Influence of Antisynthetase Antibodies Specificities on Antisynthetase Syndrome Clinical Spectrum TimeCourse

Introduction: Increased cardiovascular (CV) morbidity and mortality is observed in inflammatory joint diseases (IJDs) such as rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis. However, the management of CV disease in these conditions is far from being well established.Areas covered: This review summarizes the main epidemiologic, pathophysiological, and clinical risk factors of CV disease associated with IJDs. Less common aspects on early diagnosis and risk stratification of the CV disease in these conditions are also discussed. In Europe, the most commonly used risk algorithm in patients with IJDs is the modified SCORE index based on the revised recommendations proposed by the EULAR task force in 2017.Expert opinion: Early identification of IJD patients at high risk of CV disease is essential. It should include the use of complementary noninvasive imaging techniques. A multidisciplinary approach aimed to improve heart-healthy habits, including strict control of classic CV risk factors is crucial. Adequate management of the underlying IJD is also of main importance since the reduction of disease activity decreases the risk of CV events. Non-steroidal anti-inflammatory drugs may have a lesser harmful effect in IJD than in the general population, due to their anti-inflammatory effects along with other potential beneficial effects.This research was partially funded by FOREUM—Foundation for Research in Rheumatolog

Bi-unicompartmental versus total knee arthroplasty: long term results

Objectives. The hypothesis of the current study is that Bi-Unicompartmental knee arthroplasty (Bi-Uni) could have long term outcomes equivalent to totl knee arthroplasty (TKA).Methods. A total of 19 patients treated from January 1999 to March 2003 with the simultaneous implantation of 2 Unicompartmental knee arthroplasties (UKA) were matched with 18 patients who had undergone a computer-assisted TKA for bicompartmental tibio-femoral osteoarthritis of the knee between August 1999 and September 2002.Results. At the last follow-up no statistical significant differences were seen for KSS, Function score and WOMAC Arthritis Index (pain score), while statistical differences were reported for the function (p<0.05) and stiffness (p<0.01) WOMAC indexes, respectively, in favor of the Bi-Uni group.Conclusion. The results of this study indicate that Bi-Uni is a valid alternative to address medial and lateral tibio-femoral osteoarthritis of the knee in selected cases at least as well as TKA

Patient-specific modeling of the trochlear morphologic anomalies by means of hyperbolic paraboloids

Diagnostic and therapeutic purposes are issuing pressing demands to improve the evaluation of the dysplasia condition of the femoral trochlea. The traditional clinical assessment of the dysplasia, based on Dejour classification, recognized 4 increasing (A, B, C, D) levels of severity. It has been extensively questioned in the literature that this classification methodology can be defective suggesting that quantitative measures can ensure more reliable criteria for the dysplasia severity assessment. This study reports on a novel technique to model the trochlear surface (TS), digitally reconstructed by 3D volumetric imaging, using three hyperbolic paraboloids (HP), one to describe the global trochlear aspect, two to represent the local aspects of the medial and lateral compartments, respectively. Results on a cohort of 43 patients, affected by aspecific anterior knee pain, demonstrate the consistency of the estimated model parameters with the morphologic aspect of the TS. The obtained small fitting error (on average lower than 0.80 mm) demonstrated that the ventral aspect of the trochlear morphology can be modeled with high accuracy by HPs. We also showed that HP modeling provides a continuous representation of morphologic variations in shape parameter space while we found that similar morphologic anomalies of the trochlear aspect are actually attributed to different severity grades in the Dejour classification. This finding is in agreement with recent works in the literature reporting that morphometric parameters can only optimistically be used to discriminate between the Grade A and the remaining three grades. In conclusion, we can assert that the proposed methodology is a further step toward modeling of anatomical surfaces that can be used to quantify deviations to normality on a patient-specific basis

Navigated "small implants" in knee reconstruction

Purpose: At the beginning of this century, unprecedented interest in the concept of using less invasive approaches for the treatment of knee degenerative diseases was ignited. Initial interest in this approach was about navigated and non-navigated knee reconstruction using small implants and conventional total knee arthroplasty. Methods: To this end, a review of the published literature relating to less invasive compartmental arthroplasty of the knee using computer-based alignment techniques and on soft tissue-dedicated small implants is presented. The authors present and compare their personal results using these techniques with those reported in the current literature. These involved the use of a shorter incision and an emphasis sparing. However, nowadays most surgeons look at compartmental knee resurfacing with the use of small implants as the new customized approach for younger and higher-demand patients. The aim of this paper is to stimulate further debate. Results: Since the beginning of 2000, computer-assisted surgery has been applied to total knee arthroplasty (TKA) and later to compartmental knee arthroplasty. Recent studies in the literature have reported better implant survivorship for younger patients using navigation in TKA at longer-term follow-up. Only one published report was identified showing superior clinical outcomes at short-term follow-up using computer-assisted technology compared with conventional alignment techniques in small implant surgery. No studies were found in the literature that demonstrated similar clinical advantages with navigated small implants at long-term follow-up. Two published meta-analyses were identified reporting better implant and limb alignment and no increase in complications using a navigated unicompartmental knee arthroplasty. However, neither meta-analysis showed superior clinical outcomes or survivorship with the navigated techniques. Conclusion: In conclusion, we can assert that replacing just the damaged compartment and preserving the normal biomechanics will require not only new implant designs but also new technologies allowing the surgeon to make extremely precise adjustments to implant alignment and providing continuous feedback during surgery. Level of evidence: IV. © 2016, European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA)

Spontaneous patella fracture associated with anterior tibial tubercle pseudarthrosis in a revised knee replacement following knee Arthrodesis

BACKGROUND: Conversion of a knee arthrodesis to a Total Knee Arthroplasty is an uncommon procedure. Revision Total Knee Arthroplasty in this setting presents the surgeon with a number of challenges including the management of the extensor mechanism and patella. CASE PRESENTATION: We describe a unique case of a 69 years old Caucasian man who underwent a revision Total Knee Arthroplasty using a tibial tubercle osteotomy after a previous conversion of a knee arthrodesis without patella resurfacing. Unfortunately 9 months following surgery a tibial tubercle pseudarthrosis and spontaneous patella fracture occurred. Both were managed with open reduction and internal fixation. At 30 months follow-up the tibial tubercle osteotomy had completely consolidated while the patella fracture was still evident but with no signs of further displacement. The patient was completely satisfied with the outcome and had a painless range of knee flexion between 0-95°. CONCLUSIONS: We believe that patients undergoing this type of surgery require careful counseling regarding the risk of complications both during and after surgery despite strong evidence supporting improved functional outcomes

Towards automatic computer-aided planning in arthroplasty surgery by innovative methods for processing the bone surface models

none5nonePietro Cerveri; Mario Marchente; Norberto Confalonieri; Alfonso Manzotti; Guido BaroniCerveri, Pietro; Marchente, Mario; Norberto, Confalonieri; Alfonso, Manzotti; Baroni, Guid

Patellofemoral joint replacement, an evolving concept

Isolated patellofemoral arthritis is a rare disease, whose management is challenging and controversial. Patellofemoral joint replacement can be an effective treatment for this condition. The very concept of a patellofemoral implant has evolved throughout the years, resulting in more anatomic designs and reproducible surgical techniques. The clinical outcomes of this procedure are strictly related to surgical indications, implant design and appropriate surgical technique