Radiographic wear assessment in a total knee prosthesis. 5- to 9-year follow-up study of 158 knees

One hundred fifty-eight Porous-Coated Anatomic (Howmedica, Rutherford, NJ) primary total knee prostheses were evaluated clinically and radiographically to measure the remaining thickness of the plastic insert. Anteroposterior radiographs were taken with the beam guided parallel to the tibial plate by a fluoroscope. The knees were forced into varus and valgus, and the heights of the medial and lateral joint spaces, respectively, were measured with a digitizing table. Plastic insert wear could be calculated after correction with a magnification error factor, established by dividing the projected width of the tibial plate by the true size of the used component. After a mean follow-up period of 84 months (range, 58-116 months), wear was significantly higher for patients with osteoarthritis than rheumatoid arthritis and was 1.4 mm versus 0.7 mm medially (P < .0001) and 0.7 mm versus 0.4 mm laterally (P = .01). Wear was not correlated to thickness of the plastic insert or length of follow-up period. Young age or varus alignment contributed slightly to the amount of wear

Lavage Questionable in Treatment of Painful Reduced Mouth Opening (Stockholm)

Objective: To compare treatment with local anaesthetics and local anaesthetics in combination with lavage in patients with temporomandibular joint (TMJ) pain and reduced mouth opening in a randomized controlled trial. Material and methods: Forty-one women and four men (mean age of 35 years) participated. All patients had had TMJ pain for more than 3 months, had reduced mouth opening capacity, and had non-reducing disc displacement confirmed by magnetic resonance imaging. The patients were randomized to treatment with extra-articular local anaesthetic alone (control) or with extra-articular local anaesthetic in combination with lavage (treatment). All patients were examined at baseline and at 1 and 3 months by an examiner blind to treatment. Successful treatment was determined as 30% or more pain reduction on a 100-mm analog scale (VAS). Results: At baseline, mean pain intensity (VAS) of the TMJ during mandibular movements was rated 58 among the controls and 61 in the treatment group. At the 3 months follow-up, treatment was considered successful in 76% of the controls and 50% of the treatment group. Mouth opening capacity was 34 mm and 33 mm at baseline and 43mm and 38 mm after 3 months among the controls and in the treatment group, respectively. These differences between groups in pain intensity (VAS), successful treatment outcome (≥ 30%), and mouth opening capacity (mm) were non-significant between groups. Conclusion: Use of lavage to supplement extra-articular local anesthetic treatment of painful reduced mouth opening at non-reducing dics does not appear to improve treatment outcome. only

Lavage question in treatment of painful reduced mouth opening capacity

OBJECTIVES: To compare treatment with local anaesthetics and local anaesthetics and lavage in patients with temporomandibular joint (TMJ) pain and reduced mouth opening in a randomized controlled trial. METHODS: Forty-one women and four men (mean age 35 years) participated. All patients had had TMJ pain för more than 3 months, had reduced mouth opening capacity, and had non-reducin disc displacement confirmed by magnetic resonance imaging. The patient were randomized to treatment with extra-articular local anaesthetics alone (control) or with extra-articular local anaesthetics and lavage (treatment). All patients were examined at basline and at 1 and 3 months by an examiner blind to treatment. Successful treatment was determined as 30% or more pain reduction on a 100-mm visual analog scale (VAS). RESULTS: At baseline, mean pain intensity (VAS) on movement of the TMJ was 58 among the controls and 61 in the treatment group. At the 3-month folow-up, treatment was considered succesful in 76% of the controls and 50% of the treatment group. Mouth opening capacity without assistance was 34 mm and 33 mm at baseline and 43 mm and 38 mm after 3 months among the controls and in the treatment group, respectively. These differences between groups in median pain intesity, successful treatment outcome, and mouth opening capacity with assistance were nonsignificant. CONLUSIONS: Use of lavage to supplement extra-articular local anaesthetic treatment of painful reduced mouth opening at non-reducing discs does not appear to improve treatment outcome

Can MRI Observations Predict Treatment Outcome of Lavage in Patients with Painful TMJ Disc Displacement without Reduction?

OBJECTIVES: The purpose of this study was to examine magnetic resonance imaging findings in patients with painful disc displacement without reduction of the temporomandibular joint to determine whether the findings were able to predict treatment outcome of lavage and a control group treated with local anaesthesia without lavage in a short-term: 3-month perspective. MATERIAL AND METHODS: Bilateral magnetic resonance images were taken of 37 patients with the clinical diagnosis of painful disc displacement without reduction. Twenty-three patients received unilateral extra-articular local anaesthetics and 14 unilateral lavage and extra-articular local anaesthetics. The primary treatment outcome defining success was reduction in pain intensity of at least 30% during jaw movement at the 3-month follow-up. RESULTS: Bilateral disc displacement was found in 30 patients. In 31 patients the disc on the treated side was deformed, and bilaterally in 19 patients. Osteoarthritis was observed in 28 patients, and 13 patients had bilateral changes. Thirty patients responded to treatment and 7 did not, with no difference between the two treated groups. In neither the treated nor the contralateral temporomandibular joint did treatment outcome depend on disc diagnosis, disc shape, joint effusion, or osseous diagnoses. Magnetic resonance imaging findings of disc position, disc shape, joint effusion or osseous diagnosis on the treated or contralateral side did not give information of treatment outcome. CONCLUSIONS: Magnetic resonance imaging findings could not predict treatment outcome in patients treated with either local anaesthetics or local anaesthetics and lavage