Short-term effectiveness of INBONE TM Ⅱ total ankle prosthesis arthroplasty in the treatment of moderate to severe varus-type ankle arthritis / 中国修复重建外科杂志

OBJECTIVE@#To investigate the short-term effectiveness of INBONE TM Ⅱ total ankle prosthesis arthroplasty in the treatment of moderate to severe varus-type ankle arthritis.@*METHODS@#The clinical and radiographic data of patients with moderate to severe varus-type ankle arthritis, who were admitted between May 2017 and November 2021 and treated with total ankle arthroplasty (TAA) using INBONE TM Ⅱ prosthesis, was retrospectively analyzed. A total of 58 patients (58 ankles) met the selection criteria and were included in the study. Among them, there were 24 males and 34 females, with an average age of 62.6 years (range, 41-85 years). According to the preoperative tibiotalar angle (TTA), the patients were divided into a moderate varus group (group A, TTA 5°-15°, n=34) and a severe varus group (group B, TTA>15°, n=24). There was no significant difference in gender, side, etiology, preoperative American Orthopaedic Foot and Ankle Society (AOFAS) score, ankle dorsiflexion, plantarflexion, and total range of motion, and tibial lateral surface angle (TLS) between the two groups ( P>0.05). Yet the patients in group A were younger than group B, the degrees of oesteoarthritis (Takakura stage) and ankle pain [visual analogue scale (VAS) score] were milder, and the TTA, talar tilt angle (TT), hindfoot alignment angle (HAA) were smaller while the tibial articular surface angle (TAS) was larger, showing significant differences ( P<0.05). The pre- and post-operative VAS score, AOFAS score, the occurrence of early and late complications, the radiographic parameters of the ankle (TTA, TAS, TT, HAA, TLS), ankle dorsiflexion, plantarflexion, and total range of motion were recorded and compared.@*RESULTS@#All patients were followed up 19-72 months, with an average of 38.9 months. Compared with the preoperative data, the VAS score of all patients significantly decreased ( P<0.05); the AOFAS score, ankle dorsiflexion range of motion, and total range of motion significantly increased ( P<0.05); and the TTA, TAS, TT, HAA, and TLS significantly improved at last follow-up ( P<0.05); but there was no significant difference in plantarflexion range of motion ( P>0.05). Early complications occurred in 13 patients, and only 1 patient underwent revision surgery due to a larger size of the talar component. At last follow-up, there was no significant difference in the difference of clinical parameters before and after operation between the two groups ( P>0.05); there was a significant difference in the difference of other radiographic parameters ( P<0.05) except TLS. No significant difference in the incidence of complications between the two groups was found ( P>0.05).@*CONCLUSION@#TAA using the INBONE TM Ⅱtotal ankle prosthesis is an effective treatment for moderate or severe varus-type ankle arthritis, and good clinical and radiographic results can be obtained. Correcting bony deformities and balancing soft tissue are the keys to successful surgery.

Ankle arthritis: joint-preserving surgery and total ankle arthroplasty / 中国修复重建外科杂志

Ankle arthritis affects approximately 1% of the adult population worldwide and represents a serious global disease burden. However, compared with hip arthritis and knee arthritis, the clinical understanding and treatment of ankle arthritis are still in their infancy. For end-stage ankle arthritis, ankle arthrodesis was considered as the "gold standard" in the past. However, ankle arthrodesis will result in loss of joint mobility, altered gait, limited daily activities, and accelerated degeneration of adjacent joints. Therefore, how to preserve the range of motion of the ankle joint while relieving pain is the key to the treatment of ankle arthritis. Currently, the surgical treatment of ankle arthritis includes arthroscopic debridement, periarticular osteotomies, osteochondral transplantation, ankle distraction arthroplasty, ankle arthrodesis, and total ankle arthroplasty. The choice of treatment should be individualized and based on various factors such as the patient's symptoms, signs, imaging performance, complaints, and financial situation. However, there are no guidelines that give clear treatment recommendations. Therefore, it is necessary to conduct extensive and in-depth discussions on the diagnosis and treatment of ankle arthritis.

Protocolos de encaminhamento da atenção básica para a atenção especializada: reumatologia e ortopedia / Primary care referral protocols for specialized care: rheumatology and orthopedics

Este material tem como objetivo orientar as equipes que atuam na AB, qualificando o processo de referenciamento de usuários para outros serviços especializados. É uma ferramenta, ao mesmo tempo, de gestão e de cuidado, pois tanto guiam as decisões dos profissionais solicitantes quanto se constitui como referência que modula as avaliações apresentadas pelos médicos reguladores.

Patella Resurfacing during Total Knee Arthroplasty: Have We Got the Issue Covered?

BACKGROUND: Management of the patella during total knee arthroplasty (TKA) is controversial. Multiple studies have examined mechanical and clinical results of TKA with native and resurfaced patellae with no clear consensus. METHODS: We surveyed a large cohort of consultant surgeons in a questionnaire based study in order to assess the indications for patella resurfacing and to correlate practice with degree of specialization, experience and volume of procedures performed. RESULTS: Six hundred and nineteen surgeons were included. The main indication for patella resurfacing was patellofemoral arthritis. The ratio of those who always:sometimes:never resurfaced was 1:2:1 irrespective of experience or volume performed. There was no difference between knee specialists and non-specialists (p = 0.977) or between high and lower volume surgeons (p = 0.826). Senior and high volume surgeons tended to always resurface. CONCLUSIONS: The majority of surgeons only sometimes resurfaced the patella. The number who always and never resurfaced were similar. There was a tendency for more experienced and high volume surgeons to always resurface.

Arthrodesis of Distal Interphalangeal Joints in the Hand with Interosseous Wiring and Intramedullary K-wire Fixation

BACKGROUND: To evaluate the efficacy of intramedullary K-wire fixation and interosseous wiring in the arthrodesis of the distal interphalangeal (DIP) joint with description of surgical procedure. METHODS: We retrospectively analyzed 9 cases (7 women and 2 men) of DIP joint arthrodesis. The average age of patients was 44.2 years (range, 21 to 71 years) and the mean follow-up period was 19.6 months. Joint union was evaluated on the follow-up radiographs together with postoperative complications. RESULTS: All cases achieved radiologic union of the arthrodesis site. There was no surgical complication except for one case of skin irritation by the interosseous wire knot which was removed during the follow-up period. CONCLUSIONS: Intramedullary K-wire fixation and interosseous wiring could be an alternative procedure of arthrodesis in the DIP joint.

Patients with Arthritis Undergoing Surgery: How Should We Manage Tumour Necrosis Factor Blocking Agents Perioperatively?: A Systematic Literature Review

We systematically reviewed the literature on the infectious risk in patients treated with tumour necrosis factor blocking agents (TNF-BA) undergoing surgery: we searched the Medline (PubMed) and the online archive from the Annual European Congress of Rheumatology and the Annual Scientific Meeting of the American College of Rheumatology. Of total 1259 reports, 14 were finally analysed. With one exception all were retrospective. Four of 6 studies compared patients on TNF-BA with those not receiving TNF-BA, and found an increased risk of infection with the use of TNF-BA. None of the other studies which compared continued with discontinued treatment at surgery found an increased risk of infection, when the medication was continued perioperatively. In conclusion, while in theory there is an increased risk of infections when TNF-BA are administered perioperatively, the available literature does not necessarily support this. It rather appears that patients receiving TNF-BA are a priori at a higher risk of postoperative infections. Scheduling surgery at the end of the drug interval and adding one "safety" week prior to surgery should be an acceptable plan in daily clinical practice.

Clinical Incidence of Sacroiliac Joint Arthritis and Pain after Sacropelvic Fixation for Spinal Deformity

PURPOSE: Sacroiliac fixation using iliac screws for highly unstable lumbar spine has been reported with an improved fusion rate and clinical results. On the other hand, there is a potential for clinical problems related to iliac fixation, including late sacroiliac joint arthritis and pain. MATERIALS AND METHODS: Twenty patients were evaluated. Degenerative scoliosis was diagnosed in 7 patients, failed back syndrome in 6 patients, destructive spondyloarthropathy in 4 patients, and Charcot spine in 3 patients. All patients underwent posterolateral fusion surgery incorporating lumbar, S1 and iliac screws. We evaluated the pain scores, bone union, and degeneration of sacroiliac joints by X-ray imaging and computed tomography before and 3 years after surgery. For evaluation of low back and buttock pain from sacroiliac joints 3 years after surgery, lidocaine was administered in order to examine pain relief thereafter. RESULTS: Pain scores significantly improved after surgery. All patients showed bone union at final follow-up. Degeneration of sacroiliac joints was not seen in the 20 patients 3 years after surgery. Patients showed slight low back and buttock pain 3 years after surgery. However, not all patients showed relief of the low back and buttock pain after injection of lidocaine into the sacroiliac joint, indicating that their pain did not originate from sacroiliac joints. CONCLUSION: The fusion rate and clinical results were excellent. Also, degeneration and pain from sacroiliac joints were not seen within 3 years after surgery. We recommend sacroiliac fixation using iliac screws for highly unstable lumbar spine.

Arthroscopic treatment of acromioclavicualr joint arthritis, a modified approach in the distal clavicle excision with preservation of the superior A.C.J ligament

The acromioclavicular [AC] joint arthritis is a common and sometimes under-looked source of shoulder problems. The procedure of subacromial decompression with distal clavicular end resection [either open or arthroscopic] was the usual treatment proposed. With the increasing popular usage of this technique, some failure rates were reported after either open or arthroscopic techniques. This was attributed to Inadequate resection, or partial ACJ instability due to injury or resection of the superior ligament during the ACJ resection, and underlying muscle injury due to lack of experience or difficult portals handling. Our Aim was to assess the results of arthoscopic management of A.C.J arthritis, by distal clavicle resection using a modified arthroscopic portals and technique. Thirty two patients were managed arthroscopicaly, after proper diagnosis of A.C arthritis. A modified arthroscopic approach through anterior working portal -instead of the classical anterosuperior portal-and posterior viewing portal were used with the resection of acromial side [osteophytes] preceding the clavicular side instead of resection the clavicular side directly. This approach brings better handling of the joint and easier in preserving the superior AC ligament as widening of the ACJ is less than 1.5cm from both acromial and clavicular ends. All patients were followed up for six months using the UCLA shoulder scale in analysis of the results. This modified approach proved successful results, and comparable with the classical anterosuperior, and posterosuperior approach, showed earlier recovery. In this series 90.6% of patients showed excellent results after an average of 3.7 months, while 6.4% of patients showed good results, and only 3% showed poor results. The Meticulous preoperative evaluation, and this modified approach using the anterior portal instead of the classical anterosuperior one, with the resection of less than 1.5cm of the clavicle, preserve the superior A.C ligament, and consequent the horizontal stability of the joint. Moreover the adequate subacromial decompression that may accomplish the procedure could be easier and better. Both- viewing and working at the joint using the modified portals decreased the long learning curve, and achieved better final results

Cementless shoulder surface replacement with glenoid levelling in posttraumatic glenohumeral arthritis

Degenerative glenohumeral arthritis is a possible complication after traumatic glenohumeral dislocation. Shoulder surface replacement arthroplasty has been established for several decades as a mean to restore comfort and function of the shoulder for many afflictions that derange the normal anatomy. The surface replacement may offer some advantages over the stemmed prostheses. We encountered a case with glenohumeral arthritis following neglected fracture dislocation of the shoulder. Copeland cementless surface replacement together with glenoid levelling was done. Six months postoperatively the constant score was markedly improved [82 points]. The patient showed complete relief of pain with marked improvement of the range of movement of the shoulder. The early results in this patient with the use of Copeland cementless surface replacement for treatment of posttraumatic glenohumeral arthritis together with levelling of the glenoid surface were encouraging. The levelling of the glenoid facilitates the smooth gliding of the prosthesis which in turn improves the range of motion and avoids the replacement of the glenoid with its high risk of future loosening. More cases with longer follow-up to document these findings are necessary

Prótesis de cadera no cementada, sistema CLS / Non cemented prosthesis of the hip with the CLS

Se realizó un estudio retrospectivo, descriptivo, observacional en pacientes a quienes se les colocó una prótesis total de cadera no cementada, con el sistema CLS, durante el periodo comprendido de noviembre de 1991 a diciembre de 1996. Se aplicó un protocolo de acuerdo con los parámetros del Dr. Spotorno. Se administraron antibióticos profilácticos y terapia antiembólica. Se operó siguiendo en forma estricta la técnica sugerida por la casa comercial. Se colocaron un total de 48 protesis totales primarias con el sistema CLS, se excluyeron los casos en que este implante se colocó en revisiones, en dos casos la prótesis se colocó en forma bilateral. La indicación más frecuente fue la artrosis. Se permitió apoyar la extremidad operada hasta las 6 semanas siguientes a la cirugía en los casos que no presentaron complicaciones. Se revisaron los expedientes clínicos y radiográficos, así como a los pacientes operados. En 8 casos se presentaron fisuras estables en la región del calcar, sólo 6 casos presentaron líneas radiolúcidas a nivel acetabular, 16 por ciento de los fémures presentaron líneas radiolúcidas a nivel del hombro de la prótesis. En dos casos se presentó dolor en la cara anterior del muslo durante más de tres meses. La movilidad y la funcionalidad de la cadera operada mejoraron en el 100 por ciento de los casos. El sistema de prótesis de cadera no cementada CLS Spotorno es un buen sistema en reemplazos de cadera primarios, requisito es que el cótilo sea esférico o tenga poca deformidad, como en el resto de las prótesis no cementadas, se debe de realizar una selección cuidadosa en pacientes con adecuado stock óseo

Prótesis total de cadera cementada. Experiencia con cinco tipos de prótesis totales / Cemented total hip prosthesis. Experience with five types of total prosthesis

Se presenta una serie retrospectiva de 73 pacientes operados con 5 tipos de prótesis totales de la cadera. La indicación fue por osteoartritis en 73 por ciento de los casos, necrosis avascular en 11 por ciento y artritis reumatoide en el 10 por ciento. Las prótesis colocadas fueron: 15 Muller clásica, 11 Weller, 20 Muller autobloqueante, 12 Osteonics y 3 Response. Después de 5 años de evolución, se presentaron líneas de radiolucidez alrededor de la prótesis con mayor frecuencia en la de Muller clásica, con menor frecuencia en la Osteonics y ausente en el Response. La cirugía de revision fue más frecuente en la protesis de Muller clásica y menos frecuente en la Response, Muller autobloqueante y Osteonics

Retrospective studies on equine arthritis with special reference to its treatment

The aim of this work was to report the different types of arthritis, investigate their pathological profile and evaluate the suggested treatment

Osteoma osteóide como diagnóstico diferencial de monoartrite: descriçäo de três casos / Osteoid osteoma as the differential diagnosis of monoarthritis: description of 3 cases

Os autores relatam três casos de artrite ocasionada por osteoma osteóide. Essas lesöes foram observadas dentro da cápsula articular: dois casos em coxofemoral e um caso em joelho. O diagnóstico foi realizado por raio X convencional, tomografia computadorizada e confirmado por exame histológico. O atraso no diagnóstico e características clínicas e radiológicas säo discutidos neste trabalho

Evaluation of the results of the different types of total knee arthroplasty in arthritis

Sixty-one patients with ankylosing spondylitis who underwent 104 total hip replacements were studied. Affection of the hip was assessed preoperatively. All cases were done by a modified posterior approach. A Charnley prosthesis was used in most of them. The postoperative assessment showed excellent and good results in 75% as well as fair and poor results in 25%