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1.
Medicine (Baltimore) ; 99(46): e23299, 2020 Nov 13.
Artigo em Inglês | MEDLINE | ID: mdl-33181720

RESUMO

Calcific tendinitis (CT) of the shoulder is a painful disorder usually identified in individuals aged 40 and 60 years. The estimated global prevalence of CT is 2.7% to 36%. We examined the association of hyperlipidemia and sex with CT of the shoulder using Taiwan Biobank (TWB) and the National Health Insurance Research Database (NHIRD).Data were available for 9903 TWB participants who were recruited between 2008 and 2015. We used multiple logistic regression analysis to estimate the odds ratios (OR) and 95% confidence intervals (CI) for CT of the shoulder.Overall, 1564 women, and 1491 men were identified with hyperlipidemia. Women, compared to men, had higher odds of CT of the shoulder (OR, 1.53; 95% CI, 1.08-2.16). Hyperlipidemia, compared to no hyperlipidemia, was associated with an increased risk of CT (OR, 1.40; 95% CI, 1.02-1.93). The test for interaction was significant for sex and hyperlipidemia (P = .006). After stratification, the odds ratio for CT was 1.95 (95% CI, 1.30-2.92) in women and 0.82 (95% CI, 0.48-1.39) in men, respectively. Compared to men with no hyperlipidemia, the odds ratio was 0.86 (95% CI, 0.53-1.38) for men with hyperlipidemia and 2.00 (95% CI, 1.29-3.10) for women with hyperlipidemia.Importantly, our findings indicated that the risk for CT of the shoulder was higher among Taiwanese women with hyperlipidemia. However, CT risk among their male counterparts with hyperlipidemia was not significant.


Assuntos
Calcinose/etiologia , Hiperlipidemias/complicações , Artropatias/etiologia , Fatores Sexuais , Ombro/anormalidades , Tendinopatia/etiologia , Doenças Vasculares/etiologia , Adulto , Idoso , Calcinose/epidemiologia , Calcinose/fisiopatologia , Feminino , Humanos , Hiperlipidemias/epidemiologia , Hiperlipidemias/fisiopatologia , Artropatias/epidemiologia , Artropatias/fisiopatologia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Prevalência , Ombro/fisiopatologia , Taiwan/epidemiologia , Tendinopatia/epidemiologia , Tendinopatia/fisiopatologia , Doenças Vasculares/epidemiologia , Doenças Vasculares/fisiopatologia
2.
Bone Joint J ; 102-B(10): 1331-1340, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32993344

RESUMO

AIMS: Stiffness is a common complication after total knee arthroplasty (TKA). Pathogenesis is not understood, treatment options are limited, and diagnosis is challenging. The aim of this study was to investigate if MRI can be used to visualize intra-articular scarring in patients with stiff, painful knee arthroplasties. METHODS: Well-functioning primary TKAs (n = 11), failed non-fibrotic TKAs (n = 5), and patients with a clinical diagnosis of fibrosis1 (n = 8) underwent an MRI scan with advanced metal suppression (Slice Encoding for Metal Artefact Correction, SEMAC) with gadolinium contrast. Fibrotic tissue (low intensity on T1 and T2, low-moderate post-contrast enhancement) was quantified (presence and tissue thickness) in six compartments: supra/infrapatella, medial/lateral gutters, and posterior medial/lateral. RESULTS: Fibrotic tissue was identified in all patients studied. However, tissue was significantly thicker in fibrotic patients (4.4 mm ± 0.2 mm) versus non-fibrotic (2.5 mm ± 0.4 mm) and normal TKAs (1.9 mm ± 0.2 mm, p = < 0.05). Significant (> 4 mm thick) tissue was seen in 26/48 (54%) of compartments examined in the fibrotic group, compared with 17/30 (57%) non-fibrotic, and 10/66 (15%) normal TKAs. Although revision surgery did improve range of movement (ROM) in all fibrotic patients, clinically significant restriction remained post-surgery. CONCLUSION: Stiff TKAs contain intra-articular fibrotic tissue that is identifiable by MRI. Studies should evaluate whether MRI is useful for surgical planning of debridement, and as a non-invasive measurement tool following interventions for stiffness caused by fibrosis. Revision for stiffness can improve ROM, but outcomes are sub-optimal and new treatments are required. Cite this article: Bone Joint J 2020;102-B(10):1331-1340.


Assuntos
Artroplastia do Joelho , Artropatias/diagnóstico por imagem , Artropatias/etiologia , Imagem por Ressonância Magnética/métodos , Complicações Pós-Operatórias/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Meios de Contraste , Feminino , Fibrose , Humanos , Aumento da Imagem , Masculino , Metais , Pessoa de Meia-Idade
3.
Semin Arthritis Rheum ; 50(5): 885-889, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32896705

RESUMO

OBJECTIVES: Patients with rheumatologic diseases might be more susceptible to COVID-19 and carry a poorer prognosis. The aim of this study is to examine the incidence and outcomes of all COVID-19 patients with rheumatologic conditions in Hong Kong. METHODS: This is a population-based retrospective study. All patients tested positive for SARS-CoV-2 by PCR with a previous diagnosis of rheumatologic diseases were reviewed. The incidence of COVID-19 in patients with rheumatologic conditions was calculated and compared to the general population in Hong Kong. Descriptive data of those rheumatologic patients with COVID-19 and the clinical course of the index infection were presented. RESULTS: Up till 27 May 2020, there were 1067 cases of COVID-19 diagnosed in Hong Kong which had a population of 7.5 million. Out of the 39,835 patients with underlying rheumatologic diseases, we identified 5 PCR confirmed COVID-19 cases. The estimated incidence of COVID-19 was 0.0126% patients with rheumatologic diseases, compared to 0.0142% in the general population. All 5 patients had inflammatory arthropathies. One patient was on hydroxychloroquine and sulphasalazine, and one was on methotrexate. None of the 3534 patients on b/tsDMARDs was infected. Four patients had leucopenia/lymphopenia and stool viral PCR was positive in 3 patients. All patients made uneventful recovery without complications or flare of underlying diseases. CONCLUSIONS: We found no alarming signals of increased frequency or severity of COVID-19 in patients with rheumatologic diseases, although extrapolation of the results to other populations with different infection control strategies should be made with caution.


Assuntos
Antirreumáticos , Betacoronavirus/isolamento & purificação , Técnicas de Laboratório Clínico , Infecções por Coronavirus , Artropatias , Pandemias , Pneumonia Viral , Doenças Reumáticas , Adulto , Antirreumáticos/classificação , Antirreumáticos/uso terapêutico , Técnicas de Laboratório Clínico/métodos , Técnicas de Laboratório Clínico/estatística & dados numéricos , Comorbidade , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Feminino , Hong Kong/epidemiologia , Humanos , Incidência , Artropatias/tratamento farmacológico , Artropatias/epidemiologia , Artropatias/etiologia , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Prognóstico , Estudos Retrospectivos , Doenças Reumáticas/diagnóstico , Doenças Reumáticas/epidemiologia , Medição de Risco , Fatores de Risco
4.
J Shoulder Elbow Surg ; 29(7): 1387-1393, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32553439

RESUMO

BACKGROUND: Hyperuricemia is considered a risk factor for increased postoperative complications and adverse functional outcomes in a variety of orthopedic surgeries. The purpose of this retrospective study was to investigate the clinical efficacy of patients with different uric acid levels after elbow arthrolysis. METHODS: The study included 131 patients with post-traumatic elbow stiffness who underwent arthrolysis between March 2014 and March 2016. All patients were divided into 4 groups based on the preoperative serum level of uric acid (UA). The quartile method was used for grouping patients, including 33 in Q1 (UA <293 µmol/L), 34 in Q2 (293-348 µmol/L), 32 in Q3 (348-441 µmol/L), and 32 in Q4 (441-710 µmol/L). At baseline and each time point of follow-up, functional performance, Mayo Elbow Performance Score, visual analog scale for pain, and complications were evaluated. RESULTS: Preoperative data were not significantly different among the 4 groups (Q1, Q2, Q3, and Q4). At the final follow-up, the following data showed significant differences among the 4 groups: extension (P = .031), flexion (P = .008), range of motion (P = .003), Mayo Elbow Performance Score (P = .011), and visual analog scale (P = .032). Interestingly, patients in the Q4 group had the poorest clinical outcomes. However, no significant differences were found among the 4 groups in new onset or exacerbation of nerve symptoms (P = .919), reduced muscle strength (P = .536), instability (P = .567), or infection (P = .374) at the last follow-up. CONCLUSION: This study confirms that in patients with post-traumatic elbow stiffness, abnormal serum uric acid metabolism was a risk factor for poor performance and postoperative pain after arthrolysis. Therefore, detecting the preoperative serum uric acid levels of the patients would be helpful for evaluating the postoperative outcomes.


Assuntos
Articulação do Cotovelo/fisiopatologia , Hiperuricemia/fisiopatologia , Artropatias/cirurgia , Ácido Úrico/sangue , Adulto , Articulação do Cotovelo/lesões , Articulação do Cotovelo/cirurgia , Fixadores Externos , Feminino , Humanos , Hiperuricemia/sangue , Artropatias/etiologia , Artropatias/fisiopatologia , Masculino , Pessoa de Meia-Idade , Medição da Dor , Dor Pós-Operatória/sangue , Dor Pós-Operatória/etiologia , Amplitude de Movimento Articular , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Adulto Jovem
5.
Zhonghua Wai Ke Za Zhi ; 58(6): 416-419, 2020 Jun 01.
Artigo em Chinês | MEDLINE | ID: mdl-32498478

RESUMO

Bearing dislocation is a special complication of mobile-bearing unicompartmental arthroplasty, caused by many factors, such as imbalance of the flexion and extension gap, malposition of components, impingement by the remaining osteophytes and cement, damage or delayed chronic laxity of medial collateral ligament, traumatic accident and habitual high knee flexion. It can be reduced by strictly controlling the operation indications before operation, osteotomy and implanting the prosthesis accurately while protecting the medial collateral ligament during operation, actively guiding the appropriate rehabilitation actions and activity intensity of patients after operation. Treatment should be individualized according to the causes and individual conditions of patients.


Assuntos
Artroplastia do Joelho/efeitos adversos , Artropatias/cirurgia , Prótese do Joelho/efeitos adversos , Falha de Prótese , Artroplastia do Joelho/instrumentação , Humanos , Artropatias/etiologia , Artropatias/prevenção & controle , Articulação do Joelho/cirurgia , Desenho de Prótese , Falha de Prótese/etiologia
6.
J Pediatr Orthop ; 40(6): e473-e478, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32501918

RESUMO

BACKGROUND: Arthropathies and bone deformities are well known to occur in patients with thalassemia major and have been attributed to the disease or to its therapy. Before the advent of chelation therapy, these children developed widened diploic space and "hair-on-end" pattern in skull, "cobweb" pattern in the pelvis, and the lack of the normal concave outline in the long bones because of extensive marrow proliferation. After the introduction of iron-chelation therapy, these patients were noted to develop metaphyseal abnormalities and vertebral changes resembling spondylo-metaphyseal dysplasia. Only one study has shown some association of deferiprone (chelating agent) use with distal ulnar changes in these children. Our study was done to describe the skeletal changes and deformities in wrist joints of children with transfusion-dependent thalassemia and correlate them with age, mean pretransfusion hemoglobin level, mean serum ferritin level, and type and duration of chelation therapy in these children. METHODS: A total of 60 children with transfusion-dependent thalassemia from the thalassemia daycare center were examined. These children were divided into 3 groups on the basis of their age (group A: 2 to 6 y, group B: 6 to 10 y, and group C: 10 to 14 y). Detailed history, including treatment history, number of blood transfusions received over the last 1 year, clinical examination, and radiologic assessment of both forearm with wrists were done. RESULTS: The clinical and radiologic differences in radial and ulnar lengths increased significantly with the increasing age of these patients, the ulna being short. There was some correlation between increasing negative ulnar variance and distal radial articular angle with deferiprone consumption. CONCLUSION: Chelation therapy, particularly with deferiprone, may cause distal ulnar growth arrest causing ulnar shortening and progressive radial bowing in these children. LEVEL OF EVIDENCE: Level IV-case series.


Assuntos
Terapia por Quelação/efeitos adversos , Deferiprona/efeitos adversos , Quelantes de Ferro/efeitos adversos , Articulação do Punho/efeitos dos fármacos , Talassemia beta/tratamento farmacológico , Adolescente , Transfusão de Sangue , Criança , Pré-Escolar , Feminino , Antebraço/diagnóstico por imagem , Humanos , Artropatias/etiologia , Masculino , Radiografia , Rádio (Anatomia)/diagnóstico por imagem , Rádio (Anatomia)/efeitos dos fármacos , Ulna/diagnóstico por imagem , Ulna/efeitos dos fármacos , Punho/diagnóstico por imagem , Articulação do Punho/diagnóstico por imagem
7.
Clin Podiatr Med Surg ; 37(3): 489-504, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32471614

RESUMO

Revision surgery for failed total ankle replacement is a challenge to the revision surgeon. Deformity, presence of infection, segmental bone defects, patient comorbidities, and soft tissue compromise all are significant considerations when determining appropriate procedures. Revision total ankle replacement, explant and fusion with or without lengthening, use of a trabecular metal cage, placement of an antibiotic cement spacer, grafting, and amputation all are viable options to treat patients with failed ankle arthroplasty.


Assuntos
Articulação do Tornozelo/cirurgia , Artroplastia de Substituição do Tornozelo/efeitos adversos , Artropatias/cirurgia , Amputação , Artrodese , Remoção de Dispositivo , Feminino , Humanos , Artropatias/diagnóstico por imagem , Artropatias/etiologia , Pessoa de Meia-Idade , Seleção de Pacientes , Reoperação , Falha de Tratamento
8.
J Shoulder Elbow Surg ; 29(6): 1223-1229, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32245727

RESUMO

BACKGROUND: The aim of this study is to evaluate the correlation between the Oxford Elbow Score (OES) and Single Assessment Numeric Evaluation (SANE). To date, there has been no study investigating a correlation between this patient-reported outcome measure and SANE. METHODS: Between December 2018 and February 2019, all patients who underwent consultation for elbow pathology and completed the OES and SANE were retrospectively analyzed. Pearson correlation coefficient between the OES and SANE was calculated. Variables, including age, gender, diagnosis, chief complaint for consultation, and pain level on the visual analog scale (VAS), were also collected, and a mixed effects linear regression model was used to identify predictors for higher correlation. RESULTS: One hundred seven consultations of 86 patients were analyzed. The mean SANE and OES were 62.13% and 60.36%, respectively. Both scores correlated highly (r = 0.903). Across the OES domains, the strongest correlation was found between SANE and the OES psychosocial domain (r = 0.885). High correlations were also found between SANE and the OES function (r = 0.847) and OES pain (r = 0.804) domains. All values were statistically significant (P < .001). A moderate inverse correlation was found between SANE and VAS (r = -0.631). Aside from SANE, the VAS was identified as a significant predictor of the OES. CONCLUSION: SANE correlates highly with the OES. It is an easy tool for assessing the condition of the elbow joint, can be obtained without any license or payment restrictions, and should be considered as a worthwhile adjunct to currently used scores.


Assuntos
Articulação do Cotovelo , Artropatias/cirurgia , Medidas de Resultados Relatados pelo Paciente , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Feminino , Humanos , Artropatias/etiologia , Artropatias/fisiopatologia , Masculino , Pessoa de Meia-Idade , Diferença Mínima Clinicamente Importante , Recuperação de Função Fisiológica , Reprodutibilidade dos Testes , Estudos Retrospectivos , Adulto Jovem
9.
J Clin Ultrasound ; 48(6): 346-349, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32329518

RESUMO

Snapping hip syndrome, or coxa saltans, can result in significant clinical manifestations in patients including pain and limited mobility. A variety of both intra- and extra-articular pathologies have been implicated in snapping hip, including an anatomic variant known as the bifid iliopsoas tendon which has been briefly described in the literature. We report a case of a bifid iliopsoas tendon leading to internal snapping hip syndrome which was ultimately successfully treated with surgical release, including review of the clinical presentation, pathophysiology, and dynamic sonographic findings.


Assuntos
Articulação do Quadril/patologia , Artropatias/patologia , Tendões/patologia , Adulto , Artroscopia , Articulação do Quadril/diagnóstico por imagem , Articulação do Quadril/cirurgia , Humanos , Artropatias/diagnóstico por imagem , Artropatias/etiologia , Artropatias/cirurgia , Masculino , Dor/etiologia , Tendões/diagnóstico por imagem , Tendões/cirurgia , Resultado do Tratamento , Adulto Jovem
10.
Reumatol. clín. (Barc.) ; 16(2,pt.2): 177-179, mar.-abr. 2020. ilus
Artigo em Espanhol | IBECS | ID: ibc-194344

RESUMO

En los apicultores se ha descrito una artropatía inflamatoria de etiología desconocida pero relacionada con su actividad profesional. Se expone el caso de un apicultor que tras la picadura de abeja presentó una artritis de la articulación interfalángica del primer dedo de la mano izquierda. Aunque el curso clínico subagudo y los hallazgos de la RMN obligaban a plantear el diagnóstico diferencial con un proceso infeccioso, el resto de pruebas analíticas, de imagen y la evolución, junto al antecedente de episodio similar unos años antes en un dedo de otra mano tras la picadura de abeja, permitió el diagnóstico de esta entidad


An acute inflammatory arthritis of unknown cause has been described in beekeepers in relation to their work with the hives. We present the case of a beekeeper who, after a bee sting, developed arthritis of the interphalangeal joint of the first finger of his left hand. Although the subacute clinical course and the magnetic resonance imaging findings required the differential diagnosis with an infectious process, the rest of the laboratory tests. other imaging studies and the course, together with a history of a similar episode a few years earlier on a finger of the other hand after a bee sting, enabled us to diagnosis this condition


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Artropatias/diagnóstico por imagem , Artropatias/etiologia , Abelhas , Mordeduras e Picadas de Insetos/complicações , Anti-Inflamatórios não Esteroides/administração & dosagem , Artrite/complicações , Articulação da Mão/diagnóstico por imagem , Articulação da Mão/patologia , Antibacterianos/uso terapêutico , Manejo da Dor , Diagnóstico Diferencial
11.
J Shoulder Elbow Surg ; 29(4): 699-706, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32088078

RESUMO

BACKGROUND: This study characterized the prevalence and risk factors of inpatient and outpatient postoperative falls in patients undergoing elective shoulder arthroplasty. METHODS: A retrospective chart review of 198 patients undergoing anatomic or reverse total shoulder arthroplasty or hemiarthroplasties at one institution between 2015 and 2017 was reviewed to determine the prevalence of inpatient and outpatient falls up to 90 days after discharge. Univariate and multivariate analyses were conducted to assess potential risk factors for postoperative falls including demographics, indication for surgery, surgical procedure, medical history, length of hospital stay, perioperative hemoglobin, need for transfusion, and discharge disposition. RESULTS: There were 23 falls in 22 patients within a 90-day postoperative period. The inpatient fall rate was 1.0% (2 of 198). The outpatient fall rate was 10.6% (21 of 198). Outpatient falls resulted in emergency department evaluation in 23.8% of cases (5 of 21), readmission in 19.0% (4 of 21), injury to an anatomic site other than the shoulder in 19.0% (4 of 21), and injury at the surgical site (eg, periprosthetic humeral fracture) in 4.8% (1 of 21). No significant risk factors were identified for inpatient falls. Independent risk factors for an outpatient fall were female sex (adjusted odds ratio [aOR] = 4.79; 95% confidence interval [CI]: 1.32, 17.4; P = .007), increased length of hospital stay (aOR = 1.23; 95% CI: 1.04, 1.45; P = .02), and history of a movement disorder (aOR = 7.20; 95% CI: 1.22, 42.6; P = .03). CONCLUSION: A high outpatient fall rate of 10.6% within 90 days after discharge raises the concern that falls after shoulder arthroplasty are significantly higher than previously reported.


Assuntos
Acidentes por Quedas/estatística & dados numéricos , Artroplastia do Ombro , Hemiartroplastia , Artropatias/cirurgia , Adulto , Idoso , Procedimentos Cirúrgicos Eletivos , Feminino , Humanos , Artropatias/diagnóstico , Artropatias/etiologia , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Prevalência , Reoperação , Estudos Retrospectivos , Fatores de Risco
12.
Knee ; 27(3): 930-933, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32089394

RESUMO

BACKGROUND: To investigate the morphological changes in the tibiofibular joint following open wedge high tibial osteotomy (OWHTO). METHODS: We studied 397 joints in 341 patients. Standing femorotibial angle (FTA), %mechanical axis (%MA), corrected tibial angle, distance (D) to tibial joint surface (T) and fibular head (F) and angle (A; proximal, distal), proximal tibiofibular joint (PTFJ) osteoarthritis (OA) onset, and tibiofibular joint-related complications were the parameters assessed. RESULTS: FTA improved from 181.1° to 168.8° and %MA from 28.7 to 68.7, whereas the mean tibia corrected angle was 10.4°. Proximal TFD changed from 9.4 mm preoperatively to 7.8 mm during the investigation. The fibular head was displaced 1.6 mm upwards, and proximal tibial femoral angle (TFA) moved approximately 10° in the valgus direction from 82.5° to 92.4°. However, no significant changes were noted for the distal TFD or TFA. PTFJ OA was observed in 57 cases (14.7%), and lateroposterior knee pain in 11 cases (2.8%). Additional resection of the fibula was performed in cases with marked pain. CONCLUSIONS: With OWHTO, increased load is placed on the PTFJ postoperatively. In rare cases, this can cause pain and is therefore a complication that physicians should be aware of.


Assuntos
Fíbula/cirurgia , Artropatias/cirurgia , Articulação do Joelho/cirurgia , Osteotomia/efeitos adversos , Tíbia/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Fíbula/diagnóstico por imagem , Fíbula/patologia , Humanos , Artropatias/diagnóstico por imagem , Artropatias/etiologia , Artropatias/patologia , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/patologia , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Tíbia/diagnóstico por imagem , Tíbia/patologia , Adulto Jovem
13.
J Hand Surg Asian Pac Vol ; 25(1): 39-46, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32000595

RESUMO

Background: Arthritis can have profound debilitating effects on the hand secondary to finger deformities and pain. Arthroplasty of the metacarpophalangeal (MCP) and proximal interphalangeal (PIP) can be performed to reduce pain while maintaining joint range of motion. Methods: We used outpatient surgery registries from the states of California and Florida to assess the trends of arthroplasty across several recent years and to determine if the outcomes differ based on disease etiology. Results: We found that there has been a steady decline in number of MCP arthroplasty procedures performed annually between 2005 and 2011 while PIP arthroplasty procedures peaked in 2007 and have since also declined. There was an overall complication rate of 2.4% and no difference in cardiac, respiratory, deep venous thrombosis and infection between patients with osteoarthritis and other arthritic etiologies. However, the risk of device failure in patients with rheumatoid arthritis is found to be significantly higher than for patients with osteoarthritis (p < 0.01). Conclusions: PIP and MCP arthroplasty are safe procedures with an overall low complication rate. The increased risk of device related complications observed in patients with rheumatoid arthritis can be used to appropriately counsel this patient population regarding post-operative expectations and prognosis.


Assuntos
Artroplastia de Substituição de Dedo , Articulações dos Dedos , Artropatias/cirurgia , Articulação Metacarpofalângica , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Gerenciamento de Dados , Bases de Dados Factuais , Feminino , Humanos , Lactente , Artropatias/diagnóstico , Artropatias/etiologia , Prótese Articular , Masculino , Pessoa de Meia-Idade , Amplitude de Movimento Articular , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
14.
J Shoulder Elbow Surg ; 29(5): e175-e184, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-31899094

RESUMO

BACKGROUND: Both anatomic and reverse total shoulder arthroplasty are considered successful surgeries to treat a variety of painful shoulder conditions. Although implant survivorship for both is good to excellent in the long term, a variety of factors-clinical, technical, and psychosocial-may affect patient-reported outcomes after shoulder arthroplasty. METHODS: A comprehensive review of the literature was performed systematically using keywords "shoulder arthroplasty outcomes," "psychosocial factors shoulder," "shoulder replacement outcomes," "depression shoulder arthroplasty," "satisfaction shoulder arthroplasty," "factors shoulder replacement," "expectations shoulder arthroplasty," and "predictors shoulder arthroplasty." Studies meeting the inclusion criteria were screened and analyzed. Type of surgery performed, sample size, outcome measures, and other factors influencing patient outcomes were recorded and analyzed. RESULTS: Sixteen studies met the inclusion criteria. Six reviewed mental health disorders as predictors of postoperative outcome after shoulder arthroplasty. Of these, 4 found that disorders such a depression and anxiety were associated with increased risk of perioperative complications and lower final functional outcome scores. Two studies evaluated workers' compensation status as a possible predictor of outcomes and found that patients with claims had lower satisfaction and outcome scores at final follow-up compared with those without claims. Two studies showed that preoperative opioid use was associated with lower outcome scores and overall satisfaction rate after shoulder arthroplasty. Three studies showed that higher patient confidence and preoperative expectations were correlated with better outcomes. CONCLUSION: Our review shows that psychosocial factors may play just as important role in affecting patient outcomes after total shoulder arthroplasty as technical factors.


Assuntos
Artroplastia do Ombro/efeitos adversos , Artropatias/cirurgia , Complicações Pós-Operatórias/epidemiologia , Humanos , Artropatias/diagnóstico , Artropatias/etiologia , Medidas de Resultados Relatados pelo Paciente , Reoperação
15.
Clin Podiatr Med Surg ; 37(1): 117-123, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31735263

RESUMO

This article discusses rearfoot fusions for foot and ankle surgeons. It establishes normal foot and ankle function primarily in the stance phase of gait. The foot is greatly affected by external and internal forces, which contribute to normal function or the need for compensatory mechanisms. As a result of compensation, many symptoms develop, often leading to debilitating disorders such as degenerative joint disease. The interaction of the ankle, subtalar, and midtarsal joints are outlined. Congenital deformities, trauma and abnormal compensation are reviewed along with corresponding sequelae. Surgery is often indicated to reduce symptoms, improve position, and help stabilize the foot.


Assuntos
Artrodese/efeitos adversos , Articulações do Pé/cirurgia , Artropatias/etiologia , Complicações Pós-Operatórias/etiologia , Fenômenos Biomecânicos , Articulações do Pé/fisiopatologia , Humanos , Artropatias/prevenção & controle , Complicações Pós-Operatórias/prevenção & controle
16.
J Shoulder Elbow Surg ; 29(3): 534-540, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31526560

RESUMO

BACKGROUND: Large glenoid defects present a challenge during primary and revision reverse total shoulder arthroplasty (RTSA) especially when humeral head autograft is not available as a bone graft source. The purpose of this study was to evaluate the clinical and radiographic outcomes of RTSA with concomitant structural allografting to reconstruct large glenoid defects. METHODS: From May 2008 to July 2016, 22 patients underwent primary or revision RTSA with structural glenoid allografting. Of 22 patients, 19 (86%) were available for a minimum 2-year clinical follow-up (average, 2.8 ± 1.3 years), and 17 of 22 (77%) were available for a minimum 1-year radiographic follow-up. Functional outcomes, range of motion, radiographic deformity correction, allograft incorporation, and complication rates were determined. RESULTS: From preoperatively to postoperatively, significant improvements in the average Simple Shoulder Test score (2 ± 2 preoperatively vs. 10 ± 8 postoperatively, P = .002), the average American Shoulder and Elbow Surgeons score (31 ± 19 preoperatively vs. 70 ± 25 postoperatively, P < .001), and average active forward elevation (71° ± 41° preoperatively vs. 128° ± 28° postoperatively, P < .001) were noted. Coronal-plane radiographic correction was 29° ± 12° as measured with the reverse shoulder arthroplasty angle (P < .001) and 14° ± 11° as measured with the ß angle (P < .001). Postoperatively, of 17 patients with a minimum 1-year radiographic follow-up, 14 (82%) had complete radiographic incorporation of the graft. Acromial fracture nonunions developed in 2 patients and loosening and migration of the baseplate were found in 2 patients, although no patients elected to undergo further surgery. CONCLUSIONS: RTSA with allograft reconstruction of severe glenoid defects allows restoration of glenoid anatomy and leads to high rates of bony incorporation with low rates of glenoid loosening or requirement for revision. Structural allograft is an excellent alternative to autograft in revision RTSA to avoid graft-site morbidity.


Assuntos
Artroplastia do Ombro/efeitos adversos , Transplante Ósseo/métodos , Artropatias/cirurgia , Complicações Pós-Operatórias/cirurgia , Escápula/transplante , Articulação do Ombro/cirurgia , Idoso , Idoso de 80 Anos ou mais , Aloenxertos/cirurgia , Feminino , Humanos , Artropatias/diagnóstico , Artropatias/etiologia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Amplitude de Movimento Articular , Reoperação , Estudos Retrospectivos , Transplante Autólogo , Resultado do Tratamento
17.
Arthritis Care Res (Hoboken) ; 72(1): 122-130, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-30629828

RESUMO

OBJECTIVE: To objectively identify foot and ankle characteristics in patients with systemic lupus erythematosus (SLE) compared to age- and sex-matched controls. METHODS: A total of 54 patients with SLE and 56 control participants attended a study visit designed to comprehensively assess the foot and ankle. Objectively assessed foot characteristics included muscle strength, joint motion, foot posture, foot problems, protective sensation, vibration perception threshold (VPT), ankle brachial index (ABI), plantar pressure, and spatiotemporal gait characteristics. Self-reported measure of foot pain and impairment were also assessed using a 100-mm foot pain visual analog scale. Data were analyzed using regression models. Plantar pressure and gait models were adjusted for walking velocity, body mass index, and foot pain. RESULTS: Compared to controls, participants with SLE had lower muscle force for plantarflexion, dorsiflexion, inversion, and eversion (all P < 0.001), higher foot posture indices (P = 0.007), higher foot problem scores (P = 0.001), higher VPT (P = 0.001), and more frequent abnormal ABI (odds ratio [OR] 3.13, P = 0.044). Participants with SLE also had lower peak pressure and higher pressure time integrals for all foot regions (all P < 0.001), lower step and stride length, velocity, and cadence, and higher step, swing, stance, and single and double support times compared to controls (all P < 0.001). Compared to controls, participants with SLE also reported greater foot pain (P < 0.001). CONCLUSION: Patients with SLE experience a wide range of foot symptoms. This study has provided objective evidence of foot and ankle disease in patients with SLE, including reduced muscle strength and altered gait patterns when compared to controls. This highlights the importance of foot health assessments as part of SLE management.


Assuntos
Articulações do Pé/fisiopatologia , Marcha/fisiologia , Artropatias/fisiopatologia , Lúpus Eritematoso Sistêmico/fisiopatologia , Força Muscular/fisiologia , Músculo Esquelético/fisiopatologia , Caminhada/fisiologia , Articulação do Tornozelo/fisiopatologia , Fenômenos Biomecânicos , Estudos Transversais , Feminino , Humanos , Artropatias/etiologia , Lúpus Eritematoso Sistêmico/complicações , Masculino , Pessoa de Meia-Idade
19.
Skeletal Radiol ; 49(1): 19-30, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31321452

RESUMO

Although not as common as hip or knee arthroplasty, shoulder arthroplasty is becoming a more common procedure. Reverse total shoulder arthroplasty (RTSA) is known to be an effective surgical procedure for massive irreparable rotator cuff tears, comminuted proximal humerus fractures, and revision shoulder arthroplasty. The utilization of RTSA has been increasing, and although complications following reverse arthroplasty have been reported, there are few reports in the literature that focus on the imaging features of RTSA. Herein, we demonstrate the biomechanics of RTSA, prosthesis components, indications, and imaging features of the normal postoperative appearance and various complications after RTSA. Familiarization with the normal and abnormal imaging appearances after RTSA can be helpful for appropriate management of patients.


Assuntos
Artroplastia do Ombro/efeitos adversos , Artroplastia do Ombro/métodos , Artropatias/diagnóstico por imagem , Artropatias/cirurgia , Articulação do Ombro/diagnóstico por imagem , Articulação do Ombro/cirurgia , Humanos , Artropatias/etiologia , Artropatias/fisiopatologia , Articulação do Ombro/anatomia & histologia , Articulação do Ombro/fisiologia , Prótese de Ombro
20.
J Orthop Surg Res ; 14(1): 448, 2019 Dec 17.
Artigo em Inglês | MEDLINE | ID: mdl-31847860

RESUMO

BACKGROUND: Intraarticular scar adhesion refers to a serious complication caused by knee surgery or trauma, leading to various sequelae (e.g., articular cartilage degeneration and knee joint stiffness). Artesunate (ART) has exhibited an effect to suppress fibroblast proliferation, whereas the exact mechanism remains unclear. This study aims to delve into the possible mechanism of ART in suppressing joint adhesion. METHODS: The effect of ART on reduced intraarticular adhesions was ascertained by histological staining and immunohistochemical analysis through vivo experiments. Cell Counting Kit-8 (CCK-8) assay, Western blot analysis, flow cytometry, and tunnel staining were used to detect the effect of ART in promoting fibroblast apoptosis and delve into its possible signaling pathway. RESULTS: The results of hematoxylin-eosin (HE) staining suggested that the number of fibroblasts decreased with the increase in ART concentration. The results of Masson staining were similar, with the increase in concentration, the collagen content decreased. Immunohistochemical results showed that the expression of endoplasmic reticulum stress (ERS) characteristic proteins 78 kDa glucose-regulated protein 78 (GRP78) and C/EBP homologous protein (CHOP) increased in a concentration-dependent manner. CCK-8 results suggested that ART could inhibit fibroblast viability in a concentration- and time-dependent manner. Results of flow cytometry, tunnel staining, and Western blot suggested the apoptosis of fibroblasts occurred after ART treatment. Cells with caspase inhibitors were treated, and apoptotic proteins cleaved-poly ADP-ribose polymerase (cleaved PARP) and cleaved-caspase 3 were detected; the results showed that the apoptotic effect of ART was reduced. The expressions of ERS-related protein CHOP and apoptosis-related protein Bax were upregulated, while the expression of Bcl-2 was downregulated, and the ratio of Bax/Bcl-2 increased in a concentration-dependent manner. Continuous detection of PRKR-like ER kinase (PERK) pathway-related proteins showed that the expression of p-PERK and phosphorylating eukaryotic initiation factor 2α (p-eIF2α) increased in a time-dependent and concentration-dependent manner. PERK pathway inhibitors could partially inhibit ART-mediated apoptosis through PERK pathway. CONCLUSIONS: ART can promote fibroblast apoptosis through PERK pathway, a classical ERS pathway, and thus prevent fibrosis in the surgical area after joint surgery.


Assuntos
Artesunato/uso terapêutico , Artropatias/etiologia , Artropatias/prevenção & controle , Traumatismos do Joelho/complicações , Articulação do Joelho/cirurgia , eIF-2 Quinase/fisiologia , Animais , Artesunato/farmacologia , Células Cultivadas , Fibroblastos/efeitos dos fármacos , Humanos , Coelhos , Transdução de Sinais/efeitos dos fármacos , Aderências Teciduais/etiologia , Aderências Teciduais/prevenção & controle
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