A comparison between the complications and long-term outcome of hip and knee replacement therapy in patients with and without haemophilia; a controlled retrospective cohort study.

The outcomes of total knee arthroplasty (TKA) and total hip arthroplasty (THA) in patients with haemophilia have not been compared with other patient populations. The aim of this study was to compare the results of joint replacement therapy in patients with and without haemophilia retrospectively. This is a controlled retrospective cohort study. The complications and long-term results of 21 TKAs and 6 THAs performed in 22 haemophilia patients were compared with those of 42 TKAs and 12 THAs in patients without bleeding disorders. Patients were matched for type of arthroplasty, gender, year of surgery and age. Blood loss, infection rate, revision, implant survival and function as judged by the patient were recorded. Haemarthrosis occurred in 14 (52%) of the 27 arthroplasties performed in the haemophilia patients, while four bleedings were recorded in the 54 arthroplasties in the control group (7%, P < 0.001). All bleeds occurred in TKAs. In the patient group, two infections (7%, both in TKAs) occurred compared to seven (13%, 6/7 in TKAs) in the control group (NS). In the haemophilia patients, all but one (96%) arthroplasties were still in situ at the end of follow-up, vs. 44 (81%, NS) in the control group. For TKAs, survival was 20/21 vs. 34/42 respectively (P = 0.25). Subjective function was good in 22/27 (81%; 76% in TKAs) arthroplasties in haemophilia patients, vs. 40/54 (74%; 71% in TKAs) in controls. Haemophilia patients experienced significantly more haemarthroses, but no more infections and they have an excellent implant survival compared with non-haemophilia controls.

Hypoxia inducible factor-1-alpha (HIF-1alpha) is related to both angiogenesis and inflammation in rheumatoid arthritis.

OBJECTIVES: Despite the important role of the transcription factor HIF-1alpha in angiogenesis and inflammation, only a few studies on HIF-1alpha expression have been performed in RA patients. The aim of the present study was to identify the layer in synovial tissue of RA patients where HIF1a is expressed and to find out whether HIF-1alpha expression is related to both angiogenesis and inflammation in synovium from RA patients. METHODS: A reproducible staining method for HIF-1alpha was developed. HIF-1alpha -positive cells were quantified in synovial tissue from patients with RA. As control we used synovial tissue from patients with osteoarthritis (OA). The number of HIF-1alpha-positive cells was compared with the number of blood vessels present and was correlated with the amount of inflammation. The amount of inflammation was determined by counting inflammatory cells, by estimating the proliferation marker Ki67 in inflamed tissue, and by using a recently published synovitis score which gives an accurate estimate of the amount of inflammation present. RESULTS: HIF-1alpha was expressed weakly in the lining layer and strongly in the sublining layer in RA synovial tissue. In contrast, HIF-1alpha was only weakly expressed in OA synovial tissue. The number of HIF-1alpha -positive cells correlated strongly with the number of blood vessels in RA synovial tissue and with inflammatory endothelial cell infiltration (blood vessels), cell proliferation (Ki67) and the synovitis score. CONCLUSIONS: HIF-1alpha expression is strongest in the sub-lining layer of RA synovium and is related to both angiogenesis and inflammation in synovium from RA patients. These results thus suggest that HIF-1alpha could serve as an important new therapeutic target in RA, targeting both angiogenesis and inflammation.

Validation of a method to measure the proprioception of the knee.

INTRODUCTION: Proprioception is an important mechanism in knee stability and function. After an injury like an anterior cruciate ligament (ACL) rupture changes appear in knee proprioception which play a major role in rehabilitation. There are several methods to measure proprioception; the threshold to detect passive motion (TTDPM) is often used to quantify proprioception. In this study the reliability and validity were tested of an apparatus, which measures the TTDPM based on the Lund technique of Fridén and Roberts (Sweden). MATERIALS AND METHODS: Sixteen healthy participants were tested on both legs, from start position 20 degrees and 40 degrees, towards extension (TE) and flexion (TF). The same measurement was repeated 12 (6-21) days later. RESULTS: An overall mean TTDPM of 0.58 degrees (95% confidence interval CI=0.53-0.62 degrees ) was found. Thresholds were different depending on direction of motion and start position. TTDPM in 20 degrees TE (0.51 degrees, CI=0.48-0.56 degrees) and in 40 degrees TF (0.54 degrees, CI=0.50-0.58 degrees ) were significantly lower than TTDPM in 40 degrees TE (0.68 degrees , CI=0.63-0.74 degrees) and in 20 degrees TF (0.58 degrees, CI=0.54-0.63 degrees). Thresholds were rising with age. Women had higher thresholds than men. CONCLUSION: The method is a reliable and valid way to measure proprioception. The next step is to use this method on patients with an ACL-rupture and compare these results with healthy subjects.

A symptomatic coracoclavicular joint.

Bilateral coracoclavicular joints were found in a 44-year-old male patient following a fall. He had an Indonesian mother and a Dutch father. Prior to the injury he was asymptomatic and had full range of movement in both shoulders but the trauma resulted in pain and limitation of movement in the left shoulder which required resection of the anomalous joint, after which full pain-free movement was restored.

Atypical hamstrings electromyographic activity as a compensatory mechanism in anterior cruciate ligament deficiency.

Anterior cruciate ligament (ACL) deficiency may cause functional instability of the knee (noncopers), while other patients compensate and perform at the same level as before injury (copers). This pilot study investigated whether there is a compensatory electromyographic (EMG) activity of the hamstrings in copers, noncopers and control patients. Ten patients with an ACL deficiency were equally divided into two groups of copers and noncopers. All patients underwent gait analysis with EMG of six muscles around the knee. Ten healthy young men formed the control group. In contrast to noncopers, copers showed an atypical semitendinosus activity during stance phase; the corresponding trend was found in biceps femoris activity. There was no difference between copers and controls in knee extension during stance phase. The noncopers had less knee extension. Atypical hamstring muscle activity may thus be a compensatory mechanism by which copers enable themselves to perform on a normal level.

Arthrolysis for post-traumatic stiffness of the elbow.

Twelve of 14 patients who underwent arthrolysis of the elbow for post-traumatic stiffness were re-examined after a mean of 62 months. Pain and subjective stiffness were improved. The mean function of the elbow improved from 73 degrees to 112 degrees. Those operated on within a year of their injury improved twice as much as those who had been operated on after a longer period. Arthrolysis may be very rewarding when conservative treatment fails, especially when it is carried out within a year of the injury.