Joint capsule innervation does not explain the difference in symptoms between scaphotrapezial and trapeziometacarpal osteoarthritis.

OBJECTIVES: Peritrapezial osteoarthritis (OA) includes scaphotrapezial and trapeziometacarpal OA. In clinical practice, scaphotrapezial OA seems better tolerated than trapeziometacarpal OA, with fewer complaints and better tolerance. The difference in pain could be linked to a difference in joint capsule innervation, perhaps with fewer nerve fibers in the scaphotrapezial than the trapeziometacarpal joint. MATERIALS AND METHODS: We performed a histologic evaluation of these two joints to compare their respective innervation in 17 cadaveric specimens with peritrapezial OA. Radiographic scoring confirmed the presence of peritrapezial OA. Mean Kellgren-Lawrence score was 2.2 ± 1.1 in the trapeziometacarpal joint and 1.5 ± 0.7 in the scaphotrapezial joint (p = 0.08). RESULTS: There was no difference between scaphotrapezial and trapeziometacarpal joints in number of neurofilaments: 5.2 ± 3.9 and 4.4 ± 4.5, respectively (p = 0.20). A significant difference was found in S100 staining (myelinated structures), with a higher rate in the scaphotrapezial joint: 11.8 ± 7.5 vs 6.6 ± 5.2 (p = 0.005). CONCLUSION: The present study suggests that lower tolerance of trapeziometacarpal OA is not due to a difference in joint capsule innervation. On the contrary, we found a higher rate of myelinated tissues in the scaphotrapezial joint. These results suggested other pain pathways to explain clinical observations.

Computer Navigation Technique for Simultaneous Total Knee Arthroplasty and Opening Wedge High Tibial Osteotomy in Patients with Large Tibial Varus Deformity.

INTRODUCTION: Total knee arthroplasty (TKA) in patients with established knee osteoarthritis and major varus, mostly due to constitutional proximal deformity, remains a challenging procedure. Orthogonal cuts result in asymmetric bone resection and subsequent bone-related laxity or difficult release. A procedure that combines opening high tibial osteotomy (HTO) and TKA in the same sitting to address such major deformities is possible. But for this combined operation, precise planning and an exact intraoperative transformation of the planning is required. The assumption that the results could be predicted better by means of a navigation system was analyzed. MATERIALS AND METHODS: The precision of surgery with computer-based navigation was compared to conventional surgery. A comparative prospective study was conducted using an expert surgeon. Between 2005 and 2015, we performed 20 procedures on knees with average preoperative 18° (range, 15-25°) varus. Tibial valgus osteotomy plus TKA was performed in one sitting. It allows the surgeon to do a more sparing medial release and to achieve proper realignment with a concomitant well-balanced prothesis. A group of 10 patients had conventional surgery and the other 10 had surgery performed with computer-based navigation for both osteotomy and TKA. By means of this system, the desired mechanical axis is obtained with real-time monitoring of the coronal and sagittal plane on the navigation without intraoperative x-ray control. The positioning of the saw-jigs for the femoral and tibial cuts of the arthroplasty was also performed with the help of the navigation system. RESULTS: Postoperative mean femorotibial varus was 1.5° (range, 0-5°) with better alignment for the computer-based navigation. The mean correction following osteotomy was 16° (range, 12-24°). The intraarticular part of the deformity due to cartilage wear was addressed by the TKA. No release was done during surgery. The patients were mobilized early with limitation in range of motion up to 90° of flexion during the two weeks and were allowed full weight after. No instability and no complications were observed. On assessing radiological coronal alignment of the prostheses, there was better alignment of 0.5° varus (range, 0-3° of varus) in the computer navigation group compared to the traditional group (2.5° varus; range, 1-5° of varus). The navigation group showed better tibial slope maintenance (mean change, + 0.5°, p=0.732), whereas it was increased significantly in the conventional group (mean change, +4.2°, p<0.01). The average number of fluoroscopy shots for the computer navigation group was 2.8 (95% CI, 1.2-6.5) versus 9.4 in the control group (95% CI, 5.3-12.4). This represented a shorter (p<0.001) time of 11.4 seconds of irradiation for the computerized navigation technique compared to 36.2 seconds of irradiation for the traditional technique. CONCLUSIONS: Computer navigation improved precision with less radiation. The findings of this study suggest that computer navigation may be safely used in a complex procedure when combined with total knee arthroplasty and opening wedge high tibial osteotomy in one sitting.

Staying home during "COVID-19" decreased fractures, but trauma did not quarantine in one hundred and twelve adults and twenty eight children and the "tsunami of recommendations" could not lockdown twelve elective operations.

PURPOSE: The current pandemic caused by COVID-19 is the biggest challenge for national health systems for a century. While most medical resources are allocated to treat COVID-19 patients, fractures still need to be treated, as some patients with non-deferrable pathologies. The aim of this paper is to report the early experience of an integrated team of orthopaedic surgeons during this period. MATERIAL AND METHODS: This is a mono-geographic, observational, retrospective, descriptive study. We collected data from the beginning of the epidemic (1 March 2020), during the pandemic lockdown period (declared in the country on March 16, 2020) until the end of our study period on April 15, 2020. All the 140 patients presented to the Emergency Department of the hospital during this period with a diagnosis of fracture, or trauma (sprains, dislocations, wounds) were included in the cohort. In addition, 12 patients needing hospitalization for planning a non-deferrable elective surgical treatment were included. A group of patients from the two same hospitals and treated during the same period (1st March 2018 to April 15, 2018) but previously was used as control. RESULTS: Of these 152 patients (mean age 45.5 years; range 1 to 103), 100 underwent a surgical procedure and 52 were managed non-operatively. Twenty-eight were children and 124 were adults. The COVID-19 diagnosis was confirmed for four patients. The frequency of patients with confirmed COVID-19 diagnosis among this population treated in emergency was ten fold higher (2.6%; 4 among 152) than in the general population (0.30%) of the country. The mortality rate for patients with surgery was 2% (2 of 100 patients) and 50% (2 of 4) for those older than 60 years with COVID-19; it was null for patients who were managed non-operatively. As compared to the year 2018, the number of patients seen with trauma had decreased of 32% during the epidemic. CONCLUSION: Staying home during the COVID-19 pandemic decreased trauma frequency of 32%. The structural organization in our hospital allowed us to reduce the time to surgery and ultimately hospital stay, thereby maximizing the already stretched medical resources available to treat all the patients who needed orthopedic care during this period.

Dysthyroid optic neuropathy: atypical initial presentation and persistent visual loss.

PURPOSE: Dysthyroid Optic Neuropathy (DON) can lead to irreversible visual loss. We report risk features correlated with poor visual recovery despite an intensive treatment in a series of patients with DON. DESIGN: Retrospective analysis of a non-comparative interventional series. METHODS: Between 1997 and 2007, 300 consecutive patients with Graves' orbitopathy were seen at the Rothschild Foundation (Paris). Medical records of all consecutive patients who developed a DON were reviewed. Demographic, clinical features and visual function were collected at the time of the first onset, one month follow-up after medical and sometime surgical treatment and at the last examination. Statistical analysis (reflected as p values) gathered the significant observations into detrimental visual recovery prognostic factors for DON. RESULTS: Fifty-six eyes of 29 patients developed a DON. Sixteen eyes (28%) did not improve vision despite usual treatment (intravenous steroids and surgical decompression when necessary). An inferior altitudinal visual field defect (AVF, p=0.0004) and/or a lack of response to intravenous steroids boluses (p= 0.011) were related to a poor recovery. CONCLUSION: DON prognosis is highly variable. Our results suggest that a non-inflammatory element, probably vascular could be involved in atypical DONs. An earlier recognition could prompt to rapid surgical treatment for these patients.