Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 4.194
Filtrar
1.
Can Assoc Radiol J ; 71(1): 83-91, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32062993

RESUMEN

PURPOSE: Magnetic resonance imaging (MRI) is not beneficial in patients with joint pain and concomitant osteoarthritis (OA). We attempt to determine whether evaluation of OA via X-rays can reduce inappropriate MRI and computed tomography (CT) arthrogram use. In our jurisdiction, CT arthrograms are used as surrogate tests because of MRI wait times. MATERIALS AND METHODS: Our intervention required patients ≥55 years of age scheduled for outpatient MRI of the knee/hip/shoulder at an urban hospital to have X-rays (weight bearing when appropriate) from within 1 year. Red flags (ie, neoplasm, infection) were identified for which MRI would be indicated regardless. Through review of radiographs on picture archiving and communication system/digital media and use of the validated Kellgren-Lawrence (KL) OA scale, radiologists assessed the presence and degree of OA. A finding of significant OA (KL > 2) without red flags would preclude MRI. Monthly averages of MRI and CT arthrogram examinations were measured 33 months before and 23 months following introduction of the intervention. RESULTS: The proportion of protocoled MRI requisitions that were avoided was 21%. If extrapolated to the province of British Columbia, 2419 of 11 700 examinations could have been prevented in the past year. The average monthly number of knee/hip/shoulder MRI examinations as a percentage of total MRI examinations decreased from 4.9% to 4.3% (P < .02) following the intervention. The average monthly number of knee/hip/shoulder CT arthrogram examinations decreased from 20.6 to 12.1 (P < .0001). CONCLUSION: We were able to decrease the number of MRI and CT arthrogram examinations in patients ≥55 years of age with joint pain by implementing an evaluation for OA via recent X-ray imaging.


Asunto(s)
Artralgia/diagnóstico por imagen , Imagen por Resonancia Magnética/estadística & datos numéricos , Osteoartritis/diagnóstico por imagen , Anciano , Artrografía , Colombia Británica , Toma de Decisiones , Femenino , Humanos , Masculino , Persona de Mediana Edad , Tomografía Computarizada por Rayos X , Listas de Espera
2.
J Orthop Traumatol ; 20(1): 31, 2019 Oct 31.
Artículo en Inglés | MEDLINE | ID: mdl-31673809

RESUMEN

BACKGROUND: In recent years, a variety of short stems have been introduced. To date, mid- and long-term results of calcar-guided short-stem designs have been rarely available. MATERIALS AND METHODS: Two hundred and sixteen calcar-guided short stems were included in combination with a cementless cup in a prospective study. Patients were allowed full weight-bearing on the first day postoperatively. Harris hip score (HHS) as well as pain and satisfaction on visual analogue scale (VAS) were assessed during a median follow-up of 61.7 months. Standardised radiographs were analysed at predefined time points regarding radiological alterations such as bone resorption and remodelling, radiolucency, osteolysis and cortical hypertrophy using modified Gruen zones. RESULTS: At mid-term follow-up, no revision surgery of the stem had to be performed in the whole collective. At 5 years, HHS was 97.8 (SD 4.7), satisfaction on VAS was 9.7 (SD 0.7), rest pain on VAS was 0.1 (SD 0.5), and load pain on VAS was 0.6 (SD 1.2). Compared to the 2-year results, femoral bone resorption increased significantly at the 5-year follow-up (3.9% versus 42.3%). Rate of femoral cortical hypertrophy remained stable, occurring in a total of 9 hips (4.5%). At the 5-year follow-up, 2 stems (1.0%) showed non-progressive radiolucent lines with a maximum width of 2 mm. Signs of osteolysis were not observed. Compared to the 2-year follow-up, no further subsidence was observed. CONCLUSIONS: The rate of stem revision (0%) at the mid-term follow-up was remarkable and indicates the principle of using a calcar-guided short stem as being a safe procedure. However, signs of bone-remodelling, indicating some amount of stress-shielding, must be acknowledged at 5 years depending on stem alignment and type of anchorage. LEVEL OF EVIDENCE: IV, Prospective observational study Trial registration German Clinical Trials Register, DRKS00012634, 07/07/2017 (retrospectively registered).


Asunto(s)
Artroplastia de Reemplazo de Cadera/instrumentación , Prótesis de Cadera , Osteoartritis/cirugía , Diseño de Prótesis , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Osteoartritis/diagnóstico por imagen , Osteoartritis/etiología , Satisfacción del Paciente , Estudios Prospectivos , Radiografía , Reoperación , Factores de Tiempo , Resultado del Tratamiento , Soporte de Peso
4.
Am J Orthod Dentofacial Orthop ; 156(4): 531-544, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31582125

RESUMEN

Progressive condylar resorption, also known as idiopathic condylar resorption, is an uncommon, aggressive, degenerative disease of the temporomandibular joint (TMJ) seen mostly in adolescent girls and young women. This condition leads to loss of condylar bone mass, decrease of mandibular ramal height, steep mandibular and occlusal plane angles, and an anterior open bite. In 3 case reports, we review the pathogenesis of TMJ degenerative disease and the clinical management of TMJ arthrosis. We emphasize that TMJ arthritic disease should be discussed in dental circles as a pathologic entity in the same way that orthodontists discuss arthritic disease in orthopedic circles. Regarding the degenerative pathology of the TMJ, treatment goals include restored function and pain reduction. The treatment methods used to achieve these goals can range from noninvasive therapy to minimally invasive and invasive surgery. Most patients can be treated noninvasively, and the importance of disease prevention and conservative management in the overall treatment of TMJ disease must be acknowledged. The decision to manage TMJ osteoarthrosis surgically must be based on evaluation of the patient's response to noninvasive treatments, mandibular form and function, and effect of the condition on his or her quality of life.


Asunto(s)
Resorción Ósea/diagnóstico por imagen , Resorción Ósea/cirugía , Ortodoncia Correctiva/métodos , Procedimientos Quirúrgicos Ortognáticos/métodos , Osteoartritis/diagnóstico por imagen , Osteoartritis/cirugía , Trastornos de la Articulación Temporomandibular/diagnóstico por imagen , Trastornos de la Articulación Temporomandibular/terapia , Adulto , Resorción Ósea/patología , Niño , Terapia Combinada , Progresión de la Enfermedad , Femenino , Humanos , Cóndilo Mandibular/patología , Cóndilo Mandibular/cirugía , Osteoartritis/patología , Calidad de Vida , Trastornos de la Articulación Temporomandibular/patología , Resultado del Tratamiento
5.
Medicine (Baltimore) ; 98(40): e17336, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31577728

RESUMEN

Lumbar 3-joint complex degeneration is a multifactorial, pathological process. Previous studies included insufficient quantitative analyses to prove the relationship between disc degeneration and facet joint osteoarthritis (OA). We assessed the correlation between intervertebral disc and lumbar facet joint degeneration using computed tomography (CT) and magnetic resonance imaging (MRI) parameters.A total of 152 participants who underwent conventional MRI and CT in the clinostat position were included in this study. The presence of lumbar disc degeneration was identified using the Pfirrmann grading system, and the presence of lumbar facet joint degeneration was identified using the Weishaupt grading system. Facet tropism was defined as a divergence more than 7° between the facet joint angles of both sides at the same segment. The intervertebral disc heights were also measured.Most facet joint OA probably appeared at the segment with intervertebral disc degeneration of more than grade III. Facet joint OA was significantly exacerbated with the progression of disc degeneration grade. The intervertebral height significantly decreased with the progression of facet joint degeneration grades, except for grades 0 and 1.Our current study found that each individual joint degeneration influences the other 2 in the lumbar 3-joint complex. Facet tropism was significantly associated with lumbar disc degeneration. Narrowing of the intervertebral disc height probably aggravates the facet joint degeneration further at the same level.


Asunto(s)
Degeneración del Disco Intervertebral/diagnóstico por imagen , Vértebras Lumbares/diagnóstico por imagen , Osteoartritis/diagnóstico por imagen , Articulación Cigapofisaria/diagnóstico por imagen , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Disco Intervertebral/patología , Degeneración del Disco Intervertebral/complicaciones , Degeneración del Disco Intervertebral/patología , Vértebras Lumbares/patología , Imagen por Resonancia Magnética/métodos , Masculino , Persona de Mediana Edad , Osteoartritis/complicaciones , Osteoartritis/patología , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Tomografía Computarizada por Rayos X/métodos , Adulto Joven , Articulación Cigapofisaria/patología
6.
Rev Prat ; 69(5): 507-509, 2019 May.
Artículo en Francés | MEDLINE | ID: mdl-31626453

RESUMEN

"Osteoarthritis (OA) is one of the most common disorders of joints. The joints most frequently affected are the hip, knee and the hand, notably the base of the thumb. Use of imaging to diagnose OA, whatever its localization should be limited to plain X-Rays in the majority of cases. It is particularly useful for the diagnosis, the assessment of the severity of structural changes and follow-up. The four main radiographic features of OA are joint space narrowing, subchondral sclerosis, subchondral cyst formation and osteophyte. MRI, CT scanner and Ultrasound have no role in the diagnosis of OA in the vast majority of OA patients. However, US is useful to guide intra-articular injection, mostly in the hip, and to diagnose a baker cyst. There is no blood or urine biomarker validated at the individual level for the diagnosis of OA."


Asunto(s)
Biomarcadores/análisis , Cartílago Articular/diagnóstico por imagen , Osteoartritis , Osteofito , Humanos , Imagen por Resonancia Magnética , Osteoartritis/diagnóstico por imagen , Osteoartritis/metabolismo , Radiografía
7.
J Orthop Surg Res ; 14(1): 314, 2019 Sep 18.
Artículo en Inglés | MEDLINE | ID: mdl-31533754

RESUMEN

BACKGROUND: The objective of this study was to assess the efficacy of intra-articular injections of hyaluronic acid (HA) and a novel, on-site conjugate of HA with autologous fibrinogen in platelet-rich plasma (HA-PRP) in a canine model of osteoarthritis (OA) METHODS: Twelve beagle dogs underwent a unilateral resection of the cranial cruciate ligament (CrCL) of the stifle joint. Clinical and radiographic signs of OA were confirmed in all dogs 8 weeks following CrCL resection and prior to treatment. The dogs were randomized into three groups: saline (n = 4), HA (n = 4), and HA-PRP (n = 4). Each dog received intra-articular injections of the respective substance into the affected joint at pre-determined time points. The dogs were assessed for adverse effects for 3 days after each injection and for lameness, pain, range of motion, kinetics, and radiographic OA severity prior to treatment and 3 months after injection. OA severity as determined by radiographic examination was not significantly different among the groups at any time point. The dogs were then humanely euthanatized and the stifle joint assessed by gross and histological examinations. RESULTS: Dogs treated with four weekly injections of HA or two biweekly injections of HA-PRP were significantly (p < 0.05) better than dogs treated with four weekly injections of saline at 2-, 4-, and 12-week time points based on a comfortable range of motion (CROM) and clinical lameness score. Gait analysis measuring symmetry and weight distribution on pressure sensor walkway showed significantly (p < 0.05) improved limb function for dogs treated with HA and HA-PRP compared with dogs treated with saline yet with better clinical outcome for the HA-PRP-treated group at 12 and 20 weeks follow-up. Gross and histological analysis of synovium and articular cartilage demonstrated significant (p < 0.05) improvement by both treatments groups compared to controls. There was however significantly (p < 0.05) less damage to the cartilage in the HA-PRP group compared to the HA-treated group. CONCLUSIONS: These data suggest that while injection of HA and HA-PRP may be sufficient for short-term amelioration of the symptoms associated with OA, treatment with HA-PRP conjugates may be superior, providing significantly better long-term cartilage preservation.


Asunto(s)
Artritis Experimental/tratamiento farmacológico , Ácido Hialurónico/administración & dosificación , Osteoartritis/tratamiento farmacológico , Viscosuplementación/métodos , Viscosuplementos/uso terapéutico , Animales , Artritis Experimental/complicaciones , Artritis Experimental/diagnóstico por imagen , Artritis Experimental/patología , Cartílago Articular/patología , Perros , Fibrinógeno/administración & dosificación , Fibrinógeno/efectos adversos , Fibrinógeno/uso terapéutico , Marcha , Análisis de la Marcha/métodos , Ácido Hialurónico/efectos adversos , Ácido Hialurónico/uso terapéutico , Inyecciones Intraarticulares , Cojera Animal/etiología , Osteoartritis/complicaciones , Osteoartritis/diagnóstico por imagen , Osteoartritis/patología , Plasma Rico en Plaquetas , Radiografía , Distribución Aleatoria , Índice de Severidad de la Enfermedad , Rodilla de Cuadrúpedos/diagnóstico por imagen , Membrana Sinovial/patología , Viscosuplementación/efectos adversos
8.
Int J Mol Sci ; 20(19)2019 Sep 23.
Artículo en Inglés | MEDLINE | ID: mdl-31547612

RESUMEN

The aim of this study was to analyze the analgesic potential of Arrabidaea chica extract (EHA) as an alternative to osteoarthritis (OA) treatment. Thus, the extract was initially evaluated by the cyclooxygenase inhibition test. The analgesic effect of the extract, in vivo, was also verified in a model of OA induced by sodium monoiodoacetate (2 mg). EHA was administered to rats at doses of 50, 150, and 450 mg/kg between 3 and 25 days after OA induction. The animals were clinically evaluated every 7 days, euthanized at 29 days, and the liver, spleen, kidney and knee collected for histopathological analysis. The chemical composition of EHA was identified by HPLC-MS and the identified compounds submitted to molecular docking study. The results showed that the extract promoted cyclooxygenase inhibition and produced significant improvements in disability, motor activity, hyperalgesia, and OA-induced allodynia parameters, in addition to improvements in the radiological condition of the knees (but not observed in the histopathological study). Chemically the extract is rich in flavonoids. Among them, we evidence that amentoflavone showed very favorable interactions with the enzyme COX-2 in the in silico analysis. Thus, it is concluded that A. chica has important analgesic properties for the treatment of OA.


Asunto(s)
Bignoniaceae/química , Inhibidores de la Ciclooxigenasa 2/farmacología , Flavonoides/farmacología , Hiperalgesia/tratamiento farmacológico , Osteoartritis/tratamiento farmacológico , Extractos Vegetales/farmacología , Animales , Ciclooxigenasa 2/metabolismo , Inhibidores de la Ciclooxigenasa 2/química , Modelos Animales de Enfermedad , Flavonoides/química , Hiperalgesia/inducido químicamente , Hiperalgesia/diagnóstico por imagen , Ácido Yodoacético/toxicidad , Actividad Motora/efectos de los fármacos , Especificidad de Órganos/efectos de los fármacos , Osteoartritis/inducido químicamente , Osteoartritis/diagnóstico por imagen , Extractos Vegetales/química , Ratas , Ratas Wistar
9.
Analyst ; 144(20): 5953-5958, 2019 Oct 21.
Artículo en Inglés | MEDLINE | ID: mdl-31418440

RESUMEN

Osteoarthritis (OA) is one of the most common musculoskeletal diseases, characterized by the progressive deterioration of articular cartilage. Although the disease has been well studied in the past few years, the endogenous metabolic composition and more importantly the spatial information of these molecules in cartilage is still poorly understood. Matrix-assisted laser desorption/ionization (MALDI) mass spectrometry imaging (MSI) has been previously used for the investigation of the bimolecular distribution of proteins and lipids through the in situ analysis of cartilage tissue sections. MALDI-MSI as a tool to detect metabolites remains challenging, as these species have low abundance and degrade rapidly. In this work, we present a complete methodology, from sample preparation to data analysis for the detection of endogenous metabolites on cartilage by MSI. Our results demonstrate for the first time the ability to detect small molecules in fragile, challenging tissues through an optimized protocol, and render MSI as a tool towards a better understanding of OA.


Asunto(s)
Cartílago Articular/diagnóstico por imagen , Metabolómica , Osteoartritis/diagnóstico por imagen , Espectrometría de Masa por Láser de Matriz Asistida de Ionización Desorción , Cartílago Articular/metabolismo , Humanos , Osteoartritis/metabolismo , Manejo de Especímenes
10.
J Shoulder Elbow Surg ; 28(12): 2400-2408, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31445788

RESUMEN

BACKGROUND: The identification and precise removal of bony impingement lesions during arthroscopic débridement arthroplasty for elbow osteoarthritis is technically difficult. Surgical navigation systems, combined with preoperative 3-dimensional (3D) assessment of bony impingements, can provide real-time tracking of the surgical instruments and impingement lesions. This study aims to determine the registration accuracy of the navigation system for the humerus and ulna during elbow arthroscopy. METHODS: We tested the registration procedure using resin bone models of 3 actual patients with elbow osteoarthritis. We digitized bone surface points using navigation pointers under arthroscopy. We initially performed paired-point registration, digitizing 6 preset anatomical landmarks, and then refined the initial alignment with surface matching registration, digitizing 30 points. The registration accuracy for each trial was evaluated as the mean target registration error in each reference marker. Three observers repeated the registration procedure 5 times each with the 3 specimens (total, 45 trials). The median of the registration accuracy was evaluated in total (45 trials) as the accuracy of the registration procedure. The differences in the registration accuracy among the 3 observers (median of 15 trials) were also examined. RESULTS: The total registration accuracies were 0.96 mm for the humerus and 0.85 mm for the ulna. No significant differences were found in the registration accuracy for the humerus and ulna among the 3 observers. CONCLUSIONS: This arthroscopic-assisted registration procedure is sufficiently feasible and accurate for application of the navigation system to arthroscopic débridement arthroplasty in clinical settings.


Asunto(s)
Artroscopía , Desbridamiento , Articulación del Codo/cirugía , Osteoartritis/diagnóstico por imagen , Osteoartritis/cirugía , Cirugía Asistida por Computador , Puntos Anatómicos de Referencia , Articulación del Codo/diagnóstico por imagen , Humanos , Húmero/diagnóstico por imagen , Húmero/cirugía , Imagen Tridimensional , Masculino , Modelos Anatómicos , Cúbito/diagnóstico por imagen , Cúbito/cirugía
11.
Eur J Radiol ; 118: 10-18, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31439227

RESUMEN

OBJECTIVE: to determine thresholds and better scenario for the diagnosis of erosive rheumatoid arthritis (RA) by ultrasonography (US) in RA in comparison to osteoarthritic (OA) patients. METHODS: Patients, prospectively included, fulfilling ACR 1987; ACR/EULAR 2010 criteria for RA or hand OA criteria. Radiographic assessment (RX): Sharp erosion score, evaluated by two blinded readers and one adjudicator for discordant cases (number of eroded joints ≤ three). Definition of eroded RX RA: EULAR 2013 Definition. In US, erosions were scored on six bilateral joints (MCP2-3, 5; MTP2-3, 5) with a four-grade scale. RESULTS: A total of 168 patients were included: 122 RA (32 early RA < 2 years; 90 late RA ≥ 2 years); 46 OA patients. On RX: 42 RA patients (6 early; 36 late) and 5 OA patients have erosive diseases (sensitivity: 34.4%, specificity: 89.1%). On US, 95 RA patients (21 early; 78 late) and 12 OA patients have erosive diseases. Considering at least two joint facets eroded (threshold 1) or at least one joint facet eroded at grade 2 (threshold 2), sensitivities were good (68 and 72.1%), specificities excellent (89.1 and 100%). With only six targeted joint facets examined (6/30), sensitivities and specificities remained good (59.8 and 60.0%) and excellent (95.6 and 100%) with threshold 1 and 2 respectively. For all scenarios, agreement between RX and US for erosive RA was excellent ranged from 88.1% to 92.8%. CONCLUSION: US erosion assessment of six targeted joint facets detected 1.7 times more erosive RA patients than RX in late and early RA with good sensitivity and excellent specificity.


Asunto(s)
Artritis Reumatoide/diagnóstico por imagen , Articulaciones de la Mano/diagnóstico por imagen , Osteoartritis/diagnóstico por imagen , Ultrasonografía/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Sensibilidad y Especificidad
12.
Radiologe ; 59(11): 1010-1018, 2019 Nov.
Artículo en Alemán | MEDLINE | ID: mdl-31463538

RESUMEN

BACKGROUND: In imaging diagnostics, classification schemes are very common. As far as osteoarthritis is concerned, the Kellgren classification is the most popular. However, the Kellgren classification, which has been used for more than 50 years, is based on nonspecific criteria; thus, high interobserver variability has been reported. In addition, the Kellgren classifications have not been coordinated with magnetic resonance imaging (MRI)-based classification schemes, e.g., Vallotton. AIM: In this paper, we present some modifications concerning the criteria for both the Kellgren classification and its comparison with the MRI-based Vallotton classification. METHODS: The current surgical and imaging classifications and the precision of the nomenclature are analyzed. X­ray and MRI findings are compared. RESULTS: Suggestions for both a modification of the Kellgren classification as far as the criteria are concerned and a hierarchy (ranking) of X­ray and MRI findings to make clinical decisions more valuable are proposed. CONCLUSION: These proposed modifications (Kellgren and ranking) would be helpful for routine reporting and allow for better interobserver reliability, in particular for special reports (e.g. consultations, expert opinions, advanced diagnostics).


Asunto(s)
Imagen por Resonancia Magnética/métodos , Osteoartritis , Humanos , Variaciones Dependientes del Observador , Osteoartritis/clasificación , Osteoartritis/diagnóstico por imagen , Osteoartritis de la Rodilla/clasificación , Osteoartritis de la Rodilla/diagnóstico por imagen , Radiografía , Reproducibilidad de los Resultados
14.
Molecules ; 24(16)2019 Aug 16.
Artículo en Inglés | MEDLINE | ID: mdl-31426440

RESUMEN

Matrix metalloproteinases (MMPs) are a family of zinc- and calcium-dependent endopeptidases which are secreted or anchored in the cell membrane and are capable of degrading the multiple components of the extracellular matrix (ECM). MMPs are frequently overexpressed or highly activated in numerous human diseases. Owing to the important role of MMPs in human diseases, many MMP inhibitors (MMPIs) have been developed as novel therapeutics, and some of them have entered clinical trials. However, so far, only one MMPI (doxycycline) has been approved by the FDA. Therefore, the evaluation of the activity of a specific subset of MMPs in human diseases using clinically relevant imaging techniques would be a powerful tool for the early diagnosis and assessment of the efficacy of therapy. In recent years, numerous MMPIs labeled imaging agents have emerged. This article begins by providing an overview of the MMP subfamily and its structure and function. The latest advances in the design of subtype selective MMPIs and their biological evaluation are then summarized. Subsequently, the potential use of MMPI-labeled diagnostic agents in clinical imaging techniques are discussed, including positron emission tomography (PET), single-photon emission computed tomography (SPECT) and optical imaging (OI). Finally, this article concludes with future perspectives and clinical utility.


Asunto(s)
Aterosclerosis/diagnóstico por imagen , Enfermedades Cardiovasculares/diagnóstico por imagen , Enfermedades Pulmonares/diagnóstico por imagen , Inhibidores de la Metaloproteinasa de la Matriz/farmacocinética , Metaloproteinasas de la Matriz/química , Sondas Moleculares/farmacocinética , Neoplasias/diagnóstico por imagen , Osteoartritis/diagnóstico por imagen , Animales , Aterosclerosis/metabolismo , Aterosclerosis/patología , Enfermedades Cardiovasculares/metabolismo , Enfermedades Cardiovasculares/patología , Dominio Catalítico/genética , Modelos Animales de Enfermedad , Encefalomielitis Autoinmune Experimental/diagnóstico por imagen , Encefalomielitis Autoinmune Experimental/metabolismo , Encefalomielitis Autoinmune Experimental/patología , Matriz Extracelular/metabolismo , Matriz Extracelular/patología , Humanos , Enfermedades Pulmonares/metabolismo , Enfermedades Pulmonares/patología , Inhibidores de la Metaloproteinasa de la Matriz/síntesis química , Metaloproteinasas de la Matriz/genética , Metaloproteinasas de la Matriz/metabolismo , Imagen Molecular/métodos , Sondas Moleculares/síntesis química , Esclerosis Múltiple/diagnóstico por imagen , Esclerosis Múltiple/metabolismo , Esclerosis Múltiple/patología , Neoplasias/metabolismo , Neoplasias/patología , Osteoartritis/metabolismo , Osteoartritis/patología , Tomografía de Emisión de Positrones/métodos , Tomografía Computarizada de Emisión de Fotón Único/métodos
15.
Biomed Res Int ; 2019: 7961507, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31428645

RESUMEN

Background: Trapeziometacarpal (TMC) arthritis is treated with surgery when nonsurgical treatment fails. The best surgical option for improving pain relief, functional outcomes, and postoperative complications remains controversial. The purpose of this study was to compare clinical and radiological outcomes and complications between trapezium excision with ligament reconstruction and tendon interposition (LRTI) and pyrolytic carbon interpositional arthroplasty. Methods: From March 2009 to August 2014, 37 patients (39 wrists) with Eaton-Littler stage II or III TMC arthritis underwent complete trapezium excision with LRTI (Group L, n=19) or pyrolytic interpositional arthroplasty (Group P, n=20). Visual analog scale (VAS) pain scores; grip and pinch strength; Kapandji scores to quantify thumb opposition; and Disabilities of Arm, Shoulder, and Hand (DASH) scores were used to compare clinical outcomes between the two groups. Radiographic changes (metacarpal shortening, subluxation, and radiolucency) were evaluated on the radiographs of thumb basal joints. Results: There were no differences in patient demographics, Eaton-Littler stage, preoperative outcome measures, or the duration of follow-up between the two groups. At the last follow-up, VAS pain scores, pinch and grip strengths, Kapandji scores, and DASH scores were significantly improved in both groups compared with preoperative scores. All follow-up measurements were similar between the two groups except pinch strength, which was 1.8 kg higher in Group P (p<0.001). Proximal metacarpal migration did not differ significantly between the groups. Periprosthetic lucency more than 1 mm was observed in 7 of 20 (35%) thumbs. Complication rates were similar between the two groups. Conclusions: All subjective and objective outcomes were similar following LRTI and pyrolytic interpositional arthroplasty in patients with TMC arthritis, except pinch strength, which was more improved following pyrolytic interpositional arthroplasty. Longer follow-up is required to test adverse effects of high rates of periprosthetic lucency and prosthetic subluxation on clinical outcomes after PyroDisk interpositional arthroplasty.


Asunto(s)
Artroplastia , Carbono , Huesos del Metacarpo , Osteoartritis , Procedimientos Quirúrgicos Reconstructivos , Hueso Trapecio , Anciano , Femenino , Estudios de Seguimiento , Humanos , Masculino , Huesos del Metacarpo/diagnóstico por imagen , Huesos del Metacarpo/fisiopatología , Huesos del Metacarpo/cirugía , Persona de Mediana Edad , Osteoartritis/diagnóstico por imagen , Osteoartritis/fisiopatología , Osteoartritis/cirugía , Fuerza de Pellizco , Rango del Movimiento Articular , Estudios Retrospectivos , Hueso Trapecio/diagnóstico por imagen , Hueso Trapecio/fisiopatología , Hueso Trapecio/cirugía
16.
Orthop Clin North Am ; 50(4): 497-508, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31466665

RESUMEN

Degenerative arthritis at the articulation of the scaphoid, trapezium, and trapezoid (STT or triscaphe joint) is a common degenerative disease of the wrist. Pain and weakness with grip strength reduction and functional limitations when performing routine daily tasks are common complaints of patients with STT arthritis. Initial conservative treatments for STT arthritis include splinting, bracing, activity modification, anti-inflammatory medication, and steroid injections for pain relief. Failure of conservative treatment is the main indication for surgery, which may include distal scaphoid excision, with or without filling of the void after excision, trapeziectomy, STT arthrodesis, or STT implant arthroplasty.


Asunto(s)
Articulaciones del Carpo/diagnóstico por imagen , Articulaciones del Carpo/cirugía , Osteoartritis/diagnóstico por imagen , Osteoartritis/cirugía , Anciano de 80 o más Años , Articulaciones del Carpo/patología , Manejo de la Enfermedad , Humanos , Hallazgos Incidentales , Procedimientos Ortopédicos , Osteoartritis/epidemiología , Hueso Escafoides/diagnóstico por imagen , Hueso Escafoides/patología , Hueso Trapecio/diagnóstico por imagen , Hueso Trapezoide/diagnóstico por imagen , Hueso Trapezoide/patología , Resultado del Tratamiento
17.
J Bone Joint Surg Am ; 101(16): 1485-1494, 2019 Aug 21.
Artículo en Inglés | MEDLINE | ID: mdl-31436657

RESUMEN

BACKGROUND: Newer designs and techniques of total ankle arthroplasty (TAA) have challenged the assumption of ankle arthrodesis (AA) as the primary treatment for end-stage ankle arthritis. The objective of this study was to compare physical and mental function, ankle-specific function, pain intensity, and rates of revision surgery and minor complications between these 2 procedures and to explore heterogeneous treatment effects due to age, body mass index (BMI), patient sex, comorbidities, and employment on patients treated by 1 of these 2 methods. METHODS: This was a multisite prospective cohort study comparing outcomes of surgical treatment of ankle arthritis. Subjects who presented after nonoperative management had failed received either TAA or AA using standard-of-treatment care and rehabilitation. Outcomes included the Foot and Ankle Ability Measure (FAAM), Short Form-36 (SF-36) Physical and Mental Component Summary (PCS and MCS) scores, pain, ankle-related adverse events, and treatment success. RESULTS: Five hundred and seventeen participants underwent surgery and completed a baseline assessment. At 24 months, the mean improvement in FAAM activities of daily living (ADL) and SF-36 PCS scores was significantly greater in the TAA group than in the AA group, with a difference between groups of 9 points (95% confidence interval [CI] = 3, 15) and 4 points (95% CI = 1, 7), respectively. The crude incidence risks of revision surgery and complications were greater in the AA group; however, these differences were no longer significant after adjusting for age, sex, BMI, and Functional Comorbidity Index (FCI). The treatment success rate was greater after TAA than after AA for those with an FCI of 4 (80% versus 62%) and not fully employed (81% versus 58%) but similar for those with an FCI score of 2 (81% versus 77%) and full-time employment (79% versus 78%). CONCLUSIONS: At 2-year follow-up, both AA and TAA were effective. Improvement in several patient-reported outcomes was greater after TAA than after AA, without a significant difference in the rates of revision surgery and complications. LEVEL OF EVIDENCE: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.


Asunto(s)
Articulación del Tobillo/cirugía , Artrodesis/métodos , Artroplastia de Reemplazo de Tobillo/métodos , Osteoartritis/cirugía , Medición de Resultados Informados por el Paciente , Seguridad del Paciente , Anciano , Articulación del Tobillo/fisiopatología , Artrodesis/efectos adversos , Artroplastia de Reemplazo de Tobillo/efectos adversos , Distribución de Chi-Cuadrado , Estudios de Cohortes , Femenino , Estudios de Seguimiento , Humanos , Modelos Lineales , Masculino , Persona de Mediana Edad , Osteoartritis/diagnóstico por imagen , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/fisiopatología , Estudios Prospectivos , Reoperación/métodos , Resultado del Tratamiento
18.
Eklem Hastalik Cerrahisi ; 30(2): 130-6, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-31291861

RESUMEN

OBJECTIVES: This study aims to evaluate the clinical and radiological results of patients with multiple dorsal carpometacarpal (CMC) joint fracture dislocations treated with open reduction and internal fixation (ORIF). PATIENTS AND METHODS: We evaluated 14 patients (12 males, 2 females; mean age 35.1 years; range, 22 to 64 years) between January 2013 and December 2017. Our main outcome measurements were the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score, loss of grip strength, limitation of range of motion (ROM), and Kellgren-Lawrence osteoarthritis classification identified with radiographs and computed tomography images. RESULTS: The mean QuickDASH scores at seventh week and third month were 73.57 (range, 65-90) and 29.11 (range, 25-42.5), respectively. The mean QuickDASH score at seventh, ninth, and 12th month, and final follow-up was 4.64 (range, 0-30) and the QuickDASH score at these follow-up points was not 0 for only three patients. The mean loss of grip strength was 32.14% and two patients (14.29%) had limitation of ROM in third proximal interphalangeal joint at final follow-up. Four patients had grade I, nine patients had grade II, and one patient had grade III osteoarthritis according to Kellgren-Lawrence classification at final follow-up. CONCLUSION: Although functional results demonstrated that multiple CMC joint fracture dislocations can be treated with ORIF, the high rate of osteoarthritis is a disadvantage.


Asunto(s)
Articulaciones Carpometacarpianas/cirugía , Fractura-Luxación/cirugía , Fijación Interna de Fracturas , Fracturas Óseas/cirugía , Adulto , Articulaciones Carpometacarpianas/diagnóstico por imagen , Articulaciones Carpometacarpianas/fisiopatología , Femenino , Estudios de Seguimiento , Fractura-Luxación/diagnóstico por imagen , Fractura-Luxación/fisiopatología , Fracturas Óseas/diagnóstico por imagen , Fracturas Óseas/fisiopatología , Fuerza de la Mano , Humanos , Masculino , Persona de Mediana Edad , Reducción Abierta , Osteoartritis/diagnóstico por imagen , Osteoartritis/etiología , Rango del Movimiento Articular , Tomografía Computarizada por Rayos X , Adulto Joven
19.
J Shoulder Elbow Surg ; 28(9): e313-e320, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31326338

RESUMEN

BACKGROUND: Various surgical methods are used for osteochondritis dissecans of the capitellum; however, we have consistently performed a closed-wedge osteotomy of the lateral humeral condyle since 1983. The purpose of this study is to clarify the long-term results of closed-wedge osteotomy for osteochondritis dissecans of the capitellum. METHODS: Seventy-seven elbows with all lesion types of osteochondritis dissecans of the capitellum were treated with closed-wedge osteotomy. Unstable osteochondral fragments were fixed with a bone graft and bone pegs in combination with osteotomy. The mean age of the patients was 14.0 years. The patients were clinically and radiographically evaluated at a median value of 9.0 years after surgery. RESULTS: The range of elbow motion and standard deviation were increased significantly from 119° ± 22° preoperatively to 131° ± 18° postoperatively (P < .001). The Timmerman and Andrews score were improved significantly from 141 ± 26 points preoperatively to 184 ± 21 points postoperatively (P < .001). The Timmerman and Andrews score and the range of elbow motion at final examination in patients with preoperative osteoarthritic changes were significantly inferior to those in patients without preoperative osteoarthritic changes. Good remodeling of the capitellar lesions was radiographically observed in 53 elbows (69%). In the long-term follow-up evaluation, although 41 elbows (53%) had advanced osteoarthritic changes that were classified as grade II or III, disease progression was controlled in most of these cases. CONCLUSIONS: Good or excellent long-term clinical results were maintained in most of our patients. Closed-wedge osteotomy of the lateral humeral condyle is a useful method that can provide acceptable long-term clinical results.


Asunto(s)
Articulación del Codo/fisiopatología , Articulación del Codo/cirugía , Húmero/cirugía , Osteocondritis Disecante/cirugía , Osteotomía/métodos , Adolescente , Trasplante Óseo , Niño , Articulación del Codo/diagnóstico por imagen , Epífisis/cirugía , Femenino , Humanos , Húmero/diagnóstico por imagen , Masculino , Osteoartritis/diagnóstico por imagen , Osteoartritis/etiología , Osteoartritis/fisiopatología , Osteocondritis Disecante/complicaciones , Rango del Movimiento Articular , Estudios Retrospectivos , Factores de Tiempo , Resultado del Tratamiento
20.
J Shoulder Elbow Surg ; 28(10): e344-e351, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31279719

RESUMEN

BACKGROUND: Asymptomatic acromioclavicular osteoarthritis (AC-OA) is a frequent finding in shoulder magnetic resonance imaging (MRI). Its natural course is unknown. Therefore, the question arises whether a resection should be performed simultaneously with shoulder surgery for another reason to prevent future pain and reoperation. The purpose of this study was to investigate the mid-term course of asymptomatic AC-OA. METHODS: Overall, 114 asymptomatic AC-OA diagnosed on MRI were followed for 7 years between 2011 and 2018. At baseline, MRI signal enhancement in the clavicle and acromion, OA grade, physical demand as well as the parameters (1) Constant Score Visual Analogue Scale, (2) pain on AC-joint compression, and (3) cross-body adduction test were measured. All patients were followed up after 7 years by interview, and in case of symptoms by clinical examination. The endpoint "deterioration" was reached if 2 of the 3 parameters turned worse. RESULTS: Asymptomatic AC-OA remained asymptomatic in 83% of cases, 7% turned better, 10% turned worse. Physical demand and osteoarthritis grade increased the risk of deterioration, whereas MRI signal enhancement in the clavicle or acromion had no influence on outcome. During follow-up, the frequency of pain on AC-joint compression increased from 11% to 16% (P = .24), the frequency of a positive cross-body adduction test increased from 6% to 20% (P = .017), and the mean Constant Score Visual Analogue Scale increased from 10 to 13 points (P < .001) indicating less pain. CONCLUSIONS: Asymptomatic AC-OA remained asymptomatic in 90% over 7 years. A simultaneous resection of an asymptomatic AC-OA during shoulder surgery for another reason is not indicated in every patient.


Asunto(s)
Articulación Acromioclavicular/diagnóstico por imagen , Imagen por Resonancia Magnética , Osteoartritis/diagnóstico por imagen , Acromion/diagnóstico por imagen , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Enfermedades Asintomáticas , Clavícula/diagnóstico por imagen , Progresión de la Enfermedad , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Dolor Musculoesquelético/etiología , Osteoartritis/complicaciones , Dimensión del Dolor , Adulto Joven
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA