ABSTRACT
The aim of this study was to evaluate the early functional outcome and survivorship of a bicompartmental knee arthroplasty implant (Journey-Deuce) in a cohort of patients with combined medial and patellofemoral degenerative osteoarthritis. Fifteen patients with a mean age of 57 years were followed up prospectively and evaluated with clinical examination, Oxford knee score and radiology imaging. Poor pain scores, concerns about the tibial fixation, early aseptic loosening of the tibial component and a revision rate of 60 % at a minimum follow-up of 54 months are reported. Implantation of this prosthesis was stopped at our institution well before the first revision due to an unfavourable early clinical response. This was further endorsed by an unacceptable revision rate. The outcome of the Journey-Deuce bicompartmental knee replacement was considerably worse than the published outcome of total knee replacement.
Subject(s)
Osteoarthritis, Knee , Postoperative Complications , Arthroplasty, Replacement, Knee/adverse effects , Arthroplasty, Replacement, Knee/instrumentation , Arthroplasty, Replacement, Knee/methods , Bone-Implant Interface , Female , Humans , Knee Prosthesis , Male , Middle Aged , Osteoarthritis, Knee/diagnosis , Osteoarthritis, Knee/physiopathology , Osteoarthritis, Knee/surgery , Outcome and Process Assessment, Health Care , Postoperative Complications/diagnosis , Postoperative Complications/etiology , Postoperative Complications/physiopathology , Postoperative Complications/surgery , Prosthesis Design , Prosthesis Failure , Radiography/methods , Recovery of Function , Reoperation/methods , Reoperation/statistics & numerical data , Treatment Failure , United KingdomABSTRACT
Among 101 feet that presented with symptoms and signs similar to Morton's neuroma, intermetatarsal rheumatoid nodules were found in five feet (three patients). Two patients had bilateral involvement. Histology of the excised tissue showed the presence of a rheumatoid nodule and Morton's neuroma in four feet and a rheumatoid nodule with unremarkable nerve bundles in one. A rheumatoid nodule can coexist with Morton's neuroma, as seen in our patients, and the presentation is often similar to that of a Morton's neuroma. Our patients were rendered asymptomatic with surgical treatment and went on to have appropriate management of rheumatoid arthritis. Rheumatoid nodule should be considered in the differential diagnosis of Morton's neuroma in not only rheumatoid arthritis patients but also asymptomatic patients who have never been tested for rheumatoid antibodies.
Subject(s)
Neuroma/diagnosis , Peripheral Nervous System Neoplasms/diagnosis , Rheumatoid Nodule/diagnosis , Acute Pain/diagnosis , Adult , Biopsy , Diagnosis, Differential , Female , Humans , Rheumatoid Nodule/pathology , Rheumatoid Nodule/surgeryABSTRACT
PURPOSE: To identify the organisms causing delayed deep infection following primary total knee arthroplasty (TKA) and to compare the differences in outcome based on the infecting organism. METHODS: Between the period April 1998 and March 2004 inclusive, patients presenting with delayed deep infection following primary TKA and/or those who underwent a salvage procedure (amputation or arthodesis) were retrospectively studied. RESULTS: Organisms were isolated in 27 patients; 44% were methicillin-resistant Staphylococcus aureus and Staphylococcus epidermidis. When the organism was resistant, the mean number of surgical procedures per patient was significantly higher and the proportion of patients with satisfactory outcomes was significantly lower. CONCLUSION: Deep infection with methicillin-resistant S. aureus or S. epidermidis is increasing. Strict infection control measures must be in place to combat such problems.
Subject(s)
Arthroplasty, Replacement, Knee/adverse effects , Staphylococcal Infections/microbiology , Staphylococcus aureus/isolation & purification , Staphylococcus epidermidis/isolation & purification , Surgical Wound Infection/microbiology , Aged , Aged, 80 and over , Anti-Bacterial Agents/therapeutic use , Debridement/methods , Female , Follow-Up Studies , Humans , Male , Middle Aged , Osteoarthritis, Knee/surgery , Prognosis , Retrospective Studies , Risk Factors , Staphylococcal Infections/drug therapy , Staphylococcal Infections/surgery , Surgical Wound Infection/drug therapy , Surgical Wound Infection/surgeryABSTRACT
The aim of this study was to assess whether surgical decompression for carpal-tunnel syndrome (CTS) in the presence of primary or secondary osteoarthritis of the wrist is associated with poorer patient satisfaction. We did a retrospective matched cohort study. Twenty-four patients who underwent surgical decompression for CTS secondary to osteoarthritis were identified by reviewing the notes and the radiographs. A control group consisted of 24 patients without osteoarthritis of the wrist who underwent carpal-tunnel decompression. The control group was matched for age, sex, side, and neuro-physiological severity of the nerve compression. In the group with osteoarthritis of the wrist, 17 (71%) patients reported their symptom relief as satisfactory, and 7 (29%) reported the results as unsatisfactory. In the control group, 23 (96%) patients reported their symptom relief as satisfactory, and 1 (4%) reported the results as unsatisfactory (P=0.0325). In conclusion, patient satisfaction following surgical decompression in patients with secondary CTS due to osteoarthritis was significantly lower compared to patients without osteoarthritis of the wrist.
Subject(s)
Carpal Tunnel Syndrome/surgery , Decompression, Surgical/methods , Osteoarthritis/surgery , Patient Satisfaction , Wrist Joint , Adult , Aged , Aged, 80 and over , Carpal Tunnel Syndrome/etiology , Cohort Studies , Female , Humans , Male , Median Nerve/pathology , Median Nerve/surgery , Middle Aged , Osteoarthritis/complications , Retrospective StudiesABSTRACT
Necrotising fasciitis is a rare, life-threatening, soft-tissue infection characterised by rapidly spreading inflammation and subsequent necrosis of the muscle, fascia and surrounding tissues. We report a case of necrotising fasciitis originating from the shoulder in a 59-year-old female patient. Necrotising fasciitis of the shoulder is very rare and has a poor prognosis because of its potential to spread to the chest wall. It can occur in otherwise healthy people without any predisposing conditions and could present as muscle strain. Disproportionate pain is the hallmark of this condition. Ultrasound examination and aspiration of fluid from the involved area is a fast and efficient method of reaching the diagnosis.
Subject(s)
Fasciitis, Necrotizing/etiology , Muscle, Skeletal/injuries , Shoulder Injuries , Sprains and Strains/complications , Anti-Bacterial Agents/therapeutic use , Fasciitis, Necrotizing/drug therapy , Fasciitis, Necrotizing/surgery , Fatal Outcome , Female , Humans , Middle Aged , Multiple Organ Failure/microbiology , Shoulder Pain/etiologyABSTRACT
Myositis ossificans of the hand is extremely rare. We report an unusual case of myositis ossificans of the thenar muscles and discuss the diagnostic pitfalls whereby this condition can be mistaken for malignancy or infection.
