Narrow Joint Research Articles

Does patellofemoral osteoarthritis affect functional outcomes and survivorship after medial unicompartmental knee arthroplasty? A meta-analysis

PurposeThe argument that patellofemoral osteoarthritis (PFOA) is a contraindication to unicompartmental knee arthroplasty (UKA) remains to be resolved. The purpose of this study was to perform a meta-analysis to determine whether PFOA affects functional outcomes and survivorship after medial UKA.MethodsA literature search was performed in PubMed, Medline, Cochrane Library and Web of science to identify studies published in English (the last search was updated on June 1, 2020). The primary outcome measure was the Oxford Knee Score (OKS), whereas the secondary outcomes included range of motion (ROM) and the revision rate. Patients with patellofemoral joint narrowing or cartilage lesions as assessed intraoperatively or by radiography were assigned to the PFOA group.ResultsA total of 8 studies involving 3504 patients and 3975 knees were included in this meta-analysis. No patients had a severe lateral patellar groove. The results showed that there was no significant difference in the OKS, revision rate and ROM between PFOA patients and patients without PFOA.ConclusionsNo significant difference in functional outcomes and survivorship was found between patients with and without PFOA. Patients with PFOA assessed by radiographs or intraoperatively but without a lateral patellar groove should be considered candidates for medial UKA.

Mitochondria: Potential Targets for Osteoarthritis.

Osteoarthritis (OA) is a common and disabling joint disorder that is mainly characterized by cartilage degeneration and narrow joint spaces. The role of mitochondrial dysfunction in promoting the development of OA has gained much attention. Targeting endogenous molecules to improve mitochondrial function is a potential treatment for OA. Moreover, research on exogenous drugs to improve mitochondrial function in OA based on endogenous molecular targets has been accomplished. In addition, stem cells and exosomes have been deeply researched in the context of cartilage regeneration, and these factors both reverse mitochondrial dysfunctions. Thus, we hypothesize that biomedical approaches will be applied to the treatment of OA. Furthermore, we have summarized the global status of mitochondria and osteoarthritis research in the past two decades, which will contribute to the research field and the development of novel treatment strategies for OA.

Experimental evaluation of the shear capacity of perfobond strips with steel fiber-reinforced mortar in narrow joint structures

Appropriate transfer of the shear force of a perfobond strip used as a shear connector in steel concrete hybrid structures depends on the restraining effect around the strip, and hence, the arrangement of the surrounding reinforcements is very important to improve the restraining effect. However, when the perfobond strip is arranged in narrow joint structures and when the rapid construction is also required, reinforcements are undesirable on the site. An alternate method to improve the restraining effect around the perfobond strip is to use steel fiber-reinforced mortar (SFRM). This study aims to evaluate appropriately the shear capacity of a perfobond strip with SFRM without surrounding reinforcements for narrow joint structures. Assuming these conditions, pull-out tests were conducted, and the data obtained were considered along with the results of push-out tests conducted in the previous study of the authors. Based on the results of both test series, the impacts of various factors on the shear capacity of the perfobond strip was analyzed comprehensively. The results showed that the shear capacity of a perfobond strip with SFRM increases with the perforation diameter, SFRM compressive strength, volume content of steel fibers in the mortar, and dimensions of the mortar block around the perfobond strip. Moreover, the plasticization of the perfobond steel plate and the difference in boundary conditions between the push-out and pull-out tests also affect the shear capacity of the perfobond strip. An equation was proposed for evaluating the shear capacity of the perfobond strip with SFRM without any surrounding reinforcements for narrow joint structures. The shear capacity obtained using the proposed equation has high correlation with the experimental value for both push-out and pull-out specimens.

Preventing water penetration in traditional masonry using injection mortar and micro-grouting conservation techniques

Repointing is a universal repair technique applied to traditional masonry of historic buildings and, in particular, to ashlar masonry. Despite such long-established practices, on the British west coast at least, water penetration quite often recurs a few years after repointing has been carried out. These unfortunate statistics arise because repointing work, even when carried out well, is unable to fill open or deeply voided joints in ashlar masonry. New pointing is not always sufficient to restore the ability of a wall to shed water and prevent water ingress. At Burns Monument, Alloway, Ayrshire, longstanding water penetration caused the masonry to become saturated throughout and several repointing projects over previous decades had not stopped the ingress. Recent investigative surveys identified severe and persistent water penetration from deeply voided and open ashlar masonry joints. A comprehensive repair strategy was developed to robustly address these issues, which involved developing a new method of injecting hydraulic lime grout through its narrow mortar joints. This technique, known as micro-grouting, is able to reach and fully fill deeply voided ashlar joints in a way that has hitherto simply not been possible. During 2018–19 the monument was successfully micro-grouted and has begun to dry out. This paper aims to explain the issue of voiding in traditional solid wall masonry and the new conservation technique of micro-grouting and repointing by injection mortar by examining the case study of Burns Monument conservation project. Now developed, tested and successfully implemented, this new methodology can make an important contribution to improving the future conservation of other historic buildings across the UK and beyond, to restore the ability of many deeply voided masonry structures to shed water in a way that works with traditional lime mortar-based construction technology.

A Narrow Posterior Joint Space on a False Profile Radiograph Does Not Correlate With Posterior Joint Cartilage Degeneration in Hip Preservation Patients

PurposeTo evaluate whether a narrow posterior joint space (<2 mm) correlated with posterior joint cartilage degeneration in the hip preservation patient population. MethodsA retrospective chart review of 155 consecutive hip arthroscopy cases by a single surgeon (SKA) from March 2012 to February 2013 was performed. Patients were included in the study if they had an adequate perioperative false profile radiograph and clear intraoperative arthroscopic images of the posterior hip joint. The narrowest posterior joint space (NPJS) width and the directly posterior, posterosuperior, superior, and anterosuperior joint space widths were measured on the false profile radiograph. Femoral and acetabular cartilage of the posterior hip joint were graded according to the International Cartilage Repair Society (ICRS) classification system using arthroscopic images obtained at the time of surgery. The cartilage grades of patients with <2 mm NPJS were compared with cartilage grades of patients with ≥2 mm NPJS. ResultsThere was no difference in cartilage grading between patients with <2 mm NPJS (19 patients) and those with ≥2 mm NPJS (81 patients) (P = .905). The mean age of patients with NPJS ≥2 mm and <2 mm was 34.0 (median 31.2; interquartile range [IQR] 23.7, 42.9) and 38.7 (median 43.0; IQR 26.1, 50.9) respectively, and was not statistically different (P = .183). No correlation between cartilage grade and NPJS measurement was found (P = .374). ConclusionIn this predominantly cam-type femoroacetabular impingement patient cohort, our findings indicate there is no correlation between a <2 mm posterior hip joint narrowing seen on false profile radiographs and posterior hip cartilage degeneration confirmed with arthroscopy. Although posterior arthritis can be visualized on a false profile radiograph, a posterior joint space measurement <2 mm should not be interpreted as isolated posterior joint wear and should not be considered a hip arthroscopy contraindication. Level of EvidenceLevel IV, case series.

Unusual localization of chondrocalcinosis: The sternoclavicular joint: Case report and review of the literature

BackgroundChondrocalcinosis is a metabolic arthropathy rarely affecting the anterior chest wall (ACW). Aim of the workTo report here a case of a polyarticular chondrocalcinosis with an uncommon localization in the sternoclavicular joints (SCJs), revealed by computed tomography (CT). Case reportA 76-year old female presented to the Rheumatology outpatient clinic Kassab orthopedics institute with low back pain. The history goes back to 4 months prior to her presentation when she developed mechanical back pain that progressively worsened during the last month, becoming inflammatory with prolonged morning stiffness. She had no history of fever or weight loss and no symptoms in the cervical spine, shoulders, chest wall, hips or knees. Physical examination revealed limited range of motion of hips, cervical and lumbar spine and bilateral swelling of SCJs without tenderness on pressure or mobilization. Biochemical investigations showed normal levels of inflammatory markers, phosphorus and calcium. Conventional radiographs showed multiple areas of calcification in the intra-vertebral discs, joint space narrowing of sacroiliac (SI) and coxofemoral joints. Chest wall radiograph appeared normal. ACW and pelvic CT were done to further delineate the cause. It showed intra-cartilaginous bilateral calcifications of SCJs, sacroilliac, intervertebral discs, coxofemoral joints and pubic symphysis. The final diagnosis was polyarticular chondrocalcinosis. The patient received analgesics, non-steroidal anti-inflammatory drugs and had functional rehabilitation sessions. Conclusion: This case points to the rare localization of chondrocalcinosis in the SCJ and should be considered especially in an elderly female. Early recognition is necessary in order to initiate an appropriate and prompt treatment.

Percutaneous Partial Outside-In Release of Medial Collateral Ligament for Arthroscopic Medial Meniscus Surgery With Tight Medial Compartment by Finding a “Magic Point”

The medial meniscus is one of the more commonly injured structures as compared with the lateral meniscus. In patients with tight medial joint space, it is difficult to visualize the posterior horn and posterior root of medial meniscus and even more difficult to use instrumentation for surgical procedures. Normally, the mean medial joint space (4.74 ± 0.75 mm) is less than the mean lateral joint space width (5.63 ± 0.86). Forceful instrumentation in a tight and a narrow medial joint compartment may cause damage to the articular cartilage, which may increase chances of arthritis in future. To increase the opening of the medial compartment after valgus extension stress position of the knee, different techniques of medial collateral ligament release have been described in the literature. However, the majority of articles describe a multiple-puncture method to the medial collateral ligament called the “pie-crusting” method, not explaining the exact point or precise location of release. Here, we describe a simple and reliable method of medial collateral ligament release by finding the exact release point, a “magic point” to increase the medial joint compartment width to facilitate better visualization and instrumentation for surgical procedures.

FRI0107 EFFECTIVENESS OF ABATACEPT ON CLINICAL DISEASE ACTIVITY AND RADIOGRAPHIC PROGRESSION IN RHEUMATOID ARTHRITIS PATIENTS IN DAILY CLINICAL PRACTICE IN JAPAN: COMPARISONS ACCORDING TO ACPA STATUS

Background:The clinical effectiveness of abatacept (ABA) in rheumatoid arthritis (RA) patients has been reported to be higher when the patients’ anti-cyclic citrullinated peptide antibody (ACPA) status is positive. The report from the ORA registry demonstrated that the ACPA positivity was associated with a better response to ABA [1]. In a sub-analysis of the AMPLE trial, patients with very high ACPA titers who were treated with ABA had a statistically significant response compared to patients with lower titers [2]. However, these studies did not demonstrate the data regarding the structural progression.Objectives:This study aimed to evaluate the effectiveness of ABA on the clinical disease activity as well as the radiographic progression in patients with RA in the clinical settings.Methods:All eligible patients were registered in the TBCR, a Japanese multicenter registry system for RA patients treated with biologics [3]. The present study included 553 consecutive patients whose ACPA data were obtained, treated with ABA and observed for longer than 52 weeks. We primarily compared the status of disease activity (SDAI) and radiographic progression (van der Heijde modified total Sharp score: mTSS) between ACPA-positive [ACPA (+)] and ACPA-negative [ACPA (-)] RA patients. The ACPA positive was defined as ≥13.5 U/ml of anti-CCP antibody.Results:Number of cases was 446/ 107 [ACPA (+)/ ACPA (-)], respectively. Baseline characteristics between groups were quite similar; mean age was 68.0/ 67.3 years, rate of methotrexate (MTX) use rate was 41.2/ 50.0%, rate of bio-naive was 28.0/ 31.8%, and mean SDAI score was 22.2/ 20.8. Significant difference was observed in mean change in SDAI score from baseline to 52 weeks between the ACPA (+) and ACPA (-) group (-13.4 vs -9.9, p = 0.027) (Figure 1A). Proportion of patents that achieved low disease activity (LDA; SDAI ≤11) at 52 weeks was significantly higher in the ACPA (+) group compared to the ACPA (-) group (72.1 vs 56.0%, p &lt; 0.01) (Figure 1B). In univariate and multivariate logistic regression analysis, ACPA positivity was an independent predictor for achievement of LDA at 52 weeks (Table). There observed no significant difference between ACPA (+) and ACPA (-) group in the proportion of patients that achieved structural remission (ΔmTSS ≤0.5) at 52 weeks (66.2 vs 62.1%) (Figure 2A) as well as mean change in mTSS (1.66 vs 1.17), erosion score (0.60 vs 0.53), and joint narrowing (JSN) score (1.06 vs 0.64) (Figure 2B).Table.UnivariateMultivariateVariablesOR (95%CI)p-valueadjusted OR (95%CI)p-valueAge0.99 (0.98-1.01)0.4391.00 (0.97-1.02)0.749male (vs female)1.12 (0.70-1.80)0.6340.79 (0.40-1.58)0.511disease duration0.99 (0.97-1.00)0.0530.99 (0.97-1.01)0.468Biologics-naïve1.23 (0.81-1.85)0.3351.18 (0.67-2.08)0.575Concomitant MTX use1.12 (0.75-1.69)0.5851.14 (0.66-1.95)0.649Concomitant PSL use0.82 (0.55-1.23)0.3290.97 (0.58-1.64)0.923SDAI @baseline0.96 (0.94-0.97)&lt;0.0010.96 (0.94-0.98)&lt;0.001mHAQ @baseline0.50 (0.36-0.69)&lt;0.0010.57 (0.38-0.86)0.008ACPA positive2.03 (1.29-3.17)0.0022.61 (1.36-5.00)0.004Bold italic, p&lt;0.05Conclusion:Consistent with previous reports, the ACPA-positive group demonstrated significantly higher LDA achievement rate at 52 weeks and indeed the ACPA positivity was significantly associated with LDA achievement in multivariate analysis. However, the ACPA-negative group demonstrated quite similar transition of SDAI score and LDA achievement rate except at 52 weeks compared with the ACPA-positive group. Additionally, there was no significant difference in the structural progression at 52 weeks between the groups. ABA treatment may be considered not only in the ACPA-positive RA patients but also in the ACPA-negative patients in the clinical practice.

Literature Review: Perbandingan Efektivitas Platelet Rich Plasma (PRP) dengan Asam Hialuronat (HA) sebagai Terapi Osteoarthritis

The prevalence of osteoarthritis is increasing with age. In osteoarthritis, there is a change in the joint process that fails to repair damaged cartilages and manifestations such as joint narrowing, osteophytosis, subcondral sclerosis, and abnormal bone shape. Pharmacological therapies such as analgesics, corticosteroids, glucosamine, chondroitin sulfate, and non-steroidal anti-inflammatory drugs are used together with viscosupplementation to help and improve the development of arthritis. Intra-articular injection therapy is also used as a good choice for osteoarthritis therapy. Hyaluronic acid (HA) and platelet-rich plasma (PRP) are the two choices of intraarticular therapy that can be used. Hyaluronic acid can reshape cartilage through aggregation with proteoglycans and can improve synovial fluid present in the joints, but therapy with hyaluronic acid has a long-lasting, expensive, and proven effect. Platelet-rich plasma (PRP) is a new therapy. PRP is obtained from blood centrifugation several times. PRP is very easy to get, cheap and non-invasive. PRP contains various growth factors that can regenerate damaged cartilages. PRP can be applied and has the same benefits as HA, but until now there has been no consensus that which is a better outcome between the two therapies. From various literature it is known that PRP is more effective than hyaluronic acid as osteoarthritis therapy.

Justification of parameters of a disk tool for cutting asphalt concrete

The paper reflects the results of the study conducted to determine how a free rotary instrument cuts narrow joints in asphalt pavements required for road construction. Based on the analysis of strength characteristics of different asphalt concrete grades, we developed a mathematical model of working process, and this model stands as the calculation basis. The mathematical model associates the main parameter — cutting resistance force — with the material strength values and geometrical characteristics of the working body and the working process. The results of experimental confirmation of mathematical model reliability are presented in the paper.

Study on the interface damage of CRTS Ⅱ slab track under temperature load

To investigate the interface damage between the track slabs and the Cement Asphalt (CA) mortar layer of China Railway Track System (CRTS) Ⅱ slab track, this study established a three-dimensional finite element model of the track, in which a cohesive zone model was incorporated to simulate the non-linear traction-separation behaviour of the interface. The parameters of the cohesive model were calibrated by experimental data. A damage parameter based on the relative displacement between the track slabs and the CA mortar layer was introduced to characterize the interface damage. Different interfacial properties and different degree of joint defect were taken into consideration in the model. The interface damage evolution and distribution were investigated under the combined action of temperature rise and positive temperature gradient in summer. Results show that the proposed model is capable of predicting the interfacial damage between the track slabs and the CA mortar layer. Under the combined action of temperature rise and positive temperature gradient, interface damage initiates in the middle if bond strength is small, and at the edge if bond strength is larger. The temperature rise at which interface damage initiates when the narrow joint is incomplete can be much lower than when the narrow joint is undamaged.

Clinical and biochemical factors associated with risk of total joint replacement and radiographic progression in osteoarthritis: Data from two phase III clinical trials

ObjectivesClinical trials of new disease-modifying treatments for osteoarthritis should demonstrate a positive effect on a functional outcome or reduction in joint failure in order to be considered successful. Total joint replacement (TJR) surgery may be considered as joint failure, but great variation in the incidence of TJR complicates its use as a study endpoint. Factors predicting elevated risk of TJR could potentially be used to enrich such outcome-trials. MethodsUsing cumulative data from two phase three clinical trials with urine samples from 1255 knee OA patients followed for two years, we assessed the value of a series of baseline clinical variables including the uCTX-II biomarker, as predictors of joint-space narrowing, Kellgren-Lawrence-grade progression, and total joint replacement. ResultsA prediction-model incorporating age, sex, BMI, CTX-II and KL-grade predicted TJR within the two-year period with an AUC of 0.75 (95% CI: 0.72–0.77). The participants with a cumulative KL-grade between knees of 5, 6, or 7 had a more than 3 times higher risk of TJR in the study period compared to lower (HR: 3.03, 95% CI: 1.54 to 5.96, p = 0.001). Age was associated with increased TJR risk (per 5 years of age: HR: 1.28, 95% CI: 1.03–3.79, p = 0.05). Baseline u-CTX-II was associated with elevated risk of radiographic progression in terms of both JSN and KL-grade. ConclusionsA composite model combining baseline age, sex, BMI, u-CTX-II and KL-grade was able to acceptably predict TJR during a two-year period. In the absence of baseline radiographic OA severity, u-CTX-II independently contributed to prediction of TJR. Baseline urine CTX-II was associated with risk of radiographic progression.

Analysis of Damage of Joints in CRTSII Slab Track under Temperature and Vehicle Loads

Damage in joints has a significant effect on the integrity and stability of the China Railway Track System (CRTS)II slab track. In this study, a three-dimensional finite element model was established to investigate the damage law of joints in the CRTSII slab track under temperature and vehicle loads. In the finite element model, the non-linear constitutive law and damage parameter of the interface between the slabs and the cement asphalt (CA) mortar layer were defined by a cohesive zone model. Based on the limited results in this analysis, the recommendations of joint damage repair were put forward. Results show that in the formation of joint damage in CRTSII slab track, the temperature load plays a more important role compared with the vehicle load. The more the concrete loss at the narrow joint, the lower the temperature rise at which concrete stress reaches its compressive strength. If concrete loss at the bottom of the narrow joint is no more than 10%, the damaged joint can be repaired at the time when the temperature of slabs is close to the construction temperature. If concrete loss at the bottom of the narrow joint is larger than 10%, repair strategy should be taken according to the time when the joint damage is detected. During repair, improving bond strength of the interface between the slabs and the CA mortar layer and strength of joint concrete can help to prevent the repaired joint from being damaged again.

Factors Affecting Outcomes of Slipped Capital Femoral Epiphysis

Slipped capital femoral epiphysis (SCFE) is a frequent cause of nontraumatic painful hip of the adolescence. It is the result of the separation of the proximal femoral growth cartilage at the level of the hypertrophic cell zone. The femoral neck metaphysis rotates externally and migrates proximally relative to the femoral head epiphysis, which is stably seated in the acetabulum; early diagnosis and in situ stabilization grants the best long term results. Numerous factors affect treatment outcomes. Not all implants have the same effect on the slipped physis. Application of the traditionally used implants, such as non-threaded pins and cannulated screws, is questioned. Modern implants are available, which stabilize the slip without accelerating physis fusion. This allows femoral head and neck growth and remodeling to limit the post-slip sequellae on hip anatomy and function. Femoroacetabular impingement (FAI) complicates almost all slips. It causes progressive labral and articular cartilage damage and leads to early hip osteoarthritis and total hip replacement, approximately ten years earlier compared to the general population. Avascular necrosis of the femoral head is a dramatic complication, seen almost exclusively in unstable slips. It develops within months after the slip and leads to immediate articular joint degeneration and the need for total hip replacement. Another serious complication of SCFE is chondrolysis, which is a rapid progressive articular cartilage degeneration leading to a narrow joint space and restriction of hip motion. Implant-related complications, such as migration and loosening, may lead to the progression of the slip. Though bilateral disease is quite frequent, there is no consensus about the need for preventive surgery on the healthy contralateral hip. Diagnosis of SCFE is frequently missed or delayed, leading to slips of higher severity. Silent slippage of the capital femoral epiphysis is highly suspected as an underlying cause of cam-type FAI and early-onset hip osteoarthritis. There is controversy, whether asymptomatic implants should be removed. Novel surgical techniques, such as the modified Dunn procedure and hip arthroscopy, seem to be effective modalities for the prevention of FAI in SCFE.

Can Radiographic Joint Space Accurately Predict Chondral Damage During Hip Arthroscopy? A Cross-Sectional Analysis

To examine how preoperative radiographic joint space correlated with intraoperative chondral damage as diagnosed during hip arthroscopy, in patients without radiographic evidence of osteoarthritis or joint space <2 mm. Patients younger than the age of 50 years without previous hip conditions who underwent hip primary arthroscopy had their joint space and intraoperative chondral damage compared. A narrow joint space group was defined as those in the lowest decile of the average joint space. The demographics and presence of intra-articular findings of chondral damage were compared. In addition, receiver operator characteristic (ROC) curves were used to assess joint space as a predictor of intraarticular damage. There were 1892 in this analysis. The incidence of severe cartilage damage (Outerbridge III and IV) was not significantly different between the narrow and non-narrow groups. The ROC analysis for joint space at detecting chondral damage was poor. The ROC area under the curve for joint space detecting any chondral defect (acetabular or femoral head) was 0.536 (confidence interval 0.506-0.565), with low sensitivity (0.492), specificity (0.582), negative predictive value (0.720), and positive predictive value (0.340). Spearman correlation could not demonstrate a correlation between joint space and cartilage damage (⍴Acetabular= 0.10, ⍴Femoral Head= 0.04). Interestingly, a gradual widening was observed between the medial and lateral joint spaces, with more pronounced findings in hips without damage. The results of this study demonstrate that in patients with Tönnis 0 and 1, narrower joint space may be an anatomic variant and cannot predict actual intraoperative cartilage damage. However, if the lateral joint space has relative narrowing compared with the medial joint space, this may indicate acetabular cartilage damage. III, retrospective diagnostic comparative study.

Amyopathic Dermatomyositis and Rheumatoid Arthritis: An Uncommon Presentation of Overlap Syndrome

Abstract The objective of our study was to estimate Radiological change in patients with rheumatoid arthritis and to determine the possible correlation with established prognostic markers in those patients. Patient and method: Follow up study patients were diagnosed as Rheumatoid Arthritis (RA), those patients were studied clinically, history of fatigue, morning stiffness, number of joint pain or swollen functional disability assessed by the Health Assessment Questionnaire (HAQ), and the Disease Activity Score in 28 joints (DAS 28), Radiographic assessment; Plain radiograph of the shoulders, elbows, hips, knees, ankles, subtalar, hands and feet analysis by The Larsen score. The correlation coefficients between Radiographic changes and different prognostic markers were calculated using Pearson’s correlation coefficient (r). Statistical significance was defined as P<0.05. Result: Mean DAS 28 activity at baseline was (4.4 ± 1.2), Most patient had moderate or severe disease activity, the mean health assessment questionnaire score (HAQ) of patients (1.2) was indicated moderate disability. The mean Radiological change assessment by Larsen score (34-200) M=[106 ± 44.3) was reflect progression radiological score most of patient s had grade in between 2 to 3 (narrow joint space and erosion), The distribution erosive changes is The hands, Elbows, feet and knees were most frequently affected .the significant correlation between progression joint damage and age, duration disease, antibodies against citrullinated antigens (anti-CCP), rheumatoid factor (IgM-RF), erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). Conclusion: Improvement in health assessment questionnaire score (HAQ) after treatment from baseline indication less destructive joints.

Sub- and intercondylar fractures of the distal humerus in adults

Introductionles fractures articulaires complètes de l’extrémité inférieure de l’humérus de l’adulte sont des lésions rares et graves. Les options thérapeutiques sont nombreuses mais le traitement chirurgical par ostéosynthèse est ardemment défendu. L’objectif de notre travail a été de décrire les caractéristiques épidémiologiques, clinico-radiologiques et thérapeutiques de ces fractures, ainsi que d’évaluer les résultats fonctionnels obtenus chez nos patients.Méthodesnous avons mené une étude prospective sur une période de 3 ans, portant sur 38 patients admis pour fracture articulaire complète sus et inter-condylienne de l’humérus distal (classée type C selon la classification de l’AO), traités chirurgicalement par voie postérieure trans-olécranienne avec un recul moyen de 34 mois.Résultatsnous avons remarqué une distribution bimodale avec une atteinte du sujet jeune de sexe masculin d’une part, et une survenue chez les femmes âgées d’autre part. Les étiologies étaient dominées par les accidents de la voie publique chez 78%. Lors du suivi, nous avons noté un seul cas d’infection superficielle du site opératoire et il n’y a eu aucun cas de démontage du matériel ni de pseudarthrose. De surcroit, aucune complication de l’ostéosynthèse de l’olécrane n’a été enregistrée. Les résultats fonctionnels ont été très satisfaisants avec un score de Mayo-Clinic Elbow Performance Score (MEPS) moyen de 86.Conclusionnous considérons que la voie postérieure trans-olécranienne semble être la meilleure voie d’abord de ces fractures puisqu’elle permet une bonne exposition articulaire, condition sine qua non pour une restitution anatomique parfaite et une ostéosynthèse stable afin d’entreprendre une rééducation précoce et adaptée.

Progress in the treatment of osteoarthritis based on subchondral bone

Osteoarthritis (OA) is a common and disabling joint disorder, which is mainly characterized by cartilage degeneration and narrow joint space. Nowadays, the research on the therapy of OA is no longer limited to articular cartilage. Subchondral bone plays an important role in the genesis and development of OA, both in structure and biological function. This article briefly reviews the structural and functional association of subchondral bone and cartilage and the pathological change of subchondral bone in OA. The progress in the treatment of osteoarthritis based on subchondral bone was emphatically reviewed, and a global visualized analysis of subchondral bone in recent twenty five years was shared. Key words: Subchondral bone; Osteoarthritis; Therapy; Visualized analysis

Transient liquid phase bonding of ODS ferritic steel with a physical vapor deposited boron thin layer

Transient liquid phase bonding (TLBP) was employed to join high-Cr oxide dispersion strengthened (ODS) ferritic steels under a high vacuum atmosphere using a uni-axial compressive hot press, and microstructural evolutions and mechanical properties of the joints were investigated. As insert material, pure boron thin layer was employed and fabricated by an electron beam assisted physical vapor deposition (EBPVD). The ODS ferritic steels with an EBPVD boron layer were successfully diffusion bonded at 1200 °C for 1 h under a pressure of 10 MPa. The microstructural observation and elemental analysis revealed that the TLBP with EBPVD boron shows a very narrow joint region and minimizes the microstructural degradation of base metals in comparison with the joint with an amorphous insert foil. Nevertheless, it was inevitable that the nano-oxide particle at the joint region was agglomerated by temporarily and partially melting of the base metal at the bonding interface by boron diffusion during the TLPB process. However, the joint presented comparable tensile properties with those of the base metal at room and elevated temperatures. It also has a more favorable ductility than TLPB with an amorphous insert foil.

Radiographic analysis of subclinical appearances of the hip joint among patients with labral tears

ObjectiveLabral tears can be complicated by hip diseases, including osteoarthritis or femoral acetabular impingement. To accurately plan hip arthroscopy or subsequent conversion to total hip arthroplasty, the presence of bony abnormalities in the hip joint must be evaluated. This study aimed to elucidate the utility of multiplanar reconstruction computed tomography (mCT) for the detection of subclinical coincidence of osteoarthritis or femoral acetabular impingement with a labrum tear.Materials and methodsWe retrospectively analysed 34 patients (36 hips) with labrum tears without apparent osteoarthritis or hip dysplasia from 2012 to 2015. The joint spaces were calculated using radiographs or mCT, and the detection rates of degenerative cyst and herniation pit were compared.ResultsNarrow joint spaces (< 2 mm) were more clearly detected in mCT (p < 0.05, chi-square analysis) than in radiographs. The detection rate of cysts in the acetabulum was 8.3% using radiographs and 36.1% using mCT (p < 0.001, chi-square analysis). Additionally, the detection of herniation pit was 8.3% and 25.0% using radiographs and mCT, respectively (p = 0.053, chi-square analysis).ConclusionWe performed the radiographic analysis of patients with labral tears using radiographs and mCT. The mCT allowed for fine detection of narrow joint spaces and subtle subclinical appearances. The results of this study may provide surgeons with more appropriate strategies for the treatment of labral tears.