Short-term outcomes using the Christensen patient-specific temporomandibular joint implant system: a prospective study.

Thirty-one patients were assessed for changes in pain and maximal mouth opening (MMO) before and after total temporomandibular joint (TMJ) replacement. All prosthetic joint replacements used the Christensen fossa-eminence prosthesis system; 18 were unilateral and 13 bilateral. There were more women (n=22) than men (n=9), and their mean age was 45 years (women 46, range 18-74, and men 42, range 28-69). Indications for replacement included osteoarthritis, ankylosis, and "other". There were overall significant improvements in pain scores for the whole group at one year (95% CI 6.3-8.5 compared with 0.2-3.0) and for women alone (6.5 to 9.2 compared with -0.5 to 2.0). There were also significant improvements in pain scores in both those with osteoarthritis (95% CI 8.1 to 8.9 compared with -0.8 to 3.8) and the group with "other" diagnoses at the 12-month follow-up (95% CI 4.4 to 10.7 compared with -0.2 to 0.5). Finally, there was a significant improvement in MMO in the whole group at the time of 12-month follow-up (95% CI 15.8-23.5 compared with 24.0-32.3).

Antirheumatic medication in pregnancy.

Drug effects on fetal physiology as well as possible teratogenesis need to be considered before prescribing for women of child-bearing age. All nonsteroidal anti-inflammatory drugs (NSAIDs), because of their suppression of prostaglandin synthesis, may prolong gestation and labour. Aspirin is also associated with an increased risk of ante- and post-partum haemorrhage. Indomethacin may be teratogenic in humans and like aspirin may induce pulmonary hypertension in the neonate. To reduce the physiological alterations induced by NSAIDs, short-half-life drugs such as ibuprofen, flurbiprofen or ketoprofen should be used at the maximally tolerable dosage interval. Gold salts and corticosteroids show little human evidence of teratogenicity although the largest possible dosage interval of gold should be used. D-Penicillamine may be teratogenic thus it should not be commenced during pregnancy and if a patient becomes pregnant whilst receiving the drug, it should be slowly withdrawn or the dosage reduced. 4-Aminoquinoline compounds are contra-indicated in pregnancy.

Knee-joint rupture with giant antefemoral cyst formation.

A case of a patient with Reiter's disease, whose ruptured knee-joint effusion extended proximally along the femur to just below the inguinal ligament, and simulated an iliofemoral thrombosis, is reported. The mechanisms of joint rupture, and the need to differentiate it from thrombophlebitis, are discussed.