scholarly journals A Patient with Fatal Necrotizing Fasciitis following the Use of Intra-Articular Sodium Hyaluronate Injections: A Case Report

2013 ◽  
Vol 2013 ◽  
pp. 1-4 ◽  
Author(s):  
Shanti Virupannavar ◽  
Carla Guggenheim

Introduction.Osteoarthritis, a degenerative joint disease, is a key cause of disability around the world and an ever-growing public health concern. Intra-articular hyaluronic acid viscosupplementation is used as a conservative option for osteoarthritis knee pain relief (McArthur et al., 2012; Hootman and Helmick, 2006; Huang el al., 2011). In general, the literature has shown an excellent safety profile for this treatment modality (McArthur et al., 2012; Clegg et al., 2013; Hammesfahr et al., 2003; Neustadt et al., 2005; Cohen et al., 2008; Neustadt, 2003; Jüni et al., 2007; Peterson and Hodler, 2011).Case Presentation. In this report, we describe a case of a woman who had received multiple sodium hyaluronate injections and developed severe necrotizing fasciitis near the injection site.Conclusion.We recommend that clear guidelines for clean technique be put in place for use with sodium hyaluronate injections and consideration of full sterile technique in immunosuppressed patients.

2008 ◽  
Vol 60 (1) ◽  
pp. 93-102 ◽  
Author(s):  
G. Gonçalves ◽  
E.G. Melo ◽  
M.G. Gomes ◽  
V.A. Nunes ◽  
C.M.F. Rezende

Samples of articular cartilage of femur, tibia and patella of 15 dogs with experimentally induced degenerative joint disease (DJD) were microscopically analyzed. Animals were distributed into three groups (n=5): the control group received no medication; the second group was treated with chondroitin sulfate and the third received sodium hyaluronate. Samples were processed and stained with HE and toluidine blue for morphological evaluation. The metabolic and proliferative activity of the chondrocytes was evaluated by the measurement of nucleolar organizer regions (NORs) after impregnation by silver nitrate. Significant differences were not observed (P>0.05) in the morphology among the groups, however, the group treated with sodium hyaluronate had a higher score suggesting a trend to a greater severity of the lesions. Significant differences were not observed (P>0.05) in the measurement of NORs, cells and NORs/cells among the groups. Although differences were not significant, sodium hyaluronate group showed higher NOR and cell counts which suggested an increase of the proliferation rate of chondrocytes. In addition, a higher NOR/cell ratio in the group treated with chondroitin sulfate suggested that this drug may have stimulated the metabolic activity of the chondrocytes, minimizing the lesions resulting from DJD.


2017 ◽  
Vol 2017 ◽  
pp. 1-4
Author(s):  
J. Ribeiras Cabral ◽  
R. Henriques ◽  
J. Arvela Matoso ◽  
S. Martins ◽  
M. Sarmento

Introduction.Osteochondritis dissecans (OCD) of the capitellum is a localized disorder of the subchondral bone, in a region with limited healing capacity. Although its aetiology is still unknown, it has been associated with repetitive microtrauma. The natural history of this disease involves the evolution for degenerative joint disease in approximately half of the patients, with early identification and treatment being critical to optimizing the outcome.Case Presentation.We present a rare case in our practice, illustrating a capitellar OCD in a fifteen-year-old White male without an identified cause of repetitive microtrauma.Conclusion.In this case prompt diagnosis and arthroscopic-assisted treatment led to a successful result.


Author(s):  
Shriram Sampath ◽  
J. K. Giriraj Harshavardhan

<p class="abstract"><strong>Background:</strong> Osteoarthritis of knee is a chronic degenerative joint disease which leads to pain, swelling, stiffness and decreased quality of life. The purpose of this study was to assess the effect of intra-articular steroid injection for osteoarthritis knee by using knee society score (KSS) and visual analog scale (VAS).</p><p class="abstract"><strong>Methods:</strong> A prospective study of 38 patients (44 knees) diagnosed with osteoarthritis of knee were given 80mg of intra-articular methylprednisolone injection. The outcome was assessed using KSS and VAS before the injection and 3 months post injection.<strong></strong></p><p class="abstract"><strong>Results:</strong> The mean VAS improved 3 months post injection whereas there was no improvement in the mean KSS. The scores of VAS 3 months post injection were statistically significant whereas the KSS scores were statistically insignificant compared with the pre injection values.</p><p class="abstract"><strong>Conclusions:</strong> Intra-articular steroid injection for osteoarthritis of knee produces significant pain relief for most patients even in severe cases but this not translate to better functional outcomes.</p>


Author(s):  
Neeraj Srivastava ◽  
Shameem A. Khan ◽  
Vivek Kumar

Background: Degenerative joint disease will afflict most of the people if they live long enough. The majority of patients with osteoarthritis present to orthopaedic surgeons seeking relief of pain and associated restoration of function. Various intraarticular and periarticular structures may be the cause of pain. Improvement in osteoarthritis by arthroscopic lavage and debridement is seen due to various mechanisms.Methods: In a prospective study from July 2016 to December 2018, 35 patients with primary osteoarthritis knee were assessed for effectiveness of arthroscopic lavage and debridement in relieving symptoms of osteoarthritis of knee and to determine the indications of arthroscopy in osteoarthritis of knee. Assessment was done using variables as age of the patient, body mass index, varus deformity, radiographic grading and arthroscopic grading.Results: A declining trend was seen on follow up over time; 91.4% excellent to good results seen at one month follow up, 76.1% at six months, 49.93% at twelve months, 37.5%, at eighteen months, 23.07% at twenty-four months and 28.5% at thirty months. Results at six month follow up when compared, were better for age less than 50 years (88.8% Vs 73.1% in >50 years age), normal weight patients with BMI 18.5 to 25(94.5% Vs 58.5% in overweight), varus angulation <100(93.1% Vs 0% in >100), radiological grade I and II (95-100% Vs 45-50% in grade III and IV) and arthroscopic grade I and II (94-100% Vs 0-77% in grade III and IV).Conclusions: Arthroscopic lavage and debridement is an effective method of treatment for osteoarthritis knee in patients with grade I and grade II osteoarthritis having symptoms of pain and locking due to loose bodies or degenerative meniscal tears.


2010 ◽  
Vol 3 ◽  
pp. 117954411000300 ◽  
Author(s):  
A. Migliore ◽  
F. Giovannangeli ◽  
M. Granata ◽  
B. Laganà

Background Osteoarthritis (OA) is a chronic degenerative joint disease that is a clinically and economically important disease. The increased prevalence of OA with aging, coupled to the demographics of aging populations, make OA a high priority health care problem. Viscosupplementation (VS) is a well-established treatment option in knee OA that is included in the professional guidelines for treatment of this joint disease, and could potentially provide a useful alternative in treating such patients with painful OA. Theoretically VS is an approach that should apply to all synovial joints. Objectives The aim of this review is to assess the efficacy and safety of viscosupplementation with Hylan GF-20 (Synvisc®) in the management of joint pain in osteoarthritis. Methods The following databases were searched: Medline, Database of Abstract on Reviews and Effectiveness, Cochrane Database of Systematic Reviews. Furthermore, the lists of references of retrieved publications were manually checked for additional references. The search terms Review, Viscosupplementation, Osteoarthritis, Hyaluronic acid, Hyaluronan, Sodium Hyaluronate, Hylan GF-20, Synvisc, intra-articular injection were used to identify all studies relating to the use of Synvisc® viscosupplementation therapy in OA. Results Hylan GF-20 is a safe and effective treatment for decreasing pain and improving function in patients suffering from knee and hip OA but new evidences are emerging for its use in other joints.


2013 ◽  
Vol 18 (5) ◽  
pp. 1-10 ◽  
Author(s):  
Charles N. Brooks ◽  
James B. Talmage

Abstract Meniscal tears and osteoarthritis (osteoarthrosis, degenerative arthritis, or degenerative joint disease) are two of the most common conditions involving the knee. This article includes definitions of apportionment and causes; presents a case report of initial and recurrent tears of the medial meniscus plus osteoarthritis (OA) in the medial compartment of the knee; and addresses questions regarding apportionment. The authors, experienced impairment raters who are knowledgeable regarding the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), show that, when instructions on impairment rating are incomplete, unclear, or inconsistent, interrater reliability diminishes (different physicians may derive different impairment estimates). Accurate apportionment of impairment is a demanding task that requires detailed knowledge of causation for the conditions in question; the mechanisms of injury or extent of exposures; prior and current symptoms, functional status, physical findings, and clinical study results; and use of the appropriate edition of the AMA Guides. Sometimes the available data are incomplete, requiring the rating physician to make assumptions. However, if those assumptions are reasonable and consistent with the medical literature and facts of the case, if the causation analysis is plausible, and if the examiner follows impairment rating instructions in the AMA Guides (or at least uses a rational and hence defensible method when instructions are suboptimal), the resulting apportionment should be credible.


2000 ◽  
Vol 81 (3B) ◽  
pp. s67-s72
Author(s):  
Victoria A. Brander ◽  
Darryl L. Kaelin ◽  
Terry H. Oh ◽  
Peter A.C. Lim

1994 ◽  
Vol 07 (03) ◽  
pp. 129-135 ◽  
Author(s):  
C.W. Miller ◽  
P.W. Morgan

SummaryTwenty-four dogs (27 limbs) were evaluated after surgery for correction of forelimb angular limb deformities. Partial ulnar ostectomies or definitive corrective osteotomies were performed depending upon the age of the dog. According to owner assessment nine of fourteen limbs were considered functionally good, or excellent, after partial ulnar ostectomies. Younger dogs appeared to have better functional results after dynamic correction with the mean age at surgery of dogs with good to excellent results being 6.5 months contrasted to the mean age at surgery of dogs with fair to poor results being 9.75 months. Ten of fourteen limbs were considered functionally good or excellent after definitive corrective osteotomy. One dog had definitive osteotomy after partial ulnar ostectomy in order to further correct a residual angular deformity. However, 58% of the limbs with radiographic follow-up had signs of degenerative joint disease (DJD). There were not significant differences between neither degree of angulation remaining after surgery and the functional result nor the degree of angulation remaining after surgery and the development of DJD. A prospective study is warranted to more objectively assess the efficacy of surgical correction of angular limb deformities in dogs.Twenty-four dogs were evaluated after surgery for correction of forelimb angular limb deformities. The results are described.


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