Destruction Of Articular Surfaces Research Articles

Reaming for Tibiotalocalcaneal Nailing Removes Only 10% of the Ankle and Subtalar Joints.

Tibiotalocalcaneal (TTC) nailing in the setting of acute ankle trauma has become increasingly popular. No consensus exists as to whether formal joint preparation is necessary, although there is some concern that residual motion at unprepared joints may lead to implant loosening and/or breakage. The objective of this study was to quantify the proportion of tibiotalar and subtalar articular surface destruction that occurs during reaming for TTC nail fixation. Twelve cadaver lower extremities were procured. The specimens were pinned into neutral ankle and hindfoot alignment. A guidewire was inserted under fluoroscopy, followed by a 12-mm opening reamer. The specimens were then dissected, exposing the tibial plafond, talar dome, posterior facet of the talus, and posterior facet of the calcaneus. Images of each joint were obtained, and ImageJ software was used to calculate the total joint surface area and the area of articular destruction. The mean proportion of articular cartilage destruction was 9.3%, 10.3%, 8.9%, and 10.3% for the tibial plafond, talar dome, posterior facets of the talus, and posterior facets of the calcaneus, respectively. No joint destruction was observed in the middle facets of the subtalar joint. Reaming for TTC nail placement violates approximately 10% of each articular surface of the tibiotalar and subtalar joints. Retention of 90% of the articular surface may allow for residual motion at the joints and therefore potentially substantial stress on the implant. Formal joint preparation for the purposes of achieving fusion during TTC nail placement may be beneficial to prevent implant loosening or breakage.

How Much Subtalar and Ankle Joint Surface are Actually Destroyed when Reaming for Tibiotalocalcaneal (TTC) Nailing? A Cadaveric Study

Category: Ankle; Trauma Introduction/Purpose: Tibiotalocalcaneal (TTC) nailing in the setting of acute ankle trauma has become increasingly popular over the last decade, with expanding indications. Potential advantages of TTC nailing include: less soft tissue dissection, decreased wound burden, and earlier weightbearing. No consensus exists as to whether formal joint preparation is necessary, and at one or both joints. While some argue that joint preparation is not necessary due to inherent joint destruction from the injury and reaming during TTC nailing, others advocate for preparation to facilitate fusion and ensure no further motion occurs at the joint which could lead to nonunion and/or hardware failure. The purpose of this study was to quantify the proportion of ankle and subtalar joint articular surface destruction associated with reaming for TTC nail fixation. Methods: Twelve cadaver feet from 6 specimens were procured. The specimens were reduced and pinned into neutral ankle dorsiflexion and neutral hindfoot alignment. Prior to reaming, each specimen was secured in a simulated supine position. Per standard TTC nailing technique, a 3.0 millimeter (mm) guide wire was inserted under fluoroscopy, retrograde from the calcaneus, through the talus, and into the tibia, followed by a 12mm opening reamer. The specimens were then dissected, exposing the tibial plafond (TP), talar dome (TD), posterior facet of the talus (PFT), and posterior facet of the calcaneus (PFC). Clinical images of each joint were obtained at an angle of 90 degrees and 12 centimeters (cm) from the joint surface. The images were processed using the ImageJ software platform. The total joint surface area, area of articular destruction, and the remaining joint surface area were calculated. The percentage of joint destruction associated with reaming was then calculated. Results: The mean surface area values and percentages of articular surface destruction are summarized in Table 1. The mean surface area (cm2) after reaming was 11.82, 13.70, 9.23, and 7.79 for the TP, TD, PFT, PFC, respectively. The percentage of articular cartilage destruction was 9.32%, 10.33%, 8.89%, and 10.28% for the TP, TD, PFT, PFC, respectively. No joint destruction was observed in the middle facets of the subtalar joint. Conclusion: This study demonstrates that reaming for TTC nail placement involves only a small portion (roughly 8-10%) of each of the articular surfaces of the ankle and subtalar joints. Violation of the middle facet of the subtalar joint did not occur. These results suggest that a significant portion of hindfoot articular surface remains after reaming for TTC nail. Formal joint preparation may be beneficial to aid with fusion after TTC nail placement, particularly when used in younger, more active individuals who sustain hindfoot and ankle trauma.

Characterization of spontaneous facet joint osteoarthritis

Purpose: Although rodent models of traumatically or chemically induced spinal facet joint osteoarthritis (FJOA) were previously described, animal models of typical spontaneous FJOA haven’t been documented. This study aimed to identify the characteristics of murine spontaneous FJOA and its molecular mechanisms. Methods: The lumbar facet joints of mice bearing mutant NFAT1 alleles and of wild-type (WT, control) mice were examined by histopathology, quantitative gene expression, immunohistochemistry, and histomorphometry using a novel FJOA scoring system at 2, 6, 12, and 18 months of age. The reproducibility of the FJOA scoring system was confirmed by inter-observer and intra-observer variability tests. Tissue-specific histomorphometric and gene expression changes were statistically analyzed. Results: NFAT1-mutant facet joints displayed dysfunction of articular chondrocytes and synovial cells with aberrant gene and protein expression in cartilage and synovium as early as 2 months. osteoarthritic structural changes such as articular surface destruction and chondro-osteophyte formation became evident in NFAT1-mutant facet joints at 6 months. Severe FJOA changes including deeper cartilage loss, synovial thickening, separation of cartilage from thickened subchondral bone, as well as tissue-specific molecular and cellular alterations were evident in NFAT1-mutant mice at 12 and 18 months. OA-like structural changes were not detected in WT facet joints at any ages, though aging-related cartilage degeneration was observed at 18 months. Conclusions: This study characterized a novel murine model of spontaneous FJOA and developed the first FJOA scoring system. The age- and tissue-specific molecular and cellular characteristics in the NFAT1-mutant facet joints have provided new insights into the pathogenetic mechanisms for initiation and progression of spontaneous FJOA.

Application of CT Image Based on Three-Dimensional Image Segmentation Algorithm in Diagnosis of Osteoarthritis

Objective: To investigate the application of multi-slice spiral CT in degenerative changes of lumbar facet joints using the LOG algorithm. Methods: The CT findings of 100 cases of degenerative vertebral facet joint disease were reviewed and analyzed in this paper. Results: The main CT manifestations of facet disease are osteophyte formation, articular hyperplasia and hypertrophy, osteosclerosis, narrowing of joint space, articular surface destruction, joint capsule calcification, joint gas accumulation, joint subluxation, and lateral recesses and vertebrae. Signs such as narrow mesopores. Conclusion: The multi-slice spiral CT (MSCT) and multi-planar reconstruction (MPR) techniques are analyzed by the LOG operator algorithm. It is found that the two techniques can fully display the anatomical structure and pathological changes of the vertebral facet joints, and are useful for the diagnosis of facet joint disease. Provide enough imaging evidence.

Evaluation of Charcot Neuroarthropathy in Diabetic Foot Disease Patients at Tertiary Hospital

Purpose: To evaluate Charcot neuroarthropathy in diabetic foot patients at tertiary hospital. Methods and Material: It is a retrospective study from 2005 to 2015 of Charcot foot patients in diabetic patients admitted in King Abdulaziz University Hospital, Jeddah, Saudi Arabia. Sixty-four patients were admitted as diabetic foot disease and were studied by reviewing patients records of demography, pain, discharge, duration of disease, duration and types of diabetes IDDM [Insulin Dependant Diabetes Mellitus] NIDDM [Non Insulin Dependent Diabetes Mellitus], history of trauma, peripheral vascular disease, obesity, hypertension, co-morbid conditions, previous surgery, involvement of fore foot/midfoot/hindfoot, deformity, ulcer and treatment like casts, offloading devices, pharmacological like biphosphonates, debridement, osteotomy, arthrodesis, exostectomy, and amputation. Results: Majority of patients were males (81.2%). Mean age was 61.75 years. Pain was reported in 25% of patients, numbness in 12.5%, foot deformity in 23.4%, pus discharge in 73.4%, difficulty in walking in 12.5%, and 10.9% had history of trauma. Majority of patients were NIDDM 68.8%, IDDM 31.3%, (62.5% had DM more than 10 years and 36.9% had DM less than 10 years), controlled DM in 21.9% and uncontrolled DM in 73.4%, nephropathy in 46.3%, neuropathy in 59.4%, retinopathy in 40.6%, cardiomyopathy in 48.4% and vasculopathy in 56.3%. Charcot arthropathy was in 28.1% of cases and forefoot was involved in 65.5%, midfoot in 4.7% and hindfoot/ankle in 21.9%. It was forefoot which was mainly involved in Charcot joint disease. It was demonstrated by X-rays which showed subluxation in 40.6%, dislocation in 54.7%, disorganized foot joints in 42.2%, bone resorption in 23.4%, osteomyelitis in 14.1%, fractures in 50%, joint collapse in 39.1% and destruction of articular surfaces in 37.5%. Debridement was done in 25% of cases while 75% of patients underwent some sort of amputation. 14.1% of patients underwent above knee amputation, 10.9% below knee amputation, 10.9% transmetatarsal and 39.1% toe amputation. Debridement and amputation were the main treatment offered. Conclusions: Diabetic patients with Charcot joint disease pose great challenge in management. Emphasis should be given for early detection, investigations and prompt treatment. Treatment should be tailored according to stage of disease and patient occupation.

Knee osteoarthritis and arthroplasty of the knee joint

According to the Public Health Institute of Vojvodina one of the main causes of morbidity, invalidity and absence from work in Vojvodina are musculoskeletal diseases. Osteoarthritis is a multifactorial joint disease, with catabolism and inflammation in its background. For radiological classification of knee osteoarthritis stage Kellgren-Lawrence scale is used. It consists of five levels, from stage ?0? to stage ?4?. The goal of osteoarthritis treatment is to reduce pain and muscle spasms, improve limb function, prevent joint contractures and train patients to function in everyday life and professional activities. The therapy is divided into conservative (medical and physical) and surgical. Arthroplasty is a surgical procedure that involves destruction of articular surfaces and replacement of degenerative joints with endoprostheses, which result in increased general and working ability. Modern endoprostheses enable a high success rate of the procedure. At the Department of Orthopedics and Traumatology, Clinical Center of Vojvodina in Novi Sad, the first knee aloarthroplasty was performed in 1989. Since then, more than 3000 knee aloarthro?plasties have been done. Clinical patient evaluation was obtained through subjective status, functional evaluation and use of scoring systems. More than 80% of patients had a good or a great score.

English

Septic Arthritis also known as infectious arthritis, can be bacterial or fungal arthritis. The condition is an inflammation of a joint that is caused by an infection. Typically, Septic Arthritis affects one large joint in the body such as knee or hip. Generally, Septic Arthritis is present with complete absorption of the head of the Femur in infants. A case was encountered in which the complete absorption of the femoral head was seen in adults also. INTRODUCTION: Septic Arthritis of hip in adults is generally present with high grade fever with severe limitations of hip joint movement. The X-Ray of the Pelvis of both the hip joints in Septic Arthritis of hip in adults shows destruction of articular cartilage and narrowing of joint space and destruction of adjoining bone. But we had a case where there was a complete absorption of head of Femur with the destruction of articular surface of Acetabulum, which is more commonly seen in Septic Arthritis of hip in infants. CLINICAL HISTORY: A female patient aged about 40 years c/o high grade fever with multiple joints pain was admitted in the medical ward. The patient was investigated for all types of viral fever and other causes of fever. The patient was on IV antibiotics and analgesics with 10mg of Prednisilone twice a day. The patient c/o severe pain in the left hip joint and hence, referred to the Orthopaedic Dept. O/E, the patient was having high grade fever for the past 15 days. There was no history of injury. The patient was having multiple joint pains more on the hip joint. O/E, the hip joint was kept in 40 degrees of fixed flexion deformity with severe restriction of movements of hip joint. X-ray of pelvis with both hip joints - AP view was taken. X-ray showed that there is complete destruction of femoral head with narrowing of joint space. The patient was provisionally diagnosed as Septic Arthritis of the hip and transferred to the Orthopaedics department. INVESTIGATIONS:

Syringomyelia with Chiari I malformation presenting as hip charcot arthropathy: a case report and literature review.

Neuroarthropathy (neuropathic osteoarthropathy), also known as Charcot joint, is a condition characterized by a progressive articular surface destruction in the setting of impaired nociceptive and proprioceptive innervation of the involved joint. It is seen most commonly in the foot and ankle secondary to peripheral neuropathy associated with diabetes mellitus. Cases of hip (Charcot) neuroarthropathy are rare and almost exclusively reported in patients with neurosyphilis (tabes dorsalis). We report a case of a 36-year-old man who presented to the emergency department complaining of right hip pain. On physical examination, pain and thermal sensory deficits were noted in the upper torso with a cape-like distribution, as well as signs of an upper motor neuron lesion in the left upper and lower extremities. A magnetic resonance imaging study (MRI) of the right hip showed evidence of early articular surface destruction and periarticular edema consistent with hip Charcot arthropathy. An MRI of the spine revealed an Arnold-Chiari type I malformation with extensive syringohydromyelia of the cervical and thoracic spine.

Transcription factor Nfat1 deficiency causes osteoarthritis through dysfunction of adult articular chondrocytes

Osteoarthritis (OA) is the most common form of joint disease in middle-aged and older individuals. Previous studies have shown that over-expression of matrix-degrading proteinases and proinflammatory cytokines is associated with osteoarthritic cartilage degradation. However, it remains unclear which transcription factors regulate the expression of these cartilage-degrading molecules in articular chondrocytes. This study demonstrated that mice lacking Nfat1, a member of the nuclear factor of activated T cells (NFAT) transcription factors, exhibited normal skeletal development but displayed loss of type II collagen (collagen-2) and aggrecan with over-expression of specific matrix-degrading proteinases and proinflammatory cytokines in young adult articular cartilage of load-bearing joints. These initial changes are followed by articular chondrocyte proliferation/clustering, progressive articular surface destruction, periarticular chondro-osteophyte formation and exposure of thickened subchondral bone, all of which resemble human OA. Forced expression of Nfat1 delivered with lentiviral vectors in cultured 3 month-old primary Nfat1 knockout (Nfat1(-/-)) articular chondrocytes partially or completely rescued the abnormal catabolic and anabolic activities of Nfat1(-/-) articular chondrocytes. These new findings revealed a previously unrecognized critical role of Nfat1 in maintaining the physiological function of differentiated adult articular chondrocytes through regulating the expression of specific matrix-degrading proteinases and proinflammatory cytokines. Nfat1 deficiency causes OA due to an imbalance between the catabolic and anabolic activities of adult articular chondrocytes, leading to articular cartilage degradation and failed repair activities in and around articular cartilage. These results may provide new insights into the aetiology, pathogenesis and potential therapeutic strategies for osteoarthritis.

Role of transarticular screw fixation in tuberculous atlanto-axial instability

Prospective study of 27 consecutive cases of tuberculous atlanto-axial instability operated between 1998 and 2003. Early surgical stabilization of tuberculous atlanto-axial instability has gained popularity. This is largely due to success of chemotherapy in rapid control of infection. Although selective atlanto-axial fusion techniques are advocated in other indications, their role in tuberculosis remains confined to atlanto-axial wiring techniques that are mechanically unsound. The role of three-point rigid fixation using trans-articular screws (TAS) remains unclear. The objectives of this study are: (1) To define the role of trans-articular screws in tuberculous atlanto-axial instability based on radiological criteria. (2) To attempt to separate patients that can be treated by selective atlanto-axial fixation as against the standard occipito-cervical fusion (OCF). (3) Compare the clinical and radiological outcome parameters between the two groups. Twenty-seven consecutive patients of tuberculous atlanto-axial instability were operated between 1998 and 2003. The pattern of articular surface destruction and the reducibility of the atlanto-axial complex were assessed on plain radiographs and MRI. The reducibility of the C1-C2 joint was graded as reducible, partially reducible and irreducible. Pattern of the C1-C2 articular mass destruction was grouped as minimal, moderate and severe. The patients were divided into two surgical groups based on radiological findings and were treated with TAS (n=11) and OCF (n=16) fusion. The three-point fixation provided by the TAS allowed early brace free mobilization by 3 months with fusion rate of 100%. Fusion occurred in 83.16% in the OCF group. Implant failure occurred in two patients who underwent OCF. The patient satisfaction rate in the TAS group and the OCF group was 90.90 and 62.50%, respectively. Results in 27 consecutive patients demonstrate improved patient fusion and satisfaction rates in the TAS group. Judicious selection of patients for TAS fixation is possible with relatively few complications in tuberculosis of the atlanto-axial complex. This, however, requires a thorough understanding of the MRI pattern of involvement of the atlanto-axial complex that is difficult in non-endemic areas.

Ligamentous Lisfranc Joint Injuries: A Biomechanical Comparison of Dorsal Plate and Transarticular Screw Fixation

The current treatment of displaced ligamentous injuries of the tarsometatarsal (TMT) joints is open reduction and rigid fixation using transarticular screws. This technique causes further articular surface damage that theoretically may increase the risk of arthritis. Should the screws break, hardware removal is difficult. An alternative method that avoids these potential complications is rigid fixation using dorsal plates. The displacement between the first metatarsal and medial cuneiform, the second metatarsal and intermediate cuneiform, the first and second metatarsal bases, and the medial cuneiform and second metatarsal base were measured in 10 matched pairs of fresh-frozen cadaver lower extremities in the unloaded and loaded condition. After sectioning the Lisfranc and TMT joint ligaments, measurements were repeated in the loaded condition. The first and second TMT joints of the right feet were fixed with transarticular 3.5-mm cortical screws while those of the left feet with were fixed with dorsal 2.7-mm 1/4 tubular plates. Measurements were then repeated in the unloaded and loaded condition. After ligament sectioning, significantly increased first and second TMT joint subluxation with loading was seen. No significant difference was noted with direct comparison between plates and screws with respect to ability to realign the first and second TMT joints and to maintain TMT joint alignment during loading. The amount of articular surface destruction caused by one 3.5-mm screw was 2.0 +/- 0.7% for the medial cuneiform, 2.6 +/- 0.5% for the first metatarsal, 3.6 +/- 1.2% for the intermediate cuneiform, and 3.6 +/- 1.0% for the second metatarsal. The model reliably produced displacement of the first and second TMT joints consistent with a ligamentous Lisfranc injury. Transarticular screws and dorsal plates showed similar ability to reduce the first and second TMT joints after TMT and Lisfranc ligament transection and to resist TMT joint displacement with weightbearing load. Dorsal plating may be an alternative to transarticular screws in the treatment of displaced Lisfranc injuries.

Synovitis in a murine model of human factor VIII deficiency

Recurrent joint bleeding is the most common musculoskeletal manifestation of haemophilia and leads to a target joint and synovitis. The pathobiology of haemophilic synovitis (HS) is not well understood. Here the histopathological changes that occur following haemarthrosis were examined in an animal model for human HS. After two haemarthrosis, there was soft tissue and joint swelling and histological changes of acute synovitis included infiltration of the sub-synovial layer by mononuclear cells and neutrophils, thickening of the synovial membrane with villus formation, and hyperplasia of blood vessels. Subacute changes were evident after three haemarthrosis; muscle atrophy was present and an intense mononuclear cell infiltrate filled the sub-synovial space. There was destruction of articular surfaces and loss of cartilage. Seventeen months after three haemarthrosis, chronic joint changes included gross deformity and loss of congruence due to dense fibrotic tissue filling the joint space. The mononuclear inflammatory cell infiltrate and thickened synovial membrane persisted. Pits and erosions of articular surfaces and sub-chondral cysts were present. There was fibro-cartilage and new bone formation. This model of human HS should be useful to fully evaluate the biochemical and molecular changes that occur following joint bleeding and to test novel therapeutics to prevent HS.

Distal femur resection with endoprosthetic reconstruction: a long-term followup study.

The distal femur is a common site for primary and metastatic bone tumors and therefore, it is a frequent site in which limb-sparing surgery is done. Between 1980 and 1998, the authors treated 110 consecutive patients who had distal femur resection and endoprosthetic reconstruction. There were 61 males and 49 females who ranged in age from 10 to 80 years. Diagnoses included 99 malignant tumors of bone, nine benign-aggressive lesions, and two nonneoplastic conditions that had caused massive bone loss and articular surface destruction. Reconstruction was done with 73 modular prostheses, 27 custom-made prostheses, and 10 expandable prostheses. Twenty-six gastrocnemius flaps were used for soft tissue reconstruction. All patients were followed up for a minimum of 2 years. Function was estimated to be good or excellent in 94 patients (85.4%), moderate in nine patients (8.2%), and poor in seven patients (6.4%). Complications included six deep wound infections (5.4%), six aseptic loosenings (5.4%), six prosthetic polyethylene component failures (5.4%), and local recurrence in five of 93 patients (5.4%) who had a primary bone sarcoma. The limb salvage rate was 96%. Distal femur endoprosthetic reconstruction is a safe and reliable technique of functional limb sparing that provides good function and local tumor control in most patients.

The mandibular condyle in juvenile chronic arthritis patients with mandibular hypoplasia

Abstract.In 12 JCA patients with severe mandibular hypoplasia, who all strongly demanded early treatment, 21 mandibular condyles were replaced by costochondral grafts. All of them had radiographic morphological changes in the mandibular condyles with varying degrees of destruction of the articular cartilages. Severe pathological changes in the lower joint compartments were consistently observed at surgery. Hence, the lower joint compartments were obstructed with granulomatous tissue, whereas the upper compartments were without macroscopic pathological changes. These findings indicated a polarized involvement of the temporomandibular joint (TMJ) in juvenile chronic arthritis (JCA). The extent of condylar articular surface destruction at histological examination varied from focal to total cartilage destruction. Inflammation of the subchondral bone marrow was a frequent finding. In spite of considerable arthritic destruction of the condyles, only one patient had TMJ pain, while a restricted mouth opening capacity was a more frequent finding. Thus, TMJ pain did not seem to constitute a reliable symptom of serious arthritic destruction of the mandibular condyle.

Macroscopic and microscopic appearance of radiologic findings in temporomandibular joints from elderly individuals: An autopsy study

The macroscopic and microscopic appearance of radiologic findings in 40 temporomandibular joints (TMJ) taken at autopsy from 20 elderly individuals was investigated. The radiologic signs of erosion and sclerosis were strongly associated with macroscopic articular surface destruction only on the condyle while the soft tissue lining was most often intact in areas with a sclerosis of the temporal component. Radiologic concavity, osteophyte, and flattening presented none or mild macroscopic changes. The microscopic appearance of erosion and cyst formation was characterized by the presence of a cell-rich fibrous and wellvascularized connective tissue. In 4 joints with fibrous ankylosis, an articular soft tissue lining was completely lacking. In areas with radiologic sclerosis, thickening of the cortical and subcortical bone was observed. Both erosions and sclerosis were found in most joints with anterior disc position or disc perforation. It was concluded that radiologic signs of erosion and sclerosis in the condyle are more reliable signs of joint disease than such changes in the temporal component.

The Natural History of Arthritis in Idiopathic Haemochromatosis: Prograssion of the Clinical and Radiological Features Over Ten Years

The natural history of arthritis associated with idiopathic haemochromatosis was studied in 18 male patients over a 10 year period. Chondracalcinosis was present radiologically in at least on joint in seven patients initially and developed later in 13, with the articular cartilages of the wrists and knees affected most frequently. During the period of observation seven patients developed chondrocalcinosis in the wrists, seven in the knees, three in the hips, one in the symphysis pubis and two in the spine. In no patient did the chondrocalcinosis decrease or disappear. The development and progression of chondrocalcinosis was not affected by treatment of iron overload by venesection. The presence of chondrocalcinosis in at least one joint was not related to the age of the patient at the initial or follow-up examination or to the amount of iron removed by venesection (p greater than 0.05, Wilcoxon rank sum test). Arthritis (loss of joint space, cysts, destruction of articular surfaces) usually with associated symptoms and signs affected the hands in eight patients initially and developed later in 13. Arthritis of large joints was uncommon and none of the patients in the present series developed destructive arthritis of hips or knees. This contrast with the finding in a retrospective survey of 93 patients with idiopathic haemochromatosis seen since 1967 at King's College Hospital in which seven patients had destructive arthritis affecting the hips.

Sternal destruction in rheumatoid arthritis

In rheumatoid arthritis, erosive destruction of articular surfaces is a common finding. The diarthrodial joints primarily are involved and gross destruction of the amphiarthrodial joint of the manubriosternal area is rare.

Juvenile rheumatoid arthritis.

A clinical and biochemical study of 16 cases of rheumatoid arthritis in children has been presented. A predominance of females between the age of 4–6 years was seen. A rash, which is thought to precede the onset of the disease and is typical of it, was not seen in any case. The differential sheep cell agglutination test was positive in 5 cases. Typical radiological appearances of destruction of articular surfaces and periosteal bone formation were not seen in the present series. The problems in the diagnosis of these cases and the response to steroid therapy have been discussed.