Joint Space Changes Research Articles

Inflammatory change in the upper joint space in temporomandibular joint with internal derangement on Gadolinium-enhanced MR imaging

Abstract.The object of this study was to clarify the relationship between gadopentetate dimeglumine (Gd-DTPA) contrast enhancement of the upper joint space and the severity of internal derangement of the temporomandibular joint (TMJ). Fifty patients with 63 painful TMJs underwent 1.5T MR imaging with T1-weighted images before and after an intravenous injection of Gd-DTPA with or without fat suppression. The relationship was investigated between the contrast enhancement at the upper joint space and disc position, disc morphology or bone morphology. Of the 63 joints, a significant contrast enhancement in the upper joint space was detected in 32 joints. There was a significant high incidence of anterior disc displacement without reduction in the contrast-enhancement positive group compared to the negative group (P=0.021), but there was no significant difference for disc morphology (P=0.094) and bone morphology (P=0.384). Gd-DTPA enhanced MR imaging may potentially have diagnostic value for internal derangements of TMJs.

Correlating the efficacy of knee viscosupplementation with osteoarthritic changes on roentgenological examination

This study was designed to identify the roentgenological changes of the knee that correlated with an unfavourable outcome when treated with an intra-articular knee viscoelastic supplementation. A prospective cohort of 60 patients receiving a standard course of intra-articular knee viscoelastic supplementation with a commercial uncross-linked hyaluronic acid derivative of an intermediate molecular weight were studied. Follow up was for 12 weeks post-treatment with clinical improvement measured using the Western Ontario and McMasters Universities Osteoarthritis Index. X-Rays of the relevant knee were viewed and graded for the severity of joint space, osteophyte, tibial spine, sclerosis, cyst formation, alignment and general severity by an observer blinded to the outcome of the treatment. There were no appreciable differences noted in the age, sex, length of follow up, pre-treatment, the severity of symptoms before treatment and number of intra-articular injections given per course in each X-ray category identified. There was a significant amount of improvement in patients with a minor loss of medial and lateral joint space in all outcome measures. Minimal changes in tibial spine and global appearance also indicated a positive outcome in stiffness, pain and overall improvement. Thus, patients with moderate to severe osteoarthritic changes in joint space on roentgenological examination would not significantly benefit from intra-articular knee viscoelastic supplementation. In addition, we feel that changes in the tibial spine and global appearance are not reviewed consistently enough to be included as part of our recommendation. As such, we conclude that only patients with a minimal to mild loss in joint space on roentgenological examination should form part of the target group who are likely to benefit from intra-articular knee viscoelastic supplementation.

The effects of severe femoral bone loss on the flexion extension joint space in revision total knee arthroplasty: a cadaveric analysis and clinical consequences.

Five revision total knee arthroplasties (TKAs) involving severe femoral bone loss were performed in 1994. Each had sufficiently severe femoral bone loss in which collateral ligament origins and posterior capsular attachments were violated. A paradoxical phenomenon was observed in each case. Unlike primary TKAs, in which larger distal femoral bone resection leads to laxity of the knee joint in extension, these cases with severe distal femoral bone loss, after initial component selection, developed the opposite situation, a flexion contracture. It was hypothesized that femoral bone loss involving collateral ligament origins would permit distraction of the tibia below the femur with the knee held in flexion, but when the knee was brought to full extension, intact posterior structures would maintain a normal tibial position. To investigate this hypothesis, six fresh-frozen cadaveric lower limbs were tested in full extension and 45 degrees and 90 degrees of flexion after release of the femoral attachments of the collateral ligaments and the posterior capsule from the femur. Joint space changes were measured via a motion tracking device. Results showed that with loss of collateral attachments, 17.2+/-8.9 mm of joint space is created in 90 degrees of flexion, whereas the joint space in full extension is conserved (1.5+/-1.7 mm). With additional loss of the posterior capsule, the joint space at 90 degrees of flexion increased to 26.2+/-6.1 mm, with minimal changes in the extension gap (3.4+/-0.8 mm). Distal femoral bone loss was associated with an increase in the flexion gap compared to the extension gap.

MRI and ultrasound in children with juvenile chronic arthritis

In this era of advancing imaging technology, a knowledge of the relative values of available imaging techniques is necessary to optimize the management of children with juvenile chronic arthritis (JCA). After clinical examination, plain films remain the initial investigation. The need for radiation protection must be a priority in children with JCA. Conventional radiographs allow grouping of the various arthritides (on the base of the distribution and pattern of joint space changes) and staging of disease progression. Ultrasound (US) is very sensitive in the detection of joint effusions, especially in the hip, and guides fluid aspiration. US and Doppler can be used for the evaluation of synovial hypertrophy and activity. Arthrography and to a certain extent nuclear studies have been replaced by magnetic resonance imaging (MRI). MRI can demonstrate articular cartilage, joint effusion, synovial hypertrophy, cortical and medullary bone, cartilage and bone perfusion, and fibrocartilaginous structures (menisci and ligaments). Contrast enhanced MRI is the most sensitive modality to determine whether an arthritic condition is present. However, it does not assist in establishing a specific diagnosis. MRI determines accurately the activity and the extent of the disease and is particularly useful in the early detection of articular damage. Finally, MRI is of major importance in the evaluation of response to local therapy (especially steroids) and the detection of complications.

A cephalometric and tomographic evaluation of Herbst treatment in the mixed dentition

This study describes combined treatment and posttreatment effects for patients treated with the Herbst appliance in the mixed dentition followed by retention with a prefabricated positioner. The sample included 24 female and 16 male patients with Class II malocclusions. Posttreatment lateral cephalograms were taken an average of 17 months after Herbst removal, when the patients presented for phase II comprehensive orthodontics. The cumulative treatment and retention effects were compared with a sample of untreated Class II controls matched for age, sex, and mandibular plane angle. The overjet and molar relationship were corrected by 3.4 and 3.3 mm, respectively. A headgear effect of Herbst therapy was observed, as anterior maxillary displacement was reduced by 1.2 mm. Condylar growth was redirected to produce 2.0 mm greater posterior growth in the treatment group. These effects produced significantly greater decreases in SNA (0.8°) and ANB (1.4°), and a tendency toward an increase in SNB (0.5°) Mandibular orthopedic effects resulted in an increase in anterior facial height (1.6 mm) and inferior displacement of the chin. Minimal changes in the displacement of condylion in relation to stable cranial base structures suggest that glenoid fossa displacement does not contribute in a clinically significant way to Class II correction. Pretreatment, immediate posttreatment, and postretention corrected temporomandibular joint tomograms demonstrated a tendency for the condyle to be slightly forward (0.2 mm) at the end of treatment and then to fall back after treatment. Statistically significant joint space changes were limited to the posttreatment period. We conclude that Herbst treatment in the mixed dentition, in combination with retention, produces significant long-term improvements in dental and skeletal relationships as a result of dentoalveolar changes and orthopedic effects in both jaws. (Am J Orthod Dentofacial Orthop 1999;116:435-43)

股関節に発生した色素性じゅう毛結節性滑膜炎の１例

We report a case of pigmented villonodular synovitis (PVS) occurring in the hip joint.Case: A 54-year-old female had increasing right hip pain and swelling for over eight years. We found a slightly decreasing Range of Motion (ROM). Roentgenograph showed narrowed joint space and multiple cystic changes on the acetabulum, femoral head and neck. The lesion appeared with low intensity with T1 and T2 MRI, and showed very low intensity with T2* MRI. We diagnosed PVS by biopsy and performed only synovectomy without damaging the blood vessels around the right hip joint. She has had no reccurrence and has maintained good function of the right hip joint for seven months.

Applications of micro-CT and MR microscopy to study pre-clinical models of osteoporosis and osteoarthritis

There is a tremendous unmet therapeutic need for the treatment of osteoporosis and osteoarthritis. The ovariectomized rat and the guinea pig are widely used animal models for the evaluation of new therapeutics for osteoporosis and osteoarthritis, respectively. We have utilized X-ray micro-CT techniques to quantitatively evaluate the differences in trabecular bone in the rat proximal tibia following ovariectomy and treatment with estrogen (17-B-estradiol). Results demonstrate a loss of trabecular bone and architecture following ovariectomy (p < 0.001), and a marked inhibition of trabecular bone loss in the estrogen treated group (p < 0.001). A similar change in architecture can be visualized in images obtained by high resolution MR microscopy. In addition, a good correlation was observed between the values of trabecular bone fraction (BV/TV) in the rat tibiae as obtained from 3-dimensional micro-CT data and 2-dimensional static histomorphometry (r = 0.89, 0.73, 0.79 for sham, OVX, and treated groups, respectively). Micro-CT images were also obtained from a set of lumbar vertebrae from sham operated and ovariectomized rats. Significant bone loss can be measured as early as 8 weeks following ovariectomy (p < 0.005). Micro-CT and MR images were also obtained to study age related changes in the stifle joint of the guinea pig. Significant boney changes can be seen in the tibia and femur from the animals at various ages. Changes in cartilage and joint space can also be visualized in the images. The utility of micro-CT imaging in evaluating the mouse skeletal system is illustrated by obtaining morphological and architectural details from high resolution images of the mouse hind limb and proximal tibia, respectively. The results demonstrate the advantages that multi-dimensional imaging techniques can offer in evaluating bone and joint related changes in animal models of osteoporosis and osteoarthritis.

Condyle displacement associated with premolar extraction and nonextraction orthodontic treatment of Class I malocclusion

This study assessed condyle position change with premolar extraction and nonextraction orthodontic treatment in Class I malocclusions. Axially corrected pretreatment and posttreatment tomograms were obtained in 22 extraction and 13 nonextraction cases. Tomographic images were randomized and blinded for joint space measurement. A total of 27 linear anterior, superior, and posterior joint spaces were obtained from each tomogram and averaged. Comparisons of pretreatment and posttreatment joint spaces between groups were done by t test (pool variance estimate) with p < 0.05. Left and right anterior joint spaces were significantly increased during orthodontic treatment of the nonextraction group. No other significant changes in condyle position were determined in either group. There were no significant correlations between mean joint space changes with length of Class II elastic wear. There was no significant difference in condyle position change with extraction space closure using closing arch wires compared with alastic chain. (Am J Orthod Dentofac Orthop 1997;112:435-40.)

The Bristol ‘OA500’ Study: progression of osteoarthritis (OA) over 3 years and the relationship between clinical and radiographic changes at the knee joint

Five hundred patients with established, symptomatic limb joint OA have been recruited into an on-going prospective study of the natural history of the condition. Four hundred and fifteen patients (mean age 65.6 years, female to male ratio 2.05:1) were available for a full clinical and radiographic review 3 years after entry (mean entry to follow-up interval 37.6 months, range 31-41). The majority reported an overall worsening of their condition, although pain severity did not change. There was an overall increase in disability (Steinbrocker) and the use of walking aids in the group but 57 patients (13.7%) improved, 38 of whom had undergone joint surgery. There was a strong correlation between changes in different clinical outcome measures, but none of the baseline variables predicted change over 3 years with the exception of an association between pain severity and subsequent surgery. One hundred and ninety-three of the 415 patients had knee joint disease at entry. One hundred and forty-five of these patients had knee radiographs and full clinical data available from both time points. Some change was seen in 85 of 276 evaluable tibiofemoral joints (30.1%), but only 10 patellofemoral joints. There was a strong correlation between changes in joint space, osteophyte and subchondral bone scelerosis. However, there was no correlation between radiographic and clinical changes. It is concluded that radiographic change may not be a good surrogate for clinical outcome in established OA. This has implications for the design of long-term studies of possible structure modifying agents in OA.

高位けい骨骨切り術における術後下肢アライメント 関節裂隙の変化について

高位けい骨骨切り術における術後下肢アライメント 関節裂隙の変化について

特発性一過性大腿骨頭骨萎縮の３症例

Three cases with painful transient osteoporosis of the hip are reported. A 24-year-old female, a 38-year-old female in the ninth month of her first pregnancy, and a 43-year-old male were involved in the left, right, and left hip respectively. There was tenderness and pain with use of the involved hip, however swelling, erythema, and warmth were not noted in all cases. The roentgenographic examination showed osteoporosis of the hip without narrowing of joint space and destructive change. They were treated conservatively and spontaneous recovery occurred with subsequent remineralization of the hip in all cases. The features of the episodes among present cases are similar enough to suggest a clinical syndrome.

The joint space in normal hip radiographs.

The hip joint space in standard anteroposterior images of 120 normal subjects was measured with the aid of a special transparent pattern. The normal value was slightly over 4mm, scattered between 3 and 5 mm, except for elderly men in whom values of 6 mm or more may be normal. The lower borderline value does not change with age, nor is there any change in the average joint space with age except in men in whom it increases slightly. A narrow joint space in an elderly patient should not be expected simply because the patient is old. The measuring technique is useful in population studies. In individual cases a simple measurement with a ruler serves the same purpose if the outline of the acetabular roof is well-defined on the images.

Effect of Surgical Treatment of Aseptic Femoral Head Necrosis

During past four years, twenty one surgical treatments were carried out on thirteen patients with aseptic necrosis of femoral head; drilling & bone nailing 1, intertrochanteric rotational osteotomy 7, cup arthroplasty 1, Moore's hip prosthesis 8, cup & socket arthroplasty 3 and total hip replacement 1.13 patients who were followed up for more than six months after operation were clinically evaluated according to criteria of coxarthrosis of Jap. Orthop. Ass.The patients who received intertrochanteric osteotomy showed good results in all cases. This method should be indicated as first choice of operation to early stadium with localized necrotic area. The results of hip endoprosthesis were also excellent for pain, mobility, gait and ADL. This operation was done in cases of moderate or advanced stadium in which the acetabular change was not observed.Cup & socket arthroplasty and total hip replacement appear to be indicated to the case of severe stadium which shows narrowing of joint space and acetabular arthrotic change.

INCIDENCE AND PROGNOSIS OF COXARTHROSIS.

To define radiographic criteria, the radiographs of all patients diagnosed with coxarthrosis during the year 1951 were reviewed. Structural or joint space changes, evident radiographically in one of every seven cases in 1951, persisted at the time of the review in 1962. In the remaining cases, the diagnosis had been based upon the presence of osteophytic changes alone. Only one of 86 such cases reviewed in 1962 had structural or joint space changes. Osteophytes had no clinical significance and did not progress to coxarthrosis. Osteophytes appear to be a part of normal age changes. The radiographic diagnosis of coxarthrosis must be based on the demonstration of structural or joint changes

The radiological features of rheumatoid arthritis.

The radiological features of rheumatoid arthritis have been investigated at the Manchester Royal Infirmary by a survey of 200 cases of the disease and by the application of an enlargement technique to this and other conditions affecting the extremities. The various abnormal findings in rheumatoid arthritis are discussed. The diagnosis may be made from a consideration of joint space changes and erosions of articular bone. These features are of paramount importance when osteoporosis is absent or equivocal. Bone erosions are considered in detail and the earliest changes demonstrable in the articular cortex are described and illustrated. Osteoporosis is usually regarded as the earliest and most frequent finding, but we believe that less emphasis should be placed upon it. The lesser degrees are difficult to recognise and all the types which occur can be found in various other conditions. The metatarsophalangeal joints of the feet provide the most diagnostic information in those cases in which they are clinical...