Pathomorphology of articular cartilage of the knee and ankle joints in experimental repair of postresection tibial defect using the Ilizarov method and cement spacer

AbstractPeriprosthetic joint infection is the most common reason for a failed TKA, with a septic TKA reported rate of 1 to 4% of primary TKA patients. Septic TKA has a various number of treatment options which include chronic-suppressive antibiotics, irrigation and debridement, single or staged revision arthroplasty. The goal is to eradicate the periprosthetic joint infection and reimplant a sterile and fully functional total knee prosthesis. In case the infection becomes uncontrollable, there is only one option to eradicate the infection: knee arthrodesis or above-knee amputation.We report the case of a 63-year-old patient who in 2009 underwent TKA, the 1 year follow-up showed periprosthetic infection. At first stage, the prosthetic implants were removed and a solid cement spacer was shaped to occupy the remaining space. In 2011, after achieving complete clinical and biological remission of the infection, the cement spacer was removed and LCCK revision prosthesis was inserted.In 2013 reinfection occurred leading to removal of the prosthetic implants and reinsertion of an antibiotic impregnated cement spacer.Since the patient suffered significant bone loss and the local conditions were unfavorable, being prone to infection, there were 2 options to evaluate: knee arthrodesis or above knee amputation. We chose knee arthrodesis using Ilizarov external fixation technique.Many surgical techniques are available to achieve knee arthrodesis: internal fixation with plates or intramedullary nails and external fixation. The Ilizarov method is a very effective technique that could be taken into consideration when knee arthrodesis is required.

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MRI evaluation with severity of ankle osteoarthritis

Foot & Ankle Orthopaedics ◽

10.1177/2473011417s000295 ◽

2017 ◽

Vol 2 (3) ◽

pp. 2473011417S0002

Author(s):

Hiroyuki Mitsui ◽

Takaaki Hirano ◽

Akiyama Yui ◽

Shingo Maeda ◽

Hisateru Niki

Keyword(s):

Articular Cartilage ◽

Evaluation Method ◽

Articular Surface ◽

Medial Malleolus ◽

Mri Findings ◽

Ankle Osteoarthritis ◽

Talocrural Joint ◽

X Ray ◽

Ankle Joints ◽

The Relationship

Category: Ankle Arthritis Introduction/Purpose: Takakura-Tanaka classification is effective as an X-ray evaluation method for determining the severity of and treatment strategy for ankle osteoarthritis (OA). Concerning OA, MRI is gaining attention as a tool for examining the condition of the articular cartilage over X-ray findings. However, there are few reports on the relationship between MRI and X- ray findings in ankle joints. We assessed MRI findings of ankle OA at each stage of Takakura-Tanaka classification to investigate the effects of bone and articular cartilage. Methods: We studied the localization of Bone Marrow Edema (BME) partitioned articular surface by MRI in 22 regions at the talocrural, talocalcaneal, talonavicular, and calcaneocuboid joints of 46 feet of 45 patients who had a diagnosis of ankle OA in our hospital. Furthermore, we compared the radiological findings with the localization of BME. Results: By MRI, the area where BME was seen is located in the anterior medial part of the talocrural joint. Pointedly, 60% of BME was confirmed on the tibial side of the talocrural joint. In addition, as the Takakura-Tanaka classification advanced, the identification of BME tended to increase on the anterior of the talus and the medial malleolus articular surface. Conclusion: We found on MRI that the localization of BME was identified by Takakura-Tanaka classification in osteoarthritis of the foot. On the other hand, there are some cases of OA without BME that were identified by X-ray in this study. In the future, there is a possibility that the severity of OA can be classified into more inclusive classifications by MRI. We intend to combine the severity of ankle OA with MRI findings and Takakura-Tanaka classification together.

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Histomorphometric changes in the synovial membrane of the knee joint in combined use of the Ilizarov non-free bone plasty and the Masquelet technique (experimental study)

Genij Ortopedii ◽

10.18019/1028-4427-2021-27-2-249-253 ◽

2021 ◽

Vol 27 (2) ◽

pp. 249-253

Author(s):

T.A. Stupina ◽

◽

O.V. Diuriagina ◽

D.S. Mokhovikov ◽

Yu.А. Stupina ◽

...

Keyword(s):

Knee Joint ◽

Synovial Membrane ◽

Structural Changes ◽

Bone Defects ◽

Long Bone ◽

Segment Length ◽

Ilizarov Method ◽

Cement Spacer ◽

Masquelet Technique ◽

Functional Complex

Relevance Defects of long bones result in anatomical and functional complex of pathologies in the entire limb. There are few fundamental studies of tissues adjacent to bone defects by using different technologies for management of long bone defects. Purpose To study the structural changes in the synovial membrane of the knee joint by modelling the conditions for tibial defect management using the Ilizarov method of non-free bone plasty in combination with the Masquelet technique. Materials and methods The conditions of post-resection defect of the tibia (from 15 % of the segment length) by lengthening the distal fragment were modeled in ten mongrel dogs. Temporarily, for 30 days, a cement spacer was implanted into the post-resection defect gap. Upon its removal, the intermediate fragment in the lower third of the leg was transported at a rate of 1 mm in 4 steps until complete contact of the bone fragments. Histomorphometric studies of the synovium were carried out at the observation stages at the end of the fixation period (60 days) and after removing the apparatus (30 days). Results Two types of changes were revealed in the synovium: changes of a destructive nature without synovitis (30 % of cases) and with signs of synovitis (70 % of cases, 3 dogs had mild synovitis and 4 dogs had severe synovitis). Changes in the microvessels of the synovial membrane in synovitis indicated impaired microcirculation, high activity of angiogenesis and the development of hypervascularization. Conclusion Experimental management of the tibial bone defect by Ilizarov method in combination with the Masquelet technique revealed signs of synovitis of the knee joint in 70 % of cases using histophorphometry methods.

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Cell and matrix morphology in articular cartilage from adult human knee and ankle joints suggests depth-associated adaptations to biomechanical and anatomical roles

Osteoarthritis and Cartilage ◽

10.1016/j.joca.2013.09.011 ◽

2013 ◽

Vol 21 (12) ◽

pp. 1904-1912 ◽

Cited By ~ 29

Author(s):

T.M. Quinn ◽

H.-J. Häuselmann ◽

N. Shintani ◽

E.B. Hunziker

Keyword(s):

Articular Cartilage ◽

Human Knee ◽

Adult Human ◽

Ankle Joints ◽

Matrix Morphology

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Topographical and sex variations in theT2relaxation times of articular cartilage in the ankle joints of healthy young adults using 3.0T MRI

Journal of Magnetic Resonance Imaging ◽

10.1002/jmri.25004 ◽

2015 ◽

Vol 43 (2) ◽

pp. 455-462 ◽

Cited By ~ 5

Author(s):

Youngsik Lim ◽

Jang Gyu Cha ◽

Jisook Yi ◽

Sung Jin Kang ◽

Young Koo Lee ◽

...

Keyword(s):

Young Adults ◽

Articular Cartilage ◽

Ankle Joints ◽

3.0T Mri

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Minimal contribution of cell-bound antibodies to the immunoscintigraphy of inflamed joints with 99mTc-anti-CD4 monoclonal antibodies

Nuklearmedizin ◽

10.1055/s-0038-1623888 ◽

2002 ◽

Vol 41 (03) ◽

pp. 129-134 ◽

Cited By ~ 4

Author(s):

A. Wolski ◽

E. Palombo-Kinne ◽

F. Wolf ◽

F. Emmrich ◽

W. Becker ◽

...

Keyword(s):

T Cells ◽

Monoclonal Antibodies ◽

Synovial Membrane ◽

In Vitro Release ◽

Peritoneal Macrophages ◽

Lymphoid Organs ◽

Whole Body ◽

Free Form ◽

Ankle Joints

Summary Aim: The cellular joint infiltrate in rheumatoid arthritis patients is rich in CD4-positive T-helper lymphocytes and macrophages, rendering anti-CD4 monoclonal antibodies (mAbs) suitable for specific immunoscintigraphy of human/ experimental arthritis. Following intravenous injection, however, mAbs are present both in the free form and bound to CD4-positive, circulating monocytes and T-cells. Thus, the present study aimed at analyzing the relative contribution of the free and the cell-bound component to the imaging of inflamed joints in experimental adjuvant arthritis (AA). Methods: AA rat peritoneal macrophages or lymph node T-cells were incubated in vitro with saturating amounts of 99mTc-anti-CD4 mAb (W3/25) and injected i.v. into rats with AA. Results: In vitro release of 99mTc-anti-CD4 mAb from the cells was limited (on average 1.57%/h for macrophages and 0.84%/h for T-cells). Following i.v. injection, whole body/joint scans and tissue measurements showed only negligible accumulation of radioactivity in inflamed ankle joints (tissue: 0.22 and 0.34% of the injected activity, respectively), whereas the radioactivity was concentrated in liver (tissue: 79% and 71%, respectively), kidney, and urinary bladder. Unlike macrophages, however, anti-CD4 mAb-coated T-cells significantly accumulated in lymphoid organs, the inflamed synovial membrane of the ankle joints, as well as in elbow and knee joints. Conclusion: While the overall contribution of cell-bound mAbs to the imaging of arthritic joints with anti-CD4 mAbs is minimal, differential accumulation of macrophages and T-cells in lymphoid organs and the inflamed synovial membrane indicates preferential migration patterns of these 2 cell populations in arthritic rats. Although only validated for 99mTc-anti-CD4 mAbs, extrapolation of the results to other anticellular mAbs with similar affinity for their antigen may be possible.

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The Effect of Total Meniscectomy versus Caudal Pole Hemimeniscectomy on the Stifle Joint of the Sheep

Veterinary and Comparative Orthopaedics and Traumatology ◽

10.1055/s-0038-1632463 ◽

1999 ◽

Vol 12 (02) ◽

pp. 56-63 ◽

Cited By ~ 5

Author(s):

C. R. Bellenger ◽

P. Ghosh ◽

Y. Numata ◽

C. Little ◽

D. S. Simpson

Keyword(s):

Tissue Culture ◽

Articular Cartilage ◽

Fibrous Tissue ◽

Cartilage Degeneration ◽

Medial Compartment ◽

Proteoglycan Synthesis ◽

Stifle Joint ◽

Medial Meniscectomy ◽

Tibial Condyle ◽

Articular Cartilage Degeneration

SummaryTotal medial meniscectomy and caudal pole hemimeniscectomy were performed on the stifle joints of twelve sheep. The two forms of meniscectomy produced a comparable degree of postoperative lameness that resolved within two weeks of the operations. After six months the sheep were euthanatised and the stifle joints examined. Fibrous tissue that replaced the excised meniscus in the total meniscectomy group did not cover as much of the medial tibial condyle as the residual cranial pole and caudal fibrous tissue observed following hemimeniscectomy. The articular cartilage from different regions within the joints was examined for gross and histological evidence of degeneration. Analyses of the articular cartilage for water content, glycosaminoglycan composition and DNA content were performed. The proteoglycan synthesis and release from explanted articular cartilage samples in tissue culture were also measured. There were significant pathological changes in the medial compartment of all meniscectomised joints. The degree of articular cartilage degeneration that was observed following total meniscectomy and caudal pole meniscectomy was similar. Caudal pole hemimeniscectomy, involving transection of the meniscus, causes the same degree of degeneration of the stifle joint that occurs following total meniscectomy.The effect of total medial meniscectomy versus caudal pole hemimeniscectomy on the stifle joint of sheep was studied experimentally. Six months after the operations gross pathology, histopathology, cartilage biochemical analysis and the rate of proteoglycan synthesis in tissue culture were used to compare the articular cartilage harvested from the meniscectomised joints. Degeneration of the articular cartilage from the medial compartment of the joints was present in both of the groups. Caudal pole hemimeniscectomy induces a comparable degree of articular cartilage degeneration to total medial meniscectomy in the sheep stifle joint.

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