Conservative treatment of scaphoid fracture: Protocol for a systematic review

The scaphoid is the most commonly fractured carpal bone. Fractures affecting this bone affect young and active patients between 15 and 40 years of age. Stable scaphoid fractures are treated conservatively by plaster cast immobilization or other type of orthosis for an average period of four to 12 weeks. Failure to treat scaphoid fractures may result in avascular necrosis, nonunion, and early secondary osteoarthritis, which may result in significant economic and social impact due to the affected population, formed by young people of productive age. The management of this type of fracture varies significantly between different Institutions and orthopedic surgeons. This article describes a protocol for a systematic review that aims to evaluate the effects (benefits and harms) of conservative interventions in the treatment of scaphoid fractures in adults.

Have the Radiographic Characteristics of Total Knee Arthroplasty Recipients in Rheumatoid Arthritis Changed After the Induction of Biologic Disease Modifying Anti-Rheumatic Drugs?

Objectives Whether the characteristics of patients with rheumatoid arthritis (RA) undergoing total knee arthroplasty (TKA) have changed in the era of biologic disease-modifying antirheumatic drugs (bDMARDs) is unclear. We compared the radiographic findings of the knees in TKA recipients with RA before and after the introduction of bDMARDs. Methods Consecutive patients who underwent primary TKA between 1999 and 2002 (115 knees; 79 patients, group A) and between 2013 and 2017 (117 knees; 95 patients, group B) were retrospectively evaluated. Clinical data, including disease duration, medication, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and rheumatoid factor (RF), were collected. The Larsen classification, joint space narrowing (JSN), bone erosion, geode and osteophyte formation were evaluated on preoperative radiographs. Results Osteophyte formation was significantly increased, and bone erosion and geode formation were significantly decreased in group B. In addition, medial-dominant JSN was significantly increased, and bicompartmental JSN was significantly decreased in group B. Medial-dominant JSN was positively, and bone erosion was negatively associated with osteophyte formation. Conclusions Following the introduction of bDMARDs, typical radiographic findings of rheumatoid knees have decreased, and secondary osteoarthritis (OA)-like changes, characterized by osteophyte formation and medial-dominant JSN, have increased in the knees of TKA recipients.

Mueller Weiss syndrome, a less elucidated and unusual cause of midfoot pain: A case report

Mueller Weiss Syndrome is a rare, under-diagnosed cause of chronic mid foot pain despite having well-described imaging features. It is historically described as spontaneous adult-onset osteonecrosis of the navicular bone. The disease commonly affects bilateral navicular bones in women in the fifth decade of life. Nearly a century after its first description as a disease entity, the exact etiopathogenesis is still not well understood. From a radiographic point of view weight-bearing radiographs of the foot remains the mainstay in diagnosis. Characteristic imaging findings include the lateral collapse of navicular, dorsomedial subluxation of the remnant navicular, and lateral deviation of the talus (hind-foot varus). Progressive disease leads to pes planus and secondary osteoarthritis of the talonavicular joint with or without the involvement of other midfoot joints. Severe disease may show “listhesis navicularis” and talo-cuneiform neo-articulation. Computed tomography and magnetic resonance imaging can be used as adjuncts, especially to detect changes in the initial stage of the disease and early osteoarthritic features.

Description of Joint Alterations Observed in a Family Carrying p.Asn453Ser COMP Variant: Clinical Phenotypes, In Silico Prediction of Functional Impact on COMP Protein and Stability, and Review of the Literature

The role of genetics in the development of osteoarthritis is well established but the molecular bases are not fully understood. Here, we describe a family carrying a germline mutation in COMP (Cartilage Oligomeric Matrix Protein) associated with three distinct phenotypes. The index case was enrolled for a familial form of idiopathic early-onset osteoarthritis. By screening potential causal genes for osteoarthritis, we identified a heterozygous missense mutation of COMP (c.1358C>T, p.Asn453Ser), absent from genome databases, located on a highly conserved residue and predicted to be deleterious. Molecular dynamics simulation suggests that the mutation destabilizes the overall COMP protein structure and consequently the calcium releases from neighboring calcium binding sites. This mutation was once reported in the literature as causal for severe multiple epiphyseal dysplasia (MED). However, no sign of dysplasia was present in the index case. The mutation was also identified in one of her brothers diagnosed with MED and secondary osteoarthritis, and in her sister affected by an atypical syndrome including peripheral inflammatory arthritis of unknown cause, without osteoarthritis nor dysplasia. This article suggests that this mutation of COMP is not only causal for idiopathic early-onset osteoarthritis or severe MED, but can also be associated to a broad phenotypic variability with always joint alterations.

Total hip replacements following acetabular fractures. 7 to 15 years clinical and radiological results

This study is reporting the long term clinical and radiographic results of a group of 45 patients who underwent total hip arthroplasty following acetabular fractures. The study included 39 males and 6 females. The age of the patients ranged from 32 to 61 with a mean of 46.4 years. The indication for surgery was secondary osteoarthritis in 35 patients and avascular necrosis of the femoral head in the remaining ten. The follow up period ranged from 7 to 15 years with a median of 10.3 years. Uncemented total hip prostheses were used in 37 cases while 8 cases had hybrid prostheses with cemented cups and uncemented stems. Thirty patients (66.7%) needed autogenous acetabular bone grafting. There has been a statistically significant improvement from a preoperative mean Oxford hip score of 16 to a postoperative mean score of 39.8 (p < 0.001). At the end of follow up, two cases had revision for cup loosening. The complications included one case of transient sciatic nerve palsy, and two cases of heterotopic ossification. Currently, total hip replacement remains the best option for end stage post traumatic arthritis. There are technical challenges associated with this replacement surgery which the surgeon should be aware of.

Acetabular reconstruction with femoral head autograft in primary total hip arthroplasty through a direct anterior approach is a reliable option for patients with secondary osteoarthritis due to developmental dysplasia of the hip

Background Developmental dysplasia is challenging to treat with total hip arthroplasty via the direct anterior approach (DAA). Reconstructing the former anatomy while restoring the acetabular bone stock for future revisions in this young patient collective combined with the known advantages of the DAA would be desirable. The purpose of this study was to analyze the feasibility, radiographic outcome and clinical outcome of primary uncemented total hip arthroplasty with bulk femoral head autograft for acetabular augmentation through a DAA with a minimal follow-up of 12 months. Methods A retrospective, consecutive series from March 2006 to March 2018 of 29 primary total hip arthroplasty with acetabular augmentation with bulk femoral head autograft through a direct anterior approach was identified. All complications, reoperations and failures were analyzed. Radiographic and clinical outcome was measured. Results 24 patients (29 hips) with a mean age of 43 (18–75) years and a mean follow-up of 35 months (12–137) were included. Surgical indication was secondary osteoarthritis for developmental dysplasia of the hip (Hartofilakidis Grade A (n = 19), B (n = 10)) in all cases. We noted no conversion of the approach, no dislocation and no acetabular loosening. The center of rotation was significantly distalized by a mean of 9 mm (0–23) and significantly medialized by a mean of 18 mm (6–29). The bone graft was fully integrated after 12 months in all cases. Conclusion Acetabular reconstruction with femoral head autograft in primary THA through a direct anterior approach seems to be a reliable option for the treatment of secondary osteoarthritis in patients with DDH Hartofilakidis grade A and B. Prospective cohort studies with a large sample population and a long-term follow-up are necessary to confirm our findings.

A potential diagnostic serum immunological marker panel to differentiate between primary and secondary knee osteoarthritis

Inflammation contributes to knee osteoarthritis (KOA) where many immunological mediators participate in its initiation and progression. Most clinicians manage primary (pKOA) and secondary osteoarthritis (sKOA) alike. Whether immunological profiles of pKOA and sKOA differ remains obscure. Hence, we aimed to differentially identify potential serum immunologic diagnostic markers of pKOA and of sKOA. This case control study used 46 KOA patients (pKOA, n = 30; sKOA, n = 16), and 60 age, gender matched controls (normal healthy, n = 30; systemic lupus erythematosus [SLE] disease controls, n = 30) where serum was assayed for cytokines (TNF-α, IL-1β, IL-6, IL-10) and nitric oxide derivatives (NOx). Sandwich ELISA assessed cytokine levels, while the ‘Griess assay’ quantified NOx levels. The diagnostic accuracy of optimal marker combinations was evaluated by the CombiROC web tool. Compared with pKOA, sKOA serum displayed significantly elevated levels of pro inflammatory cytokines (TNF-α, IL-1β, IL-6) with a concurrent decrease in the anti-inflammatory cytokine, IL-10 (P<0.05). This was reiterated by significantly higher Th1:Th2 (TNF-α: IL-10) serum cytokine ratio observed in sKOA compared to that of pKOA. The CombiROC curves identified TNF-α, IL-1β, IL-6 and NOx as the best performing panel of potential diagnostic markers to discriminate pKOA from control groups (~97% accuracy, 90% Sensitivity [SE] and 98% specificity [SP]), while TNF-α, IL-1β and IL-6 discriminated sKOA from control groups (~100% accuracy, 100% SE, and 98% SP). The study identified discrete serum immune biomarker panels to differentiate between pKOA (TNF-α, IL-1β, IL-6 and NOx) and sKOA (TNF-α, IL-1β and IL-6). These findings may assist in developing distinct therapeutic agents for the two types of KOA.

The prevalence of femoroacetabular impingement in asymptomatic hips in Indian population: a radiomorphometric analysis

<p class="abstract"><strong>Background:</strong> Femoroacetabular impingement (FAI) is a common cause of secondary osteoarthritis of the hip. There are no much studies about the occurrence of FAI in asymptomatic individuals in Indian population. Our objective was to find out the radiological prevalence of FAI in asymptomatic adult Indian population.</p><p class="abstract"><strong>Methods: </strong>A cross sectional study was carried out in our institution, which is a tertiary care centre, between September 2016 and September 2018 in which in which we studied radiographs of 1600 hips from 800 pelvic x-rays of asymptomatic patients.</p><p class="abstract"><strong>Results: </strong>Out of 1600 radiographs of the hips studied 1353 were found to be normal and the remaining 247(15.4%), had features of FAI. 61 hip radiographs (3.8%) showed cam lesions and 9.2 % showed pincer type of lesion.38 hips (2.4%) showed mixed type of FAI.</p><p class="abstract"><strong>Conclusions:</strong> Significant number of radiographs of asymptomatic patients showed features of FAI. Further long-term studies are needed to see the proportion of these patients with FAI progressing to secondary osteoarthritis of hip.</p>