Bilateral Joint Research Articles

Unilateral transfemoral osseointegrated prostheses improve joint loading during walking

People with unilateral transfemoral amputation using socket prostheses are at increased risk for developing osteoarthritis in both the residual hip and intact lower-limb joints. Osseointegrated prostheses are a surgical alternative to socket prostheses that directly attach to the residual femur via a bone-anchored implant, however their multi-joint loading effect is largely unknown. Our objective was to establish how osseointegrated prostheses influence joint loading during walking. Motion capture data (kinematics, ground reaction forces) were collected from 12 participants at baseline, with socket prostheses, and 12-months after prosthesis osseointegration during overground walking at self-selected speeds. Subject-specific musculoskeletal models were developed at each timepoint relative to osseointegration. Internal joint moments were calculated using inverse dynamics, muscle and joint reaction forces (JRFs) were estimated with static optimization. Changes in internal joint moments, JRFs, and joint loading-symmetry were compared using statistical parametric mapping (p≤ 0.05) before and after osseointegration. Amputated limb hip flexion moments and anterior JRFs decreased during terminal stance (p = 0.002, <0.001; respectively), while amputated limb hip abduction moments increased during mid-stance (p < 0.001), amputated hip rotation moment changed from internal to external throughout early stance (p < 0.001). Intact limb hip extension and knee flexion moments (p = 0.028, 0.032; respectively), superior and resultant knee JRFs (p = 0.046, 0.049; respectively) decreased during the loading response following prosthesis osseointegration. These results may indicate that the direct loading transmission of these novel prostheses create a more typical mechanical environment in bilateral joints, which is comparable with loading observed in able-bodied individuals and could decrease the risk of development or progression of osteoarthritis.

Impact of Lifestyle on Knee Osteoarthritis in Mosul Hospitals

Background &amp; Objectives: Osteoarthritis (OA) is the most prevalent form of arthritis. It is a chronic, degenerative disease of the musculoskeletal system that causes significant disability in patients all over the world. The knee is the most commonly affected joint by OA, especially in older people. Knee OA is a painful disorder that progresses with time and affects the whole knee joint, leading to varying degrees of severe joint failure. It can cause pain, stiffness, and swelling in the knee. It can also lead to disability ,and Lifestyle factors were found to be related to knee OA. This study’s aim was to evaluate how lifestyle choices affected knee OA in patients visiting hospitals in Mosul, Iraq. The specific objectives of the study were to 1 Evaluate demographic characteristics of individuals with knee OA. 2 Discover the lifestyle factors for patients with knee OA. 3 Determine the relationship between lifestyle and the severity of knee OA. Methods: A cross-sectional study design was adopted for the period extended from the 1st of December 2022, to the 20th of July 2023. It included 500 knee osteoarthritis patients collected from consulting clinics in four teaching hospitals in Mosul, Iraq, by using a developed interviewing questionnaire that assessed sociodemographic characteristics, health history, lifestyle factors, and the severity of knee OA. Results: The mean age of patients (59.4) The majority of the participants were female (83.4%). (74.6%) of the sample were housewives, (75.4%) lived in urban. The most common risk factors for knee OA were obesity (27.2%), and family history (47.4%). (90.8%)of the patients had low education level. Patients had bilateral joint OA(right and left) were 64.6%. Most of patients have a sedentary lifestyle. There are significant association between lifestyle domains like health self-responsibility, nutrition, physical activity, stress management, and spiritual growth with joint OA severity. The highest association between lifestyle domains and severity is seen in the areas of health self-responsibility, diet, and physical exercise. Conclusion: Certain demographic and socio-demographic factors, such as age, gender, education, residency, occupation, BMI, previous knee injuries, and family history, had a significant association with knee osteoarthritis patients. This study has shown that lifestyle factors play a role in the development and severity of knee OA. Physical inactivity, poor diet, and obesity are all major risk factors for knee OA. The findings can suggest that modification of lifestyle may be a protective against knee OA. Participants who reported being more physically active, eating a healthier diet, and maintaining a healthy weight were less likely to have severe knee OA. Interventions that target lifestyle factors may be beneficial in preventing and managing knee OA. Keyword: Knee Osteoarthritis, Life-Style, Factor

Do Case Reports on Total Mandibular, Extended, and Bilateral Total Temporomandibular Joint Reconstruction Prostheses Adhere to the Surgical CAse REport Guidelines?

The Surgical CAse REport (SCARE) guidelines are a standardized format for reporting surgical cases. The aim of this study was to evaluate the completeness of case reports documenting alloplastic reconstruction of large craniomaxillofacial defects involving total mandibular, bilateral, and extended temporomandibular joint in major high-quality craniomaxillofacial journals, based on the SCARE guidelines. An extensive online search was performed according to the Priority Reporting Items for Systematic Reviews and Meta-Analyses statement in PubMed, Embase, Scopus, Google Scholar, and Dimensions databases to identify relevant case reports. Each selected case report was assessed on 16 topics (38 items) of the SCARE guidelines, using a scoring scale of "0" (No/noncompliance), "1" (Yes/compliance), and "2" (unclear). The completeness of reporting (COR) score was calculated as the ratio of "yes" responses to "total" (ie, yes+no+unclear) responses. Adequacy of case reporting was denoted by a COR score of 70% or more. A total of 35 case reports were selected, where the male to female patients ratio was 3:4 cases, mean±standard deviation (SD) age: 34.9±16.7years, mean±SD follow-up duration: 17.0±12.9months, and number of patients with left, right, and bilateral temporomandibular joint reconstruction prostheses were 16, 10, and 09, respectively. The mean±SD COR score for all 35 case reports and the individual item of the SCARE guidelines was 70.2±10.5% and 66.5±31.2%, respectively. The minimum and maximum COR score was found for "Keywords" (0.0%) and "Introduction" (100%) and "Clinical Findings" (100%), respectively. Adequate reporting was found for 20/35 (57%) case reports. This study revealed that case reports in major high-quality craniomaxillofacial journals suffer from insufficient reporting. Widespread adoption of available standards, such as SCARE guidelines, is proposed to improve the quality and robustness of case reporting.

Ayurvedic Management of Avascular Necrosis (AVN) Stage IV: A Case Report

Avascular Necrosis (AVN) is a disorder characterized by necrotic changes in the bone tissue due to interruption of blood supply. AVN is classified into 4 stages. AVN I and II stages may benefit from conservative treatments while patients with Stage III or IV may require surgery such as joint replacement or bone grafting. This case report gives an insight into Ayurveda management of AVN stage IV in improving the quality of life (QOL) of the patient. A 34 years aged male patient came with presenting complaints of being unable to walk due to the pain at the bilateral hip joints for 4 years. The pain restricts him to initiate walking. The MRI finding was AVN of the bilateral heads of the femurs in ARCO Stage IV A. The condition is diagnosed as Asthi-majjagata-vata. It is managed with oral medicines, abhyanga, svedana, and basti. After the treatment, the patient can walk for 30 minutes and can sit for more than 1 hour without pain. The QOL of the patient is considerably increased on Harris hip score. This case report shows the importance of Ayurveda management even in the AVN stage IV to improve the QOL. More research in AVN stage IV management with Ayurveda is needed to arrive at a specific conclusion.

The role of modified Pichha Basti in the management of Ulcerative Colitis - A Case Study

Ulcerative colitis (UC) is an inflammatory bowel disease that causes inflammation and ulcer in digestive tract. UC affected the innermost lining of large intestine also called the colon and rectum. In most popular symptoms usually develop over time rather than suddenly. UC can be draining or sometimes lead to life threatening complication. While it has no know cure there are several new treatments that can greatly reduce sign and symptoms of the disease and bring about long term remission. In Ayurveda Raktaatisara, Pitajatisara, Parvahika and Grahani shows symptoms having resemble with UC like blood and bile mixed stool with excessive foul smell, burning sensation, suppuration of colon and anus, colic pain etc. Pichha Basti indicated in Parvahika, Grahani and Atisara by Acharya Charaka and Vagbatta. This Basti reduce inflammation due to its Grahi, Deepandravya and Picchila Guna. It also improves the function of Apanvata. In modern medical science many conventional medicines are used in ulcerative colitis some drug like mesalamine may give relief in sign and symptoms but this drug is not suitable due to their side effects. The patient gradually developed the following symptoms like bilateral joint pain in all major and minor joints, hair loss, reddish discoloration on bilateral medial aspect of thigh and hip etc.

Joint Development Between Australia and Timor-Leste

1. Australia and Indonesia signed a joint development treaty regarding the Timor Sea in 1989. As the Democratic Republic of Timor-Leste (hereinafter, Timor-Leste) gained independence from Indonesia in 2001, it signed a new bilateral joint development agreement with Australia in 2002 as well as a series of subsequent agreements to establish the joint development legal framework. These two cases (the agreement between Australia and Indonesia, and that between Australia and Timor-Leste) share a great similarity in the form of cooperation, legal framework, and management structure. This paper analyzes the legal arrangement regarding common issues generally included in the joint development, and outlines relevant problems in its implementation. 2. The form of the agreement comprises three kinds of legal instruments reached in different periods. The basic form is the bilateral treaty to establish an overall framework for joint development. The second is the subsequent agreement to make revisions and adjustments to specific legal issues, such as cross-boundary deposits and the allocation ratio in a specific zone. The third refers to regulations and guidelines to deal with issues related to implementation and operation, which may be regarded as special laws dealing with the joint development zone.

An Exploratory Investigation Evaluating the Impact of Fatigue-Induced Stride Length Compensations on Ankle Biomechanics among Skilled Baseball Pitchers.

Altered propulsive and bracing ground reaction forces from lower-body fatigue significantly impact stride length to increase weakness in dynamic elbow stabilizers and risk of medial elbow injury in baseball pitchers. This work investigated altered stride length on three-dimensional ankle joint dynamics to illustrate fatigue-induced changes in ankle motion that can also be impacted by coaching errors. Nineteen pitchers (15 collegiate and 4 high school) were randomized in a crossover design study that encouraged fatigue by throwing two simulated 80-pitch games at ±25% of their desired stride length. An integrated motion-capture system with two force plates and radar gun tracked each throw. Retrospective analysis using pairwise comparisons, including effect size calculations, were undertaken to identify differences in ankle dynamics between stride length conditions for both the drive and stride leg. Longer strides were found to be more effective in drive ankle propulsion and stride-bracing mechanics. Conversely, shorter strides delayed bracing dynamics by demonstrating continued drive ankle plantar flexion moments after stride-foot contact to extend pitchers' time in propulsion (p < 0.001, d > 0.8). Additionally, heightened braking effects were seen during the acceleration phase of throwing with greater stride knee extension power when pitching with shorter strides (p < 0.001, d > 0.8). The knowledge gained from this work offers new insight into compensatory stride length adaptation that impacts systemic and throwing arm-specific fatigue to maintain ball velocity, as bilateral ankle joint dynamics can be significantly affected in response to cumulative workload.

THREE-DIMENSIONAL KINEMATICS OF THE JAW FOLLOWING UNILATERAL AND BILATERAL PROSTHETIC TMJ SURGERY

Total temporomandibular joint (TMJ) replacements reduce pain and improve quality of life in patients suffering from end-stage TMJ disorders, such as osteoarthritis and trauma. Jaw kinematics measurements following TMJ arthroplasty provide a basis for evaluating implant performance and jaw function. The aim of this study is to provide the first measurements of three-dimensional kinematics of the jaw in patients following unilateral and bilateral prosthetic TMJ surgeries.Jaw motion tracking experiments were performed on 7 healthy control participants, 3 unilateral and 1 bilateral TMJ replacement patients. Custom-made mouthpieces were manufactured for each participant's mandibular and maxillary teeth, with each supporting three retroreflective markers anterior to the participant's lip line. Participants performed 15 trials each of maximum jaw opening, lateral and protrusive movements. Marker trajectories were simultaneously measured using an optoelectronic tracking system. Laser scans taken of each dental plate, together with CT scans of each patient, were used to register the plate position to each participant's jaw geometry, allowing 3D condylar motion to be quantified from the marker trajectories.The maximum mouth opening capacity of joint replacement patients was comparable to healthy controls with average incisal inferior translations of 37.5mm, 38.4mm and 33.6mm for the controls, unilateral and bilateral joint replacement patients respectively. During mouth opening the maximum anterior translation of prosthetic condyles was 2.4mm, compared to 10.6mm for controls. Prosthetic condyles had limited anterior motion compared to natural condyles, in unilateral patients this resulted in asymmetric opening and protrusive movements and the capacity to laterally move their jaw towards their pathological side only. For the bilateral patient, protrusive and lateral jaw movement capacity was minimal.Total TMJ replacement surgery facilitates normal mouth opening capacity and lateral and inferior condylar movements but limits anterior condylar motion. This study provides future direction for TMJ implant design.

Axial rotation and pain are associated with facet joint osteoarthritis in adolescent idiopathic scoliosis

Facet joints are crucial for spinal stability and develop premature osteoarthritis in patients with adolescent idiopathic scoliosis (AIS). Here, we evaluated the association between facet joint cartilage and subchondral bone homeostasis, perceived back pain and 3-dimensional spinal deformity to understand better the role of facet joint degeneration in AIS progression and pain. Cartilage and bone osteoarthritic states of AIS facet joint surgical samples were characterized using histological OARSI scoring, visual morphological grading and μCT analysis, respectively. Back pain was self-reported using a numerical rating scale and expressed relative to the location on the patient's back. The scoliotic curves from our patient cohort were digitally reconstructed using biplanar radiographs and the eOS system (EOS imaging). The deformity was then reduced to three intervertebral angles (coronal, sagittal and axial) for each pair of bilateral facet joints. Statistical associations between the intervertebral angles, osteoarthritis parameters and pain intensity were performed using the Spearman method and Friedman test. Facet joint cartilage degeneration was associated with decreased subchondral bone volume and quality. Most importantly, asymmetrical, and overall degeneration of facet joints was strongly correlated to intervertebral axial rotation. Additionally, kyphotic intervertebral segments in the sagittal plane were good predictors of increased facet joint degeneration and back pain. Facet joint degeneration is associated with axial deformity, kyphotic intervertebral angle and back pain intensity in AIS. These results suggest that facet joints are important features to consider for rotational instability in AIS spines and related disease progression and perceived back pain.

Heerfordtův syndrom – vzácná manifestace sarkoidózy z pohledu ORL lékaře

Summary Sarcoidosis is a systemic granulomatous disease that mainly affects the pulmonary and lymphatic systems. In its rare, acute forms, it can manifest as Lofgren’s syndrome (combination of erythema nodosum, bilateral pulmonary hilar lymphadenopathy, joint pain, fever and general symptoms) and even more rarely as Heerfordt’s syndrome (combination of fever, anterior uveitis, bilateral edema of the parotid area and uni or bilateral facial nerve paresis). Although this dia­gnosis is rare, it belongs to the differential dia­gnosis of sudden paresis of the facial nerve and swelling of the parotic area. In our case report, we describe Heerfordt’s syndrome in a 50-year-old woman. The pathophysiology, symptomatology, dia­gnosis, and treatment of this rare syndrome are discussed. Key words sarcoidosis – uveoparotid fever – facial nerve paresis

Validating stroke-induced bilateral ankle coordination deficits using bilateral ankle measure relationship with motor functions in lower limbs

BackgroundCoordinated control between the bilateral ankle joints plays an important role in performing daily life functions, such as walking and running. However, few studies have explored the impact of stroke on movement disorders that decrease the coordination control of the bilateral extremities and may decrease daily activities that require coordination control of the bilateral ankles. This study aimed to investigate the coordination control of the bilateral ankles using a novel bilateral ankle measurement system and evaluate the relationship of bilateral movement coordination control deficits with motor and functional performances of the lower extremities in patients with stroke.MethodsTwenty-one healthy adults (36.5 ± 13.2 y/o) and 19 patients with chronic stroke (58.7 ± 10.5 y/o) were enrolled. A novel measurement device with embedded rotary potentiometers was used to evaluate bilateral ankle coordination control. Participants were asked to move their dominant (non-paretic) foot from dorsiflexion to plantarflexion position and non-dominant (paretic) foot from dorsiflexion to plantarflexion position (condition 1) simultaneously, and vice versa (condition 2). Alternating time and angle for coordination control with movements of both ankles were calculated for each condition. Motor and functional performance measurements of the lower extremities included the lower-extremity portion of the Fugl-Meyer assessment (FMA-LE), Berg Balance Test (BBS), Timed Up and Go Test (TUG), and Barthel Index (BI).ResultsCompared with the healthy group, alternating time was shorter in the stroke group by 8.3% (p = 0.015), and the alternating angles of conditions 1 and 2 were significantly higher than those of the healthy group by 1.4° (p = 0.001) and 2.5° (p = 0.013), respectively. The alternating angle in condition 2 showed moderate correlations with TUG (r = 0.512; p = 0.025), 10-m walk (r = 0.747; p < 0.001), gait speed (r = − 0.497 to − 0.491; p < 0.05), length (r = − 0.518 to − 0.551; p < 0.05), and BI (r = − 0.457; p = 0.049).ConclusionStroke decreases alternating time, increases alternating angle, and shows bilateral ankle coordination control deficits temporally and spatially. A higher alternating angle is moderately to highly associated with motor function and lower limb function in patients with stroke.

Imaging of bilateral tendoachilles xanthomatosis in a young woman

Bilateral tendoachilles xanthomatosis is a rare entity and is frequently found in association with the primary hyperlipidemia. It is characterized by the deposition of cholesterol in tendons. An early diagnosis with different imaging modalities changes the course of the disease. This case report illustrates the bilateral tendoachilles xanthomas on MRI imaging in a patient who presented with painless progressive swelling of bilateral ankle joints for several years. Intralesional subtotal resection was successfully done and histological evaluation further confirmed the diagnosis.

Acute effects of Kinesio Taping on lower-limb coordination of gait in hemiplegic patients

BackgroundKinesio taping can effectively strengthen weakened muscles, increase walking speed, and improve dynamic balance in hemiplegic patients, but its effect on lower-limb coordination is not clear. Improving lower-limb coordination in hemiplegic patients can decrease risk of fall during walking. Research questionThis study utilized continuous relative phase to depict the pattern and variability of lower-limb coordination in hemiplegic patients and healthy subjects during walking, and investigate whether it has the acute effect of Kinesio Taping on lower-limb coordination in hemiplegic patients during walking. MethodsGait was measured by a three-dimensional motion capture system for 29 hemiplegic patients (KT group) and 15 healthy subjects (control group). Mean continuous relative phase (MCRP) and mean continuous relative phase variability (MCRPV) were calculated to describe and evaluate lower-limb coordination. ResultsKT intervention only changed the coordination between the bilateral ankle joints in hemiplegic patients. Before the intervention, the MCRP of the two ankles (AA-MCRP) in the stance period of the control group was greater than the KT group (P < 0.001), the MCRPV of the two ankles (AA-MCRPV) in the swing period was lower than that in KT group (P < 0.001). After the intervention, the AA-MCRP in the stance period of the KT group increased (P < 0.001), the AA-MRPV in the swing period of KT group significantly decreased (P = 0.001). SignificanceImmediate ankle KT intervention can result in the in-phase or anti-phase coordination between the two ankles developing to out-of-phase coordination during the stance period of the affected limb during walking, and increase the stability of the out-of-phase coordination between the two ankles during the swing period of the affected limb. KT can be used in rehabilitation treatment for hemiplegic patients to improve acute coordination between the patients' ankles.

Comparison and analysis of the biomechanics of the lower limbs of female tennis players of different levels in foot-up serve.

Purpose: The purpose of this study was to examine biomechanical performance of the foot-up serve (FUS) in female tennis players at different skill levels. Methods: FUS analysis was completed in the biomechanical laboratory by 32 female college tennis players at three different levels. During FUS, 3D-biomechanical data from tennis players' lower limbs were collected. One-way ANOVA was used to examine differences in kinematic and kinetic data between groups Results: Range of motion (ROM) of bilateral lower-limb joints revealed significant differences in kinematics performance during both the preparation and landing cushion phases (p < 0.05). During preparation, Level 3 was significantly longer than Level 2 (P-a = 0.042, P-b = 0.001, and P-c = 0.006). During the flight phase, significant differences between levels 1 and 3 (P-a:0.002) and levels 1 and 2 (P-c:0.000) were discovered (P-a:0.002 and P-c:0.000). There were significant height differences between levels 1 and 2 as well as between levels 1 and 3. (P-a = 0.001, P-c = 0.000). During serve preparation (P-c = 0.001) and landing, GRF's peak was significantly higher than level 3. (P-c:0.007). Significant differences were found between groups in the LLS preparation stage, with level 3 significantly higher than levels 1 and 2. (P-a = 0.000, P-b = 0.001, and P-c = 0.000); during landing, level 2 LLS was significantly higher than levels 1 and 3. (P-a = 0.000, P-b = 0.000, and P-c = 0.035). Conclusion: The range of motion of joints and the stiffness of the lower limbs have a significant impact on a tennis player's FUS performance. A larger of joint mobility and lower-limb stiffness promote better performance during the FUS preparation stage.

Is it feasible to treat unstable traumatic spondylolisthesis of the axis via posterior fixation without fusion?

BackgroundFew studies reported treatment of unstable traumatic spondylolisthesis of the axis using posterior fixation without fusion. The aim of this study was to evaluate the results and feasibility of posterior fixation without fusion in treating unstable traumatic spondylolisthesis of the axis.MethodsEleven patients with traumatic spondylolisthesis of the axis were included in this study, and posterior fixation without fusion using screw-rod system was performed for them. The clinical outcomes were assessed using the Visual Analog Scale (VAS), the Neck Disability Index (NDI), and the Odom’s grading system. Plain radiography was used to measure the displacement and angulation of C2-C3, and cervical lordosis. Plain radiography and computed tomography were also used to observe the bony fusions of fracture lines and postoperative spontaneous fusion of C2-C3.ResultsThe mean follow up time was 24.6 months (range, 12–72 months). The VAS and NDI scores were significantly improved at the final follow-up compared with those before operation (P < 0.05), and according to Odom’s criteria, 90.9% (10/11) of patients rated their level of satisfaction as excellent or good. The angulation and displacement of C2-C3, and cervical lordosis were significantly improved after operation compared with those before operation (P < 0.05), and at the final follow-up, and these radiological parameters were maintained. All patients achieved solid bony fusions of fracture lines. No operative segment instability was found in all patients during the follow-up period. Spontaneous fusion at bilateral C2-C3 facet joints was found in 11 cases, and anterior and/or posterior bony bridge of intervertebral bodies at C2-C3 was found in 9 cases.ConclusionsPosterior fixation without fusion may be a feasible and effective option for unstable traumatic spondylolisthesis of the axis.

Differences in clinical and radiographic features between bilateral and unilateral adult degenerative temporomandibular joint disease: A retrospective cross-sectional study

To study the correlations of clinical findings and the severity of osseous alterations between bilateral and unilateral degenerative joint disease (DJD) of the temporomandibular joint (TMJ). Forty-eight joints from 35 adult patients with DJD were retrospectively examined. The joints were divided into two groups: bilateral DJD (BDJD) (26 joints) and unilateral DJD (UDJD) (22 joints). We collected data on patient characteristics and symptoms, including pain on palpation, limited mouth opening, pain during mandibular movement, and joint noises. Cone beam Computed Tomography (CBCT) was used to assess bony changes, including maximum condylar bone change, severity of erosion, severity of osteophytes, glenoid fossa changes, and superior joint space measurements. Data were correlated between subgroups. There was no significant difference between the two groups in terms of age or gender. However, pain on palpation was significantly more common in UDJD joints (81.8%) compared to BDJD joints (53.9%). Limitation of mouth opening was also significantly more common in BDJD cases (61.5%) compared to UDJD cases (22.7%). The number of joints with painless degeneration was more common in BDJD TMJs (38.4%) than in UDJD TMJs (9%). There was no significant difference between the two subgroups with regard to pain during mandibular movements or joint sounds and severity of bony changes. This study provided important results outlining clinical the clinical profiles of DJD patients. While painful degeneration was more frequent in UDJD joints, painless degeneration was higher in BDJD joints. Limitation of mouth opening was more common in BDJD patients.

Graft Extrusion of 3 Millimeters Is Acceptable at a Minimum of 5-Year Outcomes for Lateral Meniscal Allograft Transplantation

To determine the acceptable amount of graft extrusion based on long-term radiographic outcomes in lateral meniscal allograft transplantation (MAT). 94 lateral MAT patients with a minimum 5-year follow-up period were reviewed. Graft extrusion was measured on MRI scans taken 1 year after surgery, and the study population was divided according to the amount of extrusion: group A, extrusion <3 mm; group B, 3 mm ≤ extrusion <5 mm; and group C, extrusion ≥5 mm. For radiographic evaluation, the bilateral lateral joint space widths (JSWs) were measured on a standing 45° flexion posteroanterior radiograph. To standardize the measurements, the affected JSW was divided by the contralateral JSW. The change in the standardized JSW (ΔJSWstd) between the preoperative and latest follow-up assessments was analyzed according to the three groups. Multiple regression analysis was performed to control other related factors, such as lower limb alignment and cartilage status at the time of MAT. The acceptable amount of graft extrusion was calculated using a receiver operating characteristic (ROC) curve for the third quartile of ΔJSWstd. Clinical outcomes were evaluated using the Lysholm score and were compared among the groups. The mean follow-up duration was 8.3 ± 3.1 years. There were 54, 25, and 15 patients in group A, group B, and group C, respectively. In multiple regression analysis, both group B and group C had significant associations with ΔJSWstd and their beta coefficients were comparable (group B, P < .001, β= .642; group C, P < .001, β= 0.613). No significant difference in ΔJSWstd was found between group B and group C (P= .494). On the basis of the ROC curve, the acceptable amount of graft extrusion was 3.74 mm (sensitivity, 81.8%; specificity, 77.8%). There were no differences in the Lysholm scores among the three groups (P= .329). ΔJSWstd differed between graft extrusion <3 mm (group A) and graft extrusion ≥3 mm (group B and group C). However, there was no significant difference in ΔJSWstd between group B and group C. No significant difference in clinical outcomes was found according to graft extrusion. This study gave supporting evidence for the currently recognized acceptable amount of graft extrusion (3 mm). Level III, retrospective cohort study.

Muscle function around the hip after operation for Fibrous Dysplasia of Proximal Femur with Varus Deformity.

This study aimed to analyse the clinical effect of surgery for patients with fibrous dysplasia (FD) of the proximal femur with varus deformity, detect the muscle function around the hip joint. This is a retrospective study. A total of 20 patients who underwent operation for FD of the proximal femur with varus deformity at West China Hospital, from January 2018 to October 2022 were included in this study. The peak torque (PT) of muscle strength during abduction, adduction, flexion and extension of bilateral hip joints was measured by an isokinetic muscle test and training system associated with the comparison of bilateral hip joints, to evaluate the function of muscles around the hip joint after operation. The difference between the length of the affected limb and the healthy side was 1~2 cm in seven cases and <1 cm in 13 cases. The force line showed no abnormality in 15 affected limbs, which deviated from the center of the knee joint by 3-5 mm in five cases. The average PT during abduction of hip joints on the affected side of 20 patients was significantly lower than that on the healthy side, which was also reduced evidently during adduction and flexion of hip joints on the affected side compared with that on the healthy side. After effective recovery of the force line and length of the affected limb in patients with FD of the proximal femur with deformity, functional abnormalities of muscles are still present to a certain extent.

Total mandible and bilateral TMJ reconstruction combining a customized jaw implant with a free fibular flap: a case report and literature review

BackgroundThe need for whole mandibular bone reconstruction and bilateral joint replacement is fortunately rare, but it is an extremely challenging topic in maxillofacial surgery, due to its functional implications. CAD-CAM techniques development has opened new broad horizons in the surgical planning of complex maxillofacial reconstructions, in terms of accuracy, predictability, and functional cosmetic results. The review of the literature has revealed a small number of scientific reports on total mandibulectomy including the condyles, with only eleven cases from 1980. Most of the works describe reconstructions secondary to dysplastic or inflammatory diseases affecting the lower jaw. The aim of this work, reporting a rare case of massive fibrous dysplasia of the whole mandible, is to share our experience in the management of extended mandibular and bilateral joint reconstruction, using porous titanium patient-specific implants.Case presentationThe authors present a 20-year-old male patient suffering from massive bone fibrous dysplasia of the mandible. The mandibular body and both the rami and the condylar processes had been involved, causing severe functional impairment, tooth loss, and facial deformation. The young patient, after repeated ineffective conservative surgical treatments, has required a biarticular mandibular replacement. Using virtual surgical planning (VSP) software, the authors, in collaboration with medical engineers, have created a custom-made original titanium porous mandibular implant, suspended from a bilateral artificial temporomandibular joint. The mandibular titanium implant body has been specifically designed to support soft tissues and to fix, in the alveolar region, a free fibular bone graft, for delayed dental implant prosthetic rehabilitation.ConclusionThe surgical and technical details, as well as the new trends in mandibular reconstructions using porous titanium implants, are reported, and discussed, reviewing literature reports on this topic. Satisfactory functional and cosmetic restorative results have been obtained, and no major complications have occurred. The patient, currently in the 18th month clinical and radiological follow-up, has recently completed the functional restoration program by an implant-supported full-arch dental prosthesis.

An unusual case of tenosynovitis in Hansen's disease.

Tenosynovitis is an infrequent presentation of Hansen's disease. It may occur during the natural course of disease or treatment as part of type 1 reaction or rarely may be the presenting complaint. We report a case of tenosynovitis of bilateral wrist joints who after being ineffectively treated by an orthopedician as well as rheumatologist for several months and was finally diagnosed as a case of Hansen's disease (borderline lepromatous) in type 1 reaction with excellent response to multidrug therapy and tapering doses of systemic steroids.