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PubMed2006

Thumb arthrodesis.

PURPOSE OF REVIEW: Arthrodesis of the thumb carpometacarpal, metacarpophalangeal, and interphalangeal joints are well-established options in the management of arthritis, instability, and/or deformity. This review includes a general review of the indications and technique of arthrodesis and recent review of the literature. RECENT FINDINGS: New literature has focused on the role of arthrodesis in managing carpometacarpal arthritis and compared its results with ligament reconstruction and tendon interposition. However, no conclusive evidence demonstrates the superiority of arthrodesis. Several new articles have demonstrated good long-term results of carpometacarpal arthrodesis. A new report on complications associated with plate and screw fixation for carpometacarpal arthritis has been published, leading the authors to conclude that k-wire fixation was a better option. A technique of metacarpophalangeal joint arthrodesis using a cannulated screw has been recently published with good success. Moreover, a cup-in-cone technique of reaming surfaces of the thumb metacarpophalangeal joint to maximize bone contact surface area has been described. Other authors have reiterated and reinforced the success of some of the more standard techniques including Herbert screws for interphalangeal joint arthrodeses. SUMMARY: Thumb arthrodesis of the carpometacarpal, metacarpophalangeal, and interphalangeal joints maintains a significant role in the management of deformity and arthritis. Better comparison studies are necessary in evaluating arthrodesis of the carpometacarpal joint versus arthroplasty. New fixation techniques for metacarpophalangeal joint arthrodesis are promising. Standard fixation for interphalangeal joint fusion has been reiterated. Successful arthrodesis can lead to excellent patient outcomes and function.

Arthritis↗

PubMed2000

Hormone replacement therapy and patterns of osteoarthritis: baseline data from the Ulm Osteoarthritis Study.

OBJECTIVES: It has been suggested that hormone replacement therapy (HRT) may protect against osteoarthritis (OA). The aim of this paper was to assess the association between HRT and radiographically defined patterns of OA. METHODS: 475 consecutive women aged 50 years or older (mean age 66.1) who underwent hip or knee joint replacement because of advanced OA in four hospitals in south west Germany were enrolled in a cross sectional study. Participants underwent a standardised interview including detailed history of medication use and a physical examination. Furthermore, radiographs of the joint being replaced and of the contralateral joint as well as of both hands were obtained. Patients were categorised as having bilateral or unilateral OA according to the presence or absence of radiographic OA in the contralateral joint. If radiographic OA of different hand and finger joint groups was present, participants were categorised as having generalised OA (GOA). Logistic regression was used to estimate odds ratios and their 95% confidence intervals for the association between HRT and bilateral or GOA while adjusting for potential confounders. RESULTS: Fifty five women (11.6%) were using HRT. The median duration of use was 5.4 years. The prevalence of bilateral and GOA was similar among users of ORT (86.3% and 27.5%, respectively) and among non-users of HRT (88.7% and 35.7%, respectively). After adjustment for potential confounding factors, the odds ratios (95% confidence intervals) of bilateral OA and GOA among HRT users compared with non-users was 1.21 (0.48, 3.03) and 1. 21 (0.53, 2.74), respectively. CONCLUSION: Despite limited generalisability because of the selective study sample, these data do not support the hypothesis that HRT acts as a systemic protective factor against OA.

Aged↗

PubMed2000

An overview of radiographic analysis of joint damage in rheumatoid arthritis and its use in metaanalysis.

A brief history of the development of scoring methods to represent the extent of radiographic abnormalities in rheumatoid arthritis shows that grading systems have become more detailed with time. Taken together with the observation that physicians continue to modify scoring methods it is clear that we have not yet arrived at the ideal method. Issues to be considered in evaluating scoring methods include which abnormalities and which joints to score and what scale to use. Data from one early trial indicate that erosion and joint space narrowing scores do not progress in lockstep and progression in one does not predict progression in the other; this leads to the conclusion that including both features in a scoring method is important. Data from the same trial raise the possibility that joint space narrowing scores for the proximal interphalangeal finger joints may not be helpful in detecting treatment differences, illustrating that further investigation of which joints to include in scoring is needed. The possibility that an expanded scoring scale might be more sensitive to recording a change in radiographic damage also was raised. A simple method of determining which patients show progression of damage was proposed based on assessing the distribution of negative progression scores (baseline erosion scores subtracted from followup scores adjusted for time). It was pointed out that radiographic assessment has established that a few drugs slow the progression of joint damage. Radiographic evaluation of disease progression should continue to be utilized as an outcome measure in evaluating new therapies.

Arthritis, Rheumatoid↗

PubMed1965