Technical Considerations in Tarsometatarsal Joint Arthrodesis

2005 ◽  
Vol 95 (1) ◽  
pp. 85-90 ◽  
Author(s):  
Alan R. Catanzariti ◽  
Robert W. Mendicino
Keyword(s):  
Surgical Management ◽  
Preoperative Evaluation ◽  
Postoperative Management ◽  
Degenerative Joint Disease ◽  
Joint Disease ◽  
Tarsometatarsal Joint ◽  
Post Traumatic ◽  
Technical Considerations

Tarsometatarsal arthrodesis is indicated for degenerative joint disease after trauma. Deformity is often associated with post-traumatic arthropathy. Outcomes after surgical management are directly related to realignment. This article reviews the indications, preoperative evaluation, technical execution, and postoperative management of tarsometatarsal arthrodesis. Special emphasis is placed on realignment and restoration of normal foot architecture. (J Am Podiatr Med Assoc 95(1): 85–90, 2005)

Primary Total Hip Arthroplasty for Gunshot Injury-Induced Secondary Arthritis of the Hip: What Are the Outcomes?

2017 ◽  
Vol 01 (04) ◽  
pp. 200-204 ◽  
Author(s):  
Roby Abraham ◽  
Joseph Scollan ◽  
Patrick Mixa ◽  
Denis Cherkalin ◽  
Jeffrey Varghese ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Degenerative Joint Disease ◽  
Joint Disease ◽  
Total Hip ◽  
Hip Function ◽  
Post Traumatic ◽  
Traumatic Arthritis ◽  
Primary Total Hip Arthroplasty

AbstractGunshot wound (GSW) injuries around the hip joint can lead to debilitating post-traumatic arthritis, requiring a technically demanding primary total hip arthroplasty (THA). These surgeries are often complicated by bullet debris, extensive scaring, prior operations, and altered local anatomy. Although most literature focuses on acute management of GSW around the hip, a few reports detail the mid-term outcomes of GSW patients with primary THA for post-traumatic arthritis. The purpose of this study was to assess the outcomes and complications associated with THA in nine patients with secondary arthritis due to prior GSW injuries. At a mean follow-up of 35 months (range 12–60 months), significant improvement was shown in hip function, activity, and pain levels, and was similar to the outcomes of 18 patients who underwent primary THA for degenerative joint disease. While technically demanding, THA seems to reduce pain and improve function safely and effectively for patients with GSW-induced hip arthritis.

scholarly journals Matrix-targeted Nanoparticles for MMP13 RNA Interference Blocks Post-Traumatic Osteoarthritis

2020 ◽  
Author(s):  
Sean K Bedingfield ◽  
Fang Yu ◽  
Danielle D. Liu ◽  
Meredith A. Jackson ◽  
Lauren E. Himmel ◽  
...  
Keyword(s):  
Extracellular Matrix ◽  
Rna Interference ◽  
Targeted Delivery ◽  
Degenerative Joint Disease ◽  
Joint Disease ◽  
Specific Cell ◽  
Long Term Treatment ◽  
Post Traumatic ◽  
Mmp13 Expression

AbstractOsteoarthritis (OA) is a debilitating and prevalent chronic disease, but there are no approved disease modifying OA drugs (DMOADs), only pharmaceuticals for pain management. OA progression, particularly for post-traumatic osteoarthritis (PTOA), is associated with inflammation and enzymatic degradation of the extracellular matrix. In particular, Matrix Metalloproteinase 13 (MMP13) breaks down collagen type 2 (CII), a key structural component of cartilage extracellular matrix, and consequently, matrix degradation fragments perpetuate inflammation and a degenerative cycle that leads to progressive joint pathology. Here, we tested targeted delivery of endosome-escaping, MMP13 RNA interference (RNAi) nanoparticles (NPs) as a DMOAD. The new targeting approach pursued here deviates from the convention of targeting specific cell types (e.g., through cell surface receptors) and instead leverages a monoclonal antibody (mAbCII) that targets extracellular CII that becomes uniquely accessible at early OA focal defects. Targeted mAbCII-siNPs create an in situ NP depot for retention and potent activity within OA joints. The mAbCII-siNPs loaded with MMP13 siRNA (mAbCII-siNP/siMMP13) potently suppressed MMP13 expression (95% silencing) in TNFα-stimulated chondrocytes in vitro, and the targeted mAbCII-siNPs had higher binding to trypsin-damaged porcine cartilage than untargeted control NPs. In an acute mechanical injury mouse model of PTOA, mAbCII-siNP/siMMP13 achieved 80% reduction in MMP13 expression (p = 0.00231), whereas a non-targeted control achieved only 55% silencing. In a more severe, PTOA model, weekly mAbCII-siNP/siMMP13 long-term treatment provided significant protection of cartilage integrity (0.45+/− .3 vs 1.6+/−.5 on the OARSI scale; p=0.0166), and overall joint structure (1.3+/−.6 vs 2.8+/−.2 on the Degenerative Joint Disease scale; p<0.05). Intra-articular mAbCII-siNPs better protected articular cartilage (OARSI score) relative to either single or weekly treatment with the clinical gold stand steroid treatment methylprednisolone. Finally, multiplexed gene expression analysis of 254 inflammation-related genes showed that MMP13 inhibition suppressed clusters of genes associated with tissue restructuring, angiogenesis (associated with synovial inflammation and thickening), innate immune response, and proteolysis. This work establishes the new concept of targeting unique local extracellular matrix signatures to sustain retention and increase delivery efficacy of biologics with intracellular activity and also validates the promise of MMP13 RNAi as a DMOAD in a clinically-relevant therapeutic context. Abstract Figure:PTOA targeted delivery of MMP13 siRNA to block disease progressionThe top left schematic illustrates the progression (left to right) from healthy knee joint, through inflammation induction following traumatic injury, to cartilage loss and degenerative joint disease (including synovial response). Degradation of cartilage enhances inflammation, inducing a degenerative cycle (middle right). The bottom of the graphic illustrates the concept of the matrix targeted nanocarriers for enhanced retention and activity of MMP13 siRNA at sites of cartilage injury.

Evidence-Based Indications for Distraction Ankle Arthroplasty

2012 ◽  
Vol 33 (8) ◽  
pp. 632-636 ◽  
Author(s):  
Nicholas C. Smith ◽  
Douglas Beaman ◽  
S. Robert Rozbruch ◽  
Mark A. Glazebrook
Keyword(s):  
Degenerative Joint Disease ◽  
Joint Disease ◽  
Evidence Based ◽  
Ankle Arthritis ◽  
Comprehensive Description ◽  
Level Of Evidence ◽  
Ankle Arthroplasty ◽  
Pubmed Database ◽  
Grade Of Recommendation ◽  
Post Traumatic

Background: The purpose of this study was to review the literature to provide a comprehensive description of the Level of Evidence (LOE) available to support the operative technique of distraction ankle arthroplasty for the current generally accepted indications and make a grade of recommendation for each. Methods: A comprehensive review of the literature was performed (November 2010 to January 2011) using the PubMed database. The abstracts from these searches were reviewed to isolate literature that described therapeutic studies investigating the results of distraction ankle arthroplasty. All articles were reviewed and assigned a classification (I-V) of Level of Evidence. An analysis of the literature reviewed was used to assign a Grade of Recommendation for each current generally accepted indication for distraction ankle arthroplasty. Results: There is insufficient evidence based literature (Grade I) to support or refute the procedure for either: post-traumatic ankle arthritis, arthritis associated with ligamentous instability, primary degenerative joint disease, chondrolysis, deformity associated with arthritis, osteochondral defects and congenital ankle abnormalities. Conclusion: Inadequate evidence based literature exists to support or refute all currently accepted indications for distraction ankle arthroplasty and further high quality, scientific studies are needed upgrade to these recommendations. Level of Evidence: Systematic Review of Level III Studies

Lower limb amputation and rehabilitation in total joint arthroplasties in the ipsilateral limb

2013 ◽  
Vol 38 (3) ◽  
pp. 185-192 ◽  
Author(s):  
Jingsheng Shi ◽  
Siqun Wang ◽  
Yibing Wei ◽  
Jianguo Wu ◽  
Feiyan Chen ◽  
...  
Keyword(s):  
Distal Part ◽  
Case Reports ◽  
Preoperative Evaluation ◽  
Degenerative Joint Disease ◽  
Joint Disease ◽  
Knee Joints ◽  
Limb Amputation ◽  
Total Knee ◽  
Joint Arthroplasties

Background: Degenerative joint disease is not uncommon in amputees and reaches the orthopedic surgeon when all other conservative methods to manage these patients have failed. Several case reports describing hip and knee arthroplasties in patients with hip and knee joint diseases or fractures with the distal part amputated, either in the contralateral or ipsilateral limb, exist in literature. Objective: This article focuses only on total knee and total hip arthroplasty in amputees who have had severe osteoarthritis of the ipsilateral hip and knee joints. Study design: Literature review. Method: Literature search in database and summary of all the cases. Results: All narratives indicate positive outcomes with improvement in physical function and quality of life. Conclusion: The reports suggest that slight modifications in surgical procedure and in the rehabilitation protocol as compared to other patients with joint arthroplasties can alleviate pain and make such patients ambulatory and gain maximum range of motion. Therefore, it appears that careful preoperative evaluation and planning tailored to suit individual cases maximizes postoperative good end results beneficial to the patients regardless of age or cause of osteoarthritis.

Salvage Procedures for Distal Radioulnar Joint Complications

2016 ◽  
Vol 21 (02) ◽  
pp. 173-186 ◽  
Author(s):  
Chong Jin Yeo ◽  
Levi Philip Morse ◽  
Jeganath Krishnan ◽  
Gregory Ian Bain
Keyword(s):  
Surgical Techniques ◽  
Distal Radioulnar Joint ◽  
Degenerative Joint Disease ◽  
Joint Disease ◽  
Forearm Rotation ◽  
Radioulnar Joint ◽  
Load Transmission ◽  
Points Of Interest ◽  
Post Traumatic ◽  
Special Points

The distal radioulnar joint (DRUJ) allows forearm rotation and load transmission across the wrist. Post-traumatic and degenerative joint disease of DRUJ may cause pain and disability. Deficiency of the soft tissue or bony supports may result in DRUJ instability. Various techniques have been developed to address arthritis and / or instability of the DRUJ. A comprehensive review of the spectrum of surgical techniques and arthroplasty options is presented. The concepts of these procedures are discussed in detail, with a focus on special points of interest to optimise outcomes and to avoid complications. The salvage of the complications of arthroplasties is also presented in detail.

External Fixation Arthrodesis of the Ankle Joint Following Trauma

Foot & Ankle ◽  
1986 ◽  
Vol 7 (1) ◽  
pp. 49-61 ◽  
Author(s):  
John E. Kenzora ◽  
Shelton C. Simmons ◽  
Andrew R. Burgess ◽  
Charles C. Edwards
Keyword(s):  
High Energy ◽  
Degenerative Joint Disease ◽  
Low Energy ◽  
Joint Disease ◽  
Non Union ◽  
Energy Group ◽  
Additional Surgery ◽  
Post Traumatic ◽  
Pin Tract Infection ◽  
Incision Drainage

Arthrodesis is currently the treatment of choice for symptomatic degenerative arthropathy of the ankle. Thirty-seven patients underwent arthrodesis for post-traumatic disorders using either a Hoffmann external fixator or a Calandruccio frame. There was degenerative joint disease in 19 (51%), septic arthritis in 11 (30%), severe comminution in five (14%), and uncontrollable equinus in two (5%). The patients were divided into two groups. Twenty-six (70%) were considered to have sustained high energy open or comminuted injuries and 11 (30%), low energy injuries. Twenty-nine (78%) achieved a radiologic fusion following one operation. Four eventually united with further surgery for a final arthrodesis rate of 89%. In the high energy group 18 of 26 (69%) achieved primary fusion. Four united with additional surgery for a final arthrodesis rate of 85%. Two of these required subsequent amputations and two others, a triple arthrodesis which also failed to control chronic pain. Thus, a total of 18 of the 26 patients (69%) achieved a successful result. Also included in the high energy group were three patients with uncontrolled sepsis who underwent amputation before union occurred and one with a painful non-union. All 11 of the patients (100%) who originally sustained low energy injuries achieved a successful arthrodesis. The most common complication was pin tract infection requiring incision, drainage, and oral antibiotics in 16 patients (43%). None of these progressed to chronic osteomyelitis.

scholarly journals First person – Craig Keenan

2020 ◽  
Vol 13 (7) ◽  
pp. dmm046193
Keyword(s):  
Degenerative Joint Disease ◽  
Early Career ◽  
Joint Disease ◽  
First Person ◽  
Early Career Researchers ◽  
Research Associate ◽  
Post Traumatic ◽  
Postdoctoral Research ◽  
The University ◽  
Selection Of

ABSTRACTFirst Person is a series of interviews with the first authors of a selection of papers published in Disease Models & Mechanisms, helping early-career researchers promote themselves alongside their papers. Craig Keenan is first author on ‘Post-traumatic osteoarthritis development is not modified by postnatal chondrocyte deletion of Ccn2’, published in DMM. Craig conducted the research described in this article while a postdoctoral research associate in Dr Blandine Poulet's lab at the University of Liverpool, Liverpool, UK. He is now a lecturer in vertebrate physiology in the lab of Dr Jason Kirby at Liverpool John Moores University, Liverpool, UK, investigating the roles of cartilage and bone in the pathogenesis of degenerative joint disease.

Surgical Management of Patients With 22q11.2 Deletion Syndrome

2019 ◽  
Vol 4 (5) ◽  
pp. 857-869
Author(s):  
Oksana A. Jackson ◽  
Alison E. Kaye
Keyword(s):  
Surgical Management ◽  
Preoperative Evaluation ◽  
Preoperative Assessment ◽  
22Q11.2 Deletion Syndrome ◽  
Deletion Syndrome ◽  
22Q11.2 Deletion ◽  
Surgical Decision ◽  
Obstructive Sleep ◽  
Spine Abnormalities ◽  
Speech Assessment

Purpose The purpose of this tutorial was to describe the surgical management of palate-related abnormalities associated with 22q11.2 deletion syndrome. Craniofacial differences in 22q11.2 deletion syndrome may include overt or occult clefting of the palate and/or lip along with oropharyngeal variances that may lead to velopharyngeal dysfunction. This chapter will describe these circumstances, including incidence, diagnosis, and indications for surgical intervention. Speech assessment and imaging of the velopharyngeal system will be discussed as it relates to preoperative evaluation and surgical decision making. Important for patients with 22q11.2 deletion syndrome is appropriate preoperative screening to assess for internal carotid artery positioning, cervical spine abnormalities, and obstructive sleep apnea. Timing of surgery as well as different techniques, common complications, and outcomes will also be discussed. Conclusion Management of velopharyngeal dysfunction in patients with 22q11.2 deletion syndrome is challenging and requires thoughtful preoperative assessment and planning as well as a careful surgical technique.

Apportionment of Impairment from Meniscal Tears and Knee Arthritis

2013 ◽  
Vol 18 (5) ◽  
pp. 1-10 ◽  
Author(s):  
Charles N. Brooks ◽  
James B. Talmage
Keyword(s):  
Medial Meniscus ◽  
Degenerative Joint Disease ◽  
Joint Disease ◽  
Detailed Knowledge ◽  
Meniscal Tears ◽  
Knee Arthritis ◽  
Degenerative Arthritis ◽  
Study Results ◽  
Physical Findings ◽  
Causation Analysis

Abstract Meniscal tears and osteoarthritis (osteoarthrosis, degenerative arthritis, or degenerative joint disease) are two of the most common conditions involving the knee. This article includes definitions of apportionment and causes; presents a case report of initial and recurrent tears of the medial meniscus plus osteoarthritis (OA) in the medial compartment of the knee; and addresses questions regarding apportionment. The authors, experienced impairment raters who are knowledgeable regarding the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), show that, when instructions on impairment rating are incomplete, unclear, or inconsistent, interrater reliability diminishes (different physicians may derive different impairment estimates). Accurate apportionment of impairment is a demanding task that requires detailed knowledge of causation for the conditions in question; the mechanisms of injury or extent of exposures; prior and current symptoms, functional status, physical findings, and clinical study results; and use of the appropriate edition of the AMA Guides. Sometimes the available data are incomplete, requiring the rating physician to make assumptions. However, if those assumptions are reasonable and consistent with the medical literature and facts of the case, if the causation analysis is plausible, and if the examiner follows impairment rating instructions in the AMA Guides (or at least uses a rational and hence defensible method when instructions are suboptimal), the resulting apportionment should be credible.

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