Diagnosis and Treatment of Inflammatory Joint Disease / 대한고관절학회지

Arthritis damages the cartilage within joints, resulting in degenerative changes, including loss of function and joint instability. Ankylosing spondylitis (AS) is a chronic inflammatory condition affecting the spine and bone-to-tendon attachment area within the sacroiliac joint leading to back pain and progressive spinal stiffness. In the final stages, AS causes hyperkyphosis-a condition closely tied to the human leukocyte antigen-B27 gene. Rheumatoid arthritis is a chronic, systemic autoimmune disease characterized by the simultaneous inflammation of the synovium of multiple joints, leading to joint damage (e.g., destruction, deformation and disability). In the past, nonsteroidal anti-inflammatory drugs or conventional disease-modifying antirheumatic drug (DMARDs) have been used for the treatment of these autoimmune diseases, but biologic DMARDs have recently been introduced with excellent results. Gout is a chronic inflammatory disease that causes an alteration of joints resulting in severe pain. Specifically, gout is associated with an accumulation of uric acid within the body resulting from dysregulated purine metabolism, causing recurrent paroxysmal inflammation in the joints. Allopurinol and febuxostat are the primary treatment options for individuals with gout. It is necessary to have an accurate understanding of the pathogenesis, pathological ecology and treatment of AS, rheumatoid arthritis, and gouty arthritis, which are the representative diseases that may cause inflammatory arthritis.

Decreased Lumbar Lordosis and Deficient Acetabular Coverage Are Risk Factors for Subchondral Insufficiency Fracture

Subchondral insufficiency fracture (SIF) of the femoral head occurs in the elderly and recipients of organ transplantation. Osteoporosis and deficient lateral coverage of the acetabulum are known risk factors for SIF. There has been no study about relation between spinopelvic alignment and anterior acetabular coverage with SIF. We therefore asked whether a decrease of lumbar lordosis and a deficiency in the anterior acetabular coverage are risk factors. We investigated 37 patients with SIF. There were 33 women and 4 men, and their mean age was 71.5 years (59-85 years). These 37 patients were matched with 37 controls for gender, age, height, weight, body mass index and bone mineral density. We compared the lumbar lordosis, pelvic incidence, pelvic tilt, sacral slope, acetabular index, acetabular roof angle, acetabular head index, anterior center-edge angle and lateral center-edge angle. Lumbar lordosis, pelvic tilt, sacral slope, lateral center edge angle, anterior center edge angle, acetabular index and acetabular head index were significantly different between SIF group and control group. Lumbar lordosis (OR = 1.11), lateral center edge angle (OR = 1.30) and anterior center edge angle (OR = 1.27) had significant associations in multivariate analysis. Decreased lumbar lordosis and deficient anterior coverage of the acetabulum are risk factors for SIF as well as decreased lateral coverage of the acetabulum.

Comparison of Histological and Biochemical Findings with Magnetic Resonance Imaging on the Degeneration Severity of Meniscus / 대한정형외과학회잡지

PURPOSE: The aim of this study is to determine whether degeneration severities of meniscus assessed using magnetic resonance imaging (MRI) would well estimate those assessed using histological and biochemical examinations. MATERIALS AND METHODS: Seven lateral menisci from knees with osteoarthritis undergoing total knee arthroplasty (study group) and five from normal controls (control group) were examined for this study. Degeneration severities of the menisci were graded using MRI, histologic and biochemical examinations of the menisci were then performed. Comparative analyses of MRI grading and results of histological/biochemical examinations of the menisci were performed in each group. In addition, comparative analyses of histological/biochemical conditions were performed between specimens of the study group and the control group showing grade 0 on MRI. RESULTS: All specimens from the control group showed grade 0 on MRI and their histology was also grade 0. In addition, no significant differences in biochemical results were observed among the specimens of the control group. In the lateral meniscus from the study group showing degeneration on MRI it was found that the water and proteoglycan contents increased with increasing grade of degeneration whereas the collagen content decreased. The meniscus specimens of the control group and the study group showing grade 0 on MRI had similar histologic findings but had different biochemical properties. The grade I, II degenerations on MRI were not well matched with the histologic findings in the study group. CONCLUSION: Severities of meniscus degeneration on MRI did not well reflect the histologic findings of the meniscus. This finding may be due to the water content of the meniscus. The factors of the high signal intensity of the degenerated lateral meniscus on MRI may be due to the decreased component of collagen and increased proteoglycan. Our findings suggested that caution should be taken when the severities of meniscus degeneration on MRI are attributed to histologic severities of degenerated meniscus.

Effect of Zoledronate on the Expression of Vascular Endothelial Growth Factor-A by Articular Chondrocytes and Synovial Cells: An in Vitro Study

BACKGROUND: The aim of this in vitro study was to determine the effect of zoledronate, which is frequently used to treat osteoporosis, on osteoarthritis by analyzing zoledronate-induced expression of vascular endothelial growth factor-A (VEGF-A) in chondrocytes and synovial cells. METHODS: After chondrocytes and synovial cells were separated and cultured, zoledronate was added, and VEGF-A and pigment epithelium-derived factor (PEDF) expression were quantified by real-time polymerase chain reaction and Western blotting. RESULTS: There was no significant difference in the expression of VEGF-A mRNA in chondrocytes between the zoledronate group and the control group on the 8th day of culture. The expression of both VEGF-A and PEDF mRNA in synovial cells was significantly decreased in the zoledronate group (P<0.05). CONCLUSIONS: Zoledronate decreases the expression of VEGF-A in synovial cells and may affect the development and progression of osteoarthritis.

Bilateral Insufficiency Fracture of Medial Subtrochanteric Area of the Femur: A Case Report / 대한고관절학회지

A non-traumatic, incomplete insufficiency fracture commonly involves the lateral side of the femoral cortex; whereas a non-traumatic, incomplete stress fracture commonly involves the medial side of the femoral cortex. Here, we describe a case of a 66-year-old woman with a two-month history of bilateral thigh pain without trauma or medication usage who was diagnosed with bilateral subtrochanteric insufficiency fractures involving the medial side of the femoral cortex.

Femoral Neck Anteversion Measured Using a 3D CT Scan Perpendicular to the Mechanical Axis of the Femur

PURPOSE: We wanted to measure the femoral neck anteversion (FNA) angles using a 3D CT scan that perpendicularly cut the mechanical axis of the femur and to assess the accuracy and reproducibility of different measuring methods. MATERIALS AND METHODS: We obtained 95 cases of 3D CT images of the cross-section perpendicular to the mechanical axis of the femur. The methods used to measure the FNA angles included a method using the CT image of the area where the femoral neck is confluent to the greater trochanter (method 1), a method using the CT image taken from the neck base immediately prior to the beginning of the area of the lesser trochanter (method 2) and a method by which measurements are made after putting 3D bone models on a horizontal plane in virtual space (method 3). The reference axes of the distal femur we used were the anatomical transepicondylar axis, the surgical transepicondylar axis and the real posterior condylar axis. RESULTS: The FNA angles measured by method 1 were 4.79+/-6.41degrees to the anatomical transepicondylar axis (ATEA), 6.09+/-6.58degrees to the surgical transepicondylar axis (STEA) and 7.96+/-6.81degrees to the real posterior condylar axis (rPCA). The FNA angles measured by method 2 were 16.01+/-8.31degrees to the ATEA, 19.52+/-8.38degrees to the STEA and 21.79+/-8.52degrees to the rPCA. The FNA angles measured by method 3 were 20.15+/-12.89degrees to the rPCA. CONCLUSION: The measurement of the FNA angle using a 3D CT scan perpendicular to the mechanical axis is reproducible. The measurement method on the neck base level is more reliable than the one on the proximal neck confluence, and more similar to the measurement method by classic definition.

Changes in the Hand Strength and Related Factors after Carpal Tunnel Decompression / 대한정형외과학회잡지

PURPOSE: Our goal was to investigate an improvement in hand strength and its associated factors after carpal tunnel decompression in patients with carpal tunnel syndrome. MATERIALS AND METHODS: Between January 2008 and January 2009, a total of 31 patients (50 hands) treated with carpal tunnel decompression for carpal tunnel syndrome were enrolled into the study. Hand-strength was assessed pre- and post-surgery. In the pre-operation evaluation, we assessed multiple factors and investigated the association between these factors and recovery of hand strength. RESULTS: All patients regained hand strength after surgery. On average, the grip strength was 14.8 kg preoperatively, 13.0 kg at 6 weeks, 16.2 kg at 3 months, 18.7 kg at 6 months, and 20.6 kg at 1year postoperatively. The tip-pinch strength was 3.4 kg preoperatively and improved to 3.9 kg at 6 weeks, 4.0 kg at 3 months, 4.4 kg at 6 months and 4.7 kg at 1 year postoperatively. The key-pinch strength showed same pattern of improvement. The recovery of grip strength was significantly slower in patients with longer duration of carpal tunnel syndrome, with diabetes, or with nocturnal pain. There was no factor affecting the recovery of tip-pinch strength. Recovery of key-pinch strength was slower in patients that had experienced a longer duration of symptoms. CONCLUSION: Grip strength and pinch strength were recovered within 3 months and 6 weeks, respectively, after carpal tunnel decompression; both improved gradually until 12 months after surgery. Disease duration, diabetes, and nocturnal pain were significant factors that impacted on post-surgery recovery.

Distal Femoral Rotational Alignment Based on Mechanical Axis of the Femur: A 3-Dimensional Computed Tomographic Scan in Vivo Assessment / 대한정형외과학회잡지

PURPOSE: To measure and to analyze the relationships among the rotational axes of the distal femoral region by means of 3-dimensional (3D) computed tomographic (CT) images taken perpendicularly to the mechanical axis and a 3D rendering program. MATERIALS AND METHODS: Fifty cases involving the lower extremity were included in this study, which used 3D computed tomographic angiograms. CT images of the perpendicular cross-sections to the mechanical axis of the femur were obtained by processing 3D recombinant images using Aquaris NET(R). The following anatomical angles were obtained from axial imaging using the 3D reconstructed bone model: transepicondylar axis, surgical transepicondylar axis, anteroposterior axis, and real posterior condylar axis. RESULTS: In the tomographic images, the angles to the real posterior condylar axis formed by the anatomical femoral transepicondylar axis, the anatomical femoral transepicondylar axis, and the anteroposterior axis were 6.34+/-1.23degrees, 2.43+/-1.56degrees, and 96.52+/-1.77degrees, respectively. The angles to the anatomical femoral transepicondylar axis formed by the anteroposterior axis and the surgical femoral transepicondylar axis were 90.19+/-1.61degrees and 3.91+/-0.90degrees, respectively. In the recombinant 3D femur model, the angles to the real posterior condylar axis formed by the anatomical femoral transepicondylar axis and the anteroposterior axis were 6.29+/-1.86degrees, and 93.33+/-3.76degrees, respectively. And, the angle for anteroposterior axis from anatomical transepicondylar axis was 87.04+/-4.11degrees. CONCLUSION: The method of measuring the rotational axes of the distal femur using the CT image taken perpendicularly to the mechanical axis is considered reproducible. In particular, the measurement method using the anatomical transepicondylar axis is more accurate than that using the anteroposterior axis.

Proximal Femoral Nail Antirotation versus Compression Hip Screw with Trochanter Stabilizing Plate for Unstable Intertrochanteric Hip Fractures

PURPOSE: To analyze and compare the clinical and radiologic results of treatments in unstable intertrochanteric fractures of the femur with proximal femoral nail antirotation (PFNA) and compression hip screw with trochanter stabilizing plate (CHS with TSP). MATERIALS AND METHODS: We retrospectively reviewed the results of 66 cases of unstable intertrochanteric fractures of the femur treated with PFNA (Group I) and CHS with TSP (Group II) which could be followed up for minimum a year. We evaluated several comparative factors such as operation time, blood loss, time to bone union, changes in neck-shaft angle, sliding of screw (or blade), complications, postoperative pain, social-function score of Jensen, and mobility score of Parker and Palmer. RESULTS: Group I showed shorter operation time and less blood loss with significance than group II (p0.05). Two cases of cutting out of the blade through the femoral head were found in group I. One case of cutting out of the screw, one case of the breakage of the plate, and loosening of the plate were found in group II as complications. CONCLUSION: We think that there were no significant differences between PFNA and CHS with TSP in view point of radiologic and clinical outcomes in unstable intertrochanteric fractures of the femur, but PFNA is less invasive device than CHS with TSP, therefore it may be useful device in elderly patients.