Arthroscopic hemitrapeziectomy for first carpometacarpal arthritis: results at 7-year follow-up.
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ABSTRACT:
SUBMITTER: Hofmeister EP
PROVIDER: S-EPMC2654951 | biostudies-other | 2009 Mar
REPOSITORIES: biostudies-other
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Project description:The arthroscopic surgical procedures reported previously for a rheumatic hip joint have been primarily performed as diagnostic procedures. Only a few studies have reported the success of arthroscopic surgery in hip joint preservation. We encountered a special case in which joint remodeling was seen in a patient with rheumatoid arthritis treated with biological drugs after hip arthroscopic synovectomy and labral repair. We report the case of a 39-year-old woman with rheumatism, which was controlled with tocilizumab, prednisolone, and tacrolimus. The hip joint showed Larsen grade 3 destruction, and the Harris Hip Score was 55 points. Because of the patient's strong desire to undergo a hip preservation operation, we performed hip arthroscopic synovectomy and repair of a longitudinal labral tear. After 2.5 years, the joint space had undergone rebuilding with improvement to Larsen grade 2, and the Harris Hip Score had improved to 78 points; the patient was able to return to work with the use of 1 crutch. It is possible to perform hip arthroscopic surgery for rheumatoid arthritis with a hip preservation operation with biological drugs.
| S-EPMC4175552 | biostudies-literature
Project description:BackgroundSeptic arthritis (SA) is a dangerous condition that requires emergency treatment. Managed by culture-specific antibiotics, irrigation, and debridement (I&D), some patients require repeat surgical treatment. The objectives were to determine the risk factors for SA and risk factors for repeat arthroscopic I&D in SA patients. We hypothesized that variables which directly or indirectly contributed to a larger infection burden would be associated with the development of SA and the need for repeat arthroscopic I&D.MethodsAll patients ≥ 18 years old presenting to the emergency department, orthopaedic and rheumatology clinics at our major trauma centre between January 2018 and January 2020 with a hot, swollen joint were retrospectively evaluated. Patients with previous trauma and metalwork in the affected joint, periprosthetic joint infection, previous joint arthroplasty surgery, soft tissue infection, missing data, transferred to another centre, diagnosis not concerning the joint, and < 24-month follow-up were excluded. Two hundred eleven patients were included (SA: 28; pseudogout: 32; gout: 50; others: 101). Variables of interest in the 3-month period preceding the diagnosis of SA were compared between SA and non-SA patients using univariable analysis. A multivariable logistic regression model was formed using covariates with corresponding univariable tests of p < 0.200. Similar analyses were performed to compare SA patients with multiple washouts/procedures with those with one washout/procedure.ResultsMultivariable analysis showed multiple risk factors for SA, namely rheumatoid arthritis (RA) (OR: 3.4; 95% CI: 1.2-10.0; p = 0.023); skin infection (OR: 3.3; 95% CI: 1.2-9.0; p = 0.017), liver disease (OR: 9.9; 95% CI: 2.2-43.9; p = 0.003), knee joint involvement (OR: 3.5; 95% CI: 1.3-9.4; p = 0.014), and use of immunosuppressive medication (OR: 3.5; 95% CI: 1.2-10.6; p = 0.027). Risk factors for multiple washouts included synovial WBC levels > 10.5 × 109 cells/L (OR: 3.0; 95% CI: 2.3-38.8; p = 0.009) and RA (OR: 3.5; 95% CI: 1.9-66.3; p = 0.017).ConclusionsThese findings suggest that prophylactic actions against septic arthritis should be targeted at patients with liver disease, RA, or skin infection. Repeat arthroscopic I&D of septic joints may be needed, especially in patients with synovial WBC levels > 10.5 × 109 cells/L and RA. Key Points • The risk factors for septic arthritis determined in this study are rheumatoid arthritis, skin infection, liver disease, knee joint involvement, and immunosuppressant usage. • Some septic arthritis patients need multiple rounds of arthroscopic irrigation and debridement. The risk factors for this are a synovial WBC count > 10.5 × 109 cells/L and rheumatoid arthritis.
| S-EPMC9287235 | biostudies-literature
Project description:Brief hospitalization contributes to quicker and more effective recovery in psychiatric practice. It also leads to a progressive change in the pattern of mental morbidity. Two-year follow-up of patients treated with this technique indicates that recovery is sustained, and relapse/wastage rate is low. There is need for further research in this significant aspect of military medicine.
| S-EPMC5530633 | biostudies-other
Project description:ObjectiveSystemic juvenile idiopathic arthritis (JIA) is a multifactorial autoinflammatory disease with a historically poor prognosis. With current treatment regimens, approximately half of patients still experience active disease after 1 year of therapy. This study was undertaken to evaluate a treat-to-target approach using recombinant interleukin-1 receptor antagonist (rIL-1Ra; anakinra) as first-line monotherapy to achieve early inactive disease and prevent damage.MethodsIn this single-center, prospective study, patients with new-onset systemic JIA with an unsatisfactory response to nonsteroidal antiinflammatory drugs received rIL-1Ra monotherapy according to a treat-to-target strategy. Patients with an incomplete response to 2 mg/kg rIL-1Ra subsequently received 4 mg/kg rIL-1Ra or additional prednisolone, or switched to alternative therapy. For patients in whom inactive disease was achieved, rIL-1Ra was tapered after 3 months and subsequently stopped.ResultsForty-two patients, including 12 who had no arthritis at disease onset, were followed up for a median of 5.8 years. The median time to achieve inactive disease was 33 days. At 1 year, 76% had inactive disease, and 52% had inactive disease while not receiving medication. High neutrophil counts at baseline and a complete response after 1 month of rIL-1Ra were highly associated with inactive disease at 1 year. After 5 years of follow-up, 96% of the patients included had inactive disease, and 75% had inactive disease while not receiving medication. Articular or extraarticular damage was reported in <5%, and only 33% of the patients received glucocorticoids. Treatment with rIL-1Ra was equally effective in systemic JIA patients without arthritis at disease onset.ConclusionTreatment to target, starting with first-line, short-course monotherapy with rIL-1Ra, is a highly efficacious strategy to induce and sustain inactive disease and to prevent disease- and glucocorticoid-related damage in systemic JIA.
| S-EPMC6617757 | biostudies-literature
Project description:BACKGROUND: The risk of radiographic knee degeneration after partial or total meniscectomy is well documented, but no prior study has employed cartilage-sensitive MRI technology to assess degenerative changes after meniscectomy. HYPOTHESIS: Arthroscopic partial meniscectomy results in early articular cartilage wear and subchondral bony degeneration, even in the absence of clinical symptoms, and these findings can be evaluated with cartilage-sensitive MRI. STUDY DESIGN: Retrospective cohort. METHODS: Twenty-nine patients (ages: 15-40) who had undergone isolated arthroscopic partial medial or lateral meniscectomy with at least 5-year follow-up were evaluated. All patients had arthroscopically normal articular cartilage at the time of initial meniscectomy. Seventeen patients (18 knees) underwent partial medial meniscectomy (MM) and 12 patients underwent partial lateral meniscectomy (LM) with mean follow-up of 8.4 and 7.1 years, respectively. Follow-up evaluation included physical examination, outcome questionnaires, and cartilage-sensitive MRI examination with modified Outerbridge grading of articular surfaces. RESULTS: Outerbridge grades II-IV were noted in 64% of medial compartment joint surfaces in group MM knees versus 33% of lateral compartment joint surfaces in group LM knees. Abnormal cartilage surfaces (grades II-IV), subchondral sclerosis, and condylar squaring were all significantly more frequent after medial meniscectomy (p < 0.05). Groups MM and LM had no significant differences among outcome scores, which remained excellent in both groups. A significant negative correlation was found between the severity of cartilage wear and functional scoring in the MM group, suggesting that functional disability lags behind early MRI evidence of degeneration. CONCLUSIONS: Despite optimal preoperative prognostic factors and excellent functional outcomes, MRI evidence of early articular cartilage degeneration was present in both partial medial and lateral meniscectomy patients at a minimum 5-year follow-up. Results support the use of cartilage-sensitive MRI as a noninvasive screening technique to evaluate cartilage changes after arthroscopic partial meniscectomy and may help to counsel the high-risk patient in regard to postoperative activity.
| S-EPMC2504089 | biostudies-other
Project description:ObjectivesTo determine whether direct access to hospital review initiated by patients with rheumatoid arthritis would result in improved clinical and psychological outcome, reduced overall use of healthcare resources, and greater satisfaction with care than seen in patients receiving regular review initiated by a rheumatologist.DesignTwo year randomised controlled trial extended to six years.SettingRheumatology outpatient department in teaching hospital.Participants209 consecutive patients with rheumatoid arthritis for over two years; 68 (65%) in the direct access group and 52 (50%) in the control group completed the study (P = 0.04).Main outcome measuresClinical outcomepain, disease activity, early morning stiffness, inflammatory indices, disability, grip strength, range of movement in joints, and bone erosion. Psychological status: anxiety, depression, helplessness, self efficacy, satisfaction, and confidence in the system. Number of visits to hospital physician and general practitioner for arthritis.ResultsParticipants were well matched at baseline. After six years there was only one significant difference between the two groups for the 14 clinical outcomes measured (deterioration in range of movement in elbow was less in direct access patients). There were no significant differences between groups for median change in psychological status. Satisfaction and confidence in the system were significantly higher in the direct access group at two, four, and six years: confidence 9.8 v 8.4, 9.4 v 8.0, 8.7 v 6.9; satisfaction 9.3 v 8.3, 9.3 v 7.7, 8.9 v 7.1 (all P < 0.02). Patients in the direct access group had 38% fewer hospital appointments (median 8 v 13, P < 0.0001).ConclusionsOver six years, patients with rheumatoid arthritis who initiated their reviews through direct access were clinically and psychologically at least as well as patients having traditional reviews initiated by a physician. They requested fewer appointments, found direct access more acceptable, and had more than a third fewer medical appointments. This radical responsive management could be tested in other chronic diseases.
| S-EPMC544988 | biostudies-literature
Project description:BackgroundPatients with femoroacetabular impingement syndrome (FAIS) are offered hip arthroscopic surgery to decrease hip pain, improve their function, and decrease development of hip osteoarthritis (OA). Nonetheless, long-term follow-up data are few.PurposeTo investigate patient-reported outcomes, clinical tests, reoperations, and radiographic status 5 years after primary hip arthroscopy in patients with FAIS.Study designCase series; Level of evidence, 4.MethodsA total of 60 patients (age, 36 ± 9 years; 63% female) diagnosed with FAIS were included in the study and followed for 5 years after hip arthroscopy. Follow-up included Copenhagen Hip and Groin Outcome Score (HAGOS); Hip Sports Activity Scale; and clinical tests (flexion, adduction, internal rotation [FADIR]; flexion, abduction, external rotation [FABER]; and psoas muscle/tendon major pain provocation). Radiographic evaluation included lateral joint-space width (LJSW) and Tönnis classification for hip OA. Reoperations and conversion to total hip replacement (THR) were recorded. We calculated the proportion of patients who exceeded the minimal important change (MIC), achieved the Patient Acceptable Symptom State (PASS), and were within the 95% reference interval of age- and sex-matched persons with no hip problems. Changes were investigated using paired t tests.ResultsCompared with preoperatively, all HAGOS subscales were improved substantially 5 years after surgery (mean, ≥21 points; P < .001), and 67% to 89% of patients reported improvements exceeding MIC. Between 56% and 80% achieved PASS, but only 7% to 24% reached the 95% reference interval for the HAGOS subscales. A total of 36% had a positive FADIR test and 25% had a positive FABER test, which were improvements compared with preoperatively (P < .001 for both). Patients with a positive FADIR test had significantly worse HAGOS subscales. Six patients (10%) had a THR since their primary hip arthroscopy. In the remaining patients, the mean LJSW was decreased (-0.4 mm; P = .043), and hip OA had worsened in 9 patients (23%; P = .003).ConclusionFive years after surgery, the majority of patients experienced HAGOS improvements exceeding MIC while also showing an acceptable PASS. However, clinical tests, participation in physical activities, and quality of life indicated that many patients still experience hip problems.RegistrationNCT04590924 (ClinicalTrials.gov identifier).
| S-EPMC8908400 | biostudies-literature
Project description:The integrity of the acetabular labrum is crucial to normal biomechanics of the hip joint. Disruption of the labral seal could be detrimental to the overall nutrition of the cartilage, leading to its premature degeneration.The aim of this study is to determine the clinical effectiveness of arthroscopic hip labral reconstruction using fascia lata allograft. The hypothesis is that labral reconstruction would provide good clinical outcomes.We retrospectively reviewed all 10 patients who underwent labral reconstruction with fascia lata allograft from January 2013 to October 2015. We assessed improvement in pain and function, complications, and subsequent surgery. The minimum follow-up was 12 months (average, 22.9 months; range, 16-36 months).All patients reported subjective improvement in preoperative pain and function. The mean modified Harris hip score improved significantly from 58 (55-60) to 95 (91-98). The mean change of modified Harris hip score was 36 (31-41) and mean post-operative patient satisfaction score was 9.5(8-10). We observed no radiological progression of arthritis as well as no patient had revision procedure including total hip replacement.Arthroscopic labral reconstruction using a fascia lata tendon allograft is an effective and safe procedure that not only provides excellent clinical outcomes in short term but also potentially prevent continued cartilage degeneration by restoring acetabular labral seal in patients with deficient or resected labrums.
| S-EPMC5543695 | biostudies-other
Project description:BackgroundTo better understand the role of human rhinovirus-associated wheeze as a risk factor for childhood recurrent wheezing, a cohort of young children experiencing their first wheezing episode was followed until school age.MethodsAll 111 hospitalized wheezing children (median age, 12 months) were initially participated in a randomized, double-blind, placebo-controlled, parallel trial on the efficacy of oral prednisolone. In this 7-yr follow-up, risk factors for recurrent wheezing were analysed, and then, the efficacy of prednisolone was evaluated overall and in pre-specified subgroups post-hoc. The main outcome was time to recurrent wheezing.ResultsThe strongest independent risk factor for recurrent wheezing was rhinovirus detection (hazard ratio 3.54; 95% confidence interval 1.51-8.30) followed by sensitization (3.47; 1.55-8.30, respectively) age <1 yr (2.45; 1.29-4.65) and eczema (2.33; 1.11-4.90). Overall, prednisolone did not prevent recurrent wheezing. In subgroup analysis, prednisolone was associated with less recurrent wheezing in children affected by rhinovirus (0.32; 0.12-0.90, adjusted to sensitization, young age, viral aetiology and parental asthma) and/or with eczema (0.27; 0.08-0.87, adjusted respectively).ConclusionsOur data strengthen the role of rhinovirus-associated wheeze as an important risk factor for recurrent wheezing and asthma in young first-time wheezing children. Prospective randomized trials on the efficacy of corticosteroids in rhinovirus-associated early wheezing are warranted. (ClinicalTrials.gov number, NCT 00494624).
| S-EPMC7167822 | biostudies-literature
Project description:Sarcoidosis + Follow-up 6 month after Keywords = sarcoidosis Keywords = follow-up Keywords: other
2005-01-18 | GSE1907 | GEO