Management and Outcomes of Bilateral Acetabular Fractures: A Critical Review of the Literature

Background Bilateral acetabular fractures constitute a rare entity, and their optimal management is unknown. Materials and Methods A systematic literature search was conducted in PubMed, Embase and Cochrane Library between 1995 and 2020. Inclusion criteria were studies presenting cases of bilateral acetabular fractures and reporting outcomes. Extracted data included patient demographics, injury mechanism, fracture classification, associated injuries, management and outcomes. Results Thirty-seven studies (47 cases; 35 males vs 12 females) were included. Mean age was 46 years old (range 13–84) and mean follow-up was 19.8 months (range 1.5–56). High-energy injuries (49%) and seizures (45%) were the most common injury mechanisms. Fracture type distribution differed according to injury mechanism. Treatment was surgical in 70% of cases (75% open reduction and internal fixation vs 25% acute total hip arthroplasty). Outcomes were excellent/good in 58% of patients. Complications included heterotopic ossification (11%), nerve injury (11%), degenerative arthritis (6%), DVT (6%), and infection (3%). Conclusions Bilateral acetabular fractures most commonly occur either after trauma or seizures and are commonly managed operatively. They are not devoid of complications, however, more than half (58%) achieve complete functional recovery.

Viscosupplementation in the Therapy for Osteoarthritic Knee

Osteoarthritis (OA) is a degenerative disease that is spreading worldwide due to an aging population. This is not simply a disease caused by worn out joints, but a complex disease accompanied by various mechanisms such as inflammatory reactions. Among various joints, knee joints show degenerative changes earlier than other joints because they carry most of the weight load, causing social-economic problems. In the case of OA of the knee that does not respond to relatively simple conservative treatments such as physical therapy or medication, intra-articular injection is preferred. However, intra-articular injection drugs have limited effectiveness and uncertainties. There are several intra-articular viscous supplement drugs such as hyaluronic acid. Tissue regeneration active materials such as polydeoxyribonucleotide and polynucleotide are also newly used. The objective of this paper was to compare effects of intra-articular supplementation drugs used for degenerative arthritis of the knee.

Establishment of a Qualified Integrated Care System After Total Knee Arthroplasty as a Role of Regional Rheumatoid and Degenerative Arthritis Centers

Background: The geriatric population and advanced knee osteoarthritis are rapidly increasing in Korea, and the socioeconomic burden of total knee arthroplasty (TKA) is increasing. This study aimed to analyze the demographic, clinical and socioeconomic characteristics of patients who underwent TKA and to differentiate the factors affecting participation in inpatient-intensive rehabilitation programs after TKA in oo regional rheumatoid and degenerative arthritis centers established by the government.Methods: This retrospective cohort study included 845 patients (735 females; 72.0±5.8 years) diagnosed with primary osteoarthritis (OA) of the knee who underwent elective unilateral primary TKA between January 2013 and June 2016. Demographic, clinical and socioeconomic characteristics, including age, body mass index, obesity, length of stay, OA severity, underlying disease, education level, occupation, and location of residence, were reviewed. Patients were allocated to the TKA-only group (home discharge) and to the TKA+ rehab group (participation in post-TKA rehabilitation). The variables were analyzed and compared before and after the establishment of the center and according to participation in intensive rehabilitation.Results: They showed a predominance of females and geriatrics and a high prevalence of comorbidities and obesity. Additionally, the only factor differentiating participation in intensive rehabilitation was the location of residence.Conclusion: The regional rheumatoid and degenerative arthritis center was appropriate to meet the high need for participating in intensive rehabilitation after TKA and for the qualified integrated post-TKA care system. Policy support should ensure early rehabilitation and a qualified integrated care system and prepare for the increased burden of revision, and future longitudinal studies should be conducted to assess the long-term effect of the integrated post-TKA rehabilitation program on functional outcomes and patient survivorship free from revision.

Effect of Ksheera Vaitarana Vasti, Janu Vasti along with Adjuvant Ayurveda Drugs in the management of Sandhigatavata (Osteoarthritis in knee joint)- A case study

Sandhigatavata is a disease with Shoola (pain), Shotha (swelling) and Hanti Sandhi Gatah Sandhi (impairment of the functions of joints). This can be correlated with osteoarthritis. Osteoarthritis is a degenerative arthritis. While any joint can be affected in osteoarthritis, knee joint is most commonly affected. Vangasena Samhitha mentions Ksheera Vaitarana Vasti as a treatment for Janu Sankocha (stiffness of joint), Kati Prushta Shoola Shotha (swelling and pain in waist, knee and back). Prasarana Akunchanayoh Pravrutthishca Savedana (pain during contraction and extension of limbs) is described as a symptom of Sandhigatavata and stiffness in joint is a symptom of osteoarthritis. Sri Lankan traditional physician family ‘Weerasinghe’ treat Sandhigatavata with Belimul Thippilimul Amu Inguru Kashaya with effective results. Gugguladi Thaila is described in Sri Lankan Ayurveda Pharmacopeia in treatment of Vata Roga. Susruta advises to conduct Snehana in treatment of Vata Roga. Janu Vasti is one method of administering Bhahya Snehana to Janu Sandhi (knee joint). A 65 years old female with an 8 years history of Sandhigatavata Ayurveda treatments for 21 days. Ksheera Vaitarana Vasti was conducted for seven days and from Day 8 to 21, with oral administration of Belimul Thippilimul Amu Inguru Kashaya along with Janu Vasti using Gugguladi Thaila. After completion of treatment, it was observed that swelling, tenderness and pain during contraction and extension of limbs were completely relived. It is concluded that above treatment regimen is effective in treatment of Sandhigatavata (osteoarthritis).

Hallux Rigidus: Prevalence and Risk Factors

Background: Hallux rigidus (HR) is a common degenerative arthritis of the first metatarsophalangeal joint. However, the epidemiology and risk factors of this pathology have yet to be clarified.Methods: This cohort study estimated the prevalence of and clarified risk factors for radiographic HR in individuals over 50 years old.Results: The prevalence of HR was 26.7% (161/604). Rates of grade 0, 1, 2, and 3 HR according to the Hattrup and Johnson classification were 73.3% (443/604), 16.4% (99/604), 8.0% (48/604), and 2.3% (14/604), respectively. Overall ratio of symptomatic HR was 8.1%. Univariate analysis revealed knee osteoarthritis (KOA), gout attack (GA), and hallux valgus (HV) as significantly associated with HR. The same factors were confirmed as independent risk factors for HR in multivariate analysis. All parameters were significantly associated with HR. Odds ratios of KOA, HV, and GA for HR were 1.73, 3.98, and 3.86, respectively. The presence or absence of KOA was significantly associated with severity of HR.Conclusion: Our study revealed the prevalence of HR in the elderly (≥50 years) was 26.7%, and KOA, HV, and GA were independent risk factors for HR. KOA was associated with severity of HR.

Osteoarthritis of the Wrist: Pathology, Radiology, and Treatment

Osteoarthritis (OA) is a degenerative disease that can manifest in any synovial joint under certain conditions. It leads to destruction of articular cartilage and adjacent bone, as well as formation of osteophytes at the edges of afflicted joint surfaces. Regarding the wrist, typical degenerative arthritis affects particular joints at a specific patient age, due to asymmetric load distribution and repetitive microtrauma. However, in the presence of instability or systemic diseases, early-onset degeneration can also impair the range of motion and grip strength in younger patients. Although advanced stages of OA display characteristic signs in radiography, the detection of early manifestations frequently requires computed tomography or magnetic resonance imaging (in some cases with additional arthrography). If a wrist becomes unstable, timely diagnosis and precise treatment are essential to prevent rapid disease progression. Therefore, close collaboration between radiologists and hand surgeons is obligatory to preserve the carpal function of patients.