Delayed normalization of C-Reactive protein and erythrocyte sedimentation rate was not associated with inferior clinical outcomes after total knee arthroplasty.

BACKGROUND: The purpose of this study aimed to identify the proportion of patients with delayed normalization of C-reactive protein (CRP) and Erythrocyte sedimentation rate (ESR) after TKA, to determine postoperative thresholds predictive of prolonged elevation. Further, we aimed to determine if the clinical outcomes of patients with prolonged elevation were inferior to those without prolonged elevation. METHODS: The records of 211 unilateral and 320 bilateral TKA were reviewed. Patients were divided into the normal and elevation group based on CRP and ESR levels at 6 weeks and 3 months. The temporal pattern of CRP and ESR change in both groups was compared, and thresholds predictive of elevation at 6 weeks and 3 months were identified. Further, the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index and Tegner activity scale of both groups at 6 months, 1 year, and 2 years after TKA were compared. RESULTS: The proportion of patients with elevated CRP and ESR at 6 weeks and 3 months was CRP: 24.2%, 10%, ESR: 51.6%, 29.9% in unilateral and CRP: 31.5%, 10.6%, ESR: 58.1%, 42.7% in bilateral TKA. The thresholds for elevation at 6 weeks and 3 months were 9.5 mg/dL, 11.4 mg/dL (CRP at 6 weeks) and 81.5 mm/h, 74.5 mm/h (ESR at 3 months). There was no difference in the WOMAC score and Tegner activity scale between both groups. CONCLUSIONS: CRP and ESR are often elevated for a prolonged period even in the absence of infection after TKA. Such cases show distinct temporal patterns, which are predictable, and do not appear to have a significant effect on clinical outcome.

Retrospective study of relationship between vastus medialis volume on SPECT-CT and outcome of unilateral total knee arthroplasty.

ABSTRACT: Although the importance of quadriceps femoris function was reported previously, little is known about volume-related factors and their effects on clinical outcomes after total knee arthroplasty (TKA). We sought to determine whether there was a bilateral difference in vastus medialis muscle volume measured on single-photon emission computed tomography-computed tomography (SPECT-CT) in patients who underwent unilateral TKA. We also aimed to determine whether vastus medialis volume was related to osteoarthritis (OA) severity or scintigraphic uptake degree around the knee joint on SPECT-CT. And finally, we attempted to investigate the factors, such as vastus medialis volume and scintigraphic uptake degree, associated with the functional outcomes of TKA.This retrospective study included 50 patients (41 female, 9 male) undergone unilateral TKA due to primary OA. The maximal cross-sectional area of the vastus medialis was measured on axial SPECT-CT images. Scintigraphic uptake degrees and Kellgren-Lawrence (K-L) grade at the tibiofemoral joints were assessed. We compared maximal cross-sectional area of the vastus medialis on SPECT-CT for difference of bilateral lower limbs. We also analyzed the relationship between volume of vastus medialis and scintigraphic uptake measured on SPECT-CT and the severity of OA on conventional radiographs. The clinical outcomes were evaluated using the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index at baseline and at 1 and 2 years after surgery. The relationship between preoperative muscle volume and scintigraphic uptake on SPECT-CT and WOMAC index was analyzed.The amount of muscle volume measured on SPECT-CT was smaller in operated limb in patients who underwent unilateral TKA. Preoperative vastus medialis muscle volume was not related to preoperative OA severity measured on conventional radiographs and scintigraphic uptake on SPECT-CT. However, a decreased vastus medialis muscle volume was related to worse clinical outcomes after TKA (P = .045), whereas the degree of scintigraphic uptake on SPECT-CT was not associated with postoperative clinical outcomes.Muscle volume of vastus medialis was decreased in the operated knee than in the nonoperated knee, and that was correlated with worse postoperative results. Even if the preoperative volume of vastus medialis were not related to OA severity on conventional radiographs and scintigraphic uptake on SPECT-CT, preservation and improvement of the muscle mass of the knee undergoing TKA is important.

A Systematic Review and Meta-Analysis of Arthroscopic Meniscus Repair in Young Patients: Comparison of All-Inside and Inside-Out Suture Techniques.

PURPOSE: The purposes of the present study were to review published studies that investigated arthroscopic meniscus repair to treat meniscus injury in young patients and to compare all-inside and inside-out suture techniques. METHODS: Various electronic databases were queried for published articles, and this search was updated in August 2017 for evaluating the outcomes of arthroscopic meniscus surgery in young patients. Data search, extraction, analysis, and quality assessment were performed according to the Cochrane Collaboration guidelines, and the clinical outcomes were evaluated using various outcome values in young patients according to suture techniques. RESULTS: Three randomized controlled trials and three prospective comparative studies were included in this systematic review and meta-analysis. There were no significant differences in clinical outcomes such as meniscus healing rate (risk ratio [RR], 1.11; 95% confidence interval [CI], 0.90 to 1.37; I2=39%) and perioperative complications (RR, 0.62; 95% CI, 0.23 to 1.72; I2=43%) between all-inside and inside-out techniques for meniscus repair. CONCLUSIONS: The present study shows favorable results for clinical outcomes such as meniscus healing rate and perioperative complications in young patients. Furthermore, based on our results, both all-inside and inside-out meniscal suture techniques are equally effective in these patients.

Diagnostic value of oblique magnetic resonance images for evaluating cervical foraminal stenosis.

BACKGROUND CONTEXT: The benefits of oblique magnetic resonance imaging (MRI) reformations to assess cervical neural foramina have been reported previously in clinical and cadaveric studies. But there is a paucity of literature investigating intra- and interobserver variabilities for assessing cervical foraminal stenosis using oblique MRI views. PURPOSE: To determine the value of oblique MRI views compared with axial and sagittal views for assessing foraminal stenosis of the cervical spine using intra- and interobserver variabilities. STUDY DESIGN: A retrospective study. PATIENT SAMPLE: Twenty-six patients were included. OUTCOME MEASURES: Two independent reviewers blindly identified the presence of foraminal stenosis as definite or indeterminate on the sagittal, axial, and oblique views. The assessments using the different views were compared using an independent t test. Intra- and interobserver variabilities were assessed using Kappa analysis. METHODS: We evaluated the cervical spine MRIs of patients with varying degrees of foraminal stenosis. The mean age of the patients was 60.8 years (range 50-86 years). Male to female ratio was 16:10. The oblique images were obtained by reformatting the scans perpendicular to the long axis of the right and left neural foramina, respectively. RESULTS: The oblique or axial views had significantly greater confidence rates for determining the presence of foraminal stenosis than the sagittal views (92.3%, 88.1% vs. 58.0%, respectively, p=.000). The oblique view had significantly better intraobserver agreement than the sagittal and axial images. Both the axial and oblique views had significantly better interobserver agreement than the sagittal images. CONCLUSIONS: Oblique MRI views of the cervical spine significantly reduce the degree of intra- and interobserver variabilities and increase observer confidence in the assessment of foraminal stenosis. Our results suggest that routine use of oblique cervical MRI views might be useful for evaluating cervical foraminal stenosis.

Facet joint degeneration of the cervical spine: a computed tomographic analysis of 320 patients.

STUDY DESIGN: Retrospective study. OBJECTIVE: To determine the frequency of facet arthrosis according to age, sex, and cervical level. In addition, we propose and evaluate a new grading system for cervical facet degeneration. SUMMARY OF BACKGROUND DATA: Cervical facets can play an important role in symptomatology. However, there is only one computed tomographic grading system for cervical facet joints. METHODS: From January 2003 to January 2012, 1944 patients underwent computed tomography of the cervical spine in our institution. We randomly selected 40 males and 40 females from each of the following age groups: 40 to 49, 50 to 59, 60 to 69, and 70 to 79, such that we had a total of 320 patients. We then graded the degree of arthrosis of the facet joints from C2 to C7 on the axial, sagittal, or coronal images according to 4 grades. These categories were: grade I, normal; grade II, degenerative changes including joint space narrowing, cyst formation, small osteophytes without joint hypertrophy seen; grade III, facet joint hypertrophy from large osteophytes without fusion; and grade IV, bony fusion of the facet joint. The intra- and interobserver reliabilities for the grading system were calculated using reliability statistics by intraclass correlation. RESULTS: Facet arthrosis is common with older patients and at C2-C3, C3-C4, and C4-C5. Facet arthrosis was more common on the left side and in males. Greater than grade III facet joint arthrosis was common in patients older than 60 and at C2-C3, C3-C4, and C4-C5. The reliability statistics by intraclass correlation for the grading system was 0.878 for the intraobserver reliability and 0.869 for the interobserver reliability. CONCLUSION: It seems that upper cervical levels are more likely to degenerate and to have more advanced degrees of degeneration than the lower cervical levels. As expected, age correlates with worsening degeneration. The proposed computed tomographic grading system for cervical facet arthrosis seemed to be reliable.