A Comparison of Two Indices for Ulnar Translation and Carpal Height in the Rheumatoid Wrist

2004 ◽  
Vol 29 (2) ◽  
pp. 144-147 ◽  
Author(s):  
N. BORISCH ◽  
K. LERCH ◽  
J. GRIFKA ◽  
P. HAUSSMANN
Keyword(s):  
Rheumatoid Arthritis ◽  
False Negative ◽  
Hand Surgery ◽  
X Rays ◽  
Joint Surgery ◽  
Rheumatoid Wrist ◽  
Two Indices ◽  
Radiolunate Arthrodesis ◽  
Carpal Height

The indices for ulnar translation described by Chamay et al. (1983 , Annales de Chirurgie de la Main, Vol. 2, pp. 5–17), and Bouman et al. (1994 , Journal of Hand Surgery Vol. 19B, pp. 325–329), and for carpal height described by Youm et al. (1978 , Journal of Bone and Joint Surgery, Vol. 40A, pp. 423–431) and Bouman et al. (1994) were compared in pre- and postoperative wrist X-rays of 91 patients with rheumatoid arthritis undergoing radiolunate arthrodesis. Both indices described by Bouman had a higher applicability and sensitivity than the Chamay and Youm indices and are recommended for use with the rheumatoid wrist. However false-negative values may result when the Bouman index for ulnar translation is used to follow up radiolunate arthrodesis.

Radiolunate Arthrodesis in the Rheumatoid Wrist: A Retrospective Clinical and Radiological Longterm Follow-Up

2002 ◽  
Vol 27 (1) ◽  
pp. 61-72 ◽  
Author(s):  
N. BORISCH ◽  
P. HAUSSMANN
Keyword(s):  
Retrospective Study ◽  
Joint Space ◽  
Carpal Collapse ◽  
Radiological Results ◽  
Rheumatoid Wrist ◽  
Clinical And Radiological Results ◽  
Radiolunate Arthrodesis ◽  
Midcarpal Joint ◽  
Carpal Height

A retrospective study was performed to investigate the clinical and radiological results of radiolunate arthrodesis in the rheumatoid wrist. Ninety-one wrists in 78 patients were assessed at a mean follow-up of 60 months. Most patients were pain-free and content with the overall result. In 68 wrists the carpus had been repositioned or maintained in neutral or slightly ulnar alignment and no further translation occurred. Midcarpal dislocation occured in ten and midcarpal rotation in 13 wrists. The midcarpal joint underwent further arthritic destruction in 34 wrists and secondary arthrosis in 32 wrists. In 25 wrists the midcarpal joint space remained unchanged. Radiolunate arthrodesis can successfully be performed in wrists even with advanced destruction. In cases with fixed carpal collapse, anatomical repositioning of the lunate and restoration of carpal height should not be attempted as this causes midcarpal dislocation or rotation or precipitates secondary arthrosis.

MRI in early rheumatoid arthritis: synovitis and bone marrow oedema are independent predictors of subsequent radiographic progression

2010 ◽  
Vol 70 (3) ◽  
pp. 428-433 ◽  
Author(s):  
Pernille Bøyesen ◽  
Espen A Haavardsholm ◽  
Mikkel Østergaard ◽  
Désirée van der Heijde ◽  
Sølve Sesseng ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Bone Marrow ◽  
Early Rheumatoid Arthritis ◽  
Radiographic Progression ◽  
Bone Marrow Oedema ◽  
Tender Joint Count ◽  
X Rays ◽  
Tender Joint ◽  
Reactive Protein

ObjectivesTo determine whether MRI and conventional (clinical and laboratory) measures of inflammation can predict 3-year radiographic changes measured by the van der Heijde Sharp score in patients with early rheumatoid arthritis (RA).Methods55 patients with RA with disease duration <1 year participated in this 3-year follow-up study. Patients were evaluated at baseline, 3, 6, 12 and 36 months by swollen and tender joint count, disease activity score based on 28-joint count, erythrocyte sedimentation rate (ESR), C reactive protein, MRI measures of synovitis, bone marrow oedema and tenosynovitis of the dominant wrist, as well as conventional x-rays of the hands and wrists.ResultsAll measures of inflammation decreased during the follow-up period. ESR, MRI synovitis and MRI bone marrow oedema were independent predictors of 3-year radiographic progression adjusted for age, sex and anti-citrullinated protein antibodies. The 1-year cumulative measures of MRI synovitis and bone marrow oedema provided an improved explanation of variation (adjusted R2) in radiographic change compared with the baseline MRI values (adjusted R2=0.32 and 0.20 vs 0.11 and 0.04, respectively).ConclusionsBoth baseline and 1-year cumulative measures of MRI synovitis and bone marrow oedema independently predicted 3-year radiographic progression. These results confirm that MRI synovitis and MRI bone marrow oedema precede radiographic progression in patients with early RA.

The Wrightington Classification of Rheumatoid Wrist X-Rays: A Guide to Surgical Management

1989 ◽  
Vol 14 (4) ◽  
pp. 451-455
Author(s):  
S. P. HODGSON ◽  
J. K. STANLEY ◽  
A. MUIRHEAD
Keyword(s):  
Rheumatoid Arthritis ◽  
Surgical Management ◽  
X Rays ◽  
Rheumatoid Disease ◽  
Rheumatoid Wrist ◽  
Practical Guidance ◽  
Surgical Choices ◽  
Results Of Surgery

We have reviewed the pre-operative radiological appearances, the type of operation performed and the results of surgery of 234 wrists in 179 patients with rheumatoid arthritis. Based on this, a classification of X-rays of the rheumatoid wrist is described. It is designed to provide practical guidance to the surgeon who is planning surgery in a patient with rheumatoid disease. The surgical choices at each stage of the disease are briefly discussed.

Isoelastic Cementless Total Hip Replacement in Rheumatoid Arthritis. Long-Term Results

1992 ◽  
Vol 2 (2) ◽  
pp. 43-46
Author(s):  
U. Fusco ◽  
R. Capelli ◽  
A. Avai ◽  
M. Gerundini ◽  
L. Colombini ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Hip Replacement ◽  
The Other ◽  
Long Term Results ◽  
X Rays ◽  
X Ray ◽  
The Mean ◽  
Cementless Total Hip Replacement

Between 1980 and 1987 we have implanted 46 isoelastic cementless THR in 40 patients affected with rheumatoid arthritis. We have reviewed 38 hips clinically and by X-ray. The mean follow-up was 8,5 years. Harris hip scores ranged from 30.6 preoperatively to 73,4 post-operatively when reviewed. While on the other hand Merle D'Aubigné hip scores ranged from 7,06 pre-operatively to 15,59 post-operatively. All patients have been satisfied, and X-rays showed an improvement for both Charnely and Gruen X-ray score.

Fibrous Stabilization of the Rheumatoid Wrist

1995 ◽  
Vol 20 (2) ◽  
pp. 143-145 ◽  
Author(s):  
A. BIYANI ◽  
A. J. M. SIMISON
Keyword(s):  
Rheumatoid Arthritis ◽  
Important Determinant ◽  
Deep Infection ◽  
Wrist Movement ◽  
Range Of Movement ◽  
The Poor ◽  
Rheumatoid Wrist

19 patients (mean age 59.8 years) underwent fibrous stabilization of the wrist for rheumatoid arthritis. 17 patients were reviewed after a mean follow up of 24.5 months (range 13–40 months). There were four excellent, 11 good, and two poor results according to modified Koka and D’Arcy (1989) criteria. The poor results were due to deep infection in one patient and an unbalanced wrist due to ruptured radial extensors in another. The pre-operative range of wrist movement was an important determinant of the frequency of radio-carpal and/or mid-carpal fusion and the final post-operative range of movement.

scholarly journals Subsidence in Collarless Corail Hip Replacement

2015 ◽  
Vol 9 (1) ◽  
pp. 194-197 ◽  
Author(s):  
Veenesh Selvaratnam ◽  
Vishwanath Shetty ◽  
Vishal Sahni
Keyword(s):  
Rheumatoid Arthritis ◽  
Revision Surgery ◽  
Hip Replacement ◽  
X Rays ◽  
Indications For Surgery ◽  
Retrospective Case ◽  
Female Ratio ◽  
X Ray ◽  
Male To Female

The purpose of this study was to assess whether subsidence occurs in collarless Corail hip replacement (CCHR) and to ascertain the extent and timing of subsidence if present. Retrospective case notes analysis was performed. Sixty eight patients who had CCHR were identified from our database. Male to female ratio was 32:36. Their mean age was 74.2 years (range 37-95 years). Indications for surgery were osteoarthritis in 64 (94%) patients, rheumatoid arthritis in two (3%) patients and avascular necrosis in two (3%) patients. Subsidence was measured at 6 weeks, 6 months and 1 year post-op compared to initial post-op x-rays. At 6 weeks x-ray 21 patients did not have any subsidence, 18 patients had 1 millimeter (mm) subsidence, 10 patients had 2mms subsidence, 4 patients had 3mms subsidence, 5 patients had 4mms subsidence, 1 patient had 5mms subsidence, 4 patients had 6 mms subsidence and 1 patient each had subsidence of 7mms, 9mms, 11mms, 13mms and 26 mms respectively. When compared with 6 months x-rays only 2 patients had a further subsidence of 2mms while another patient had 3mms subsidence. No further subsidence occurred at 1 year follow up x-rays. One patient had revision surgery due to symptomatic subsidence (29mms) at 6 months follow up. Subsidence does occur in the first 6 weeks in collarless Corail hip replacement, and to a lesser extent until 6 months postoperatively, but does not progress further.

scholarly journals Assessing spontaneous passage of prophylactic pancreatic duct stents by X-ray: is a radiology report adequate?

2019 ◽  
Vol 12 ◽  
pp. 263177451986289
Author(s):  
Justin Loloi ◽  
Jacob S. Lipkin ◽  
Eileen M. Gagliardi ◽  
John M. Levenick
Keyword(s):  
Pancreatic Duct ◽  
False Negative ◽  
Retrospective Chart Review ◽  
Pancreatic Ducts ◽  
X Rays ◽  
X Ray ◽  
Radiology Reports ◽  
Spontaneous Passage ◽  
Pancreatic Duct Stent

Background: Pancreatic duct stents are frequently placed for prophylaxis of post-endoscopic retrograde cholangiopancreatography pancreatitis. Because of concern for possible secondary ductal changes from a retained stent, these stents need to be monitored and removed if retained. Usually an abdominal X-ray is performed to assess retained stent, and if present, an esophagogastroduodenoscopy is performed to remove the stent. Limited data is published on false-negative radiology reports for spontaneous passage of stents. Methods: Using an Institutional Review Board–approved stent log, a retrospective chart review of all pancreatic duct stents placed at our institution from 2008 to 2014 was performed. Results: A total of 856 pancreatic duct stents were placed during the study period. Of these, 435 (50.8%) were prophylactic stents and 421 (49.2%) were therapeutic. Complete follow-up data were available in 426 (97.9%) patients with prophylactic stents. Six patients (1.4%) were lost to follow up and three (0.7%) expired prior to removal. In all, 283 (66%) had follow-up imaging, with 167 (39.2%) having the official radiology read with no retained pancreatic duct stent in place. Eight of these cases were “false-negative” radiology interpretation (4.8% of cases read as “no stent,” NNH = 20). The stent was found either by review of image by an endoscopist or incidental stent discovery during a follow-up procedure. Conclusion: Radiologist interpretation of abdominal X-rays to assess spontaneous passage of prophylactic pancreatic ducts stents resulted in a false-negative interpretation in approximately 5% of cases. Independent review of the images by the endoscopist may be beneficial given unfamiliarity of these stents by radiologists.

Radiological Evolution of the Rheumatoid Wrist after Radio-Lunate Arthrodesis

1995 ◽  
Vol 20 (2) ◽  
pp. 146-154 ◽  
Author(s):  
D. DELLA SANTA ◽  
A. CHAMAY
Keyword(s):  
Rheumatoid Arthritis ◽  
Carpal Instability ◽  
Advanced Stage ◽  
Middle Stage ◽  
Rheumatoid Wrist ◽  
Established Technique

Radio-lunate arthrodesis of the rheumatoid wrist is an established technique which has been in use for more than 12 years. The evolution of 26 operated wrists and 20 non-operated wrists has been studied with a mean follow-up of 5 years. The results show that although radio-lunate arthrodesis can prevent dislocation of an unstable wrist, it cannot prevent deterioration. Collapse, ulnar translation, tilt of the lunate, and the inter-carpal instability continued with time, whether the wrists were operated on or not. The speed of deterioration was dependent on the type of rheumatoid arthritis and is faster in the disintegration type than in the osteoarthritis or the ankylosis type. The technique is applicable to the osteoarthritis type of rheumatoid arthritis, in the middle stage (2 to 4a according to the Larsen-Alnot classification). At that stage, the ankylosis type and the disintegration type, and the osteoarthritis type at an advanced stage, are better treated by total arthrodesis or total prosthetic arthroplasty.

scholarly journals AB0181 COULD TITERS OF ACPA PREDICT THE SEVERITY OF RHEUMATOID ARTHRITIS, ANALYSIS OF DATA DURING A 3-YEARS FOLLOW-UP?

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1390.3-1390
Author(s):  
R. Shpatz ◽  
Y. Braun-Moscovici ◽  
A. Balbir-Gurman
Keyword(s):  
Rheumatoid Arthritis ◽  
Smoking History ◽  
X Rays ◽  
Negative Group ◽  
Biological Dmards ◽  
Bone Erosions ◽  
Significant Difference ◽  
Group A ◽  
Group B

Background:Rheumatoid Factor (RF) and/or Anti Citrullinated Protein Antibodies (ACPA). Are included in classification criteria of Rheumatoid arthritis (RA); their presence correlates with RA severity. The influence of ACPA titer on RA course and outcome in long-term follow-up is limited.Objectives:To check the correlation between ACPA titers at the time of RA diagnosis to RA features and severity during 3 years follow-up.Methods:We performed a retrospective study on patients treated at our institution during the years 2006-2015 with known ACPA titers at RA diagnosis, who completed at least 3 years of follow-up. Patients (pts) were divided according to ACPA titer: A - seronegative (<15 U/ml), B - weak positive (15-49 U/ml) and C - strong positive (>50 U/ml) with subdivision to C-1 - moderately high (50-99 U/ml), C-2 - high (100-299 U/ml) and C-3 - very high (>300 U/ml). Patient’s data including DAS28, bone erosion on hands and/or foot X-rays, treatments with corticosteroids and DMARDs and hospitalizations due to flares. Chi-Square and Mann-Whitney method were used for statistical analysis; p<0.05 was considered statistically significant.Results:Among 850 pts with RA, 133 (mean age 55 years, 65% female) met the inclusion criteria: group A: 55 (42%) pts, group B: 18 (13%) pts, group C: 60 (45%) pts [C1- 10 pts, C2-21 pts and C3-29 pts]. Most of the characteristics were similar between the groups (including C subgroups). There were no significant differences between the groups in terms of tender and/or swollen joints, acute phase reactants, bone erosions, need for corticosteroids or DMARDs, hospitalizations, number of DMARDs and number of biologicals. There was significant correlation between ACPA titers and positive RF (p<0.0001); it was consistent in all patients groups. Higher ACPA titers were associated with greater percentage of patients with positive RF. The percentage of male was higher in subgroup with highest ACPA: 25% in ACPA-negative group compared to 45% in the strong positive group (group C-3); it correlated with current or ever smoking. DAS28 was high in all groups without significant difference; over 80% of patients had DAS28 higher than 3.2 and 50-60% had a value higher than 5.2. During the 3-year follow-up, 95% of pts received prednisone with an average daily dose of 14.8 mg (SD, 8.9 mg), 50% of pts received more than 15 mg prednisone daily. The average number of synthetic and biological DMARDs was 2.5 (SD 0.73) and 0.56 (SD 0.84) per patient; methotrexate was prescribed in 89% of cases. There were no correlations between negative (group A) or positive ACPA (group B and C) and the variables defined as representing the severity of RA: the percentage of pts with DAS28>3.2 (p=0.136) and DAS28>5.2 (p=0.774). The percentage of pts receiving prednisone dosage higher than 15 mg/day (p=0.828) or at least two synthetic (p=0.846) or biological DMARDs (p=0.668) or their combination (p=0.770) were not significantly different. There was no correlation between ACPA titer and bone erosions (87 pts, p=0.883) during 3 years of follow-up. Finally, there was no correlation between ACPA titers and the number of hospital admissions (p=0.951).Conclusion:In our cohort of RA pts, higher ACPA titers were observed in males with smoking history. Higher ANCA titers correlated with RF positivity but were not identified as predictive factor for RA severity.Disclosure of Interests:Rotem Shpatz: None declared, Yolanda Braun-Moscovici: None declared, Alexandra Balbir-Gurman Consultant of: Novartis

scholarly journals Total elbow replacement with the Coonrad-Morrey prosthesis: our medium to long-term results

2012 ◽  
Vol 94 (3) ◽  
pp. 189-192 ◽  
Author(s):  
R Maheshwari ◽  
S Vaziri ◽  
RH Helm
Keyword(s):  
Rheumatoid Arthritis ◽  
The Other ◽  
Long Term Results ◽  
X Rays ◽  
Total Elbow Replacement ◽  
Ulnar Nerve Palsy ◽  
The Mean ◽  
Elbow Replacement

INTRODUCTION Semiconstrained total elbow replacement is now a well recognised and reliable surgical option for advanced elbow disease, mainly rheumatoid arthritis. METHODS We report a retrospective analysis of 31 primary total elbow replacements in 28 patients with a mean follow-up duration of 55 months. The mean age of the patients was 65 years. The indications included 27 cases of rheumatoid arthritis, 3 fractures and 1 case of osteoarthritis. Twenty-one elbows in nineteen patients were assessed using the Mayo elbow performance score (MEPS) in a special follow-up clinic. In the other nine patients (ten elbows), the assessment was carried out with case notes and x-rays. RESULTS The mean pre-operative MEPS in the 21 elbows recalled was 40. This improved to 89 post-operatively (range: 55-100). Sixteen of the twenty-one elbows were considered excellent, two good, two fair and one poor. The range of movement was recorded in eight of the other ten elbows and the mean was 98°. At the last follow-up visit, x-rays were normal in 23 elbows although the ulnar component was loose in 3, the humeral component loose in 2. There were also two cases of nonunion of the medial epicondyle and one patient had mild heterotopic ossification. Complications included one infection, which needed irrigation and debridement with a satisfactory final result, and two cases of ulnar nerve palsy/neurapraxia. Two elbows were considered failures due to severe pain caused by prosthetic loosening. These were referred for revision surgery. CONCLUSIONS Excellent pain relief and good function can be achieved in the medium and long term with the Coonrad-Morrey semiconstrained total elbow replacement prosthesis in patients with severe destructive elbow arthropathy.

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