Clinical Presentation, Management, and Prognosis of Pseudogout in Joint Arthroplasty: A Retrospective Cohort Study

Abstract. Introduction: Calcium pyrophosphate deposition disease (CPPD), or pseudogout, is rare in prosthetic joints, but can mimic prosthetic joint infection (PJI) according to case reports. The purpose of this case series is to describe the demographics, presentation, management, and outcomes of a cohort of these patients seen at our academic medical center.Methods: Patients with post-implant pseudogout, who were evaluated at our medical center between January 1, 2000 and June 30, 2016, were identified from our EHR. Data pertaining to demographics, presentation, management, and outcomes were abstracted, and patients were categorized into two groups based on presence of concomitant infection along with positive CPDD findings in synovial fluid.Results: 22 patients were included. 90.9% of cases involved a TKA. The most common indication for arthroplasty was degenerative joint disease. Only four patients had a history of previous gout or pseudogout, three of which belonged to the group with no evidence of concomitant joint infection. Clinical features for patients without concomitant infection included pain (100%), swelling at the joint (88.9%), redness (33.3%), fever (22.2%), and decreased range of motion (100%). 45.5% of patients received antibiotics prior to joint aspiration (44.4% of patients with negative synovial fluid cultures, 46.2% of patients with concomitant infection).Conclusion: Our study suggests similar clinical presentation between post-implant pseudogout and PJI. Among patients with pseudogout as well as in those with PJI, the first dose of antibiotics should not be given before sampling for synovial culture. Unfortunately, many patients receive antibiotics prior to culture ascertainment, which raises concern for antibiotic overuse.

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Optimal Use of a Panoramic Radiograph as a Screening Tool for Condylar Resorption in Patients Undergoing Active Orthodontic Treatment: A Case Series

Journal of Clinical Imaging Science ◽

10.25259/jcis_143_2020 ◽

2020 ◽

Vol 10 ◽

pp. 65

Author(s):

Shaima Malik ◽

Shilpa Singh ◽

Robby T. George ◽

Mayank Kakkar ◽

Nikhilesh R. Vaid

Keyword(s):

Orthodontic Treatment ◽

Behavioral Therapy ◽

Mandibular Condyle ◽

Case Series ◽

Panoramic Radiograph ◽

Degenerative Joint Disease ◽

Joint Disease ◽

Initial Examination ◽

Panoramic Radiographs ◽

Specific Medication

Condylar resorption of temporomandibular joint findings in the panoramic radiographs is an indication of bone resorption suggesting possible degenerative joint disease that warrants early screen and subsequent referral to a dedicated specialist. This case series reports three patients that underwent the active orthodontic treatment for the duration of approximately 24–36 months. The patients were asymptomatic at the initial examination. The clinical examination was negative for clicking; the range of motion on opening, lateral excursion, and protrusion was normal. Neither of these patients had a history of rheumatic disease or bruxism. During the later stages of orthodontic treatment, two of the three patients reported mild pain and clicking during mastication, which was also confirmed chairside on clinical evaluation. Patients were referred to the orofacial pain specialist, were they were prescribed specific medication for the symptoms, along with cognitive behavioral therapy, and were further evaluated for splint therapy. Panoramic radiographs taken before the start of the treatment, during the treatment and at the completion of the orthodontic treatments indicate the progression in the resorption of mandibular condyle in all three patients suggesting possible degeneration that warrants further investigation and therapy.

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A case of Mycobacterium fortuitum prosthetic joint infection successfully treated medically without prosthesis explantation or joint debridement

BMJ Case Reports ◽

10.1136/bcr-2021-243675 ◽

2021 ◽

Vol 14 (8) ◽

pp. e243675

Author(s):

Maya Ramanathan ◽

Folusakin Ayoade

Keyword(s):

Prosthetic Joint Infection ◽

Hip Replacement ◽

Joint Infection ◽

Degenerative Joint Disease ◽

Joint Disease ◽

Mycobacterium Fortuitum ◽

Replacement Surgery ◽

Hip Replacement Surgery ◽

Prosthetic Joint ◽

The Right

A 58-year-old man with a history of end-stage degenerative joint disease developed a postsurgical infection at the right hip 4 weeks after hip replacement surgery. He underwent surgical washout of the right hip without opening the joint capsule. Arthrocentesis returned positive for Mycobacterium fortuitum. He was started on antibiotics with the recommendation to remove the prosthesis. The prosthesis was retained. Based on antimicrobial susceptibilities, he was treated with 4 weeks of intravenous therapy using cefoxitin and amikacin and later switched to oral ciprofloxacin and doxycycline for 5 additional months. Eighteen months from his initial hip replacement surgery, he continues to do well. Joint aspiration culture is important to make a diagnosis of prosthetic joint infection (PJI) when periprosthetic culture is not available. In the absence of serious systemic or comorbid joint conditions, PJI due to M. fortuitum can be managed medically without having to remove the prosthesis or debride the joint.

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Hereditary neuropathy with liability to pressure palsies in childhood: case series and update from the literature

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/cjn.2015.90 ◽

2015 ◽

Vol 42 (S1) ◽

pp. S15-S15

Author(s):

N Chrestian ◽

C Campbell ◽

C Poulin ◽

H McMillan ◽

J Vajsar

Keyword(s):

Clinical Presentation ◽

Case Reports ◽

Conduction Block ◽

Case Series ◽

Hereditary Neuropathy ◽

Pmp22 Gene ◽

Gene Testing ◽

Appropriate Care ◽

Peroneal Palsy ◽

Pressure Palsies

Introduction: HNPP presentation in childhood is rare and diverse and most of the published literature is based on case reports. Materials and Methods: we analyzed the data of 11 children with deletion in PMP22 gene, reviewed the published reports of HNPP in children and compared our data with the reports from the literature review. Results: Peroneal palsy was the most common presentation (50%) followed by the brachial plexus palsy in 30% of cases. The trigger of the demyelinating event was identified only in 27%. 72% of our cohort developed only one acute episode of nerve palsy. Nerve conduction studies were always suggestive of the diagnosis demonstrating 60% of cases a polyneuropathy, 50% of cases conduction block but 100% of bilateral or unilateral electrophysiologic entrapment of the median nerve at the carpal tunnel. Conclusion: The clinical presentation of HNPP in childhood is heterogeneous and EMG findings are abnormal. Any unexplained mononeuropathy or multifocal neuropathy should lead to PMP22 gene testing to look for the deletion. Early diagnosis is important for the genetic counselling but also for the appropriate care of these patients.

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Down Syndrome as an Independent Risk Factor for Thrombosis in Children.

Blood ◽

10.1182/blood.v108.11.1489.1489 ◽

2006 ◽

Vol 108 (11) ◽

pp. 1489-1489 ◽

Cited By ~ 4

Author(s):

Janna M. Journeycake ◽

Laura E. Brumley

Keyword(s):

Down Syndrome ◽

Risk Factor ◽

Retrospective Analysis ◽

Moyamoya Disease ◽

Arterial Thrombosis ◽

Independent Risk Factor ◽

Medical Center ◽

Case Reports ◽

Case Series ◽

Thromboembolic Complications

Abstract Thromboembolic complications in children occur at an estimated rate of 5.3 per 10,000 hospitalized children per year. Over the last decade, investigators have determined that underlying medical conditions such as cancer and congenital heart disease (CHD) and the intensive therapies required to manage these conditions are strongly associated with the thromboembolic complications. Recently, we perceived an increase in the incidence of thrombosis in children with Down Syndrome (DS), a chromosomal abnormality which is associated with both CHD and cancer, but there is very little evidence in the medical literature to suggest that it is an independent risk factor for thrombosis. Although, there are case series describing an association of moyamoya disease and DS, only a few case reports describe venous and arterial thrombosis in children with DS, and there is no information about its rate and severity. Therefore, we conducted a retrospective analysis of patients treated at Children’s Medical Center Dallas between January 1, 2000 and November 30, 2005, hypothesizing that thrombosis would be more prevalent in patients with DS (with or without associated co-morbidities) than in children without DS. ICD-9 codes for CHD, DS, cancer, and thromboembolic complications and the CPT codes for the surgical procedures used to correct CHD were used to identify patients of interest. During the study period, the emergency center, ambulatory outpatient areas, and inpatient units saw 729,324 children. Among these, we identified 511 patients with DS (0.07%), 2168 (0.29%) with CHD, and 1182 (0.16%) with cancer. Sixty-one percent (n=311) of the patients with DS also had CHD, and 2.9% (n=15) had cancer. Thrombosis was identified in 398 (5.4 per 10,000 children). The majority (n=220, 55%) developed deep venous thrombosis (DVT), with catheter-related thrombosis (n= 156) being most common. There were 165 (41%) arterial ischemic strokes (AIS), 19 associated with moyamoya disease. Fifteen children with DS developed thrombosis (rate of 293 per 10, 000 children with DS). Among these 15, DVT occurred in 11 (73%) patients and AIS in 5 (33%), 2 with moyamoya. Among the subgroup of patients diagnosed with AIS, DS was not found to be a risk factor for moyamoya disease (OR 5.6, 95% CI 1.05, 30.5, p=0.1). Two patients with DS (13%) had both DVT and AIS. Children diagnosed with DS (OR 57.5, 95% CI 34.2, 96.5, p<0.0001), CHD (OR 129.5, 95% CI 103, 163, p<0.0001), or cancer (OR 57.3, 95% CI 40, 82, p<0.0001) were more likely to develop thrombosis than children without these three diagnoses. Among the children with CHD, having DS did not increase the odds for thrombosis. However, for children with cancer, DS did increase the odds (OR 9.5, 95% CI 2.7, 33.1, p= 0.007). Four of 15 (27%) children with DS did not have cancer or CHD and still had a higher than expected rate of venous and/or arterial thrombosis (OR 60, 95% CI 23, 156, p< 0.0001). In conclusion, the results of this retrospective analysis indicate that DS may be an independent risk factor for thromboembolic disease during childhood. Prospective studies are needed to confirm these findings and explore potential mechanisms.

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Application of platelet-rich plasma for canine osteoarthritis treatment - a clinical series

BULGARIAN JOURNAL OF VETERINARY MEDICINE ◽

10.15547/bjvm.2019-0095 ◽

2021 ◽

Vol 24 (4) ◽

pp. 601-607

Author(s):

K. B Aminkov ◽

N. H. Mehandzhiyski ◽

B. Y. Aminkov ◽

N. Z. Zlateva-Panayotova

Keyword(s):

Platelet Rich Plasma ◽

Autologous Blood ◽

Case Series ◽

Brief Pain Inventory ◽

Degenerative Joint Disease ◽

Joint Disease ◽

Knee Joints ◽

Radiographic Findings ◽

Clinical Series ◽

Osteoarthritis Treatment

Osteoarthritis, also known as degenerative joint disease (DJD), is defined as a progressive and permanent long-term deterioration of the cartilage surrounding the joints. There is no known cause for primary DJD. However, there are a wide variety of causes for secondary DJD, such as trauma, abnormal wear of joints and cartilage, or a congenital defect present at birth such as an improperly formed hip. One of the most popular methods used to biologically enhance healing in the fields of orthopaedic surgery and medicine includes the use of autologous blood products, namely, platelet rich plasma (PRP). Reports suggest that PRP, presumably containing high levels of platelet growth factors, may promote the recovery of the affected cartilage. This case series presents clinical and radiographic findings of three dogs with osteoarthritis of the elbow and knee joints. Pain score were assessed by CBPI (Canine Brief Pain Inventory). Treatment with three-fold intra-articular application of PRP, obtained by double centrifugation method, resulted in significant improvement in the function of the affected joint. Therefore, it could be concluded that PRP was clinically effective in the treatment of osteoarthritis in these three cases.

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Giant cell tumor of tendon sheath: a case series

International Surgery Journal ◽

10.18203/2349-2902.isj20182258 ◽

2018 ◽

Vol 5 (6) ◽

pp. 2372

Author(s):

Ramesh Kumar Korumilli ◽

Jakkula Srikanth ◽

Sri Harsha Muvva ◽

B. M. Yashwanth Reddy

Keyword(s):

Giant Cell Tumor ◽

Giant Cell ◽

Case Series ◽

Surgical Excision ◽

Tendon Sheath ◽

Degenerative Joint Disease ◽

Cell Tumor ◽

Joint Disease ◽

High Recurrence Rate ◽

Malignant Soft Tissue Tumor

Giant cell tumor of tendon sheath is a relatively rare non-malignant soft tissue tumor arising from the synovial cells and is associated with high recurrence rate. Many factors are considered for high recurrence including proximity to distal interphalangeal joints, presence of degenerative joint disease, pressure erosions in the radiograph and increased mitotic activity. But the most common cause for recurrence is incomplete surgical excision. However, it is the second most common tumor in hands after ganglion cysts. Here we present a case series comprising of 3 cases for whom marginal excision was done and they were kept on regular follow up without any recurrence.

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Fracture of the Posteromedial Tubercle of the Talus: Case Series of Fifteen Patients Along with Cadaveric Dissection and Anatomic Considerations for Surgical Approach

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00458 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0045

Author(s):

Andrew M. Steffensmeier ◽

Robert Matar ◽

David Chung ◽

Ruixian A. Yue ◽

Tonya L. Dixon ◽

...

Keyword(s):

Surgical Technique ◽

Surgical Approach ◽

Medical Center ◽

Case Reports ◽

Case Series ◽

Cadaveric Dissection ◽

Subtalar Dislocation ◽

Posterior Process ◽

Subtalar Arthritis ◽

Operative Fixation

Category: Ankle; Hindfoot; Trauma Introduction/Purpose: Fractures of the talus are among the most commonly fractured bone of the foot, with 10 to 21% involving the posterior process. These fractures have not been well characterized or reported in the literature and is limited to case reports and case series. The primary objective of this study is to characterize posterior process fractures, describe a surgical approach for open reduction internal fixation (ORIF) with the use of cadaveric dissection pictures of surgical technique and describe 15 cases. Methods: A search query of the institutional database was performed for all adult patients that sustained talar fractures at the University of Cincinnati Medical Center from 1/1/2010 to 12/31/2018. Patients sustaining posterior process talus fractures who underwent operative fixation and nonoperative treatment were identified. All radiographs and CT images were then reviewed by three orthopedic surgeons and the electronic medical record was reviewed for injury characteristics, method of operative fixation, and postoperative complications. Results: 15 cases of posterior process fractures were identified. Overall, 4 patients had fixation placed in the posterior process fracture while 11 did not. None of the patients who underwent ORIF of the posterior process developed subtalar arthritis at their latest follow-up, while 3 of the 11 (27.3%) that did not receive fixation suffered from subtalar arthritis and 1 (9.1%) required surgery for removal of retained loose bodies. 13 patients (86.67%) initially had plain radiographs that missed the diagnosis. Cadaveric specimens were used to illustrate surgical approach for ORIF of these talus fractures. Anatomic pictures of the surgical dissection were taken to show the extent of exposure to the posterior process fracture using traditional techniques, as well as methods of distraction to enhance visualization are demonstrated. Conclusion: Providers must have high suspicion for posterior process talus fractures as many are missed on the initial radiographs. CT scans are recommended for all patients with subtalar dislocations. Those with subtalar dislocation tend to have comminuted fragments. Significant morbidity is associated with this injury regardless of whether it is treated operatively or nonoperatively. We describe a surgical technique using distractors to adequately visualize the posteromedial process fracture of the talus.

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Efficacy of Autologous Platelet-Rich Plasma Injections for Grade 3 Symptomatic Degenerative Meniscal Lesions: A 1-Year Follow-up Prospective Study

Sports Health A Multidisciplinary Approach ◽

10.1177/19417381211011074 ◽

2021 ◽

pp. 194173812110110

Author(s):

Mattia Alessio-Mazzola ◽

Lamberto Felli ◽

Roberto Trentini ◽

Matteo Formica ◽

Andrea Giorgio Capello ◽

...

Keyword(s):

Platelet Rich Plasma ◽

Symptomatic Relief ◽

Case Series ◽

Degenerative Joint Disease ◽

Joint Disease ◽

Level Of Evidence ◽

Meniscal Lesions ◽

Activity Scale ◽

Tegner Activity Scale

Background: Platelet-rich plasma (PRP) injections have been proposed as a biologic option to provide symptomatic relief and delay surgery in patients with degenerative joint disease of osteoarthritis (OA). The efficacy of autologous PRP on symptomatic degenerative meniscal lesions (DMLs) has never been investigated. Hypothesis: We hypothesized that patients with symptomatic DMLs without OA undergoing autologous PRP injections experience a significant clinical improvement at 12 months. Study Design: Prospective case series. Level of Evidence: Level 4. Methods: A total of 69 patients with symptomatic DMLs without radiographic evidence of knee OA (Kellgren-Lawrence radiographic grading scale 0-1) received 4 autologous PRP injections once a week. Patients were prospectively evaluated before the injection and then at 1, 3, 6, and 12 months. Evaluation was based on Lysholm knee scoring scale (primary outcome), Western Ontario and McMaster Universities Arthritis Index (WOMAC), Tegner activity scale, and visual analogue scale scores. Results: Patients treated with PRP injections demonstrated an improving knee function and symptoms over the duration of the study. A significant improvement from baseline to 12 months was observed in all the outcome measures, and no patients experienced failure or required surgery during the follow-up. Patients younger than 50 years reported lower subjective level of pain and higher Tegner activity scale at baseline and had significantly better Lysholm knee scoring scale ( P = 0.03) and WOMAC ( P = 0.03) scores at 6 months, as well as better range of motion at 3, 6, and 12 months ( P < 0.001). Thirty-three (47.8%) patients were very satisfied, 26 (37.7%) satisfied, 8 (11.6%) partially satisfied, and 2 (2.9 %) not satisfied, with 62 (89.8%) patients willing to repeat the same treatment. No patient was lost to follow-up and no patient experienced adverse reaction, infection, failure, recurrence or underwent further surgery. Conclusion: PRP injections provide short-term benefits in symptomatic DMLs. Although promising results were evident at 12 months, this is a preliminary study and no definitive recommendation can be made based, for example, on longer follow-up. Clinical Relevance: This research supports the use of autologous PRP injections for symptomatic DMLs.

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Stabilization of Talocalcaneal Luxation with a Dorsal 1.0 mm Compression Plate in Four Cats

VCOT Open ◽

10.1055/s-0041-1732302 ◽

2021 ◽

Vol 04 (01) ◽

pp. e72-e78

Author(s):

Matthew Smith ◽

Nicholas Macdonald

Keyword(s):

Musculoskeletal Pain ◽

Low Cost ◽

Case Series ◽

Degenerative Joint Disease ◽

Joint Disease ◽

Term Outcome ◽

Long Term Outcome ◽

Compression Plate ◽

Cost Treatment

AbstractThe objective of this case series was to report the surgical technique, complications, and long-term outcome of feline talocalcaneal luxation stabilized with a dorsally applied two-hole, 1.0 mm compression plate. It is a retrospective study of four cats that underwent surgical stabilization of talocalcaneal luxation with a dorsally applied two-hole, 1.0 mm compression plate between 2013 and 2019. Medical history and diagnostic imaging (radiographs ± computed tomography scans) were reviewed. The owners of three of the four cats were contacted with a follow-up questionnaire based on the Feline Musculoskeletal Pain Index to assess long-term outcome. No intraoperative or postoperative complications were encountered. All three owner questionnaires were returned and Feline Musculoskeletal Pain Index scores of 0, 1, and 4 were recorded out of a maximum score of 83 (normal cat range is −18 to 4; cats with degenerative joint disease range from 11 to 66). Quality of life was rated by the owners as excellent (⅔) or good (⅓). All cats returned to full activity. Stabilization of feline talocalcaneal luxation with a dorsally applied two-hole, 1.0 mm compression plate was technically straightforward, easily accessible, and a relatively low-cost treatment option which carries a low risk of complications and an excellent prognosis.

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Hematologic Immune-Related Adverse Events from Immune Checkpoint Inhibitors: A Systematic Review of Case-Reports and Case-Series

Blood ◽

10.1182/blood-2019-132203 ◽

2019 ◽

Vol 134 (Supplement_1) ◽

pp. 3606-3606

Author(s):

Karthik Gnanapandithan ◽

Prakash Kharel ◽

Alyssa Grimshaw ◽

Smith Giri

Keyword(s):

Immune Checkpoint Inhibitors ◽

Clinical Presentation ◽

Checkpoint Inhibitors ◽

Case Reports ◽

Treatment Strategies ◽

Case Series ◽

Supportive Treatment ◽

Hematopoietic Growth Factors ◽

Eligibility Criteria ◽

Organ Systems

Introduction: Immune checkpoint inhibitors (ICI) have proven to be a significant breakthrough in modern cancer therapy. However, this has come at a cost of immune-related adverse events (irAE) affecting various organ systems. Hematological irAEs including autoimmune hemolytic anemia (AIHA), pure red cell aplasia (PRCA), immune thrombocytopenia (ITP), thrombotic thrombocytopenic purpura (TTP), hemophagocytic lymphohistiocytosis (HLH), aplastic anemia and pancytopenia, are well recognized side effects of ICI. Due to their rarity, existing literature is confined to case reports and series. We conducted a systematic review of all published case reports and series till date to summarize clinical presentation, risk factors, management, and outcomes of patients who develop hematologic irAEs during ICI treatment. Methods: Using free text and controlled vocabulary (MESH and EMTREE terms), we performed a systematic search of the literature using Ovid Embase, Ovid Medline, Pubmed, Scopus, and Web of Science Core Collection. Eligibility criteria included any case report or case series describing at least one hematologic irAEs developing during and likely related to ICI therapy for solid/hematologic malignancy. Two authors independently screened the titles, abstracts, and the full text of the selected papers. Patients who had received at least one FDA approved ICI (PD-1, PDL-1 or CTLA-4 inhibitors), and subsequently developed a decline in one or more of cell lines were included. Data regarding clinical presentation, concomitant other irAEs, treatment and clinical outcomes was extracted using a standardized data extraction form and summarized using descriptive statistics. Results: Of the 19856 articles screened, a total of 59 articles were selected for full-text review, and a total of 54 reports describing 57 cases met our eligibility criteria. The median age at the time of presentation was 63 y(interquartile range (IQR) 51-74) yrs, and 29 (50.9%) were males. PD-1 inhibitors were implicated in 35 (61%), CTLA-4 inhibitors in 14 (25%) and PD1/CTLA4 combination therapy in 7 (12%). The most common malignancies included metastatic melanoma (n=32, 56%) and non-small cell lung cancer (n=16, 28%). Only 8 patients (14%) reported a pre-existing history of autoimmune disease and only 11 (19%) had additional irAES involving other organ systems. AIHA (n=16, 28%), ITP (n=12, 21%) and pancytopenia (n=13, 23%) were the three most common subtypes of hematologic irAEs. Two or more cell lines were affected in 13 patients (23%). Twenty-six (46%) of the irAEs were detected on regular laboratory tests. The median number of cycles prior to the onset of hematologic irAEs was 3 (IQR 2-4). Among treatment strategies, corticosteroids were used in most patients (n=50, 88%). Other treatment modalities employed included Intravenous Immunoglobulin (IVIg) (n=14; 25%), hematopoietic growth factors and other supportive treatment were Treatment strategies were based on the actual irAE and the patient's condition. Corticosteroids, transfusion of blood products, hematopoietic growth factors, and other supportive treatment were primarily employed in most patients. Steroids were used in 50 (88%) patients and intravenous immunoglobulins in 14 (25%). Other immunosuppressants, anti-thymocyte globulins, and plasma exchange were used in select patients. Most of the patients (n=44, 77%) were described as having improved or recovered blood counts with treatment. Only 5 (9%) of these patients were rechallenged with the same or other ICI therapy. Among these, the same hematologic irAE recurred in 2 patients (40%). Cytopenia, as an irAE, was directly responsible for the death of 8 patients (14%). Conclusion: Hematologic irAEs are rare but potentially fatal adverse effect of ICI therapy. Although it can have diverse manifestations, AIHA and ITP are the most common subtypes. Almost half of these patients are clinically silent and detected in routine laboratory evaluation. Most hematologic irAEs appear early during the course of therapy and without pre-existing/concomitant irAEs. Most cases report successful resolution with treatment that commonly include high dose corticosteroids, and successful re-challenge has been reported in a few cases. Disclosures No relevant conflicts of interest to declare.

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