Patellar groove replacement in patellar luxation with severe femoro-patellar osteoarthritis.

OBJECTIVE: To report a novel method of treating femoro-patellar instability in association with severe femoro-patellar osteoarthritis, by substituting the femoral trochlear with a patellar groove replacement prosthesis. STUDY DESIGN: Retrospective case series. METHODS: Preoperative lameness was scored from 0-4, and radiographic studies including standard positions for patellar luxation were obtained for evidence of malalignment and femoro-patellar osteoarthritis. Cases with or without previous surgeries were included. The size of trochlear implant was determined by transparent templates and confirmed intra-operatively with trials. Radiographic images, together with clinical examinations, were reviewed immediately and at three months postoperatively and at longer term when available. RESULTS: Thirty-five cases of patellar luxation ranging from grades II to IV were included. Eleven of these cases had prior surgical interventions which failed to stabilize the patella. Fourteen dogs required additional surgical procedures in conjunction with patellar groove replacement. Complications occurred in six patients, of which three required revision. Complete resolution of subjectively-assessed lameness was evident in 24/35 cases by the third month and in another seven of 35 patients on the longer term re-evaluations. CLINICAL SIGNIFICANCE: Use of a patellar groove replacement prosthesis has the potential to decrease the lameness associated with severe femoro-patellar arthritis, to improve patellar stability, and to correct the alignment of the extensor mechanism.

Conversion of azathioprine to mycophenolate mofetil and chronic graft failure progression.

The purpose of the study was to evaluate the impact of conversion from azathioprine (AZA) to mycophenolate mofetil (MMF) on graft function in 35 renal transplant recipients with chronic allograft nephropathy (CAN). The immunosuppressive regimen originally consisted of AZA, cyclosporine (CsA), and prednisone (Pr). At the onset of the study (mean period = 39 posttransplant months), a graft biopsy was performed on all patients who were randomly divided into group 1 (n = 17) in whom MMF was introduced instead of AZA. The remaining 18 subjects (group 2) were maintained on the previous regimen. Two periods were analyzed: period I: 12 months before, and period II: 12 months after biopsy and therapy conversion. Graft function was assessed monthly by measurements of the 24-hour creatinine clearance (CCr). Analysis of variance (ANOVA) was used to compare the differences in CCr and proteinuria between the two groups. No difference was observed in the baseline characteristics, in the incidence of delayed graft function and acute rejection, or in the mean CsA dose. Pathohistological analysis revealed advanced CAN in the majority of patients in both groups. The morphological changes negatively correlated with graft function. The graft function showed parallel deterioration in the two groups; no significant difference was observed in the mean CCr values in the periods studied. Proteinuria was similar for both groups throughout the study. Conversion of AZA to MMF in recipients with CAN, albeit safe, was without significant benefit on the progression of chronic graft failure over the period of a year.