Have the radiographic characteristics of total knee arthroplasty recipients in rheumatoid arthritis changed after the induction of biologic disease modifying antirheumatic drugs?

OBJECTIVES: Whether the characteristics of patients with rheumatoid arthritis (RA) undergoing total knee arthroplasty (TKA) have changed in the era of biologic disease-modifying antirheumatic drugs (bDMARDs) is unclear. We compared the radiographic findings of the knees in TKA recipients with RA before and after the introduction of bDMARDs. METHODS: Consecutive patients who underwent primary TKA between 1999 and 2002 (115 knees; 79 patients, group A) and between 2013 and 2017 (117 knees; 95 patients, group B) were retrospectively evaluated. Clinical data, including disease duration, medication, C-reactive protein, erythrocyte sedimentation rate, and rheumatoid factor, were collected. The Larsen classification, joint space narrowing (JSN), bone erosion, and geode and osteophyte formation were evaluated on preoperative radiographs. RESULTS: Osteophyte formation was significantly increased, and bone erosion and geode formation were significantly decreased in group B. In addition, medial-dominant JSN was significantly increased, and bicompartmental JSN was significantly decreased in group B. Medial-dominant JSN was positively and bone erosion was negatively associated with osteophyte formation. CONCLUSIONS: Following the introduction of bDMARDs, typical radiographic findings of rheumatoid knees have decreased, and secondary osteoarthritis-like changes, characterized by osteophyte formation and medial-dominant JSN, have increased in the knees of TKA recipients.

Anatomic Reconstruction of Lateral Ankle Ligaments and Both Peroneus Tendons After Open Fracture Dislocation of the Ankle: A Case Report.

Extensive soft tissue defects of the ankle are an uncommon but challenging problem that require a combination of reconstructive options. We report the case of a complex injury involving the skin, lateral ankle ligaments, and peroneal tendons that were anatomically reconstructed. A 15-year-old girl was injured in an automobile accident resulting in extensive soft tissue defects and marked instability of her right ankle. The lower two-thirds of the anterior talofibular ligament (ATFL) had segmental defects, and calcaneofibular ligament (CFL) was completely torn, and both peroneal longus and brevis tendons were severely damaged. Initial debridement was performed on the day on injury. Two weeks after injury, the ATFL and CFL were reconstructed using a semitendinosus autograft and suture tape augmentation. Both peroneal tendons were reconstructed using a gracilis autograft. The skin defect (10 × 10 cm) was covered with an anterolateral thigh flap. After removing a short leg cast at 3 weeks postoperatively, the patient started range of motion exercises without using any brace. Weightbearing was allowed at 4 weeks. At the 24-month follow-up examination, she had returned to her preoperative level of work and sports activities.

Iron load and liver enzymes in 10- and 13-year-olds.

OBJECTIVES: Iron plays a pivotal role in adult steatosis, but its role in child and adolescent steatosis is unclear. We investigated the effect of dietary iron, serum iron, and ferritin on serum transaminases and γ-glutamyltransferase in 10- and 13-year-olds. PATIENTS AND METHODS: The study included 4894 fifth and eighth graders enrolled between 2006 and 2009 in all schools in Shunan City, Japan. Multiple regression analyses were performed with adjustments for grade, sex, z score of the body mass index, serum lipids, plasma glucose, frequency of sports activities, having a single parent, number of siblings, tobacco smoking behavior, passive smoking at home, resident areas, and schools, using linear mixed models. In addition, we analyzed ferritin and insulin resistance in randomly selected subset of participants. RESULTS: Dietary iron intake was positively associated with serum alanine aminotransferase levels (standardized coefficient ß = 2.35, P = 0.019). Serum iron concentrations were associated with transaminase and γ-glutamyltransferase levels (ß = 3.22, and 4.05, respectively, P < 0.01). In the subset of 421 subjects with further serum analysis, serum ferritin levels were significantly associated with serum enzyme levels (ß = 2.43-3.35; P < 0.05) and showed significant odds ratio for the elevated alanine aminotransferase levels (1.05 for 1 SD with 95% confidence intervals 1.02-1.08). However, iron load did not show a positive association with insulin resistance. CONCLUSIONS: Although an effect size for iron is small in regression analyses, iron is implicated in increased transaminase levels in prepubertal and pubertal children.