Diagnosis and Management of Intra-articular Causes of Pain After Total Knee Arthroplasty.

Total knee arthroplasty (TKA) is an effective procedure for decreasing pain, improving functional capability, and increasing the overall quality of life for thousands of people with chronic knee osteoarthritis. Although patient outcomes and satisfaction remain high, a substantial percentage of patients report residual pain after TKA. Sources of postoperative pain include intra- and extra-articular etiologies as well as factors unrelated to the implants themselves. A patient-centered approach to the painful TKA may aid clinicians in diagnosing and treating patients with intra-articular causes of pain after TKA. A thorough understanding of the mechanisms involved may lead to improved preoperative planning and patient selection, ultimately decreasing the number of patients with less than optimal postoperative outcomes.

Neuromuscular disease as the cause of late clubfoot relapses: report of 4 cases.

Following correction with the Ponseti method some idiopathic clubfeet still will relapse even after six years of age. A better understanding of the cause for these late relapses will greatly help in the management of this condition. We evaluated a consecutive case-series from 1948 through December 1984 including 209 patients (321 clubfeet). Patients were treated following the Ponseti method. Initial number of casts, age at relapse, neurological evaluation, and final treatment for the late-relapses were recorded. There were 12 patients (6%) having a relapse after the seventh birthday. In 4 of these patients (6 clubfeet) a neuromuscular disease was diagnosed, representing 33% of the late relapses. These patients were initially treated with an average of 4 casts (range: 2-6) with 2 requiring an Achilles tenotomy. Patients used the brace for an average of 4 years. The average age at the relapse prior to the suspicion of neuromuscular disease was 9 years (range: 8-11 years). Two patients had family history of neuromuscular disease (myotonic dystrophy and multiple core disease). In the other two cases (Charcot-Marie-Tooth Disease type IA and myasthenia gravis) neuromuscular disease was not suspected. All four patients required an anterior tibialis transfer, three had a plantar fasciotomy, and two had peroneus longus to brevis transfers. One patient required a subsequent posterior tibialis transfer and another patient a triple arthrodesis (myotonic dystrophy). In conclusion, late relapses in patients with idiopathic clubfoot may represent the onset of a previously undiagnosed neuromuscular disease, and should be thoroughly evaluated.

Patient location strategies for pediatric long-term follow-up studies.

BACKGROUND: Poor follow-up rates greatly diminish the validity of prospective and long-term studies. Therefore, locating patients is of critical importance. This is especially true in populations treated during childhood because addresses will change several times in intervening years. Recent publications have reported new strategies for patient location. The purpose of this study is to test an algorithm proposed by King et al., as well as other search methods, using a cohort of patients treated for clubfoot in childhood METHODS: The study population included 126 patients with clubfeet treated between 1950 and 1967. We followed the search algorithm proposed by King et al. In addition, we used state driver's license records, Reunitetonight.com, and Intelius.com. Patients were considered to be found when they returned a postage-paid reply letter or were contacted by phone. RESULTS: Using web pages recommended by King et al. we located 26 of 126 (21 percent) patients. Operator directory assistance failed to locate any patients not located by free internet sources. Additional websites had varied results. State driver's license records found 25 patients. Reunitetonight.com found none with thirty attempted. The best search engine was Intelius.com which located 68 out of 126 (54 percent) patients. CONCLUSION: The algorithm proposed by King et al. is not effective for long-term follow-up studies of pediatric populations. Intelius.com is worth the small fee charged (dollar 22.45) as it was the most effective method of locating patients.