Polymorphic variation of hypoxia inducible factor-1 A (HIF1A) gene might contribute to the development of knee osteoarthritis: a pilot study.

BACKGROUND: Osteoarthritis (OA) is a multifactorial degenerative condition of the whole joint with a complex pathogenesis whose development and progression is significantly mediated by interactions between the joint cartilage and articular tissues, particularly, proinflammatory mediators and oxidative stress, which results in cartilage deterioration and subchondral bone destruction. HIF-1 alpha regulates oxygen homeostasis in hypoxic tissues such as joint cartilage; efficiency of transcriptional activity of the HIF1A gene is strongly influenced by the presence of polymorphic variants. Given the loss of articular cartilage and with intention to restore damaged tissue, WISP-1 participates in the development of subchondral bone; further, its expression is highly increased in chondrocytes of OA patients. The aim of this study was to evaluate gene frequencies of HIF1A and WISP1 polymorphisms in Mexican patients suffering from knee OA. METHODS: We determined HIF1A rs11549465 (P582S), rs11549467 (A588T), and rs2057482 (C191T), and WISP1 rs2929970 (A2364G) polymorphisms in 70 Mexican patients with knee OA and compare them to those present in 66 ethnically matched healthy controls. Genotyping for these polymorphisms was performed by Real-Time PCR using TaqMan probes. RESULTS: Gene frequencies exhibited a significant increase of the CC genotype of rs11549465 polymorphism in knee OA patients as compared with those present in controls (P = 0.003 OR = 5.7, 95% CI = 1.7-21.6); CT genotype and T allele showed decreased frequency in the knee OA group vs. the controls (P = 0.003 OR = 0.2, CI = 0.05-0.6; and P = 0.004 OR = 0.2, CI = 0.05-0.65, respectively). Allele frequencies of the other polymorphic variants were similar in both patients and controls. CONCLUSIONS: These results suggest that the presence of the rs11549465 SNP (HIF1A) plays a role protective in the loss of articular cartilage in our population, and offers the possibility to further study the molecular mechanisms within cartilage and subchondral bone.

A comprehensive review of hip arthroscopy techniques and outcomes.

Transforming the orthopedic landscape, hip arthroscopy pioneers a minimally invasive surgical approach for diagnosing and addressing hip pathologies. With its origins dating back to Burman's 1931 cadaveric study, this groundbreaking technique gained clinical relevance in 1939 through Takagi's report. However, the 1980s marked the actual emergence of hip arthroscopy for treating a wide range of hip disorders. Now, a staple in modern orthopedics, hip arthroscopy empowers patients with previously undiagnosed and untreated hip conditions, enabling them to obtain relief and reclaim their lives. By employing a compact camera and specialized tools, surgeons expertly navigate the hip joint, performing procedures from excising loose bodies and mending labral tears to addressing femoroacetabular impingement and tackling other intricate issues. This innovative approach has dramatically elevated patients' quality of life, allowing them to embrace targeted treatments and resume daily activities without resorting to lifestyle alterations.

Prospective randomized study of 2 different techniques for endoscopic iliopsoas tendon release in the treatment of internal snapping hip syndrome.

PURPOSE: To evaluate the short-term results of 2 different techniques of endoscopic iliopsoas tendon release for the treatment of internal snapping hip syndrome. METHODS: Between January 2005 and January 2007, a consecutive series of patients with the diagnosis of internal snapping hip syndrome was treated with endoscopic release of the iliopsoas tendon. The patients were randomized into 2 different groups. Patients in group 1 were treated with endoscopic iliopsoas tendon release at the lesser trochanter, and patients in group 2 were treated with endoscopic transcapsular psoas release from the peripheral compartment. Hip arthroscopy of both the central and peripheral compartments was performed in both groups using the lateral approach. Associated injuries were identified and treated arthroscopically. Postoperative physical therapy was the same for both series, and each patient received 400 mg of celecoxib daily for 21 days after surgery. Preoperative and postoperative Western Ontario MacMaster (WOMAC) scores and imaging studies were evaluated. RESULTS: Nineteen patients were included in the study: 10 in group 1 (5 male and 5 female; average age, 29.5 years) and 9 in group 2 (8 female and 1 male; average age, 32.6 years). No statistical difference was found in group composition. Associated injuries were found and treated in 8 patients in group 1 and 7 patients in group 2. No statistical difference was found between groups in preoperative WOMAC scores, and every patient in both groups had an improvement in the WOMAC score. Improvements in WOMAC scores were statistically significant in both groups, and no difference was found in postoperative WOMAC results between groups. No complications were seen. CONCLUSIONS: Iliopsoas tendon release at the level of the lesser trochanter or at the level of the hip joint using a transcapsular technique is effective and reproducible. We found no clinical difference in the results of both techniques.

A minimalist approach to hip arthroscopy: the slotted cannula.

Adequate patient positioning with a traction device to provide sufficient distraction of the hip to access the femoral-acetabular joint is the first and most important step in hip arthroscopy. Cannulated instruments provide reproducible access to the hip joint from every portal by following guidewires into the joint. These guidewires are positioned through long spinal needles via fluoroscopic navigation and, subsequently, direct arthroscopic vision. By using these techniques adequately, the risk of iatrogenic damage to the hip joint is reduced. The traditional option for introduction of instruments to the hip joint has been the use of closed working cannulas of increasing diameters to accommodate instruments of different sizes. Curved instruments usually require large-diameter standard cannulas or flexible plastic cannulas. Large cannulas increase the risk of damage to the articular cartilage and may not accommodate every curved instrument. Flexible cannulas may leave debris inside the joint if damaged. Slotted cannulas allow curved instruments to be introduced into the hip joint by sliding them through their open side. With the instrument inside the joint, the slotted cannula can be slid out for better instrument mobility. It can also be reinserted around the previous instrument for instrument or portal exchange.

Arthroscopic retrieval of a broken guidewire fragment from the hip joint after cannulated screw fixation of slipped capital femoral epiphysis.

The use of cannulated screws for internal fixation of slipped capital femoral epiphysis (SCFE) is recognized as the standard method of treatment and has fewer complications compared with previous methods such as pins or tri-flanged nails. Some complications related to guidewires have been reported in the treatment SCFE. The most dangerous complication is inadvertent advance of the guidewire into the pelvic cavity. Guidewire breakage is frequent and maybe under-reported. Articular migration of a guidewire fragment has potentially devastating effects and implies a second surgical procedure. Open arthrotomy is the traditional method for fragment removal from the hip joint. We report the case of a 12-year-old-girl with bilateral SCFE. Both hips were fixed with cannulated screws. A guidewire broke inside her right hip, leaving an articular fragment located at the inferior-posterior acetabular notch. Hip arthroscopy was performed 6 weeks after the index procedure; the fragment was located and removed from the joint. No evidence of cartilage damage other than the perforation created by the guidewire was found. Hip arthroscopy is an attractive option for articular foreign body removal; it has the potential for less morbidity and is adequate for evaluating and treating articular cartilage lesions.

Endoscopic iliotibial band release for external snapping hip syndrome.

PURPOSE: The external snapping hip syndrome is caused by slippage of the iliotibial band over the greater trochanter. Most cases are treated conservatively but if this fails, open surgical treatment is commonly performed by Z-plasty or by creating a defect on the iliotibial band. We present a series of 11 hips that were surgically treated by an endoscopic technique. TYPE OF STUDY: Prospective consecutive series of patients. METHODS: Diagnosis of external snapping hip syndrome was clinical in all cases and anteroposterior pelvis radiographs were taken to evaluate the hip joint. Endoscopic release was performed with the patient in the lateral decubitus position without traction using 2 portals, the superior trochanteric and inferior trochanteric. A standard 4-mm, 30 degrees arthroscope was introduced at the inferior trochanteric portal over the iliotibial band. A needle was placed at the proximal trochanteric portal and visualized endoscopically. The portal was then established and subcutaneous tissue resection was performed with radiofrequency (RF) probes and a shaver until the iliotibial band was identifiable and released with a vertical cut made using an RF hook probe. The arthroscope was introduced into the space created under the iliotibial band and a transverse cut at the middle of the vertical release was then made, creating a cross-shape. Next the 4 resulting flaps were resected to make a diamond-shaped defect. RESULTS: Between September 2001 and December 2003, we treated 11 patients, 9 female (1 bilateral) and 1 male with an average age of 26 years, for external snapping hip syndrome using an endoscopic technique. At an average 2-year follow-up, we had 1 patient with nonpainful snapping. The rest of the patients in the series had no complaints and returned to their previous level of activity. CONCLUSIONS: We present a reproducible endoscopic technique for the treatment of external snapping hip syndrome. Our results are comparable to those reported for open procedures. LEVEL OF EVIDENCE: Level IV.

Monosodium urate crystals induce oxidative stress in human synoviocytes.

BACKGROUND: Gout is the most common inflammatory arthropathy of metabolic origin and it is characterized by intense inflammation, the underlying mechanisms of which are unknown. The aim of this study was to evaluate the oxidative stress in human fibroblast-like synoviocytes (FLS) exposed to monosodium urate (MSU) crystals, which trigger an inflammatory process. METHODS: Human FLS isolated from synovial tissue explants were stimulated with MSU crystals (75 µg/mL) for 24 h. Cellular viability was evaluated by crystal violet staining, apoptosis was assessed using Annexin V, and the cellular content of reactive oxygen species (ROS) and nitrogen species (RNS) (O2 (-), H2O2, NO) was assessed with image-based cytometry and fluorometric methods. In order to determine protein oxidation levels, protein carbonyls were detected through oxyblot analysis, and cell ultrastructural changes were assessed by transmission electron microscopy. RESULTS: The viability of FLS exposed to MSU crystals decreased by 30 % (P < 0.05), while apoptosis increased by 42 % (P = 0.01). FLS stimulated with MSU crystals exhibited a 2.1-fold increase in H2O2 content and a 1.5-fold increase in O2 (-) and NO levels. Oxyblots revealed that the spots obtained from FLS protein lysates exposed to MSU crystals exhibited protein carbonyl immunoreactivity, which reflects the presence of oxidatively modified proteins. Concomitantly, MSU crystals triggered the induction of changes in the morphostructure of FLS, such as the thickening and discontinuity of the endoplasmic reticulum, and the formation of vacuoles and misfolded glycoproteins. CONCLUSIONS: Our results prove that MSU crystals induce the release of ROS and RNS in FLS, subsequently oxidizing proteins and altering the cellular oxidative state of the endoplasmic reticulum, which results in FLS apoptosis.

Animal model of acute gout reproduces the inflammatory and ultrasonographic joint changes of human gout.

INTRODUCTION: Gout is an inflammatory condition induced by the deposition of monosodium urate (MSU) crystals in the joints and soft tissues that can produce acute or chronic arthritis. Several animal models of crystal-induced inflammation have been proposed that involve direct injection of MSU-crystals into different anatomical structures; however, only a few of these models reflect a true diarthrodial joint microenvironment in which an acute gouty attack takes place. The aim of this study was to assess the inflammatory and structural joint changes in a rabbit model of acute gout attack by ultrasound (US), synovial fluid (SF) and histopathological analyses. METHODS: Under US guidance, 42 rabbit knees were randomly injected with a suspension of 50 mg/ml of either MSU or allopurinol synthetic crystals. The control group received intra-articular vehicle of phosphate-buffered saline (PBS). US evaluation, SF and histopathological analyses were performed at days 1, 3, and 7. RESULTS: A total of 21 rabbit knees were assigned to the control group, 12 to the MSU-crystals group, and 9 to the allopurinol crystals group. By US, the MSU crystals group displayed the double contour sign and bright stippled aggregates in 67% and 75% of joints, respectively. Neither control knees nor allopurinol crystals group displayed these US signs. Power Doppler (PD) signal was moderate to intense in the MSU-crystals group and greater than both the allopurinol crystal and control groups at day 1 (P<0.001) and 3 (P<0.05), with its practical disappearance by day 7. SF leukocyte count was 40,312±6,369 cells/mm3 in the MSU-crystals group, higher than in controls (P=0.004) and allopurinol crystal group (P=0.006). At day 7, SF leukocyte count decreased in both MSU and allopurinol crystal groups reaching the non-inflammatory range. Histologically, at day 3 intense synovial polymorphonuclear cells infiltration and MSU aggregates were identified. CONCLUSION: The rabbit model of MSU crystal-induced acute arthritis efficiently reproduces the inflammatory, US, SF and histopathological changes of the human acute gouty attack.

[Triphalangeal thumb]. / Pulgar trifalángico.

Triphalangeal thumb is often thought to be a rare congenital abnormality; it has an incidence of 1 in 25,000 births. We reviewed 49 triphalangeal thumbs in 28 Mexico City patients at the Diaz Lombardo Hospital from 1974 to 1979, Shriners Hospital from 1979 to 1982, Instituto Nacional de Ortopedia from 1981 to 1982, and at the ABC Hospital from 1971 to 1998. A total of 21 patients (75%) had bilateral deformity. Patients were classified according to Dieter Buck-Gramcko system and Müller teratologic line. All were surgically treated and evaluated with Cheng graduation scale, finding good results in 48 patients (97%), fair results in one (3%), and no poor results.

[Total hip arthroplasty in patients with cerebral vascular event. Case report]. / Artroplastia total de cadera primaria en paciente con evento vascular cerebral. Reporte de un caso.

INTRODUCTION: Associated neurological disorders pose a challenge hip joint reconstruction. The imbalance and poor muscle tone predispose to dislocation and loosening of the prosthesis. CLINICAL CASE: The following is the case of a 67 years old patient with a hemorrhagic cerebral vascular event with a secondary left hemiparesis. Ten years later had a femoral neck fracture on the affected side. Initially she was treated with conservative management resulting in pain and discapacity, valued with WOMAC scale as 12 points. Two years later was treated with total hip arthroplasty with large diameter femoral head. We present the follow up of 41 months, asymptomatic, walking using a cane and a WOMAC score of 41, with no signs of radiological loosening or dislocation. CONCLUSIONS: There is no experience documented in neurological disorders associated with hip diseases that requires a total hip arthroplasty. Loosening of the implants, dislocation and heterotopic ossification has been described as complications of the procedure. Large heads in total hip arthroplasty and a correct surgical technique associated with a multidisciplinary management in patients with neurological disorders offers an opportunity as a treatment in patient with hip disorders.

Hip arthroscopy after traumatic hip dislocation.

BACKGROUND: Traumatic posterior dislocation of the hip joint usually results from high-energy trauma, which can cause additional injuries that may need to be addressed after reduction. PURPOSE: This study was undertaken to present arthroscopic findings after traumatic posterior hip dislocation in patients with mechanical hip symptoms. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: All patients treated with hip arthroscopy between 2002 and 2006 for mechanical hip symptoms after traumatic posterior hip dislocation with subsequent closed reduction were included in this study. The time between closed reduction and arthroscopy, arthroscopic findings and treatment, preoperative and last follow-up WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) scores, and last follow-up radiographs were analyzed. Complications or the need for further surgical treatment are reported. RESULTS: There were 17 patients (13 male, 4 female) with an average age of 28.5 years (range, 19-37 years). The average time between closed reduction and arthroscopy was 3 months. Fourteen patients had anterior labral tears, 6 had posterior labral tears, 16 had acetabular chondral damage, all had femoral chondral damage, and 14 had intra-articular fragments. The preoperative WOMAC score was 46; the last follow-up (average 45 months) WOMAC score was 87 (range, 45-93); this was considered statistically significant (P = .001). One patient required total hip replacement for osteoarthritis and 1 presented with osteonecrosis and is waiting for hip replacement. CONCLUSION: The clearest indication for arthroscopy after traumatic posterior hip dislocation was loose fragments inside the joint. Arthroscopy was also performed in every patient with mechanical hip symptoms. Intra-articular damage was demonstrated in every case. Most of the patients had significant improvement after hip arthroscopy.

Soft tissue pathology around the hip.

Snapping hip syndromes have been treated with open surgery for many years. Recently, endoscopic techniques have been developed for treatment of snapping hip syndromes with results that are at least comparable if not better than those reported for open procedures. The greater trochanteric pain syndrome is well known by orthopedic surgeons. However, deep understanding of the pathologic conditions generating pain in the greater trochanteric region and endoscopic access to it has only recently been described. Although evidence regarding endoscopic techniques for the treatment of the greater trochanteric pain syndrome is mainly anecdotal, early published reports are encouraging.

Endoscopic treatment of snapping hips, iliotibial band, and iliopsoas tendon.

Indications for endoscopic surgery of the hip have expanded recently. The technique has found a clear indication in the management of snapping hip syndromes, both external snapping hip and internal snapping hip. Even though the snapping hips (external and internal) share a common name, they are very different in origin. The external snapping hip is produced by the iliotibial band snapping over the prominence of the greater trochanter during flexion and extension. Indication for surgical treatment is painful snapping with failure of conservative treatment. The endoscopic technique is designed to release the iliotibial band producing a diamond shape defect on the iliotibial band lateral to the greater trochanter. The defect allows the greater trochanter to move freely without snapping. The greater trochanteric bursa is resected through the defect and the abductor tendons inspected. This procedure is performed without traction and usually only the peritrochanteric space is accessed. If necessary, hip arthroscopy can also be performed. There is limited literature regarding the results of endoscopic treatment for the external snapping hip syndrome, but early reports are encouraging. The internal snapping hip syndrome is produced by the iliopsoas tendon snapping over the iliopectineal eminence or the femoral head. The snapping phenomenon usually occurs with extension of the hip from a flexed position of more than 90 degree. Two different endoscopic techniques have been described to treat this condition. Iliopsoas tendon release at the level of the hip joint, with this technique the iliopsoas bursa is accessed through an anterior hip capsulotomy and is frequently referred to as a transcapsular release. The second technique is a release at the insertion of the iliopsoas tendon on the lesser trochanter, with this technique the iliospaos bursa is accessed directly. In every report the iliopsoas tendon release has been combined with arthroscopy of the hip joint. It has been documented that more than half of the patients with internal snapping hip syndrome have intra-articular hip pathology. The results of endoscopic release of the iliopsoas tendon in the treatment of internal snapping hip syndrome are encouraging and seem to be better than those reported for open procedures.

[Functional outcomes in patients subjected to acetabular revision with reinforcement rings]. / Resultados funcionales de los pacientes sometidos a revisión acetabular con anillos de reforzamiento.

BACKGROUND: Total hip arthroplasty is the most successful orthopedic procedure and the frequency of use of revision components has grown exponentially. The increased number of revisions results from the longer life expectancy of the population and the greater frequency of the hip arthroplasty indication among young patients. The purpose of this study is to evaluate the functional results of patients subjected to revision of the acetabular component using reinforcement rings. MATERIAL AND METHODS: The study included patients with a diagnosis of septic or aseptic prosthetic loosening and sequelae of acetabular fractures between January 2007 and November 2009 in whom a reinforcement ring was used. The WOMAC scale was used for the functional evaluation. RESULTS: According to the WOMAC scale, the patient functionality results showed a mean preoperative score of 41.89 and a mean postoperative score of 74.26, which represented an improvement of 33.11 points in the median of patients subjected to the surgical intervention, with a statistically significant difference (p = 0.036). DISCUSSION: This study shows an improvement in the functionality of the patients subjected to surgery with a reinforcement ring, as, first and foremost, a statistically significant difference was seen between the preoperative and postoperative values and, secondly, there are papers published in the literature showing that a difference of more than 12 points between the preoperative and postoperative scores in the WOMAC scale indicates a significant clinical improvement of patients. CONCLUSION: Patients subjected to acetabular revision with a reinforcement ring together with cemented polyethylene have an improved quality of life after the surgical intervention.

[Fracture dislocation of the proximal interphalangeal joint]. / Fractura-luxación de la articulación interfaláingica proximal.

INTRODUCTION: The proximal interphalangeal (PIP) joint is the most commonly dislocated joint in the body and the hand. We did a review of the literature and report herein our experience treating this condition at the ABC Medical Center from 1991 to 2007. MATERIAL AND METHODS: Systematic review of the literature. Retrospective and descriptive study. RESULTS: A total of 13 patients were included between 1991 and 2007. Three of them were managed with ORIF with Kirschner nails, 3 with OR and Kirschner nails blocking extension, 2 with plasty with volar plate interposition, and one with CRIF with a Kirschner nail. Mean follow-up was 4.8 months in 8 patients, the ranges of motion were recorded. The following factors were negatively correlated with the range of motion: age, time elapsed between the injury and the treatment, the combined approaches, and the pins blocking extension. Those treated with interposition arthroplasty had a better range of motion. CONCLUSION: The fracture dislocation of the PIP joint is a rare pathology with multiple treatments and variable outcomes that usually result in the limitation of flexion and extension.

Arthroscopic treatment of cam-type femoroacetabular impingement: preliminary report at 2 years minimum follow-up.

Femoroacetabular impingement is defined as anterior hip abutment between the acetabular rim and proximal femur. When it is secondary to acetabular overcoverage, it is pincer impingement. When it is secondary to femoral head and neck deformity, it is cam impingement. Open remodeling of impinging deformities is the standard treatment of this condition. We describe arthroscopic treatment of cam impingement in 19 patients using standard hip arthroscopy portals by the lateral approach. Sixteen patients improved their symptoms after the procedure; and 3 patients deteriorated, with 1 needing a total hip arthroplasty at 2 years follow-up. We had no cases with postoperative femoral neck fractures or avascular necrosis. Hip arthroscopy can be successfully used to treat cam impingement. The precautions used in open surgery to preserve femoral neck bone stock and hip vascularity should be followed.

[Surgical treatment of hip osteoarthritis: hpdete on hip arthroscopy]. / Tratamiento quirúrgico de la osteoartritis en la cadera: actualidades en artroscopia de cadera.

Arthroscopic surgery of the hip is a routine procedure in an increasing number of institutions around the world. Indications for this procedure increase as more experience is developed. Thanks to hip arthroscopy some intraarticular lesions like labral or ligamentum teres tears and cartilage lesions have been recognized. All of these have the potential to develop hip osteoarthritis. Open techniques for the treatment of femoroacetabular impingement have been transformed to arthroscopic techniques. Femoroacetabular impingement has the potential to cause hip osteoarthritis. The role of hip arthroscopy in the treatment of formally established hip osteoarthritis is limited and has better results in young patients with early degenerative changes.

[Surgical treatment of hip osteoarthritis: update in total hip arthroplasty]. / Tratamiento quirúrgico de la osteoartritis en la cadera: actualidades en artroplastia total de cadera.

Total hip replacement is one of the most successful procedures in orthopaedic surgery. There are two different technologies for implant fixation in total hip replacement: cemented and cementless, both can be combined, which is called Hybrid arthroplasty. Long term implant stability results in long term function. The most important factor that limits longevity of well-fixed implants is the wear of the articular surfaces. Wear of the polyethylene from the acetabulum generates particles that access the implant bone or the implant-cement-bone interface. This produces an inflammatory reaction, osteolysis and implant loosening. Polyethylene of higher resistance to wear and prosthetic articulations without polyethylene (hard on hard bearings), have been introduced to improve wear particle generation. Minimally invasive surgical techniques minimize surgical trauma to sort tissue around the hip joint, facilitating a better and more rapid recovery.

[Cutaneous lobular capillary hemangioma of the hand during pregnancy. A case report]. / Hemangioma lobular capilar cutáneo en mano en el embarazo. Informe de un caso.

Hemangiomas are abnormal blood vessel proliferations representing the 4th most common tumor of the hand and are frequent among women in their twenties. The case of a 27-year-old woman with a lobular capillary hemangioma in the index finger that appeared during the second month of pregnancy is presented. There are reports stating that these tumors may change their course as a result of various factors such as estrogen or progesterone. They have not been much studied and it is important to know that even though they are benign neoplasias, their course may be aggressive an therefore appropriate treatment is mandatory.