scholarly journals Knee Preservation Techniques for Severe Synovial Osteochondromatosis in End-Stage Osteoarthritic Knee Using High Tibia Osteotomies, Cartilage Restoration Procedure, and Biologics; A Case Report in Bilateral Knees

2020 ◽  
Vol 1 (1) ◽  
pp. 63-67
Author(s):  
Andre Yanuar ◽  
Dwikora Novembri Utomo
Keyword(s):  
Football Player ◽  
Joint Space ◽  
Left Knee ◽  
Patient Specific ◽  
Return To Sports ◽  
Joint Replacement Surgery ◽  
Replacement Surgery ◽  
Synovial Osteochondromatosis ◽  
End Stage

Synovial osteochondromatosis can occur idiopathic or secondary to osteoarthritis. While joint replacement surgery has shown promising results for end-stage osteoarthritis, it isn’t always the answer for certain individual. In young athletic individual, the treatment should be patient specific, with consideration for return to sports activities. We present a 48-year-old ex-national professional football player with significant osteoarthritis and severe synovial osteochondromatosis. After discussion with the patient, we decide that knee preservation is suitable for him. Surgical treatments that are considered the best option are High Tibial Ostetomies, extraction of the loose bodies, partial synovectomy, and microfracture. Those procedures were performed in 8 months interval for each knee. The patient received intra-articular injection of cultured Mesenchymal Stem Cells (MSCs) with hyaluronic acid for 4 weeks after surgery. In a 34-month follow-up for right knee and 26-month follow-up for left knee, the patient regained significantly higher Knee injury and Osteoarthritis Outcome Score (KOOS) compare to before surgery (94 vs. 47). Radiologic examination also reveals the improvement of both knees joint space.

scholarly journals SPORTS ACTIVITY AND HIP, KNEE, SHOULDER AND INTERVERTEBRAL DISC ARTHROPLASTIES

2018 ◽  
Vol 26 (5) ◽  
pp. 350-355 ◽  
Author(s):  
Diogo Lino Moura ◽  
Fernando Pereira Fonseca
Keyword(s):  
Intervertebral Disc ◽  
Scientific Evidence ◽  
Small Scale ◽  
Early Failure ◽  
Level Of Evidence ◽  
Sports Activity ◽  
Joint Replacement Surgery ◽  
Replacement Surgery ◽  
Prosthesis Durability

ABSTRACT The success of joint replacement surgery has been responsible for raising patients' expectations regarding the procedure. Many of these procedures are currently designed not only to relive the pain caused by arthrosis, but also to enable patients to achieve functional recovery and to engage in some degree of physical activity and sports. However, as physical exercise causes an increase in forces exercised through the articular prosthesis, it can be an important risk factor for its early failure. Scientific literature on sports after arthroplasty is limited to small-scale retrospective studies with short-term follow-up, which are mostly insufficient to evaluate articular prosthesis durability. This article presents a review of the literature on sports in the context of hip, knee, shoulder and intervertebral disc arthroplasty, and puts forward general recommendations based on the current scientific evidence. Systematic Review, Level of Evidence III.

scholarly journals A Systematic Review Investigating the Presence of Inflammatory Synovitis in Hip and Knee Joint Replacement Surgery

Arthritis ◽  
2015 ◽  
Vol 2015 ◽  
pp. 1-9 ◽  
Author(s):  
Sherif Hosny ◽  
Francesco Strambi ◽  
Nidhi Sofat ◽  
Richard Field
Keyword(s):  
Systematic Review ◽  
Joint Replacement ◽  
Critical Appraisal ◽  
Clinical Symptoms ◽  
Joint Replacement Surgery ◽  
Replacement Surgery ◽  
Cytokines And Chemokines ◽  
Appraisal Tool

Synovial tissue can display an inflammatory response in the presence of OA. There is increasing interest to better understand the role of inflammation in OA, particularly with regard to those who require joint replacement. A systematic review of inflammatory synovitis in OA of literature databases was undertaken from their inception until October 14, 2014. Independent critical appraisal of each study was undertaken using the CASP appraisal tool. From a total of sixty-six identified citations, twenty-three studies were deemed eligible for review. The studies presented moderate to strong methodological quality. Strong correlation was identified between histological and imaging synovitis severity. Correlation was weaker between clinical symptoms and imaging and/or histological synovitis severity. There was little consensus, with regard to expressed cytokines and chemokines at the different stages of OA disease progression. Few studies investigated the influence of inflammatory synovitis on the outcome of major joint replacement. Research into inflammatory synovitis in OA is an emerging field. Longitudinal studies applying proven imaging modalities, histological analysis, and longer follow-up are required in order to further define our understanding of the role of synovitis in the pathogenesis of OA and its effects on outcomes following major joint replacement.

scholarly journals Outcomes of Revision Total Ankle Replacement: A Minimum of 2 Year Follow-up

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0032
Author(s):  
Andrea Pujol Nicolas ◽  
Jayasree Ramas Ramaskandhan ◽  
Triin Nurm ◽  
Malik Siddique
Keyword(s):  
Total Ankle Replacement ◽  
Return To Sports ◽  
Ankle Arthritis ◽  
Ankle Replacement ◽  
Patient Reported ◽  
The Mean ◽  
End Stage ◽  
Average Domain

Category: Ankle, Ankle Arthritis Introduction/Purpose: Total ankle replacement as a valid treatment for end stage ankle arthritis, is gaining popularity and every year there is an increasing number of procedures. With revision rates as high as 21% at 5 years and 43% at 10 years there is a need for understanding and reporting the outcome of revision ankle replacement. Our aim was to study the patient reported outcomes following revision TAR with a minimum of 2 year follow up. Methods: All patients that underwent a revision total ankle replacement between 2012 and 2016 were included in the study. All patients received a post-operative questionnaire comprising of MOX-FQ score, EQ-5D (UK) and Foot and Ankle outcomes scores (FAOS) and patients satisfaction questionnaire with a minimum of 2 years follow up. Results: 32 patients had a revision total ankle replacement between 2012 and 2016. 2 patients were deceased therefore 30 patients were included in the study. 5 patients declined participation for completing questionnaires. We received 21 (66%) completed questionnaires. The mean MOX-FQ average domain score for pain was 58.8, walking/standing 65.8 and social function was 48.2. The mean FAOS scores were 50.7 for pain, 50.6 for symptoms, 54.9 for ADL and 28.2 for quality of life. The mean overall health score today for EQ-5D was 67.8/100. 45% of patients were satisfied with the pain relief and return to sports and recreation obtained following the operation, 48% were satisfied with the improved in daily activities. 52% were overall satisfied with the results from surgery. Conclusion: Revision total ankle replacement gives overall satisfactory results demonstrated from patients reported outcomes at a minimum of 2 years following surgery.

scholarly journals Development of a Simplified Ankle Distractor

2017 ◽  
Author(s):  
Thomas Baer ◽  
Ryan Frisbie ◽  
Michael Willey ◽  
Jessica Goetz
Keyword(s):  
Total Joint Replacement ◽  
Major Life ◽  
Distraction Arthroplasty ◽  
Joint Replacement Surgery ◽  
Replacement Surgery ◽  
Joint Distraction ◽  
Wide Range ◽  
Natural Movement ◽  
Range Of Functions ◽  
End Stage

The physical impairment caused by OA of a single lower extremity joint is comparable to that reported for major life-altering disorders such as end-stage kidney disease and heart failure. (Buckwalter, et al) [1] Ankle distraction arthroplasty has been shown to greatly decrease pain due to end-stage ankle arthritis. Unlike arthrodesis (fusion of the joint), distraction arthroplasty maintains the joint’s natural movement, and it is far less complicated than total joint replacement surgery. There is a considerable body of research supporting the idea that distraction of an end-stage arthritic joint (most of the work thus far has been done on ankles, although there has also been some investigation of the efficacy of the treatment for knee arthritis) for a period of weeks allows the growth of new tissue in the joint. Although this tissue is not true articular cartilage, distraction arthroplasty has been shown to significantly decrease pain and, in the majority of cases, to be a long lasting remedy for a condition that would otherwise commonly be treated with arthrodesis. [2] Devices currently available for this procedure are generally quite complicated because they are designed for a wide range of functions related to bone fixation. This versatility also tends to make those systems larger and more expensive, and their aggressively mechanical appearance makes potential joint distraction patients hesitant to select the procedure. While fracture patients may not have a choice about being treated with such devices, elective patients are instinctively resistant to their use, even when assured that the end result will most likely significantly improve in the quality of their lives.

Docking Robustness of Patient Specific Surgical Guides for Joint Replacement Surgery

2015 ◽  
Vol 137 (6) ◽  
Author(s):  
Joost Mattheijer ◽  
Just L. Herder ◽  
Gabriëlle J. M. Tuijthof ◽  
Edward R. Valstar
Keyword(s):  
Joint Replacement ◽  
Patient Specific ◽  
Angular Deviation ◽  
Joint Replacement Surgery ◽  
Replacement Surgery ◽  
Surgical Guides ◽  
Surgery Patient ◽  
Graphical Tool ◽  
Robustness Framework ◽  
Contact Efficiency

In joint replacement surgery, patient specific surgical guides (PSSGs) are used for accurate alignment of implant components. PSSGs are designed preoperatively to have a geometric fit with the patient's bone such that the incorporated guidance for drilling and cutting is instantly aligned. The surgeon keeps the PSSG in position with a pushing force, and it is essential that this position is maintained while drilling or cutting. Hence, the influence of the location and direction of the pushing force should be minimal. The extent that the pushing force may vary is what we refer to as docking robustness. In this article, we present a docking robustness framework comprising the following quantitative measures and graphical tool. Contact efficiency ηc is used for the quantification of the selected bone–guide contact. Guide efficiency ηg is used for the quantification of the whole guide including an application surface whereon the surgeon can push. Robustness maps are used to find a robust location for the application surface based on gradient colors. Robustness R is a measure indicating what angular deviation is minimally allowed at the worst point on the application surface. The robustness framework is utilized in an optimization of PSSG dimensions for the distal femur. This optimization shows that 12 contacts already result in a relatively high contact efficiency of 0.74 ± 0.02 (where the maximum of 1.00 is obtained when the guide is designed for full bone–guide contact). Six contacts seem to be insufficient as the obtained contact efficiency is only 0.18 ± 0.02.

Shaping Patient Specific Surgical Guides for Arthroplasty to Obtain High Docking Robustness

2013 ◽  
Vol 135 (7) ◽  
Author(s):  
Joost Mattheijer ◽  
Just L. Herder ◽  
Gabriëlle J. M. Tuijthof ◽  
Rob G. H. H. Nelissen ◽  
Jenny Dankelman ◽  
...  
Keyword(s):  
Analytical Method ◽  
Joint Surface ◽  
Patient Specific ◽  
Theoretic Approach ◽  
Joint Replacement Surgery ◽  
Replacement Surgery ◽  
Surgical Guides ◽  
Physical Experiments ◽  
Minimal Contact ◽  
Angular Limits

Patient specific surgical guides (PSSGs) are used in joint replacement surgery to simplify the surgical process and to increase the accuracy in alignment of implant components with respect to the bone. Each PSSG is fabricated patient specifically and fits only in the planned position on the joint surface by the matching shape. During surgery, the surgeon holds the PSSG in the planned position and the incorporated guidance is used in making the essential cuts to fit the implant components. The shape of the PSSG determines its docking robustness (i.e., the range of forces that the surgeon may apply without losing the planned position). Minimal contact between the PSSG and the joint surface is desired, as this decreases the likelihood of interposition with undetected tissues. No analytical method is known from literature where the PSSG shape can be optimized to have high docking robustness and minimal bone-guide contact. Our objective is to develop and validate such an analytical method. The methods of motion restraint, moment labeling and wrench space—applied in robotic grasping and workpart fixturing—are employed in the creation of this new method. The theoretic approach is utilized in an example by optimizing the PSSG shape for one joint surface step-by-step. The PSSGs that arise from these optimization steps are validated with physical experiments. The following design tools for the analytical method are introduced. The optimal location for bone-guide contact and the application surface where the surgeon may push can be found graphically, respectively, by the use of the wrench space map and the application angle map. A quantitative analysis can be conducted using the complementary wrench space metrics and the robustness metric R. Utilization of the analytical method with an example joint surface shows that the PSSG's shape can be optimized. Experimental validation shows that the standard deviation of the error between the measured and calculated angular limits in the docking force is only 0.7 deg. The analytical method provides valid results and thus can be used for the design of PSSGs.

scholarly journals Anti-Phospholipid Antibodies in Patients Undergoing Total Joint Replacement Surgery

Thrombosis ◽  
2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
Melissa Simpson ◽  
Michael J. Sanfelippo ◽  
Adedayo A. Onitilo ◽  
James K. Burmester ◽  
William Hocking ◽  
...  
Keyword(s):  
Joint Replacement ◽  
Total Joint Replacement ◽  
Patient Specific ◽  
Preoperative Period ◽  
Joint Replacement Surgery ◽  
Replacement Surgery ◽  
Increased Risk ◽  
Patients At Risk ◽  
Total Knee ◽  
Arthroplasty Procedure

Background. Patients undergoing joint replacement remain at increased risk for venous thromboembolism (VTE) compared to other types of surgery, regardless of thromboprophylactic regimen. The pathophysiologic processes rendering this group of patients at risk for VTE are multifactorial. Procedure-specific and patient-specific exposures play a role in the postoperative development of VTE, including the development of anti-phospholipid antibodies (aPL). Methods. We measured three aPL (anti-cardiolipin, anti-β2 glycoprotein, and lupus anticoagulant) in 123 subjects undergoing total knee or hip arthroplasty to describe the presence of these antibodies preoperatively and to describe the rate of postoperative seroconversion among those people who were negative preoperatively. Postoperative antibodies were measured at day 7, 14, and 21. Results. The prevalence of aPL antibodies in the preoperative period was 44%, positive subjects were more likely to be smokers (P=0.05) and were less likely to have undergone a previous arthroplasty procedure (P=0.002). Subjects seroconverted in a 21 day postoperative period at a rate of 79%. Conclusions. These pilot data suggest that the prevalence of aPL in this population both preoperatively and postoperatively is higher than previously expected. Further studies are needed to describe aPL in a larger population and to establish their clinical significance in populations undergoing joint replacement surgeries.

scholarly journals Exploring Views of Orthopaedic Surgeons, Rheumatologists, and General Practitioners About Osteoarthritis Management

2020 ◽  
Author(s):  
Jason Andrew Wallis ◽  
Christian J Barton ◽  
Natasha K Brusco ◽  
Joanne L Kemp ◽  
James Sherwood ◽  
...  
Keyword(s):  
General Practitioners ◽  
Surgical Management ◽  
Exercise Therapy ◽  
Joint Replacement ◽  
Medical Professionals ◽  
Orthopaedic Surgeons ◽  
Joint Replacement Surgery ◽  
Knee Oa ◽  
Replacement Surgery ◽  
End Stage

Abstract Background: Delivery of recommended treatments for hip and knee osteoarthritis (OA) is known to be discordant with guideline recommendations. However, professional opinions related to OA management across medical and surgical disciplines are not well understood. The aim of this study was to explore the views of medical professionals about management of hip and knee OA.Methods: Qualitative study. Semi-structured individual interviews were conducted with orthopaedic surgeons, rheumatologists and general practitioners routinely involved in the management of OA. Interviews were audiotaped, transcribed, member-checked, coded and thematically analysed. Results: Fifteen medical professionals were interviewed. Three main themes were: (i) recognition of the importance of non-surgical management of hip and knee OA, focussed on exercise-therapy, weight management and analgesia, (ii) joint replacement being considered the ‘last resort’ for end stage disease not responding to non-surgical management, and (iii) determination of management ‘success’ through patient perceptions was more common than the use of validated instruments. Views on management broadly converged across disciplines, except for the role of joint replacement, considered an adjunct in the overall management of OA by rheumatologists, and as a definitive cure by orthopaedic surgeons.Conclusions: Aligning with current guidelines, medical professionals recognised the importance of non-surgical management focussed on exercise-therapy for hip and knee OA, and concurred that joint replacement surgery should be a last resort. A focus on patient education was less prominent, which along with implementation of validated outcome measures in routine medical practice, may require greater health system support.

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