1/31. Fracture of the femoral component associated with polyethylene wear and osteolysis after total knee arthroplasty.Fracture of the femoral component associated with polyethylene wear and osteolysis after total knee arthroplasty (TKA) has not been well reported before. A 63-year-old man with osteoarthritis of the right knee underwent TKA with a New Jersey LCS Knee, with cementing on the tibia and patella but not on the femoral component. After 42 months, in addition to wearing of polyethylene of the tibia and patella, severe osteonecrosis of the medial femoral condyle was noted. osteonecrosis caused loss of osseous support of the medial flange of the femoral component, and the bone ingrowth of the central and lateral flange to the distal femur was so good that it overcame the yield stress of the metal of the femoral component and caused fracture of the femoral component. The osteolytic area was filled with autogenous iliac bone, and a new femoral component was inserted and cemented. The patient's condition became satisfactory with relief of pain. Although uncommon, fracture of the femoral component does occur associated with polyethylene wear and osteolysis.- - - - - - - - - - ranking = 1keywords = osteoarthritis (Clic here for more details about this article) |
2/31. Allograft reconstruction of the extensor mechanism for progressive extensor lag after total knee arthroplasty and previous patellectomy: a 3-year follow-up.Major extensor lag after total knee arthroplasty may follow operative damage to the patellar tendon or its insertion. It may also occur in a late progressive form postoperatively. A successful allograft reconstruction of the extensor mechanism for progressive extensor lag after total knee arthroplasty is described. Patellectomy had been carried out earlier on the same knee for patellofemoral osteoarthritis.- - - - - - - - - - ranking = 1keywords = osteoarthritis (Clic here for more details about this article) |
3/31. Primary total knee arthroplasty for supracondylar/condylar femoral fracture in osteoarthritic knees.Supracondylar or condylar femoral fractures require extended treatment and often result in loss of knee range of motion. We present 3 cases in which femoral fractures and preexisting painful knees secondary to osteoarthritis were treated using total knee arthroplasty with a stemmed femoral implant. The patients were all women aged 83, 84, and 87 years old. All fractures united within 3 months, and the patients could walk with 1 cane within 2 months. Primary total knee arthroplasty should be considered as a treatment for supracondylar/condylar femoral fractures in osteoarthritic knees.- - - - - - - - - - ranking = 1keywords = osteoarthritis (Clic here for more details about this article) |
4/31. Reversal of medial compartment osteoarthritic uptake pattern after high tibial osteotomy.Two cases of osteoarthritis of the knee are presented that illustrate the typical medial compartment pattern of scintigraphic uptake. In both cases the patients had significant medial joint pain. After high tibial osteotomy, the pattern of uptake was altered and paralleled the improvement in symptoms. These observations prompt several important issues regarding the cause of the uptake and may provide a way to monitor treatment response.- - - - - - - - - - ranking = 1keywords = osteoarthritis (Clic here for more details about this article) |
5/31. Extensive plasma cell infiltration with crystal IgG inclusions and mutated IgV(H) gene in an osteoarthritis patient with lymphoplasmacellular synovitis. A case report.The presence of immunoglobulin crystal inclusions in plasma cells from plasmacytomas and B-NHLs (linked to overstimulation and overproduction) has been frequently reported. Our case describes a lymphoplasmacellular synovitis in a patient with osteoarthritis (OA) showing an unusually high plasma cell infiltration and for the first time crystals in plasma cells. Using immunohistochemistry. these crystals were identified as being IgG with a balanced lambda/kappa ratio. IgV(H) gene analysis (n = 5 clones) showed that they were somatically mutated (R/S of CDR > 3): in one case, an insertion of 9 nucleotides on the CDR2 region was observed. High R/S values in the CDR indicated antigen selectivity and affinity (4/5). Since no germinal centers could be detected and the analyzed B cells showed antigen selectivity, it may be concluded that already antigenically activated B cells migrated into the synovium and locally differentiated into plasma cells, leading to the extensive infiltration observed. Rheumatoid fibroblasts were shown to support terminal B cell differentiation. Our data suggests that the ability of fibroblasts to activate B cells is not only restricted to RA, but also occurs in OA. The intense plasma cell infiltration contributed to further cartilage damage by altering the microenvironment of the nourishing synovial tissue or by the local production of pathogenic autoantibodies.- - - - - - - - - - ranking = 5keywords = osteoarthritis (Clic here for more details about this article) |
6/31. Destructive osteoarthritis after delayed diagnosis of tuberculosis.Osteoarticular tuberculosis rarely occurs in developed countries. Initial symptoms are often overlooked and the diagnosis is frequently delayed for several months. Thus, despite available diagnostic tools and accessible treatment, destruction of affected joints remains a complication of non-vertebral osteoarticular tuberculosis even in industrialized countries. We report a patient from Cleveland, ohio, USA, in whom the delayed diagnosis of tuberculous osteoarthritis led to severe destruction of the left knee and finally, after superinfection with staphylococcus aureus, to an above-the-knee amputation. The epidemiology, presentation, diagnosis and treatment of nonvertebral tuberculous osteoarthritis are discussed.- - - - - - - - - - ranking = 6keywords = osteoarthritis (Clic here for more details about this article) |
7/31. Agility and perturbation training for a physically active individual with knee osteoarthritis.BACKGROUND AND PURPOSE: People with knee osteoarthritis (OA) sometimes report episodes of knee instability that limit their activities of daily living. The episodes of instability are similar to those reported by people with knee ligament injuries. The authors believe that modifications of interventions that are used to promote knee stability in individuals with knee ligament injuries can be used to enhance knee stability and function in people with knee OA. The purpose of this case report is to describe the development and implementation of an agility and perturbation training program that was used in conjunction with traditional rehabilitation activities for a patient with knee OA. CASE DESCRIPTION: The patient was a 73-year-old woman with a diagnosis of bilateral knee OA. Her chief complaints were knee pain and episodes of partial "giving way" at the knee during walking, stair climbing, and participation in tennis and golf. The patient participated in 12 treatment sessions at a frequency of 2 visits per week. The rehabilitation program consisted of lower-extremity stretching, strengthening and endurance exercises that were supplemented with a variety of walking-based agility training techniques, and perturbation training techniques. OUTCOME: At the completion of rehabilitation, the patient was able to walk on level surfaces and stairs and return to playing golf and tennis without episodes of instability and with reduced pain. DISCUSSION: Supplementing rehabilitation programs for people with knee OA with a modified agility and perturbation training program may assist them in returning to higher levels of physical activity with less pain and instability following rehabilitation. Further research is needed to determine the role of agility and perturbation training in people with knee OA.- - - - - - - - - - ranking = 5keywords = osteoarthritis (Clic here for more details about this article) |
8/31. A case report: reconstruction of a damaged knee following treatment of giant cell tumor of the proximal tibia with cryosurgery and cementation.OBJECTIVE: Reconstruction of a knee damaged by cement packed to cure a giant-cell tumor is sometimes difficult. We reconstructed such a knee by removal of the cement, autologous bone transplantation and distraction osteogenesis using the Ilizarov apparatus. In this paper the results 29 months after the salvage surgery are given. PATIENT AND methods: We saw a 31-year-old woman's knee joint that showed osteoarthritic change after curettage, cryosurgery and cementation performed 4 years previously for a giant-cell tumor of the proximal tibia. We reconstructed the knee joint. This procedure included cement removal, alignment correction by tibial osteotomy, subchondral bone reconstruction by autologous bone transplantation, and filling the defect after removing the bone cement by elongating the diaphysis using the Ilizarov apparatus. RESULTS: Distraction was terminated 4 months later when 54 mm of elongation was performed. All devices were removed 12 months after the surgery. Seventeen months after the removal of the apparatus, the range of motion of the right knee was 0 degrees extension and 110 degrees flexion, and the patient was able to walk without pain. CONCLUSIONS: Although the treatment period is long and there may be some complications of Ilizarov lengthening and distraction osteogenesis, this procedure has numerous benefits. Bony defects can be soundly reconstructed and, at the same time, the alignment of the knee can be corrected. Also it is not necessary to reconstruct the ligaments because the insertions are intact. If osteoarthritis progresses, a surface type total knee replacement can be performed, not constrained type prosthesis, which would be used if the bony structure had not been reconstructed. This procedure may be one of the candidates for reconstructing such knee joints destroyed by bone cement.- - - - - - - - - - ranking = 1keywords = osteoarthritis (Clic here for more details about this article) |
9/31. The influences of biomechanical factors on cartilage regeneration after high tibial osteotomy for knees with medial compartment osteoarthritis: clinical and arthroscopic observations.PURPOSE: A high tibial osteotomy (HTO) is often performed on knees with medial compartment osteoarthritis. However, in varus knees with medial compartment osteoarthritis, degeneration of the articular cartilage tends to progress due to medial deviation of the mechanical axis. This can result in eburnated bone. A widening of the medial joint space has been observed after HTO with a proper correction as a result of decreased stress on the load-bearing cartilage in the medial compartment. Researchers have reported obtaining a repair of the articular cartilage with both eburnation and clinical improvement using HTO in patients showing a medial deviation of the mechanical axis. However, which factors influence cartilage regeneration remain unclear. The purpose of this study was to quantitatively evaluate the influence of cartilage regeneration after a high tibial osteotomy for knees with medial compartment osteoarthritis. TYPE OF STUDY: Observational cohort study. methods: The study involved 58 knees in 47 patients. A modified Noyes classification was used for arthroscopic grading. The patients underwent a second look arthroscopic evaluation of the articular cartilage 18 months after surgery. The articular cartilage was classified as no regenerative change (grade 1), white scattering with fibrocartilage (grade 2), partial coverage with fibrocartilage (grade 3), and even coverage with fibrocartilage (grade 4). The functional results were evaluated according to the Japanese Orthopedic association score for osteoarthritic knees (JOA score), femorotibial angle (FTA), percentage of mechanical axis, and body mass index (BMI). RESULTS: Partial or even coverage with fibrocartilage (grade 3 and 4) was achieved on 55% of the femorotibial joint surfaces. A repair with white scattering with fibrocartilage (grade 2) was achieved in 34%, and 3 knees showed no regenerative change (grade 1). At follow up, significant differences were seen between grade 4 and grade 1 in JOA score and percentage of mechanical axis. CONCLUSIONS: This study demonstrates the correlation between the visible improvement of the articular surface, the functional score, and the degree of correction obtained with a lateral closing wedge HTO.- - - - - - - - - - ranking = 7keywords = osteoarthritis (Clic here for more details about this article) |
10/31. Bilateral lipoma arborescens associated with early osteoarthritis.lipoma arborescens is a rare disease that has generally been considered to be unilateral. We report a case of bilateral disease in a patient with associated marked premature osteoarthritis of the knees. We postulate a possible association between these two conditions and explain a possible underlying mechanism. We suggest that lipoma arborescens be considered as a rare underlying cause of young patients with bilateral premature osteoarthritis, and recommend MRI as the definitive imaging modality.- - - - - - - - - - ranking = 6keywords = osteoarthritis (Clic here for more details about this article) |
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