Novel subtype of coxitis knee associated with acetabular dysplasia of the hip: a case series.

BACKGROUND: Multiple joint arthritis patterns require a comprehensive understanding to optimize patient management. This study aimed to present a patient cohort that deviated from known definitions of coxitis knee (CK), identifying and characterizing this atypical group. METHODS: Patients undergoing both total hip arthroplasty and total knee arthroplasty between January 2008 and December 2018 were retrospectively reviewed. The patients were classified into a typical coxitis knee group (classic, long leg arthropathy, and windswept deformity) and an atypical coxitis knee group. Leg-length discrepancy, body mass index (BMI), and radiographic parameters of the groups were compared and analyzed. RESULTS: A total of 31 patients were allocated to the typical coxitis knee group (n = 10), and atypical coxitis knee group (n = 21). In the atypical group, 27 hips were involved, of which 21 had acetabular dysplasia, 5 exhibited subchondral insufficiency fracture-like changes, and only 1 had classic osteoarthritis. Among the 27 knees undergoing total knee arthroplasty, 26 showed varus alignment, 1 was within the normal range, and none was valgus. Acetabular dysplasia involved ipsilateral (n = 1), contralateral (n = 14), and bilateral (n = 6) hips, showing atypical coxitis knee. Patients with acetabular dysplasia were more likely to exhibit atypical CK. CONCLUSION: Most patients in the cohort displayed acetabular dysplasia and contralateral varus knees, constituting a pattern referred to as acetabular dysplasia-associated gonarthritis. Identifying this novel subtype may have important clinical implications for regions with high risk factors, where acetabular dysplasia and constitutional genu varum are prevalent.

Accuracy of cup placement using computed tomography-based navigation system in total hip arthroplasty through the direct anterior approach.

BACKGROUND: This study aimed to elucidate the accuracy of cup placement with the computed tomography (CT)-based navigation system (CTN) in the direct anterior approach (DAA)-total hip arthroplasty (THA) in the supine position compared with the mechanical cup alignment guide (MG) or the fluoroscopy (FS). METHODS: A total of 171 hips of 156 patients undergone primary THA were classified into the following three groups (the MG group: 63 hips, the FS group: 58 hips, the CTN group: 50 hips). Comparing the preoperative planning with postoperative CT measurement by three-dimensional templating software, the accuracy of cup placement was investigated in the three groups. RESULTS: There were significant differences in the mean absolute error of radiographic inclination (RI) between the MG group (4.4° ± 3.2°) and the CTN group (2.8° ± 2.5°) (p = 0.01). The mean absolute error of radiographic anteversion (RA) also showed significant differences between the CTN group (2.8° ± 1.9°) and the MG group (5.8° ± 4.7°) (p = 0.0001) or the FS group (4.8° ± 4.1°) (p = 0.02). Regarding the cup center position, the mean absolute error of vertical position from preoperative planning was the smallest in the CTN group (1.8 ± 1.4 mm) compared with those in other groups (MG: 3.3 ± 3.2 mm, p = 0.007, FS: 3.2 ± 3.0 mm, p = 0.017). CONCLUSION: The CTN guarantees accurate cup placement in the DAA-THA in the supine position compared with the MG and FS groups.

Synovial fluid presepsin as a novel biomarker for the rapid differential diagnosis of native joint septic arthritis from crystal arthritis.

OBJECTIVE: To investigate whether presepsin can be used as a novel biomarker to differentiate between native joint septic arthritis (NJSA) and crystal arthritis (CA). METHODS: This study included 75 patients diagnosed with either NJSA (n = 21) or CA (n = 54). Presepsin in synovial fluid and blood, C-reactive protein, and procalcitonin were measured and compared between the NJSA and CA groups. Receiver operating characteristic (ROC) curve analyses were performed to differentiate between the two groups. RESULTS: Synovial fluid and blood presepsin were significantly higher in the NJSA group than in the CA group (p < 0.0001 and p < 0.01, respectively). The area under the ROC curve for synovial fluid presepsin in the NJSA group compared with the CA group was 0.93 (sensitivity 85.7%, specificity 85.2%, positive predictive value 69.2%, negative predictive value 93.9%, positive likelihood ratio 5.79, negative likelihood ratio 0.17). Among the tests, synovial fluid presepsin was the most accurate. CONCLUSIONS: Measurement of synovial fluid presepsin is reliable for the early diagnosis of NJSA, and synovial fluid presepsin could be used as a novel biomarker for differentiating between NJSA and CA.

Ultrasonography-detected synovitis of hand is associated with the presence of synovitis in the forefoot of patients with rheumatoid arthritis.

BACKGROUND: In rheumatoid arthritis, forefoot disease activity can lead to joint damage, pain, and disability during weight-bearing activities; therefore, the evaluation and control of forefoot disease activity is important. We aimed to investigate an association between the prevalence of abnormalities in the forefoot based on ultrasonography (US) and the clinical and US findings related to arthritis and identify factors related to the presence of synovitis in the forefoot of RA patients. METHODS: In total, 810 metatarsophalangeal joints of 81 rheumatoid arthritis patients were examined using US. Patients were assigned to either a forefoot synovitis group (n = 22), with foot synovitis detected using US, or a non-forefoot synovitis group (n = 59). We assessed associations between clinical parameters and US finding of the hand and US finding of the metatarsophalangeal joints. RESULTS: The following were significantly higher in forefoot synovitis group than in non-forefoot synovitis group: swollen joint count [P < 0.001]; Disease Activity Score 28 based on C-reactive protein [P < 0.05]; clinical disease activity index [P < 0.001]; and total Power Doppler score of the hand [P < 0.001]. Receiver-operating characteristic analysis for total Power Doppler scores of the hand to suggest the presence of synovitis in the metatarsophalangeal joints showed that a total Power Doppler score of the hand of ≥5 was associated with synovitis in the metatarsophalangeal joints, with a sensitivity of 68% and a specificity of 85% (odds ratio = 11.9). CONCLUSION: Total Power Doppler scores of the hand had a good valuable score for suggesting the presence of synovitis in metatarsophalangeal joints of rheumatoid arthritis patients.

Early diagnosis of septic arthritis using synovial fluid presepsin: A preliminary study.

Therapeutic outcomes for septic arthritis vary greatly depending on the span of time between disease-onset and surgery. The most important factor is making an early and definitive diagnosis; however, some cases may be difficult to diagnose. We investigated presepsin, a biomarker of sepsis, to determine whether or not presepsin in synovial fluid would be useful for the diagnosis of septic arthritis. We selected 18 patients with septic arthritis including periprosthetic joint infections (SA group) and 28 patients with osteoarthritis (OA group). We measured the concentrations of synovial fluid presepsin, blood presepsin and procalcitonin (PCT) in the two groups. We compared the sensitivities and specificities of synovial fluid presepsin, blood presepsin and PCT. Synovial fluid and blood presepsin and blood PCT were all significantly higher in the SA group. Synovial fluid presepsin exhibited both 100% sensitivity and 100% specificity in the SA group, which were higher rates than those for blood presepsin and PCT. We found that synovial fluid presepsin is markedly elevated in case of septic arthritis, and therefore, it has potential as a new biomarker of septic arthritis.

Risk Factors Associated With Short-term Clinical Results After Total Hip Arthroplasty for Patients With Rheumatoid Arthritis.

Clinical outcomes of total hip arthroplasty for rheumatoid arthritis are reportedly worse than those of total hip arthroplasty for osteoarthritis of the hip. The authors examined pre- and postoperative factors associated with the modified Harris hip score (mHHS). Fifty-one joints of 48 rheumatoid arthritis patients who underwent total hip arthroplasty were studied retrospectively. The authors examined the correlation between preoperative rheumatoid arthritis disease activity (Disease Activity Score in 28 joints-C-reactive protein and C-reactive protein) and mHHS at 1 year after total hip arthroplasty. Furthermore, pre- and postoperative mHHS values were compared between patients with other affected joints and patients with no affected joints in the lower limbs. The mean mHHS improved to 73.5 points postoperatively from 36.4 points preoperatively. Preoperative Disease Activity Score in 28 joints-C-reactive protein and C-reactive protein values were negatively correlated with pre- and postoperative mHHS values. Preoperative mHHS was not significantly different between the affected and not affected groups; however, postoperative mHHS was significantly lower in the affected group than in the not affected group. Total hip arthroplasty showed good clinical results for rheumatoid arthritis at short-term follow-up. However, pre- and postoperative mHHS values were influenced by preoperative rheumatoid arthritis disease activity. Moreover, the presence of additional affected joints in the lower limbs preoperatively resulted in a lower postoperative mHHS. Unlike patients with osteoarthritis, patients with rheumatoid arthritis often have multiple affected joints, which may contribute to a lower mHHS. Comprehensive treatment, including surgery for the other affected joints in the lower limbs, may improve a patient's postoperative mHHS. [Orthopedics. 2018; 41(6):e772-e776.].

Weight Bearing Joints Destruction In Rheumatoid Arthritis.

In many cases of rheumatoid arthritis (RA) joints of the upper extremities are affected. However, involvement of weight bearing joints of the lower extremities is strongly associated with a decreased activities of daily living ability such as gait disorder. Once the progression of weight bearing joint destruction occurs, lower extremity function will decrease even if RA disease activity is improved by pharmacotherapy. In this article, we investigated joint destruction suppressing effects of pharmacotherapy on the hip and knee joints, as well as risk factors for joint destruction. We also discuss surgical treatment strategies and clinical outcomes for progressive joint destruction.

Weight bearing joints destruction in rheumatoid arthritis.

In many cases of rheumatoid arthritis (RA) joints of the upper extremities are affected. However, involvement of weight bearing joints of the lower extremities is strongly associated with a decreased activities of daily living ability such as gait disorder. Once the progression of weight bearing joint destruction occurs, lower extremity function will decrease even if RA disease activity is improved by pharmacotherapy. In this article, we investigated joint destruction-suppressing effects of pharmacotherapy on the hip and knee joints, as well as risk factors for joint destruction. We also discuss surgical treatment strategies and clinical outcomes for progressive joint destruction.

Postpartum pyogenic sacroiliitis with methicillin-resistant Staphylococcus aureus in a healthy adult: A case report and review of the literature.

OBJECTIVE: Back and buttock pain during pregnancy and the postpartum period generally improves spontaneously and rarely causes problems. However, such pain is infrequently induced by pyogenic sacroiliitis. CASE REPORT: We herein present a 37-year-old female patient with no previous medical history who developed pyogenic sacroiliitis with severe right buttock pain 7 days after cesarean delivery. Arthrocentesis was performed, and a culture revealed the presence of methicillin-resistant Staphylococcus aureus (MRSA). After 6 weeks of treatment with intravenous antibiotics, her infection became quiescent. Eight cases of pyogenic sacroiliitis during the postpartum period and seven cases during pregnancy have been reported, but most of the causative pathogens were methicillin-sensitive Staphylococcus or Streptococcus species. CONCLUSION: This report describes the first case of postpartum pyogenic sacroiliitis caused by MRSA. The frequency of infection with MRSA has recently increased, and community-acquired MRSA, which affects even healthy young people, has also become a problem. Antibiotics for empirical therapy after a diagnosis of pyogenic sacroiliitis, including anti-MRSA antibiotics, should be carefully selected.

Treatment for Staphylococcus aureus infection following open wedge high tibial osteotomy using antibiotic-impregnated calcium phosphate cement.

UNLABELLED: This report describes a case of Staphylococcus aureus infection following open wedge high tibial osteotomy, which was successfully treated with by implant removal and replacement with antibiotic-impregnated calcium phosphate cement along with external fixation. The infection occurred 7 months after primary surgery and was treated by implant removal, debridement, external fixation, and application of vancomycin impregnated calcium phosphate cement to fill the defect. Subsequently, the infection resolved completely, and the osteotomy healed with no correction loss. Compared with conventional bone cement, calcium phosphate cement might be an optimal material for certain cases of infection after open wedge high tibial osteotomy because of its higher antibiotic retention, biocompatibility, osteoconductivity, and compatibility with heatlabile antibiotics. LEVEL OF EVIDENCE: V.

Knee joint destruction driven by residual local symptoms after anti-tumor necrosis factor therapy in rheumatoid arthritis.

In patients with rheumatoid arthritis who had symptomatic knee joints at the start of anti-tumor necrosis factor (TNF) therapy, the relationship between local symptoms and knee joint destruction at 94 weeks was retrospectively investigated. Among the patients with rheumatoid arthritis and received anti-TNF therapy, the 32 patients (52 joints) having swollen and/or tender knee joints were included in this study. Changes of disease activity score in 28 joints based on C-reactive protein (DAS28-CRP) and knee joint destruction using Larsen's grading system 94 weeks after anti-TNF therapy were evaluated. Furthermore, the differences of the DAS28-CRP, swollen and tender knee joints between the patients who showed progression of joint destruction (Progression group) and those who did not (Non-progression group) were investigated. DAS28-CRP showed time-dependent, favorable results. However, progression of joint destruction was observed in 12 out of 52 joints. DAS28-CRP at 0 and 94 weeks after anti-TNF therapy were not different between Progression and Non-progression groups. However, the rate of swollen knee joints was higher in Progression group from 0 week. In addition, the ratio of swollen and/or tender knee joints was higher in Progression group from 22 to 94 weeks after anti-TNF therapy. The disease activity evaluated using DAS28-CRP was improved by anti-TNF therapy, but residual local symptoms in the knee joints were associated with a high incidence of joint destruction progression. We should treat rheumatoid arthritis patients with consideration for the possibility of joint destruction in the knee joints having residual local symptoms to progress.

Rotational acetabular osteotomy for habitual hip dislocation with posterior acetabular wall deficiency in patients with Down syndrome.

Hip dislocation associated with Down syndrome is relatively rare. Hip dislocation can progress to severe subluxation or habitual dislocation if the initial therapy is improperly performed. However, definitive treatment guidelines for conservative and surgical therapy for hip dislocation in patients with Down syndrome have not been established. This article describes a case of a 12-year-old girl with Down syndrome with nontraumatic habitual hip dislocation. Her hip joint was associated with acetabular dysplasia and hypoplasia of the posterior acetabular wall. Although conservative therapy was initially performed, no effects were observed. Rotational acetabular osteotomy and capsular plication were performed to reconstruct the posterior acetabular wall. No postoperative redislocation occurred, and the treatment effects were favorably sustained for 2 years. In Down syndrome, few cases of developmental dysplasia and hypoplasia of the posterior acetabular wall have been reported. In previous reports, these morphological abnormalities were rarely taken into consideration when determining the treatment strategy, and to our knowledge, no other reports demonstrate therapy involving rotational acetabular osteotomy for hip dislocation complicated with Down syndrome. Whether the acetabulum had posterior wall deficiency was thought to be important for conservative and surgical therapies in hip dislocation in patients with Down syndrome. Rotational acetabular osteotomy could be an effective surgical procedure for reconstruction of the acetabulum by posterolateral rotation of the osteotomized acetabulum.