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Long-term local effects of carbon fibre in the knee.

A radiological and histological analysis of five knee joints after a minimum of 15 years following the implanting of carbon fibre, which had been used as a treatment for knee instability, was undertaken. All patients underwent total knee replacement for secondary osteoarthritis. Histological analysis demonstrated a variable amount of macroscopically visible carbon particles in the synovium, hyaline cartilage and menisci. At microscopy these particles were found in association with fibrous tissue adjacent to bone with no acute inflammatory changes. No intact carbon fibre ligament was noted within the joint, small portions of the old ligament were covered with a thin fibrous layer but there was no evidence of any structure resembling neo-ligament. Extra articularly the carbon fibre was covered with a thick fibrous sheath with no active inflammation changes inflammation. In the bone tunnels, the carbon fibre-bone interface showed an apposition of the bone to the carbon fibre without any interposing fibrous sheath. Carbon fibre bonds directly with the bone without fibrous interposition.

Anterior Cruciate Ligament↗

Metacarpophalangeal joint implant arthroplasty.

Rheumatoid arthritis (RA) usually requires lifelong treatment and sometimes surgery. Metacarpophalangeal joint (MCPJ) implant arthroplasty is one surgical treatment for patients with severe RA malformation of the finger joints. Although not a cure, MCPJ implant arthroplasty can enhance patients' quality of life by improving their performance of independent activities of daily living. The silicone implant acts as a spacer until tendons and connective tissues are able to control the joint's functions. Comprehensive preoperative and postoperative patient teaching and aggressive physical therapy are needed to achieve optimal outcomes in patients who undergo this surgical procedure.

Arthritis, Rheumatoid↗

Imaging orthopedic hardware with an emphasis on hip prostheses.

This article reviews contemporary evaluation of hip prostheses, emphasizing both the accepted use of conventional radiographs, arthrograms, and scintigraphy, as well as the evolving use of CT and MR imaging in evaluating suspected complications. Developments in CT postprocessing and MR pulse sequence design now allow successful imaging of soft tissues adjacent to hardware components.

Artifacts↗

Pasteurella multocida: bilateral septic knee joint prostheses from a distant cat bite.

We report a case of septic arthritis and bacteremia caused by the Gram-negative rod, Pasteurella multocida. The patient was superficially bitten by her cat, and within two years infection necessitated removal of both of her artificial knee prostheses. P multocida is found in the mouths of cats, dogs, and other domestic animals. The pathogenesis, prevention, and treatment of infections caused by this organism, and the question of prophylactic antibiotics are discussed.

Aged↗

Fingers, hands or patients? The concept of independent observations.

In hand surgery trials, it is often possible to take several measurements from the same patient, because many disorders here affect bilateral or multiple structures, such as the hand itself, the finger joints or the tendons. Most conventional statistical analyses that take place on the level of hands, digit rays or joints rather than patients violate the assumption that observations should be independent. Furthermore, ignoring the multiplicity of data inflates sample size and thus may lead to spurious significance. This article describes three options to deal with such problems. First, the analysis can simply be restricted to only one measurement per patient. Second, a self-controlled design may be advantageous for conditions that usually have a bilateral pattern. Third, complex statistical modelling (involving generalized estimating equations) can be used to analyse all available measurements with adjustment for data dependency.

Controlled Clinical Trials as Topic↗

Candida infection of a silicone metacarpophalangeal arthroplasty.

Fungal infections following joint arthroplasty are extremely rare. Only 16 cases of Candida prosthetic infections have been reported, involving the hip, knee or shoulder joints. We report a case of a silicone metacarpophalangeal joint replacement complicated by a Candida albicans infection.

Aged↗

Functional and biomechanical assessment of the normal and rheumatoid hand.

OBJECTIVE: To assess hand function in accordance with its accepted definition and to compare the results of three different assessment techniques. DESIGN: A clinical-type assessment was used together with measurement of pinch grip and three-dimensional biomechanical trials. BACKGROUND: Traditional clinical assessment may not relate to a patient's actual hand function. If hand function is defined as "the ability to use the hand in daily activities" then it is more appropriate to measure the forces available for performing everyday tasks using biomechanical tests. METHODS: Eight female patients with rheumatoid arthritis and eight control subjects were recruited for the study. Volunteers underwent a clinical-type assessment using a six-task activity board. Lateral pinch grip of both hands was measured using a custom-built transducer. Biomechanical trials were conducted using a 6 degree-of-freedom transducer and 6-camera motion analysis. RESULTS: Functional differences between the two subject groups were apparent using all three methods of assessment. Pinch strength correlated well with the biomechanical trial data but results from the clinical-type assessment provided only a weak correlation. CONCLUSIONS: Clinical-type assessments do not give an accurate measure of hand function. Pinch strength measurements can provide a cost-effective alternative to full biomechanical analysis. RELEVANCE: Traditional functional assessment uses measurements of grip or pinch strength and range of motion together with a subjective assessment of activities of daily living. This study demonstrates that pinch strength measurements can provide an accurate measure of hand function. The results from activity-board trials do not reflect hand ability and are of limited use for hand evaluation.

Adult↗

Comparative investigations of regional lymph nodes and pseudocapsules after implantation of joint endoprostheses.

Morphological alterations of pseudocapsules and regional lymph nodes were studied by light and electron microscopy and by Laser Microprobe Mass Analysis (LAMMA). The tissue specimens originated from 32 autopsies of patients with hip joint endoprostheses (time in situ: 3 weeks - 15 years, average: 6 years) and two cases with knee joint endoprostheses. Characteristic changes of the lymph nodes as well as of the pseudocapsules consisted in an infiltration by monocytic histiocytes with various intracytoplasmatic wear particles. The foreign material consisted mainly of the components of bone cement: polymethylmethacrylate (PMMA) and zirconium oxide, to a lesser degree of polyethylene from the articulating surfaces. In two cases with special types of prostheses ceramic or metallic wear particles could be detected too. Most of the wear particles were found in the ipsilateral parailiac lymph nodes and in the paraaortic lymph nodes bilaterally. In the cases with mostly stable prostheses small amounts of wear particles were found in the lymph nodes as soon as 1.5 years after insertion and their number increased in all groups of lymph nodes after longer duration of the implant. The phagocytosing histiocytes showed degenerative changes. At present it is not clear, if the cell damage is caused by the amount of phagocytosed wear particles alone or if specific toxic effects of certain substances are of importance.

Granulation Tissue↗

Implant arthroplasty in the rheumatoid hand and wrist: current state of the art in the United States.

Implant arthroplasty in deforming arthritis of the hand and wrist is a useful procedure that provides pain relief and mobility. Resection arthroplasty enhanced by silicone elastomer interpositional implants remains the standard of comparison and procedure of choice in most areas. Articulated and nonarticulated fixed-fulcrum implants have had limited success. Soft tissue disease significantly limits the eventual success of implant arthroplasty in the rheumatoid hand and wrist.

Arthritis, Rheumatoid↗