contribute to inferior outcomes necessitating revision TKA. In this pilot study, we hypothesized that patients suffering from complications of arthrofibrosis or instability may exhibit differences in adaptive immune function. Patients (n = 31) undergoing revision TKA for an indication of arthrofibrosis or instability were prospectively enrolled. Whole blood and synovial fluid (SF) from the operative knee were collected at time of surgery. Peripheral blood mononuclear cells were isolated and analyzed by flow cytometry. Serum and SF were assessed for immunoglobulin levels by Luminex and antiphospholipid antibodies by enzyme-linked immunoassay. No significant differences were observed in peripheral blood T/B cell populations or serum immunoglobulins levels between groups. SF analysis demonstrated significant differences between the two groups, with higher levels of immunoglobulin G1 (IgG1) (p = 0.0184), IgG3 (p = 0.0084) and antiphosphatidyl serine IgG (p = 0.034) in arthrofibrosis relative to instability patients. Increased levels of both IgG subclasses and antiphospholipid antibodies in the SF suggest that intra-articular T-B cell interactions, potentially triggered by exposure to apoptotic components generated during post-op healing, could be functioning as a source of immune complexes that fuel fibrous tissue growth in arthrofibrotic patients.
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Affiliation(s)
- Daniel Jenkins
- HSS Research Institute, Autoimmunity and Inflammation Program, Hospital for Special Surgery, New York City, New York, USA
| | - Swati Phalke
- HSS Research Institute, Autoimmunity and Inflammation Program, Hospital for Special Surgery, New York City, New York, USA
| | - Richard Bell
- HSS Research Institute, Arthritis and Tissue Degeneration Program, Hospital for Special Surgery, New York City, New York, USA
- HSS Research Institute, David Z. Rosensweig Genomics Research Center, Hospital for Special Surgery, New York City, New York, USA
| | - Samantha Lessard
- HSS Research Institute, Orthopedic Soft Tissue Research Program, Hospital for Special Surgery, New York City, New York, USA
| | - Sanjay Gupta
- HSS Research Institute, Autoimmunity and Inflammation Program, Hospital for Special Surgery, New York City, New York, USA
| | - Mark Youssef
- Department of Orthopedic Surgery, Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York City, New York, USA
| | - Kathleen Tam
- Department of Orthopedic Surgery, Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York City, New York, USA
| | - Allina Nocon
- Department of Orthopedic Surgery, Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York City, New York, USA
| | - Juan Rivera-Correa
- HSS Research Institute, Autoimmunity and Inflammation Program, Hospital for Special Surgery, New York City, New York, USA
| | - Timothy Wright
- Department of Biomechanics, Hospital for Special Surgery, New York City, New York, USA
| | - Thomas Sculco
- Department of Orthopedic Surgery, Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York City, New York, USA
| | - Miguel Otero
- HSS Research Institute, Orthopedic Soft Tissue Research Program, Hospital for Special Surgery, New York City, New York, USA
- HSS Research Institute, Orthopedic Soft Tissue Research Program, Weill Cornell Medical College, New York City, New York, USA
| | - Alessandra B Pernis
- HSS Research Institute, Autoimmunity and Inflammation Program, Hospital for Special Surgery, New York City, New York, USA
- HSS Research Institute, David Z. Rosensweig Genomics Research Center, Hospital for Special Surgery, New York City, New York, USA
- Department of Medicine, Weill Cornell Medicine, New York City, New York, USA
- Department of Medicine, Immunology & Microbial Pathogenesis, Weill Cornell Medicine, New York City, New York, USA
| | - Peter Sculco
- Department of Orthopedic Surgery, Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York City, New York, USA
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Walocha A, Rutowicz B, Przybycień W, Zarzecki M, Kłosiński M, Depukat P, Solewski B, Mizia E, Gil A, Walocha E. Arthrofibrosis - a myth or true joint disorder? Folia Med Cracov 2022; 62:55-70. [PMID: 36088593 DOI: 10.24425/fmc.2022.141691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Accepted: 03/18/2022] [Indexed: 06/15/2023]
Abstract
Authors, mostly specialists on rehabilitation and orthopedic surgery prove that arthrofibrosis is a commonly overlooked phenomenon, which may lead to serious limitation in the range of movement, leading to limitation in patients quality of functioning. The main goal of this article is to emphasize the importance of understanding a such complex condition. Non typical patomechanism, lack of biomarkers dedicated to this dysfunction and general lack of understanding in this pathology causes that risk factors and the most effective strategies remain vastly unknown. Pathophysiology of the arthrofibrosis in the joints is definitely multifactorial, but intense production of collagen seems to be the main factor. Most modern pharmacological methods concentrate on the regulation of collagen fiber production and reducing the inflammation. Inflammation from joint contractures stimulates the proliferation of activated cells that results in the production of extracellular matrix macromolecules to form fibrotic tissue that is deposited into the capsule, thereby resulting in fibrosis. Lack of unified classification scale is caused by relatively high variation of the functions fulfilled by particular joints and each treatment plan should be constructed individually. Quality of surgical treatment and physical therapy play a major role in both prevention and treatment of such complex condition as arthrofibrosis. Both iatrogenic mistakes and overly aggressive manual therapy are some of main factors increasing the risk of this pathological condition. Introducing properly conducted physical therapy treatment in the early stage is crucial to main the range of movement and preventing this significant problem.
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Affiliation(s)
| | - Bartosz Rutowicz
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Wojciech Przybycień
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Michał Zarzecki
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Michał Kłosiński
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Paweł Depukat
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Bernard Solewski
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Ewa Mizia
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Anna Gil
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Ewa Walocha
- Laboratory of Nursing Theory and Fundamentals, Institute of Nursing and Midwifery, Faculty Of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
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Hees T, Abdelatif Y, Karpinski K, Bierke S, Häner M, Park HU, Petersen W. Soaking ACL grafts in vancomycin solution (1 mg/ml) reduces the infection rate without increasing the risk for re-rupture and arthrofibrosis. Arch Orthop Trauma Surg 2022; 142:1141-1146. [PMID: 34216258 DOI: 10.1007/s00402-021-04004-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 06/15/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE The aim of the present study was to evaluate if the vancomycin (1 mg/ml) is effective for the prevention of septic arthritis after ACL reconstruction. The hypothesis was that local antibiotic prophylaxis by soaking ACL grafts in vancomycin results in significantly less infections than ACL reconstruction without local antibiosis. METHODS In group 1, 636 patients who were operated between 1.9.2014 and 31.8.2016 received no local antibiotic treatment with vancomycin. In group 2, 536 patients who were operated between 1.9.2016 and 31.8.2018 received local antibiotic treatment with vancomycin (1 mg/ml). In this group the graft was soaked in the vancomycin solution for 10 min prior to graft passage and fixation. RESULTS In group 1 (ACL reconstruction without vancomycin application), a postoperative infection was detected in ten patients (infection rate: 1.6%). In group 2 (ACL reconstruction with 1 mg/ml vancomycin), no postoperative infection was detected (infection rate: 0%). The statistical analysis showed a clear significant difference between the two groups (p = 0.002). The re-rupture rate and the rate of arthrofibrosis differed not significantly between the two treatment groups (p = 0.526). CONCLUSION The results of the present study show that graft soaking in vancomycin (1 mg/ml) is effective for the prevention of septic arthritis after ACL reconstruction. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Tilman Hees
- Klinik Für Orthopädie Und Unfallchirurgie, Martin Luther Krankenhaus, Grunewald Caspar Theyss Strasse 27-31, 14193, Berlin, Germany
| | - Yassen Abdelatif
- Klinik Für Orthopädie Und Unfallchirurgie, Martin Luther Krankenhaus, Grunewald Caspar Theyss Strasse 27-31, 14193, Berlin, Germany
| | - Katrin Karpinski
- Klinik Für Orthopädie Und Unfallchirurgie, Martin Luther Krankenhaus, Grunewald Caspar Theyss Strasse 27-31, 14193, Berlin, Germany
| | - Sebastian Bierke
- Klinik Für Orthopädie Und Unfallchirurgie, Martin Luther Krankenhaus, Grunewald Caspar Theyss Strasse 27-31, 14193, Berlin, Germany
| | - Martin Häner
- Klinik Für Orthopädie Und Unfallchirurgie, Martin Luther Krankenhaus, Grunewald Caspar Theyss Strasse 27-31, 14193, Berlin, Germany
| | - Hi Un Park
- Klinik Für Orthopädie Und Unfallchirurgie, Martin Luther Krankenhaus, Grunewald Caspar Theyss Strasse 27-31, 14193, Berlin, Germany
| | - Wolf Petersen
- Klinik Für Orthopädie Und Unfallchirurgie, Martin Luther Krankenhaus, Grunewald Caspar Theyss Strasse 27-31, 14193, Berlin, Germany.
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Murakami T, Nakaminami Y, Takahata Y, Hata K, Nishimura R. Activation and Function of NLRP3 Inflammasome in Bone and Joint-Related Diseases. Int J Mol Sci 2022; 23:ijms23105365. [PMID: 35628185 PMCID: PMC9141484 DOI: 10.3390/ijms23105365] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 05/09/2022] [Accepted: 05/10/2022] [Indexed: 12/12/2022] Open
Abstract
Inflammation is a pivotal response to a variety of stimuli, and inflammatory molecules such as cytokines have central roles in the pathogenesis of various diseases, including bone and joint diseases. Proinflammatory cytokines are mainly produced by immune cells and mediate inflammatory and innate immune responses. Additionally, proinflammatory cytokines accelerate bone resorption and cartilage destruction, resulting in the destruction of bone and joint tissues. Thus, proinflammatory cytokines are involved in regulating the pathogenesis of bone and joint diseases. Interleukin (IL)-1 is a representative inflammatory cytokine that strongly promotes bone and cartilage destruction, and elucidating the regulation of IL-1 will advance our understanding of the onset and progression of bone and joint diseases. IL-1 has two isoforms, IL-1α and IL-1β. Both isoforms signal through the same IL-1 receptor type 1, but the activation mechanisms are completely different. In particular, IL-1β is tightly regulated by protein complexes termed inflammasomes. Recent research using innovative technologies has led to a series of discoveries about inflammasomes. This review highlights the current understanding of the activation and function of the NLRP3 (NOD-like receptor family, pyrin domain-containing 3) inflammasome in bone and joint diseases.
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21
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Dhahri R, Amri K, Slouma M, Tbini H, Metoui L, Gharsallah I, Nouisri L, Louzir B. Lipoma Arborescens: A Rare Cause of Bilateral Knee Swelling. J Clin Rheumatol 2021; 27:S641-S643. [PMID: 35073636 DOI: 10.1097/rhu.0000000000001662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
| | | | | | | | | | | | | | - Bassem Louzir
- Internal Medicine, Military Hospital of Tunis, Tunis, Tunisia
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Landro Carla Daffunchio Guillermo Cambiaggi Gustavo Galatro Horacio Caviglia ME, Daffunchio C, Cambiaggi G, Galatro GG, Caviglia H. Platelet-rich plasma vs platelet-rich plasma plus hyaluronic acid for haemophilic knee arthropathy treatment. Acta Orthop Belg 2021; 87:705-712. [PMID: 35172437 DOI: 10.52628/87.4.15] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Repeated joint bleeding leads to chronic synovitis, cartilage damage and bone alterations which result in haemophilic arthropathy and are associated with pain, functional impairment and poor quality of life. There are evidence that Hyaluronic Acid (HA) and Platelet-rich Plasma (PRP) have different mechanisms of action in the treatment of arthropathy for this reason we decided to use both components. The aim of this study is to compare, the efficacy, safety and duration of a single intra-articular injection of PRP against PRP+HA for pain, bleeding episodes and joint health, in the same patient with bilateral hemophilic knee arthropathy. Twenty-one men patients (42 knee joints) were treated with intra- articular injections of PRP or PRP+HA. All of them were haemophilia type A severe. The mean age was 36.6 years (21-72). All patients were evaluated for: Haemophilia Joint Health Score (HJHS), pain (VAS), the number of bleeding episodes (BE) in the last 30 days, before treatment, at three and six months after treatment. Statistically significant improvement were shown for both knee joints at three and six months after treatment for VAS and BE (P < 0.00001). The HJHS score did not significantly improve for either knee in the 6-month period after injection. A single PRP or PRP+HA injection is safe and effective in treating haemophilic arthropathy of the knee for up to 6 months follow-up, reducing pain, bleeding episodes and delaying total knee arthroplasty.
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Kumps C, Stanovici J, Chaibi E, Campos‐Xavier B, Pavlidou DC, Tran C. Black cartilage: Incidentally discovered articular ochronosis during arthroplasty. J Inherit Metab Dis 2021; 44:1503-1504. [PMID: 34264534 PMCID: PMC9290713 DOI: 10.1002/jimd.12417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 07/08/2021] [Accepted: 07/11/2021] [Indexed: 11/12/2022]
Affiliation(s)
- Camille Kumps
- Center for Molecular Diseases, Division of Genetic MedicineUniversity of Lausanne and University Hospital of LausanneLausanneSwitzerland
| | - Julien Stanovici
- Division of Orthopedics and TraumatologyUniversity of Lausanne and University Hospital of LausanneLausanneSwitzerland
| | - Emmelie Chaibi
- Division of Orthopedics and TraumatologyUniversity of Lausanne and University Hospital of LausanneLausanneSwitzerland
| | - Belinda Campos‐Xavier
- Center for Molecular Diseases, Division of Genetic MedicineUniversity of Lausanne and University Hospital of LausanneLausanneSwitzerland
| | - Despina Christina Pavlidou
- Center for Molecular Diseases, Division of Genetic MedicineUniversity of Lausanne and University Hospital of LausanneLausanneSwitzerland
| | - Christel Tran
- Center for Molecular Diseases, Division of Genetic MedicineUniversity of Lausanne and University Hospital of LausanneLausanneSwitzerland
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Singeap AM, Girleanu I, Diculescu M, Gheorghe L, Ciocîrlan M, Gheorghe C, Costache A, Tanțău A, Zaharie R, Goldis A, Gheonea D, Dobru D, Dumitru E, Prelipcean CC, Gîlcă-Blanariu GE, Moscalu M, Stanciu C, Trifan A. Risk Factors for Extraintestinal Manifestations in Inflammatory Bowel Diseases - Data from the Romanian National Registry. J Gastrointestin Liver Dis 2021; 30:346-357. [PMID: 34375380 DOI: 10.15403/jgld-3818] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND AIMS Identifying the risk factors for extraintestinal manifestations (EIMs) in inflammatory bowel diseases (IBD) may optimize the therapeutic decision. We aimed to assess the prevalence of EIMs in IBD patients in Romania and to determine the risk factors. METHODS We analyzed 2,626 patients registered in the Romanian IBD Prospect National Registry. We performed a descriptive cross-sectional study to assess the point prevalence of EIMs, calculating global prevalence and analyzing the different types of EIMs and their respective frequencies were carried out. Demographic and clinical risk factors were researched as possible predictors for EIMs development, based on the results of the univariate and multivariate logistic regression analysis. RESULTS The overall point prevalence of EIMs was 16.3%. A significantly higher frequency of EIMs in Crohn's disease (CD) was noted in comparison to ulcerative colitis (UC) and IBD unclassified (IBDU) (23.2% vs 11.3% and 16.3%, respectively, p<0.001). The most frequent type of EIM was peripheral arthropathy (8.3%), significantly associated with CD (p<0.001). Univariate analysis highlighted the significant independent common predictive risk factors for EIMs, in both CD and UC patients: female gender, patient's urban area of origin, anemia, hypoalbuminemia, and high level of C-reactive protein (CRP), while significant independent IBD phenotype-related risk factors were ileocolonic location and concomitant involvement of upper gastrointestinal tract for CD, non-smoker status and both moderate and severe disease activity for UC (p<0.05). Multivariate analysis determined that female CD patients with moderate or severe disease activity, with other than isolated ileal disease, and female UC patients with moderate or severe extensive colitis are the most likely to develop EIMs. CONCLUSIONS IBD patients are experiencing EIMs in a large proportion, with higher rates for CD. As EIMs negatively affect patient outcomes, foreseeing the risk by identifying independent and associated predictive factors could be a first step to optimal work-up and treatment.
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Affiliation(s)
- Ana-Maria Singeap
- Grigore T. Popa UMF, Inst. of Gastroenterol. and Hepatol., Emergency County Hospital Saint Spiridon, Iasi, Romania. .
| | - Irina Girleanu
- Grigore T. Popa UMF, Inst. of Gastroenterol. and Hepatol., Emergency County Hospital Saint Spiridon, Iasi, Romania.
| | - Mircea Diculescu
- Carol Davila UMF, Digestive Diseases and Liver Transplantation Center, Fundeni Clinical Inst., Bucharest, Romania.
| | - Liana Gheorghe
- Carol Davila UMF, Digestive Diseases and Liver Transplantation Center, Fundeni Clinical Inst., Bucharest, Romania.
| | - Maria Ciocîrlan
- Carol Davila UMF, Digestive Diseases and Liver Transplantation Center, Fundeni Clinical Inst., Bucharest, Romania.
| | - Cristian Gheorghe
- Carol Davila UMF, Digestive Diseases and Liver Transplantation Center, Fundeni Clinical Inst., Bucharest, Romania.
| | - Adrian Costache
- Carol Davila UMF, Dr. I. Cantacuzino Clinical Hospital, Bucharest.
| | - Alina Tanțău
- Iuliu Hațieganu University of Medicine and Pharmacy, 4th Medical Clinic, Cluj- Napoca, Romania.
| | - Roxana Zaharie
- Iuliu Hatieganu University of Medicine and Pharmacy, Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania.
| | - Adrian Goldis
- Victor Babeș University of Medicine and Pharmacy, Municipal Emergency Hospital, Department of Gastroenterology and Hepatology, Timișoara, Romania.
| | - Dan Gheonea
- University of Medicine and Pharmacy, Craiova, Research Center of Gastroenterology and Hepatology, Craiova, Romania.
| | - Daniela Dobru
- University of Medicine and Pharmacy, Tg Mures, Emergency County Hospital, Department of Gastroenterology, Târgu-Mureș, Romania.
| | - Eugen Dumitru
- Faculty of Medicine, Ovidius University of Constanța, Emergency County Hospital, Department of Gastroenterology, Constanta, Romania.
| | | | | | - Mihaela Moscalu
- Department of Preventive Medicine and Interdisciplinarity, Grigore T. Popa University of Medicine and Pharmacy, Iași, Romania.
| | - Carol Stanciu
- Grigore T. Popa UMF, Inst. of Gastroenterol. and Hepatol., Emergency County Hospital Saint Spiridon, Iasi, Romania.
| | - Anca Trifan
- Grigore T. Popa UMF, Inst. of Gastroenterol. and Hepatol., Emergency County Hospital Saint Spiridon, Iasi, Romania.
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Hernandez NM, Cunningham DJ, Kabirian N, Mont MA, Jiranek WA, Bolognesi MP, Seyler TM. Angiotensin Receptor Blockers Were Not Associated With Decreased Arthrofibrosis After Total Knee Arthroplasty. Orthopedics 2021; 44:e274-e280. [PMID: 33373459 DOI: 10.3928/01477447-20201216-09] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Stiffness after total knee arthroplasty (TKA) remains a challenging problem. Angiotensin receptor blockers (ARBs) have been associated with decreased muscle fibrosis. The aim of this study was to evaluate whether perioperative use of ARBs was associated with a reduction in arthrofibrosis and manipulation under anesthesia (MUA) in patients undergoing primary TKA at 90 days and 1 year postoperative. In this retrospective study, the authors used a national database to evaluate patients undergoing TKA for primary osteoarthritis from 2007 to 2017. They evaluated patients with filled prescriptions for ARBs within the study time frame and the specific type of ARB and its association with arthrofibrosis and MUA. After adjusting for age, sex, a comorbidity index, and obesity, any ARB or specific ARBs were not associated with a reduction in the rate of arthrofibrosis or MUA after TKA (P≥.05). Male sex, age 55 years or older, and obesity were associated with a reduction in the rate of arthrofibrosis and MUA after TKA (P≤.05). Studies should be performed to evaluate ARBs to see whether there is a more specific role in preventing joint stiffness in certain patient subpopulations following TKA. [Orthopedics. 2021;44(2):e274-e280.].
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Abstract
ABSTRACT This article discusses the "bidirectional" relationship between inflammatory bowel disease (IBD) and physical activity. Intestinal symptoms and extraintestinal manifestations of IBD negatively impact a patient's ability to participate in sports. IBD also impacts athletic performance via its effects on muscle mass, muscle function, bone density, and fatigue. Surveys of IBD patients consistently show that IBD interferes with athletic participation. While IBD negatively affects physical activity, there is growing evidence that physical activity can be beneficial for IBD patients. Prospective studies have revealed that structured physical activities may positively influence inflammatory markers, disease activity, muscle strength, bone density, fatigue, stress, anxiety, and quality of life. This suggests that physical activity may be a simple and safe adjuvant therapy for IBD patients. Future studies assessing the optimal activity regimen are warranted. Finally, a cohort of professional athletes with IBD are described for the first time - football players in the National Football League.
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Affiliation(s)
- Daniel L Cohen
- The Gonczarowski Family Institute of Gastroenterology and Liver Diseases, Shamir (Assaf Harofeh) Medical Center, Zerifin, affiliated with the Sackler School of Medicine, Tel Aviv University, ISRAEL
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Di Natali G, Carlisi E, Marin L, Lisi C. [Evaluation of quality of life and arthropathy in the adult haemophilic patient]. G Ital Med Lav Ergon 2021; 43:156-166. [PMID: 34370927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Accepted: 06/01/2021] [Indexed: 06/13/2023]
Abstract
Haemophilia in its most severe clinical form can lead to alterations in the physical and psychosocial state with important repercussions on the quality of life. Purpose. A retrospective study was conducted to highlight the impact of haemophilic arthropathy on quality of life. Materials. We considered 25 patients, with a mean age of 42 years (min 17 - max 71) with haemophilia A, 18 had the severe clinical form (72%). The WFH Physical Examination Score, specific for haemophilia, was used for joint function; the joints examined were: knee, ankle, hip and elbow. To assess the quality of life, two generic self-filling questionnaires were used, SF-36 and the EQ 5D. Results. Significant statistical values have shown that arthropathy affects the SF-36 domain of general health and the subjective well-being EQ-VAS. Conclusions. In the treatment of haemophilic arthropathy, prevention is essential, understood both as a prophylactic medical therapy and as a physiotherapeutic treatment in order to maintain or improve joint function and at the same time play a fundamental role in improving the quality of life of patients.
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Affiliation(s)
- Giuseppe Di Natali
- Rehabilitation Unit, Department of Medicine, Foundation IRCCS Hospital "San Matteo" Pavia
| | - Ettore Carlisi
- Rehabilitation Unit, Department of Medicine, Foundation IRCCS Hospital "San Matteo" Pavia
| | - Luca Marin
- Department of Rehabilitation, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Claudio Lisi
- Rehabilitation Unit, Department of Medicine, Foundation IRCCS Hospital "San Matteo" Pavia
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Abstract
Ankle impingement refers to a chronic painful mechanical limitation of ankle motion caused by soft tissue or osseous abnormality affecting the anterior or posterior tibiotalar joint. Impingement can be associated with a single traumatic event or repetitive microtrauma. These syndromes are a possible etiology of persistent ankle pain. An arthroscopic approach to this pathology, when indicated, is considered as ideal treatment with its high safety and low complication rate. We describe the clinical and potential imaging features, and the arthroscopic/endoscopic management strategies, for the 4 main impingement syndromes of the ankle: anterolateral, anterior, antero-medial, and posterior.
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Affiliation(s)
- Caio Nery
- UNIFESP - Federal University of São Paulo, Brazil
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29
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Resende VAC, Neto AC, Nunes C, Andrade R, Espregueira-Mendes J, Lopes S. Higher age, female gender, osteoarthritis and blood transfusion protect against periprosthetic joint infection in total hip or knee arthroplasties: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 2021; 29:8-43. [PMID: 30413860 DOI: 10.1007/s00167-018-5231-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 10/17/2018] [Indexed: 01/20/2023]
Abstract
PURPOSE The goal of this systematic review and meta-analysis was to identify the main risk factors for periprosthetic joint infection (PJI) in patients undergoing total hip or knee arthroplasties. METHODS A systematic review was conducted of the potential risk factors for PJI in total hip or total knee arthroplasty. Risk factors were compared and grouped according to demographics, comorbidities, behavior, infections, native joint diseases and other patient-related and procedure-related factors. Meta-analysis (random-effects models) was conducted using odds ratio (OR) and mean difference (MD). Risk of bias (ROBBINS-I) and strength of the evidence (GRADE) were assessed. RESULTS The study included 37 studies (2,470,827 patients). Older age was a protective factor (MD = - 1.18). Male gender (OR 1.34), coagulopathy (3.05), congestive heart failure (2.36), diabetes mellitus (1.80), obesity (1.61), systemic neoplasia (1.57), chronic lung disease (1.52), and hypertension (1.21) increased the risk for PJI. Behavioral risk factors comprised alcohol abuse (2.95), immunosuppressive therapy (2.81), steroid therapies (1.88), and tobacco (1.82). Infectious risk factors included surgical site infections (6.14), postoperative urinary tract infections (2.85), and prior joint infections (2.15). Rheumatoid arthritis, posttraumatic native joint disease, high National Nosocomial Infections Surveillance (NNIS) system surgical patient index score, prior joint operation, American Society of Anesthesiologists score ≥ 3 and obesity were also significantly associated with higher risk of PJI. Osteoarthritis and blood transfusion were protective factors. CONCLUSIONS The main risk factors for PJI in each category were male gender, coagulopathy, alcohol abuse, surgical site infection (highest score) and high NNIS system surgical patient index score. Protective factors were age, female gender in TKA, osteoarthritis and blood transfusion. Optimization of modifiable risk factors for PJI should be attempted in clinical practice. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Vera Alice Correia Resende
- Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa, Lisbon, Portugal.
- Centro Hospitalar de Entre o Douro e Vouga, Rua Dr. Cândido de Pinho, 4520-211, Santa Maria da Feira, Portugal.
| | - Artur Costa Neto
- Centro Hospitalar de Entre o Douro e Vouga, Rua Dr. Cândido de Pinho, 4520-211, Santa Maria da Feira, Portugal
| | - Carla Nunes
- Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa, Lisbon, Portugal
- Centro de Investigação em Saúde Pública, Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Renato Andrade
- Clínica do Dragão, Espregueira-Mendes Sports Centre-FIFA Medical Centre of Excellence, Porto, Portugal
- Faculty of Sports, University of Porto, Porto, Portugal
- Dom Henrique Research Centre, Porto, Portugal
| | - João Espregueira-Mendes
- Clínica do Dragão, Espregueira-Mendes Sports Centre-FIFA Medical Centre of Excellence, Porto, Portugal
- Dom Henrique Research Centre, Porto, Portugal
- 3B's Research Group-Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark, Parque de Ciência e Tecnologia, Zona Industrial da Gandra, Barco, 4805-017, Guimarães, Portugal
- ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
- Orthopaedics Department of Minho University, Braga, Portugal
| | - Sílvia Lopes
- Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa, Lisbon, Portugal
- Centro de Investigação em Saúde Pública, Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa, Lisbon, Portugal
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30
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Cellini M, Biamonte E, Mazza M, Trenti N, Ragucci P, Milani D, Ferrante E, Rossini Z, Lavezzi E, Sala E, Mantovani G, Arosio M, Fornari M, Balzarini L, Lania AG, Mazziotti G. Vertebral Fractures Associated with Spinal Sagittal Imbalance and Quality of Life in Acromegaly: A Radiographic Study with EOS 2D/3D Technology. Neuroendocrinology 2021; 111:775-785. [PMID: 32980840 DOI: 10.1159/000511811] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 09/12/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Acromegaly is commonly complicated by arthropathy and skeletal fragility with high risk of vertebral fractures (VFs). OBJECTIVE This study aimed to assess whether VFs may be associated with sagittal spine deformities, arthropathy, impaired quality of life (QoL), pain, and disability. METHODS Thirty-eight patients with acromegaly (median age: 55 years, 20 males) and 38 matched control subjects were evaluated by a low-dose sagittal and coronal planes, X-ray imaging system (EOS®-2D/3D) for morphometric VFs, radiological signs of spine arthropathy, and spine deformities (Cobb thoracic index ≥40°, pelvic incidence minus lumbar lordosis ≥10°, pelvic tilt >20°, and sagittal vertical axis ≥4 cm) determining sagittal spine imbalance. Acromegalic patients were also evaluated by questionnaires for QoL (Acromegaly QoL Questionnaire [AcroQoL] and Short Form-36 [SF-36]) and pain and disability (Western Ontario and McMaster University [WOMAC]). RESULTS Acromegalic patients showed higher prevalence of thoracic hyperkyphosis (i.e., Cobb thoracic index ≥40°; p = 0.04) and pelvic tilt >20° (p = 0.02) than control subjects. VFs were found in 34.2% of acromegalic patients (p = 0.003 vs. control subjects), in relationship with higher prevalence of hyperkyphosis (p = 0.03), pelvic tilt >20° (p = 0.04), sagittal vertical axis ≥4 cm (p = 0.03), and moderate/severe subchondral degeneration (p = 0.01). Moreover, patients with VFs had lower AcroQoL general health (p = 0.007) and SF-36 general health (p = 0.002) scores and higher WOMAC pain (p = 0.003) and global (p = 0.009) scores than patients who did not fracture. CONCLUSIONS In acromegaly, VFs may be associated with spine deformities and sagittal imbalance, spine arthropathy, impaired QoL, and disability.
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Affiliation(s)
- Miriam Cellini
- Endocrinology, Diabetology and Andrology Unit - Metabolic Bone Diseases and Osteoporosis Section, Milan, Italy
| | - Emilia Biamonte
- Endocrinology, Diabetology and Andrology Unit - Metabolic Bone Diseases and Osteoporosis Section, Milan, Italy
| | - Massimiliano Mazza
- Endocrinology, Diabetology and Andrology Unit - Metabolic Bone Diseases and Osteoporosis Section, Milan, Italy
| | - Nicoletta Trenti
- Department of Radiology, Humanitas Clinical and Research Center IRCCS, Rozzano, Italy
| | - Pasquala Ragucci
- Department of Radiology, Humanitas Clinical and Research Center IRCCS, Rozzano, Italy
| | - Davide Milani
- Department of Neurosurgery, Humanitas Clinical and Research Center IRCCS, Rozzano, Milan, Italy
| | - Emanuele Ferrante
- Endocrinology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Zefferino Rossini
- Department of Neurosurgery, Humanitas Clinical and Research Center IRCCS, Rozzano, Milan, Italy
| | - Elisabetta Lavezzi
- Endocrinology, Diabetology and Andrology Unit - Metabolic Bone Diseases and Osteoporosis Section, Milan, Italy
| | - Elisa Sala
- Endocrinology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giovanna Mantovani
- Endocrinology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Maura Arosio
- Endocrinology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Maurizio Fornari
- Department of Neurosurgery, Humanitas Clinical and Research Center IRCCS, Rozzano, Milan, Italy
| | - Luca Balzarini
- Department of Radiology, Humanitas Clinical and Research Center IRCCS, Rozzano, Italy
| | - Andrea G Lania
- Endocrinology, Diabetology and Andrology Unit - Metabolic Bone Diseases and Osteoporosis Section, Milan, Italy,
- Department of Biomedical Sciences, Humanitas University, Milan, Italy,
| | - Gherardo Mazziotti
- Endocrinology, Diabetology and Andrology Unit - Metabolic Bone Diseases and Osteoporosis Section, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
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Pelsma ICM, Biermasz NR, van Furth WR, Pereira AM, Kroon HM, Kloppenburg M, Claessen KMJA. Progression of acromegalic arthropathy in long-term controlled acromegaly patients: 9 years of longitudinal follow-up. J Clin Endocrinol Metab 2021; 106:188-200. [PMID: 33099640 DOI: 10.1210/clinem/dgaa747] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Indexed: 02/13/2023]
Abstract
CONTEXT Joint complaints in patients with acromegaly are common, although the long-term disease course is largely unknown. OBJECTIVE This study aims to evaluate the long-term course of acromegalic arthropathy. DESIGN AND SETTING A prospective longitudinal cohort study was conducted in controlled acromegaly patients followed at a tertial referral center, with 3 study visits: at baseline and after a median of 2.6 and 9.1 years. PATIENTS We included 31 patients with biochemically controlled acromegaly for 2 or more years (49% female; median age, 60 years) at baseline. MAIN OUTCOME MEASURES Radiographic arthropathy of the knee, hip, hand, and cervical and lumbar spine were evaluated using Kellgren and Lawrence (KL) scores, developed for assessment of primary osteoarthritis (OA). Radiographic progression was defined as a KL increase above the smallest detectable change. Joint symptoms were assessed using self-reported questionnaires. Progression was defined using existing clinically important cutoff values. Risk factors for progression were investigated using a multivariable model. RESULTS All patients had definite radiographic OA at 1 or more joints at baseline. Radiographic progression was observed in 29%, 48%, 84%, and 94% of patients in the knees, hips, hands, and axial joints, respectively. Deterioration in hand-related pain and function was observed in 10 (32.3%) and 11 patients (35.5%), respectively. Solely baseline KL scores of the hip were associated with hip OA progression (OR 1.88; 95% CI, 1.09-3.16). CONCLUSIONS Acromegalic arthropathy showed significant radiographic progression over 9.1 years of follow-up in patients in remission, whereas clinical progression was observed less frequently. Future studies should focus on adequate prevention and treatment strategies of acromegalic arthropathy.
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Affiliation(s)
- Iris C M Pelsma
- Department of Medicine, Division of Endocrinology, and Center for Endocrine Tumors Leiden, Leiden University Medical Center, ZA, Leiden, the Netherlands
| | - Nienke R Biermasz
- Department of Medicine, Division of Endocrinology, and Center for Endocrine Tumors Leiden, Leiden University Medical Center, ZA, Leiden, the Netherlands
| | - Wouter R van Furth
- Department of Neurosurgery, Leiden University Medical Center, ZA, Leiden, the Netherlands
| | - Alberto M Pereira
- Department of Medicine, Division of Endocrinology, and Center for Endocrine Tumors Leiden, Leiden University Medical Center, ZA, Leiden, the Netherlands
| | - Herman M Kroon
- Department of Radiology, Leiden University Medical Center, ZA, Leiden, the Netherlands
| | - Margreet Kloppenburg
- Department of Rheumatology, Leiden University Medical Center, ZA, Leiden, the Netherlands
- Department of Epidemiology, Leiden University Medical Center, ZA, Leiden, the Netherlands
| | - Kim M J A Claessen
- Department of Medicine, Division of Endocrinology, and Center for Endocrine Tumors Leiden, Leiden University Medical Center, ZA, Leiden, the Netherlands
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32
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Lin CC, Nfor ON, Su CL, Hsu SY, Tantoh DM, Liaw YP. Interactive associations of sex and hyperlipidemia with calcific tendinitis of the shoulder in Taiwanese adults. Medicine (Baltimore) 2020; 99:e23299. [PMID: 33181720 PMCID: PMC7668432 DOI: 10.1097/md.0000000000023299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 09/10/2020] [Accepted: 10/22/2020] [Indexed: 11/08/2022] Open
Abstract
Calcific tendinitis (CT) of the shoulder is a painful disorder usually identified in individuals aged 40 and 60 years. The estimated global prevalence of CT is 2.7% to 36%. We examined the association of hyperlipidemia and sex with CT of the shoulder using Taiwan Biobank (TWB) and the National Health Insurance Research Database (NHIRD).Data were available for 9903 TWB participants who were recruited between 2008 and 2015. We used multiple logistic regression analysis to estimate the odds ratios (OR) and 95% confidence intervals (CI) for CT of the shoulder.Overall, 1564 women, and 1491 men were identified with hyperlipidemia. Women, compared to men, had higher odds of CT of the shoulder (OR, 1.53; 95% CI, 1.08-2.16). Hyperlipidemia, compared to no hyperlipidemia, was associated with an increased risk of CT (OR, 1.40; 95% CI, 1.02-1.93). The test for interaction was significant for sex and hyperlipidemia (P = .006). After stratification, the odds ratio for CT was 1.95 (95% CI, 1.30-2.92) in women and 0.82 (95% CI, 0.48-1.39) in men, respectively. Compared to men with no hyperlipidemia, the odds ratio was 0.86 (95% CI, 0.53-1.38) for men with hyperlipidemia and 2.00 (95% CI, 1.29-3.10) for women with hyperlipidemia.Importantly, our findings indicated that the risk for CT of the shoulder was higher among Taiwanese women with hyperlipidemia. However, CT risk among their male counterparts with hyperlipidemia was not significant.
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Affiliation(s)
- Chuan-Chao Lin
- Department of Physical Medicine and Rehabilitation, Chung Shan Medical University Hospital, Taichung
- School of Medicine
| | - Oswald Ndi Nfor
- Department of Public Health and Institute of Public Health, Chung Shan Medical University, Taichung
| | - Chun-Lang Su
- School of Medicine
- Department of Public Health and Institute of Public Health, Chung Shan Medical University, Taichung
- Department of Physical Medicine and Rehabilitation, Yuan Sheng Hospital, Changhua City
| | - Shu-Yi Hsu
- Department of Public Health and Institute of Public Health, Chung Shan Medical University, Taichung
| | - Disline Manli Tantoh
- Department of Public Health and Institute of Public Health, Chung Shan Medical University, Taichung
- Department of Medical Imaging, Chung Shan Medical University Hospital
| | - Yung-Po Liaw
- Department of Public Health and Institute of Public Health, Chung Shan Medical University, Taichung
- Department of Medical Imaging, Chung Shan Medical University Hospital
- Medical Imaging and Big Data Center, Chung Shan Medical University Hospital, Taichung City, Taiwan
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Abstract
AIMS Stiffness is a common complication after total knee arthroplasty (TKA). Pathogenesis is not understood, treatment options are limited, and diagnosis is challenging. The aim of this study was to investigate if MRI can be used to visualize intra-articular scarring in patients with stiff, painful knee arthroplasties. METHODS Well-functioning primary TKAs (n = 11), failed non-fibrotic TKAs (n = 5), and patients with a clinical diagnosis of fibrosis1 (n = 8) underwent an MRI scan with advanced metal suppression (Slice Encoding for Metal Artefact Correction, SEMAC) with gadolinium contrast. Fibrotic tissue (low intensity on T1 and T2, low-moderate post-contrast enhancement) was quantified (presence and tissue thickness) in six compartments: supra/infrapatella, medial/lateral gutters, and posterior medial/lateral. RESULTS Fibrotic tissue was identified in all patients studied. However, tissue was significantly thicker in fibrotic patients (4.4 mm ± 0.2 mm) versus non-fibrotic (2.5 mm ± 0.4 mm) and normal TKAs (1.9 mm ± 0.2 mm, p = < 0.05). Significant (> 4 mm thick) tissue was seen in 26/48 (54%) of compartments examined in the fibrotic group, compared with 17/30 (57%) non-fibrotic, and 10/66 (15%) normal TKAs. Although revision surgery did improve range of movement (ROM) in all fibrotic patients, clinically significant restriction remained post-surgery. CONCLUSION Stiff TKAs contain intra-articular fibrotic tissue that is identifiable by MRI. Studies should evaluate whether MRI is useful for surgical planning of debridement, and as a non-invasive measurement tool following interventions for stiffness caused by fibrosis. Revision for stiffness can improve ROM, but outcomes are sub-optimal and new treatments are required. Cite this article: Bone Joint J 2020;102-B(10):1331-1340.
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Affiliation(s)
- Veronica Attard
- Leeds NIHR Biomedical Research Centre, Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, Leeds, UK
| | - Cheuk Yin Li
- Department of Orthopaedics, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Alexander Self
- Department of Radiology, Royal Victoria Infirmary, Newcastle University Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Derek A. Mann
- Fibrosis Research Group, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Lee A. Borthwick
- Fibrosis Research Group, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Phil O’Connor
- Leeds NIHR Biomedical Research Centre, Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, Leeds, UK
| | - David J. Deehan
- Department of Orthopaedics, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- Fibrosis Research Group, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Nicholas S. Kalson
- Department of Orthopaedics, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- Fibrosis Research Group, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
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Morris FM, Bain SC. Clumsy hands in a woman with long-standing diabetes. Diabet Med 2020; 37:1770-1771. [PMID: 31127641 DOI: 10.1111/dme.14041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/23/2019] [Indexed: 12/01/2022]
Affiliation(s)
- F M Morris
- Swansea Bay University Health Board, Singleton Hospital, Swansea, UK
| | - S C Bain
- Swansea Bay University Health Board, Singleton Hospital, Swansea, UK
- Diabetes Research Unit Cymru, Swansea University Medical School, Swansea, UK
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Schreiner AJ, Schweikardt N, Gühring D, Ahrend MD, Döbele S, Ahmad SS, Baumann M, Hirschmann MT, Bozzi F, Ateschrang A. Arthroscopic arthrolysis leads to improved range of motion and health-related quality of life in post-traumatic elbow stiffness. J Shoulder Elbow Surg 2020; 29:1538-1547. [PMID: 32381474 DOI: 10.1016/j.jse.2020.01.099] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 01/22/2020] [Accepted: 01/28/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Post-traumatic elbow stiffness is a frequent and disabling complication after elbow trauma. Surgical release is needed if conservative treatment fails. In contrast to open surgical release, arthroscopic arthrolysis is a good and least invasive option to restore joint mobility. The aim of this study was to evaluate the clinical outcomes, range of motion (ROM), and function of post-traumatic elbow contracture after arthroscopic arthrolysis and to assess health-related quality of life (HRQL). METHODS Between 2007 and 2013, 44 patients with post-traumatic elbow stiffness were treated by arthroscopic arthrolysis and followed up in a consecutive series. Clinical (ROM) and functional analyses (Disabilities of the Arm, Shoulder, and Hand Questionnaire [DASH], Mayo Elbow Performance Index [MEPI]) were performed at final follow-up 3 (1-7) years postoperatively. Furthermore, HRQL was evaluated (EQ-5D, 36-Item Short Form Health Survey [SF-36]). DISCUSSION The average arc of elbow motion increased from 84° ± 28° preoperatively to 120° ± 18° postoperatively. All applied scores significantly improved pre- to postoperatively: the MEPI (59.8 ± 17.3 / 84.3 ± 14.0), DASH (43.5 ± 23.1 / 16.8 ± 15.6), EQ-5D (72.8 ± 16.6 / 84.0 ± 13.6), and SF-36 showed improved results in all categories. Univariate logistic regression revealed that preoperative pain level predicts a poorer postoperative outcome measured with the MEPI score. Revision arthroscopy was needed in 1 case because of persistent pain. CONCLUSIONS Arthroscopic arthrolysis leads to good clinical and functional results in post-traumatic elbow stiffness regarding ROM, pain relief, functionality, and quality of life. The complication rate as well as the revision rate is very low.
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Affiliation(s)
- Anna J Schreiner
- BG Trauma Center Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Nicola Schweikardt
- BG Trauma Center Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Dorothee Gühring
- BG Trauma Center Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Marc-Daniel Ahrend
- BG Trauma Center Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany; AO Research Institute Davos, Davos, Switzerland.
| | - Stefan Döbele
- BG Trauma Center Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Sufian S Ahmad
- BG Trauma Center Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Matthias Baumann
- BG Trauma Center Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Michael T Hirschmann
- Department of Orthopaedic Surgery & Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), Bruderholz, Switzerland
| | - Federico Bozzi
- Università Cattolica del Sacro Cuore, Fondazione Poliambulanza, Brescia, Italy
| | - Atesch Ateschrang
- BG Trauma Center Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany
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Liebeskind B, Olinger K. Bifid iliopsoas tendon as a cause for internal snapping hip syndrome: A case report. J Clin Ultrasound 2020; 48:346-349. [PMID: 32329518 DOI: 10.1002/jcu.22846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 04/07/2020] [Accepted: 04/08/2020] [Indexed: 06/11/2023]
Abstract
Snapping hip syndrome, or coxa saltans, can result in significant clinical manifestations in patients including pain and limited mobility. A variety of both intra- and extra-articular pathologies have been implicated in snapping hip, including an anatomic variant known as the bifid iliopsoas tendon which has been briefly described in the literature. We report a case of a bifid iliopsoas tendon leading to internal snapping hip syndrome which was ultimately successfully treated with surgical release, including review of the clinical presentation, pathophysiology, and dynamic sonographic findings.
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Affiliation(s)
- Bernard Liebeskind
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kristen Olinger
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Andrawes NG, Saker HM, Salah El-Din NY, Abd Elhakim Hussain M. Tissue-inhibitors of metalloproteinase-1 and vascular-endothelial growth-factor in severe haemophilia A children on low dose prophylactic recombinant factor VIII: Relation to subclinical arthropathy. Haemophilia 2020; 26:607-614. [PMID: 32445517 DOI: 10.1111/hae.14041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 04/22/2020] [Accepted: 04/29/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Subclinical synovitis occur long before clinical haemophilic arthropathy (HA). New biomarkers are needed for early detection of HA. AIM To compare the levels of tissue inhibitors of metalloproteinase-1 (TIMP-1) and vascular endothelial growth factor (VEGF)in severe haemophilia A boys on prophylaxis and on-demand therapy to healthy boys and correlate them with the haemophilia joint health score (HJHS) & the Denver magnetic resonance imaging (MRI) scale; hence, determine their values in early detection of HA. METHODS Haemophilia joint health score, serum TIMP-1, VEGF and Denver MRI score were assessed in 50 boys with severe haemophilia A (31 on prophylactic factor VIII therapy (62%) with a dose of 15 IU/kg/twice weekly) and 50 age-matched healthy boys. RESULTS Boys with severe haemophilia A had significantly higher TIMP-1 240 ng/mL, SD200-350 (P < .001) and VEGF 600 pg/mL, SD400-1100 (P < .001). Their mean HJHS was 4.5 ± 3.0 (0-11) and their mean Denver MRI score was 5.55 ± 1.6 (2.00-8.00). A significant positive correlation was found between TIMP-1 and VEGF (P < .001), BMI Z-score (P = .029), HJHS (P = .041)and total MRI score (<.001). Significant correlations were found between VEGF and age (P < .001), HJHS (P = .003) and total MRI score (P < .001). Boys with severe haemophilia A on prophylaxis therapy had significantly lower HJHS (P = .021), VEGF (P < .001), TIMP-1 (P = .002) and total MRI score (P = .021) than those on on-demand therapy. Receiver operating characteristic curve, defined a cut-off value of 160 ng/mL for TIMP-1 with a sensitivity of 90% and specificity of 60% and that of 350 pg/mL for VEGF with a sensitivity of 78% and specificity of 88% for discrimination between severe haemophilia A and healthy boys. CONCLUSION Vascular endothelial growth factor and TIMP-1 can be used for early detection of HA. Further prospective studies should include larger study populations. In addition, studies should address the role of various anti-VEGFs as potential therapy for HA and their impact on prevention and treatment of HA.
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Affiliation(s)
| | - Hossam Mousa Saker
- Radiology Department, Faculty of Medicine, Ain-Shams University, Cairo, Egypt
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Gomi N, Chikaishi N, Ohnishi K. Morphological changes in the tibiofibular joint following open wedge high tibial osteotomy. Knee 2020; 27:930-933. [PMID: 32089394 DOI: 10.1016/j.knee.2020.01.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 01/17/2020] [Accepted: 01/28/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND To investigate the morphological changes in the tibiofibular joint following open wedge high tibial osteotomy (OWHTO). METHODS We studied 397 joints in 341 patients. Standing femorotibial angle (FTA), %mechanical axis (%MA), corrected tibial angle, distance (D) to tibial joint surface (T) and fibular head (F) and angle (A; proximal, distal), proximal tibiofibular joint (PTFJ) osteoarthritis (OA) onset, and tibiofibular joint-related complications were the parameters assessed. RESULTS FTA improved from 181.1° to 168.8° and %MA from 28.7 to 68.7, whereas the mean tibia corrected angle was 10.4°. Proximal TFD changed from 9.4 mm preoperatively to 7.8 mm during the investigation. The fibular head was displaced 1.6 mm upwards, and proximal tibial femoral angle (TFA) moved approximately 10° in the valgus direction from 82.5° to 92.4°. However, no significant changes were noted for the distal TFD or TFA. PTFJ OA was observed in 57 cases (14.7%), and lateroposterior knee pain in 11 cases (2.8%). Additional resection of the fibula was performed in cases with marked pain. CONCLUSIONS With OWHTO, increased load is placed on the PTFJ postoperatively. In rare cases, this can cause pain and is therefore a complication that physicians should be aware of.
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Affiliation(s)
- Noriyuki Gomi
- Department of Joint Surgery Center, Sakaide Kaisei General Hospital, Kagawa, Japan.
| | - Nobuhiro Chikaishi
- Department of Joint Surgery Center, Sakaide Kaisei General Hospital, Kagawa, Japan
| | - Kazutomo Ohnishi
- Department of Joint Surgery Center, Sakaide Kaisei General Hospital, Kagawa, Japan
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Rajkumar N, Soundarrajan D, Dhanasekararaja P, Rajasekaran S. Clinical and radiological outcomes of total joint arthroplasty in patients with ochronotic arthropathy. Eur J Orthop Surg Traumatol 2020; 30:923-929. [PMID: 32172376 DOI: 10.1007/s00590-020-02651-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 03/03/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE Alkaptonuria is a rare metabolic disorder, and only a few case reports of total joint arthroplasty (TJA) for ochronotic arthropathy are described in the literature. We aim to analyse the functional and radiological outcomes of TJA in patients with ochronotic arthropathy. METHODS We retrospectively collected the data of twenty-seven TJA in sixteen patients with ochronotic arthropathy from April 2007 to December 2017. We assessed the functional outcome through pre- and post-operative modified Harris hip score (HHS) and knee society score (KSS). The hip radiographs were analysed for migration and radiolucent zones, and the knee radiographs were assessed using knee society roentgenographic evaluation and scoring system. RESULTS The mean follow-up was 39.4 months (12-132 months). Two patients died before the final follow-up. There was a statistically significant improvement in mean HHS from 17.8 preoperatively to 78 at the final follow-up (p < 0.001). Similarly, there was a significant improvement in mean KSS, following the surgery, from 27.2 preoperatively to 89.4 (p < 0.001). One patient developed deep infection, and another patient presented with aseptic loosening of the acetabular component after 7 years. In the radiological evaluation at the final follow-up, signs of lysis or loosening were not noted in any of the other patients. CONCLUSION End-stage arthritis in ochronotic arthropathy is not uncommon. These patients can have multiple joint involvements, and the need for multiple surgeries should be considered. TJA in ochronotic arthropathy leads to a significant improvement in the functional outcome compared with the preoperative disability.
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Affiliation(s)
- Natesan Rajkumar
- Department of Orthopaedics, Ganga Hospital, 313, Mettupalayam Road, Coimbatore, 641 043, India.
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Yamaguchi T, Urita A, Endo T, Ota M, Iwasaki N. Charcot Arthropathy of the Shoulder Joint in a Patient with Guillain-Barré Syndrome: A Case Report. JBJS Case Connect 2020; 10:e0530. [PMID: 32224650 DOI: 10.2106/jbjs.cc.19.00530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
CASE A 53-year-old woman presented with Charcot arthropathy of the shoulder joint secondary to residual sensory neuropathy of Guillain-Barré syndrome, which was accompanied by swollen shoulder and restricted range of motion of the right shoulder. We performed a reverse shoulder arthroplasty (RSA). The range of motion had improved 15 months postoperatively, and there was no postoperative complication after RSA. CONCLUSION Clinicians should be aware that Guillain-Barré syndrome can cause Charcot arthropathy of the shoulder joint. RSA is regarded as a useful treatment, although careful follow-up is needed.
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Affiliation(s)
- Tetsuya Yamaguchi
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University Graduate School of Medicine, Kita-ku, Sapporo, Japan
| | - Atsushi Urita
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University Graduate School of Medicine, Kita-ku, Sapporo, Japan
| | - Takeshi Endo
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University Graduate School of Medicine, Kita-ku, Sapporo, Japan
| | - Mitsutoshi Ota
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University Graduate School of Medicine, Kita-ku, Sapporo, Japan
| | - Norimasa Iwasaki
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University Graduate School of Medicine, Kita-ku, Sapporo, Japan
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Gutefeldt K, Lundstedt S, Thyberg ISM, Bachrach-Lindström M, Arnqvist HJ, Spångeus A. Clinical Examination and Self-Reported Upper Extremity Impairments in Patients with Long-Standing Type 1 Diabetes Mellitus. J Diabetes Res 2020; 2020:4172635. [PMID: 32258166 PMCID: PMC7086441 DOI: 10.1155/2020/4172635] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 02/21/2020] [Accepted: 02/28/2020] [Indexed: 12/24/2022] Open
Abstract
AIM The aims of the current study were (1) to determine the prevalence of upper extremity impairments (UEIs) in patients with type 1 diabetes by clinical investigation; (2) to investigate if self-reported impairments were concordant with clinical findings and if key questions could be identified; and (3) to investigate if answers to our self-reported questionnaire regarding UEIs are reliable. METHODS Patients with type 1 diabetes were invited to participate in a cross-sectional study of clinical and self-reported (12 items) UEIs in adjunction to ordinary scheduled clinical visit. Before the visit, a questionnaire on UEIs was filled in twice (test-retest) followed by clinical testing at the planned visit. RESULTS In total, 69 patients aged 45 ± 14 years and with diabetes duration 26 ± 15 were included in the study. In the clinical examination, two-thirds (65%) of the patients showed one or more UEI, with failure to perform hand against back as the most common clinical finding (40%) followed by positive Phalen's test (27%), Tinel's test (26%), and Prayer's sign (24%). UEIs observed by clinical examination were often bilateral, and multiple impairments often coexisted. Self-reported shoulder stiffness was associated with impaired shoulder mobility and with Prayer's sign. Self-reported reduced hand strength was associated to lower grip force, Prayer's sign, trigger finger, fibrosis string structures, and reduced thenar strength as well as reduced shoulder mobility. In addition, self-reporting previous surgery of carpal tunnel and trigger finger was associated with several clinical UEIs including shoulder, hand, and finger. The test-retest of the questionnaire showed a high agreement of 80-98% for reported shoulder, hand, and finger impairments. CONCLUSION UEIs are common in type 1 diabetes. Self-reported shoulder stiffness and reduced hand strength might be used to capture patients with UEIs in need of clinical investigation and enhanced preventive and therapeutic strategies, as well as rehabilitative interventions.
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Affiliation(s)
- Kerstin Gutefeldt
- Department of Endocrinology, Linköping University Hospital, Linköping, Sweden
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Simon Lundstedt
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Ingrid S. M. Thyberg
- Department of Rheumatology and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Margareta Bachrach-Lindström
- Division of Nursing Sciences, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Hans J. Arnqvist
- Department of Endocrinology, Linköping University Hospital, Linköping, Sweden
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Anna Spångeus
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Acute Internal Medicine and Geriatrics, Linköping University Hospital, Linköping, Sweden
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Shao J, Gao YZ, Gao K, Yu ZH. Ankylosing Spondylitis Complicated with Atlantoaxial Dislocation and Destruction of the Dens and Lateral Atlantoaxial Joint: A Case Report. JBJS Case Connect 2019; 9:e0216. [PMID: 31833976 DOI: 10.2106/jbjs.cc.19.00216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
CASE Non-neoplastic bone destruction, known as Andersson lesion, is not rare in ankylosing spondylitis (AS) and always appeared as bone destruction and sclerosis in the vertebral body-intervertebral disc region. The Andersson lesion has been reported mostly in the thoracic and lumbar spine and rarely in the lower cervical spine. We surgically treated a patient with AS complicated with atlantoaxial dislocation and destruction of dens and lateral atlantoaxial joint, which was similar to the Andersson lesion. CONCLUSIONS AS can cause destructive lesion in the upper cervical spine. Posterior reduction, removal of the lesion, and fusion were possible approaches for the treatment of this destructive lesion.
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Affiliation(s)
- Jia Shao
- Department of Spinal Surgery, Henan Provincial People's Hospital, Zhengzhou, Henan, China
| | - Yan Zheng Gao
- Department of Spinal Surgery, Henan Provincial People's Hospital, Zhengzhou, Henan, China
| | - Kun Gao
- Department of Spinal Surgery, Henan Provincial People's Hospital, Zhengzhou, Henan, China
| | - Zheng Hong Yu
- Department of Spinal Surgery, Henan Provincial People's Hospital, Zhengzhou, Henan, China
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Noailles T, Chalopin A, Boissard M, Lopes R, Bouguennec N, Hardy A. Incidence and risk factors for cyclops syndrome after anterior cruciate ligament reconstruction: A systematic literature review. Orthop Traumatol Surg Res 2019; 105:1401-1405. [PMID: 31405748 DOI: 10.1016/j.otsr.2019.07.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Revised: 06/24/2019] [Accepted: 07/18/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Cyclops syndrome after anterior cruciate ligament (ACL) reconstruction is due to a fibrous nodule that develops in the anterior part of the intercondylar notch and prevents full knee extension. The primary objective of this systematic literature review was to evaluate the incidence of symptomatic cyclops lesion after ACL reconstruction. The secondary objective was to identify risk factors for cyclops syndrome. HYPOTHESIS Cyclops syndrome is common after ACL reconstruction and has several risk factors reported in the literature. METHODS A systematic literature review was performed by searching the PubMed, Medline, CINAHL, Cochrane, and Embase databases with the key terms 'cyclops' and 'ACL reconstruction'. The data thus retrieved were evaluated independently by two investigators. All articles in English or French that reported the incidence and risk factors of cyclops syndrome after ACL reconstruction were included. RESULTS The search retrieved the titles and abstracts of 79 articles, of which 20 were selected to be read in full; among these, 10 were included in the study. The incidence of symptomatic cyclops lesion ranged from 1.9% to 10.9%. Identified risk factors were as follows: pre-operatively, knee inflammation and/or motion restriction at the time of ACL reconstruction; intra-operatively, narrow intercondylar notch and excessively anterior position of the tibial tunnel; and post-operatively, persistent hamstring muscle spasm. DISCUSSION Development of a cyclops lesion is common after ACL reconstruction, occurs early, and may require further surgery. The knowledge of the risk factors provided by this study may improve the ability to devise effective preventive measures. LEVEL OF EVIDENCE II, systematic literature review.
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Affiliation(s)
- Thibaut Noailles
- Département de Chirurgie Orthopédique, Polyclinique de Bordeaux Nord, 15, rue Claude-Boucher, 33000 Bordeaux, France
| | - Antoine Chalopin
- Département de Chirurgie Orthopédique Infantile, Hôpital Universitaire Hôtel-Dieu, 1, place Alexis-Ricordeau, 44000 Nantes, France
| | - Mathieu Boissard
- Département de Chirurgie Orthopédique, Polyclinique de l'Atlantique, avenue Claude-Bernard - BP 40419, 44819 Saint Herblain Cedex, France
| | - Ronny Lopes
- Département de Chirurgie Orthopédique, Clinique Bretéché, 3, rue de la Béraudiere, 44000 Nantes, France
| | - Nicolas Bouguennec
- Département de Chirurgie Orthopédique, Clinique du Sport, 4, rue Georges-Negrevergne, 33700 Mérignac, France
| | - Alexandre Hardy
- Département de Chirurgie Orthopédique, Hôpital Ambroise-Paré, 9, avenue Charles de Gaulle, 92100 Boulogne-Billancourt, France.
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Zitouna K, Riahi H, Zheni A, Rekik S, Arfa W, Barsaoui M. A knee stiffness unusual etiology. Tunis Med 2019; 97:1307-1310. [PMID: 32173835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Progressive unilateral knee stiffness is an uncommon complaint in older adult. Tumor and specific infection should be considered in addition to osteoarthritis. We report a case of intracapsular and paraarticular chondroma in the infrapatellar Hoffa's fat pad that presented as a painless limited knee in 64-year old man. A physical examination revealed a firm, movable mass in the infrapatellar area. Radiographs and Magnetic resonance images showed an ovoid, well-defined, soft tissue mass with focal calcification in the infrapatellar fat pad. The mass was completely resected surgically through a medial parapatellar approach. The final pathology revealed an intracapsular and paraarticular chondroma. At follow-up, 3 years after the operation, patient was pain-free, with complete recovery of the range of motion of the knee and without any clinical or radiographic evidence of recurrence. Intracapsular and paraarticular chondroma is a rare benign lesion of the large joints (mostly the knee). The Pathogenesis of these tumours is controversial. The diagnosis is made with correlation of clinical, radiological and histological features. The treatment of choice is surgical excision.
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Pejhan S, Denroche SK, Frew GJ, Acker SM. Effects of Knee Savers on the quadriceps muscle activation across deep knee bending postures. Appl Ergon 2019; 80:193-199. [PMID: 31280805 DOI: 10.1016/j.apergo.2019.05.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 02/08/2019] [Accepted: 05/24/2019] [Indexed: 06/09/2023]
Abstract
Workers who kneel or squat frequently are at a high risk of developing knee pathologies. Knee Savers® are wedge-shaped pads, worn on the lower calf by baseball catchers that aim to reduce this risk. This study examined how Knee Savers® change the bilateral quadriceps muscle activity during dorsiflexed kneeling, and heels-up and flat-foot squatting. For twenty participants, integrated and peak electromyography (EMG) during descent and ascent phases, mean EMG during a 10-s static phase, and participants' subjective perception of muscle fatigue were compared between equipment conditions (with (W) and without (WO) Knee Savers®). Knee Savers® did not significantly reduce integrated or peak EMG during transitions into and out of the postures; however, they significantly reduced (p < .03) mean EMG in five of six muscles during the static phase. These findings indicate potential for Knee Savers® to reduce cumulative muscular effort and fatigue in applications where prolonged static kneeling or squatting are required.
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Affiliation(s)
- Shabnam Pejhan
- Department of Kinesiology, University of Waterloo, 200 University Avenue West, Waterloo, ON, Canada.
| | - Sean K Denroche
- Department of Kinesiology, University of Waterloo, 200 University Avenue West, Waterloo, ON, Canada.
| | - Geena J Frew
- Department of Kinesiology, University of Waterloo, 200 University Avenue West, Waterloo, ON, Canada.
| | - Stacey M Acker
- Department of Kinesiology, University of Waterloo, 200 University Avenue West, Waterloo, ON, Canada.
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Warren BB, Jacobson L, Kempton C, Buchanan GR, Recht M, Brown D, Leissinger C, Shapiro AD, Abshire TC, Manco-Johnson MJ. Factor VIII prophylaxis effects outweigh other hemostasis contributors in predicting severe haemophilia A joint outcomes. Haemophilia 2019; 25:867-875. [PMID: 31115111 PMCID: PMC7273872 DOI: 10.1111/hae.13778] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 04/15/2019] [Accepted: 05/03/2019] [Indexed: 02/01/2023]
Abstract
INTRODUCTION The Joint Outcome Study (JOS) demonstrated that previously untreated children with severe haemophilia A treated with prophylactic factor VIII (FVIII) concentrate had superior joint outcomes at age 6 years compared to those children treated episodically for bleeding. However, variation in joint outcome within each treatment arm was not well explained. AIM In this study, we sought to better understand variation in joint outcomes at age 6 years in participants of the JOS. METHODS We evaluated the influence of FVIII half-life, treatment adherence, constitutional coagulant and anticoagulant proteins, and global assays on joint outcomes (number of joint bleeds, total number of bleeds, total MRI score and joint physical exam score). Logistic regression was used to evaluate the association of variables with joint failure status on MRI, defined as presence of subchondral cyst, surface erosion or joint-space narrowing. Each parameter was also correlated with each joint outcome using Spearman correlations. RESULTS Prophylaxis treatment arm and FVIII trough were each found to reduce risk of joint failure on univariate logistic regression analysis. When controlling for treatment arm, FVIII trough was no longer significant, likely because of the high level of covariation between these variables. We found no consistent correlation between any laboratory assay performed and any joint outcome parameter measured. CONCLUSION In the JOS, the effect of prescribed prophylactic FVIII infusions on joint outcome overshadowed the contribution of treatment adherence, FVIII half-life, global assays of coagulation and constitutional coagulation proteins. (ClinicalTrials.gov number, NCT00207597).
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Affiliation(s)
| | - Linda Jacobson
- University of Colorado Anschutz Medical Campus, Aurora,
CO
| | | | - George R. Buchanan
- University of Texas Southwestern Medical Center and
Children’s Medical Center at Dallas, TX
| | - Michael Recht
- Phoenix Children’s Hospital, Phoenix, AZ
- Oregon Health & Science University, Portland, OR
| | | | | | - Amy D. Shapiro
- Indiana Hemophilia and Thrombosis Center, Indianapolis,
IN
| | - Thomas C. Abshire
- Emory University School of Medicine, Atlanta, GA
- Blood Research Institute, BloodCenter of Wisconsin/Versiti,
Milwaukee, WI
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Abstract
Joint problems commonly occur in people with diabetes. Cheiroarthropathy affects the hands and results in painless limited finger joint extension, appearing to be associated with longer diabetes duration and the presence of microvascular complications. The prevalence of cheiroarthropathy seems to be falling, perhaps as a result of improvements in glycaemic management. Non-enzymatic glycation of collagen results in abnormally crosslinked protein resistant to degradation with subsequent increased build-up of collagen in joints. The management of cheiroarthropathy is predominantly conservative, with occupational and hand therapy at the forefront. Tendinopathy is more common in people with diabetes than those without, and is associated with obesity and insulin resistance. As with cheiroarthropathy, the exact causative mechanism of tendinopathy in diabetes is not known, but may be linked to inflammation, apoptosis and increased vascularity of affected tendons, driven by hyperinsulinaemia. Local fat pads have also been suggested to play a role in the pathogenesis of tendinopathy.
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Affiliation(s)
- N E Hill
- Imperial College Healthcare NHS Trust, London
| | - D Roscoe
- Defence Medical Rehabilitation Centre, Loughborough
- University of Loughborough, Loughborough
| | - M J Stacey
- Imperial College Healthcare NHS Trust, London
- Defence Medical Services, Lichfield, UK
| | - S Chew
- Imperial College Healthcare NHS Trust, London
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Jiménez-Martín A, Gómez-Cobo R, Rubio-Gallardo Y, Pérez-Hidalgo S. Transient migratory osteoporosis in lower limbs. Reumatol Clin (Engl Ed) 2019; 15:246-248. [PMID: 28392249 DOI: 10.1016/j.reuma.2017.02.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 02/26/2017] [Accepted: 02/28/2017] [Indexed: 06/07/2023]
Affiliation(s)
- Antonio Jiménez-Martín
- Servicio de Cirugía Ortopédica y Traumatología, Hospital FREMAP Sevilla, Sevilla, España.
| | - Rolando Gómez-Cobo
- Servicio de Cirugía Ortopédica y Traumatología, Hospital FREMAP Sevilla, Sevilla, España
| | - Yolanda Rubio-Gallardo
- Servicio de Cirugía Ortopédica y Traumatología, Hospital FREMAP Sevilla, Sevilla, España
| | - Santiago Pérez-Hidalgo
- Servicio de Cirugía Ortopédica y Traumatología, Hospital FREMAP Sevilla, Sevilla, España
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Schwarz GM, Hirtler L. Ectopic tendons of the pectoralis minor muscle as cause for shoulder pain and motion inhibition-Explaining clinically important variabilities through phylogenesis. PLoS One 2019; 14:e0218715. [PMID: 31226146 PMCID: PMC6588231 DOI: 10.1371/journal.pone.0218715] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 06/07/2019] [Indexed: 11/18/2022] Open
Abstract
OJECTIVE Clinical consequences of ectopic tendons of the pectoralis minor muscle (PMM) for shoulder pain and range-of-motion limitation have been demonstrated. For better understanding the existence of such ectopic tendons, a phylogenetic hypothesis is proposed. METHODS Forty-five shoulders of anatomical specimens were dissected and examined. Insertions areas of PMM were measured and occurring aberrant tendons were identified. Their relationship with the coracohumeral ligament (CHL) described and samples of the ligament were collected and histologically stained. RESULTS The prevalence of PMM variations was 37.84%. Shoulders with variations showed a statistically significant smaller coracopectoral distance (p<0.001) and larger insertion areas (p<0.003) than shoulders without. A strong negative correlation between these two variables (p<0.001, r = -0.620) was shown. CONCLUSIONS The presented results prompted the conclusion that the CHL may be in fact the remnant of the pectoralis minor tendon (PMT), which migrated from the humerus to the coracoid process through the process of phylogenetic evolution. Variations of PMTs are significantly more common than in previous studies. Imaging techniques appear to be insufficiently sensitive for reliably detecting ectopic tendons. Especially in patients experiencing shoulder pain and stiffness in whom the commoner pathologies have been ruled out the possibility of ectopic PMT should be kept in mind and ruled out.
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Affiliation(s)
- Gilbert M. Schwarz
- Department of Orthopedics and Trauma-Surgery, Medical University of Vienna, Vienna, Austria
| | - Lena Hirtler
- Division of Anatomy, Center for Anatomy and Cell Biology, Medical University of Vienna, Vienna Austria
- * E-mail:
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Sánchez-Martínez EM, García-Briz MI, Moneva-Léniz LM, Gegúndez-Hernández H, Pose-Lapausa P, Mateu-Puchades A. Endogenous ochronosis: when clinical suspicion prevails over histopathology. Dermatol Online J 2019; 25:13030/qt5q2763pj. [PMID: 31046911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Accepted: 04/28/2019] [Indexed: 06/09/2023] Open
Abstract
Endogenous ochronosis (EO) or alkaptonuria is an inherited autosomal recessive disease caused by the insufficiency of the enzyme homogentisic acid dioxygenase. This disturbance causes an accumulation and increased renal excretion of homogentisic acid (AHG), which manifests as dark urine when it oxidizes on contact with air. Other clinical manifestations of OE are the result of the deposit of AHG in the form of ochronotic pigment at the level of collagen in the skin and cartilage, where it causes blue-gray cutaneous hyperpigmentation, degenerative arthropathy, valvular disease, and other multisystem effects. Despite the progressive and irreversible nature of OE and the lack of a curative treatment, the life expectancy is preserved. We report a new case of EO with cutaneous and joint involvement, in which a high clinical suspicion, confirmed by elevated AHG in urine was the key in the diagnosis.
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