Orthopedic Doctors Research Articles

Radiographic Analysis Comparison of Cervical Alignment After Variable Level of Anterior Cervical Discectomy and Fusion (ACDF)

Background: To compare the radiographic cervical lordosis alignment between pre-operative and post-operative surgery after variable level of anterior cervical discectomy and fusion (ACDF) .In the current review, the standard surgical treatment of cervical spondylotic myelopathy is ACDF the restoration and maintenance of cervical lordosis alignment is an important clinical parameter after single level or multilevel anterior cervical discectomy and fusion. The increase or decrease cervical lordosis alignment is affected by the sagittal vertical axis and balance. Methods: This study was performed a retrospective radiographic analysis of 147 patients who underwent single to multilevel ACDF (Total N= 147; 1-level (N=36), 2-level (N=60), 3-level (N=42) and 4-level (N=9)) by orthopedic spine surgeons and neurosurgeons between 2016 and 2018. The authors measured the cervical lordosis alignment of the cervical spine using the Cobb method (Inferior endplate of C2 to inferior endplate of C7) at pre-operative and post-operative surgery. Radiographs were measured by three orthopedic doctor viewers. Statistical analysis were performed using R software. Results: The radiographic analysis comparison of cervical alignment after ACDF was showed the results that cervical lordosis alignment had no significantly change of decreased cervical lordosis alignment at pre-op mean 14.88°(± 8.66) and initial post-op mean 13.01°(±7.65) in all level of ACDF. Conclusions: The radiographic analysis of variable level anterior cervical discectomy and fusion in single to multilevel (1-level, 2-level, 3-level and 4-level) has no significantly change in cervical lordosis alignment after initial postop surgery.

Battling chronic pain and learning self-advocacy: the long journey of becoming pain free

I had returned to running for about 6 months following a stress fracture in my left femur when I started noticing pain high up in my right hamstring. It got...

Correlation of static knee angle in kinematic and radiographic in medial knee osteoarthritis

Abstract Introduction The hip-knee-ankle (HKA) angle measured on a full-length weight bearing X-ray made in standing position is considered the gold standard to measure the knee static alignment. However, this method requires special equipment, involves significant radiation exposure and generates extra costs. The 3D motion capture can assess knee angles in a reliable and accurate way. Objectives This study aimed to analyse the correlation between the HKA angle achieved in full-length X-ray and the in static knee kinematic analysis in patients with medial knee osteoarthritis (OA). Methodology A descriptive study was design. Anterior-posterior full-limb radiographs were obtained using standard procedures in the same hospital. The HKA angle was measure by an experimental orthopaedic doctor. The kinematics were obtained using Visual3D software after 3D motion capture in two static positions: static comfortable position (Static-1) and a static standard position (Static-2). Kinematic data were filtered (6 Hz) and expressed in degrees (°). The knee joint was created by the distance between the distal end of the thigh and the proximal end of the shank. The angles lower than 180° were considered as varus alignment and those higher than 180° valgus alignment. Results This study includes 36 patients (22 females; mean age 61,6 ± 8,4; weight 75,8 ± 12,7 kg, and height 161 ± 9,2 cm) with diagnosed medial knee OA Kellgren/Lawrence grade 2 (16 patients) or 3. The patients presented a mean of HKA of 176,2° ± 3,2 in X-ray; 182,1° ± 6,0 in Static-1 and 180,0° ± 5,6 in Static-2. A significant correlation was found between HKA angle and Static-1 (r = 0,525; p = 0,001) and between HKA angle and Static-2 (r = 0,556; p = 0,000). Conclusion A moderate but significant correlation was found between X-ray and two measure of 3D motion capture in frontal knee angle. Clinically, 3D analysis may help health care professionals in a more practical way to identify the joint angles.

Malpractice claims associated with foot surgery.

Surgery of the foot constitutes a substantial portion of orthopedic procedures, performed by both orthopedic surgeons and doctors of podiatric medicine. Little research exists on the medicolegal implications of foot surgery amongst these specialties. This study seeks to investigate the different medical and legal factors associated with foot surgery-based malpractice litigation. Malpractice data between 2004 and 2017 was collected using the VerdictSearch legal database. Cases involving foot surgery were identified, and case information including physician specialty, procedure, medical outcome, verdict, and payment amount were obtained. A total of 72 cases were analyzed. A majority of lawsuits involved podiatrists (76.4%), with orthopedic surgeons accounting for 15.3%. Lawsuits against podiatrists primarily occurred over elective procedures (94.5%) and most frequently involved plaintiff complaints of persistent pain (41.8%) or deformation (27.3%). Podiatrist cases most often involved allegations of failure to treat (45.5%) or inappropriate surgical procedure (27.3%). Orthopedic surgeons saw higher rates of urgent cases (45.5%), with surgical complications (27.3%) occurring at higher rates than podiatrists. Despite different trends in case types, similar rates of plaintiff victories, and mean payments were seen between podiatrists (25.5%, $911,884 ± 1,145,345) and orthopedic surgeons (27.3%, $975,555 ± 448,795). This investigation is the first to analyze malpractice trends amongst podiatrists and orthopedic surgeons. Differing factors related to medical and legal outcomes can suggest quality improvement targets for both specialties. This data may assist in reducing malpractice risk and refining patient care, particularly with regards to outlining risks, benefits, and alternatives during pre-operative counselling.

Improving communication lines: quality improvement project moving a department away from outdated paging

IntroductionPaging systems in Hospitals have been established for some time, but they are now outdated and unreliable. This opinion is shared by the UK government, which has given the NHS...

Synthesis of Bio-composite CHA/PVA/Alginate as Bone Substitute Material

The main inorganic constituent of human bone is carbonated-hydroxyapatite (CHA). The CHA powder had been successfully synthesized by using chicken eggshell through microwave assisted precipitation methods. In the application, the biomaterials needed by orthopaedic doctors were in the form of scaffold. The addition of PVA and alginate to CHA can improve mechanical properties and affect the pores. The freeze-drying method was used to synthesize bio-composite scaffold. The FTIR result showed that spectrums correspond to functional group of PO4 3−, OH−, CO3 2− which were the characteristic of CHA. The elastic scaffold was produced in this research. The scaffold mechanical test results showed that the higher PVA content showed the higher mechanical properties. The phase composition was evaluated by XRD and indicated the presence of CHA. The morphology of the sample was evaluated by SEM which formed pores. These scaffolds showed good prospects for bone substitute material.

Prognosis after autologous peripheral blood stem cell transplantation for osteonecrosis of the femoral head in the pre-collapse stage: a retrospective cohort study

ObjectivesAutologous peripheral blood stem cell (auto-PBSC) transplantation is an effective therapeutic for the osteonecrosis of the femoral head (ONFH) but without prognosis estimation. This study mainly aimed to (1) determine whether auto-PBSC transplantation is a promising option, (2) assess the risk of hip-preservation failure, (3) achieve a predictive model of femoral head survival after the intervention, and (4) eventually identify clinical indications for auto-PBSC transplantation in future.MethodsAfter reviewing the in-patient database of the First Affiliated Hospital of Zhejiang Chinese Medicine University from June 2012 to June 2014, 37 eligible patients with Association Research Circulation Osseous stage I or II ONFH who were receiving intra-arterial infusion of auto-PBSCs were recruited. A case form was designed to retrieve relevant data. Hip-preservation failure was defined as the endpoint. All participants were stratified by the categorical risk of collapse, which was statistically tested through log-rank analysis. All significant factors were evaluated using Cox proportional hazards regression model, and a predictive nomogram plot was generated.ResultsIn total, 47 hips were followed up for 53.96 ± 21.09 months; the median survival time was 60.18 months. Among the predictors, body mass index (BMI; P = 0.0015) and Harris hip score (HHS; P < 0.0001) independently affected femoral head survival. Patients with BMI ≥ 24 kg/m2 exhibited a 2.58 times higher risk of hip-preservation failure [95% confidence interval (CI), 1.32–5.45] than those with BMI < 24 kg/m2, whereas those with HHS ≥ 70 exhibited a 0.19 times lower risk (95% CI, 0.09–0.38) than those with HHS < 70. Hazard ratios associated with age (P = 0.042), BMI (P = 0.012), HHS (P = 0.022), and necrotic volume (P = 0.000) were 1.038 (95% CI, 1.001–1.075), 1.379 (95% CI, 1.072–1.773), 0.961 (95% CI, 0.928–0.994), and 1.258 (95% CI, 1.120–1.412), respectively. A nomogram plot (score test P = 0.000; C-index = 0.8863) was available for the orthopedic doctor to predict hip survival probability.ConclusionsThe results suggest that intra-arterial infusion of auto-PBSCs prolongs femoral head survival. Age, BMI, HHS, and necrotic volume can influence the efficacy of this intervention.This study was approved by ethics committee of the trial center, number 2019-KL-075-01.

Monteggia fracture: an easy fracture to miss.

To assess the incidence of missed Monteggia fracture by radiologists and bedside clinicians (emergency and orthopaedic doctors) at a tertiary hospital. A comprehensive search was conducted on Picture Archiving and Communication System (PACS) and electronic medical records (EMR) between Jan 2010 and April 2019. All consecutive paediatric and adult patients who presented to the emergency department with the diagnosis of Monteggia fracture were included. The patient's emergency presentation medical notes and trauma film reports were compared. Most emergency presentations were discussed with orthopaedics; hence, this was combined as a single group (bedside clinician group). All images were blindly reviewed by a senior consultant radiologist. Results from the radiologist and bedside clinician groups were compared. Fifty-one patients were identified; 4 were excluded as they were not true Monteggia fracture on review. Forty-seven patients were included in the study (age range 3-70years, mean age 15years). Thirty-three patients (70%) were correctly diagnosed by both groups. Twelve patients (25.5%) had a missed diagnosis by the radiologist's group. Seven patients (14.9%) were missed by the bedside clinicians. Five patients (10.6%) were missed by both groups with fractures detected on re-presentations. The most commonly missed finding was a radial head dislocation/subluxation, followed by a subtle ulnar fracture (confirmed by periosteal reaction development on subsequent radiographs) and an ulnar plastic deformity. The Monteggia fracture is an important diagnosis, but it is not infrequently missed by radiologists and clinicians. Special attention to the radiocapitellar joint alignment and ulnar periosteum, and looking for a subtle ulnar fracture or plastic deformity would ensure correct diagnosis.

Management of hospitalised osteoporotic vertebral fractures.

To explore the management of hospitalised vertebral fragility fracture (VFF) patients in Ireland. A cross-sectional survey of orthopaedic doctors (specialist registrar level) and physiotherapists was conducted across all hospitals with major orthopaedic trauma units in Ireland. Data were analysed using descriptive statistics in SPSS (V24). Responses were achieved from 100% (n = 16) of the hospitals (42 individual physiotherapists and 47 orthopaedic doctors). Conservative management was usual with both orthopaedic doctors (n = 37, 79%) and physiotherapists (n = 40, 96%) reporting prescription of bracing as common practice despite a lack of underpinning evidence. A majority (87%) of the doctors believed osteoporosis medications should commence prior to discharge from the acute setting, but 68% did not agree that responsibility for coordination and delivery of bone health assessment and fracture risk management rested with them. A majority (72%) of physiotherapists reported an absence or were unsure regarding existence of fracture liaison services. 73% of physiotherapists reported prescribing an inpatient or home (78%) exercise programme, including mobility, strength and balance exercise though detail on dose and adherence remain unknown. Wide variance in referral patterns to multi-disciplinary team (MDT) members existed although 79% of orthopaedic doctors supported an MDT approach. Clinical care pathways for the hospitalised VFF population lack standardisation in Ireland. Key challenges reported by orthopaedic doctors and physiotherapists relate to pain management, osteoporosis medication prescription, clarity on indications for bracing and a lack of fracture liaison services. Clinical guidelines, defined clinical care pathways and high-quality clinical research trials are required for VFF management.

Now I Am The Voice: "a journey of self-discovery through the eyes of a Thalassemic".

Now I Am The Voice: "a journey of self-discovery through the eyes of a Thalassemic".

Internal Fixation Treatments for Intertrochanteric Fracture：A Systematic Review and Network Meta-Analysis

Background: Choosing the best internal fixation treatment for intertrochanteric fractures is a challenge faced by orthopedic doctors. This network meta-analysis aims to search and analyze outcomes from randomized clinical trials (RCTs) of internal fixation methods for intertrochanteric fractures. Methods: we performed searches in MEDLINE, EMBASE, Web of Science, and the Cochrane Central Register of Controlled Trials from inception to April 2020. Data were extracted if the sample size of RCTs was over 100 and the follow-up period was at least 1 month. A Bayesian multiple treatment network meta-analysis was performed. And a pairwise meta-analysis was conducted to generate the direct estimates for outcomes. Findings: 61 RCTs (13728 patients) included 25 internal fixation methods were eligible. In network meta-analysis of complications, proximal femoral nail (PFN) had the highest probability of re-operation and later fracture events based on the SUCRA value, while sliding hip screws (SHS) had the lowest probability of re-operation and later fracture events based on the SUCRA value. In the subgroup analysis of patients aged 60 years and older, patients with PFN were found to have a higher risk of later fracture than gamma nail (GN) (GN vs. PFN: 0.31 [0.10, 0.91]), and GN needed shorter operation time than patients who used dynamic hip screw (DHS) (GN vs. DHS: -6.30 [-11.74, -0.86]). In the subgroup analysis of unstable fractures, DHS’s operation time and intraoperative blood loss were more than GN and proximal femoral nail anti-rotation (PFNA). Patients using PFN had a higher later fracture risk than using GN (PFN vs. GN: 3.27 [1.10, 9.71]), and the mortality rate of patients using GN was higher than that using DHS (DHS vs. GN: 0.19 [0.05, 0.65]). Interpretation: PFN had the highest risk of complications, followed by GN, and SHS had the lowest risk of complications. PFNA had a short operation time, less intraoperative blood loss, and a relatively low risk of complications, which should be a priority choice for intertrochanteric fractures, especially in elderly patients. Funding Statement: This study is supported by National Natural Science Foundation of China(No. 81702133). Declaration of Interests: No conflicts to declare.

Human Arthritis Analysis in Fog Computing Environment Using Bayesian Network Classifier and Thread Protocol

Nowadays, many people are facing the problem of arthritis. Regular monitoring and consultation of joint health from a specialist can help patients with this chronicle disease. The ratio of orthopedic doctors to patients with arthritis is low, worldwide. Use of smart devices can support the healthcare industry a lot. Motivated by these facts, here we propose an architecture to track the hand movements of the patient. For regular monitoring of patients with arthritis, fog and cloud gateways for real-time response generation are used. Thread protocol and Bayesian network classifier have been included in the proposed architecture to achieve reliable communication and anomaly detection, respectively. A dataset of 431 patients with arthritis is taken in real time and simulated on OMNet++ simulator. Observations show that the packet delivery ratio is improved by 15–20%, the response time is reduced by 20–30%, and the packet delivery rate is improved by 25–35%, in comparison to not using the fog and thread protocol.

Development and Validation of a Smartphone Application for Orthopedic Residency Education

Abstract: Introduction: Mobile learning offers several benefits, such as new learning environments. We developed and validated a smartphone application for orthopedics and traumatology residents in an attempt to assist their study and, consequently, pass the Board of Orthopedics and Traumatology Exam. Methods: quantitative study, aimed at the validation of a mobile application. It was developed for the iOS® and Android® platforms, in the Portuguese language, and free of charge. 132 participants, divided into three groups, used the tool. A validated questionnaire - System SUS Scale (SUS) - and a questionnaire created by the authors (properly validated) were used to assess the practicality and viability of the application as a learning tool. The mode, the absolute frequency and the percentage of the studied variables were crossed by Fisher's test or Pearson's chi-square test. Results: of the 132 participants, 55.3% have iOS®. All participants said they had already used an application on their smartphones, whereas 6 (4.5%) mentioned never having used applications for academic purposes (p value &lt;0.001). 100% said it was a useful technology in the resident's theoretical development. 124 (93.9%) agreed it was an auxiliary learning method for orthopedic doctors in general. An average SUS score of 84.2 (SD 10.8) was obtained with a margin of error of 1.9. The SUS score varied between 82.4 and 86.1 (95% CI). Cronbach's alpha coefficient was 0.797. Conclusion: the developed application was successful in the tests performed and can be an alternative in medical education in the orthopedic area.

Diabetes Research: Open Access - Editorial

Diabetes is a worldwide health issue affecting about 415 million people at present and more and more sufferers are expected to be seen in near future. The physicians working in the field of diabetes certainly have to update their knowledge about the disease, its complications and managent strategies. Moreover physicians who are not directly involved in the follow up and management of diabetes-such as orthopedic surgeons, ophtalmologists, neurologists, cardiologists and doctors who deal with transplant medicine- will surely encounter diabetic patients in daily practice because of various aspects of the disease presentation.

PO 18146 - The efficacy of a diabetic educational program and predictors of compliance of patients with non-insulin dependent diabetes mellitus (type 2)

Introduction: Diabetes mellitus (DM) has become a global public health problem. The concept of detection and management of diabetes mellitus in primary care centers is widely practiced in Brazil by the general practitioner. The aim of this study was to evaluate the efficacy of our educational program for diabetics for patients with diabetes mellitus and to determine the predictors of compliance. Methods: A cross-sectional prospective study was performed in a quaternary hospital where patients with diabetes were referred to the outpatient clinic of the diabetic foot group so that they were part of a multidisciplinary group (medical orthopedists specialists in foot and ankle, medical endocrinologists, physiotherapist and nurse) with a specific protocol for guidelines for foot care. Specialist orthopedic doctors of the foot and ankle completed the protocol and performed the specific physical examination. Results: Of the 578 diabetic patients, the mean age was 67 years, 69% were female, 53% used insulin to control the disease and the disease duration was 14 years. Obesity was diagnosed by calculation of the body mass index (BMI), and 85% patients were overweight. Evaluation of protective sensibility showed that 68% were significantly decreased, with sensation from the 4.0 g monofilament. One hundred and twenty seven patients required surgery resulting from clinical complications of the disease: 64 ulcers (Wagner classification 57% ulcers had a degree 1 Wagner classification, 63% affected forefoots), 54 Charcot arthropathies (52% Eichenholz in phase 3, 61% located in the mid-foot), and 9 cases of osteomyelitis. Fifty-three patients had one or more prior amputations at the time of their first appointment, mostly of the toes (66%). Conclusion: The costs related to the disease increased greatly with the appearance of complications, especially if there was a need for hospitalization and surgical treatment. The prevention of injuries with adequate glycemic control and the provision of protective shoes is essential.&#x0D;

Finite Element Analysis of Tibia Bone Model

In this Paper tibia bone is generated and analyzed using finite element method by applying static load on it and various stress concentrated regions in tibia bone is identified and analyzed for stresses at various locations by taking Von Misses stress and displacement. The body of the human being consists of many bones and muscles and many instances, the application of different loads leads to the damage in the bone. So it is necessary to evaluate the effect of applied loads on the bone of human body. In most of the cases whole body weight is carried by the tibia bone which is below the knee roll. So it’s necessary to estimate the strength of the tibia bone to carry the body weight. The behavior of the tibia bone under dynamic and static load is necessary for the orthopedic doctors during the treatment of ankle trauma and fractures, but in this paper the study is limited to only static and find out the aspects like Von Misses stress and displacement of tibia bone model under different forces of 800N, 810N, 820N &amp;830N and from the result its understood that both Von Misses stress and displacement are directly proportional to the applied force and the value of Von misses stress in result is less than the maximum value i.e 18MPa for calcium, hence its concluded that generated bone model can withstand the applied force in the range of 800 to 850N

Research progress in animal model of Perthes disease

Perthes disease is the ischemic necrosis of femoral head in children.It was also called osteochondrositis of femoral head in children, aseptic necrosis of femoral head, avascular necrosis of femoral head, etc., which reflected people′s understanding of this disease in different periods.The disease has a certain tendency of self-healing.The femoral head deformity left behind by some of the children may lead to the hip joint weight-bearing and mobility dysfunction, or even disability and deformity, and the clinical effect is worrying.Despite more than 100 years of research, the etiology and pathogenesis are still unclear, mainly due to the lack of ideal animal models for the corresponding research.Over the years, many efforts and attempts have been made by scholars.At present, the recent studies on animal model of Perthes disease have been reviewed in order to provide references for children′s orthopaedic doctors to further understand this disease. Key words: Perthes disease; Animal model; Etiology

How to evaluate the clinical outcome of joint-preserving treatment for osteonecrosis of the femoral head: development of a core outcome set

BackgroundThis study aimed to develop a core outcome set (COS) for clinical trials of joint-preserving treatment for osteonecrosis of the femoral head (ONFH), that is, to define a minimal set of outcomes that should be reported in such trials.MethodsA mixed research method was adopted in this study. First, clinical trials of hip preservation therapy were systematically researched and analyzed. Second, a three-round Delphi survey involving both doctors and patients was carried out to obtain the core outcome indicators. Round 1 was a modified Delphi questionnaire for doctors and patients to determine which outcomes are important to these stakeholders, round 2 determined what clinical evaluation core outcomes should be included for the joint-preserving treatment of ONFH, and round 3 determined how core outcomes should be measured. Finally, a consensus meeting was held to discuss and vote on the established COS.ResultsThe results of the systematic review showed that 42 outcome indicators were classified according to common signs and symptoms, quality of life, long-term outcomes, radiological evaluation, blood biochemistry, and indexes of safety. The three rounds of Delphi surveys completed the selection of indicators for the COS and the determination of the corresponding measurements.A total of 73 orthopedic doctors and 103 patients participated in round 1, and the top 10 indicators selected were basically the same. In round 2, 32 experts identified the following indicators: pain, range of motion (ROM) of hip flexion, walking distance, and stable rating of X-ray images. In round 3, 35 experts defined the measurement of each indicator. Finally, the consensus meeting identified the four indicators aforementioned that constituted the COS.The scores for pain, ROM of hip flexion, and walking distance are from 0 to 10; 0 represents the best scores, while 10 represents the most serious impairment. The stable rating of X-ray images is determined by the morphology of the femoral head and the change in the density of the necrotic area.ConclusionsWe established a COS for hip-preserving treatment of ONFH that includes four indicators: pain, ROM of hip flexion, walking distance, and stable rating of X-ray images.

We have the ability to serenely aggregate, account and reap

We are going through a political, economic and social moment when human relations are fragmented. There is an attempt to impose wills that dominate economic power over disadvantaged people, as regularly shown. The leaders of the most powerful nations try to subdue those without economic assets, blocking people's free movement through land and sea blockages, and strengthening land confinements. While others always wait for some heroic attitude. In our activity as orthopaedic doctors, surgeons or managers we also face strong economic and financial impositions, "windows close but doors open."&#x0D; &#x0D; The speed of information in the current times will determine in the near future the quality of services that will be required, both for the ethical characterization of the information and for its credibility. Not long ago, the main complaint of ABTPé members was related to professional remuneration. We observed that the purposeful attitude of all associate members and the willingness of some members led to the beginning of change. We begin to consider the ethical views of payer and service provider, the legal aspects of adoptable attitudes, as well as the ethical attitudes of medical practice. Thus, these facts illustrate the strength and ability of fellow foot and ankle surgeons to take action that results in advantages for the entire class.&#x0D; &#x0D; These facts illustrate the strength and ability of foot and ankle surgeons to take action that results in advantages for the entire ABTPé.&#x0D; &#x0D; Making an analogy with the field of scientific culture we must also show how capable we are in producing useful scientific knowledge that benefits everyone. Creativity will be present with the release of new space for presentation of innovative procedures, through the technical notes in our publications.&#x0D; &#x0D; Discussions should be stimulated.&#x0D; &#x0D; The willingness of foot and ankle surgeon training centers to cultivate purposeful, ethical and socially comprehensive attitudes becomes extremely relevant. Thus, we will keep the flow of scientific development, improving our publications and projecting the potential of generating new knowledge compatible with our socioeconomic and cultural conditions.&#x0D; &#x0D; Our strength in producing publications capable of summing up the various currents of thought and our cultures will set our continent on a new level. In this edition we are considering the internationalization of knowledge.&#x0D; &#x0D; Yes, we are capable. Everyone's effort will be worth the award.&#x0D; Have a great reading.&#x0D; &#x0D; Jorge Mitsuo MizusakiEditor-in-Chief

Treatment of rheumatic disease with renal insufficiency

Reduced renal function is not rare in patients with inflammatory rheumatic diseases and is associated with an increased risk of treatment-induced and perioperative adverse events. Aliterature search was carried out for the medical treatment and perioperative management of rheumatic disease in the presence of renal insufficiency. Patients with rheumatic disease and renal insufficiency have ahigher risk of cardiovascular disease, bone loss and immunodeficiency than those without kidney disease. The perioperative rate of cardiovascular and infectious complications and the risk of acute kidney failure are elevated in these patients. The pharmacokinetics of many drugs used in rheumatology is influenced by the kidney function. Especially methotrexate is contraindicated in patients with an estimated glomerular filtration rate (eGFR) <45 ml/min. Nonsteroidal anti-inflammatory drugs (NSAIDS) and cyclooxygenase (COX)-2 inhibitors should not be used with renal insufficiency or only for ashort term with the lowest effective dose. The treatment of osteoporosis with antiresorptive drugs may lead to adynamic bone disease in advanced kidney disease, and, therefore, the use of these drugs is controversial. Medication should be modified in patients with rheumatic disease and kidney involvement according the grade of renal insufficiency. There is also aneed for special perioperative management in these patients, with interdisciplinary cooperation of rheumatologists, nephrologists and orthopedic doctors.