Joint Denervation in the Digits: Technique and Patient Satisfaction.

BACKGROUND: Traditional approaches to treating painful osteoarthritis of the fingers include arthrodesis and arthroplasty. Although highly effective for pain control, arthrodesis sacrifices joint motion and can be complicated by nonunion, malunion, and infection.Implant arthroplasty preserves motion but is likewise subject to complications-particularly at the level of the proximal interphalangeal joint. In contrast, finger joint denervation is a simple outpatient procedure that maintains joint motion. In this study, we describe our surgical techniques for joint denervation and review our survey of patient satisfaction. METHODS: A retrospective review was performed of all patients undergoing finger joint denervation for osteoarthritis at our institution from 2012 to 2014. Each patient was contacted by phone and asked to rate their pre- and postoperative pain and function.Patients were also asked about any complications experienced and if they would choose to undergo the operation again. RESULTS: Over the 2-year period, 12 patients underwent denervation of 23 joints. Of the 12 patients in the study, 11 undergoing 22 joint denervations were available for our survey. Patient-reported pain scores fell from a median of 5/5 preoperatively to 0/5 after recovery (P < 0.001). Perceived hand function improved from a preoperative reported median of 2/5 to a postoperative median of 5/5 (P < 0.001). Complications were few, and 9 of 11 patients said they would choose to have the operation again. CONCLUSIONS: Joint denervation is a safe and effective treatment modality for osteoarthritis of the digits, resulting in good pain relief and high patient satisfaction with low complication rates.

Natural variation in life history and aging phenotypes is associated with mitochondrial DNA deletion frequency in Caenorhabditis briggsae.

BACKGROUND: Mutations that impair mitochondrial functioning are associated with a variety of metabolic and age-related disorders. A barrier to rigorous tests of the role of mitochondrial dysfunction in aging processes has been the lack of model systems with relevant, naturally occurring mitochondrial genetic variation. Toward the goal of developing such a model system, we studied natural variation in life history, metabolic, and aging phenotypes as it relates to levels of a naturally-occurring heteroplasmic mitochondrial ND5 deletion recently discovered to segregate among wild populations of the soil nematode, Caenorhabditis briggsae. The normal product of ND5 is a central component of the mitochondrial electron transport chain and integral to cellular energy metabolism. RESULTS: We quantified significant variation among C. briggsae isolates for all phenotypes measured, only some of which was statistically associated with isolate-specific ND5 deletion frequency. We found that fecundity-related traits and pharyngeal pumping rate were strongly inversely related to ND5 deletion level and that C. briggsae isolates with high ND5 deletion levels experienced a tradeoff between early fecundity and lifespan. Conversely, oxidative stress resistance was only weakly associated with ND5 deletion level while ATP content was unrelated to deletion level. Finally, mean levels of reactive oxygen species measured in vivo showed a significant non-linear relationship with ND5 deletion level, a pattern that may be driven by among-isolate variation in antioxidant or other compensatory mechanisms. CONCLUSIONS: Our findings suggest that the ND5 deletion may adversely affect fitness and mitochondrial functioning while promoting aging in natural populations, and help to further establish this species as a useful model for explicit tests of hypotheses in aging biology and mitochondrial genetics.