Accuracy of direct magnetic resonance arthrography in the diagnosis of triangular fibrocartilage complex tears of the wrist

The aim of this study was to assess the value of direct magnetic resonance (MR) arthrography of the wrist for detecting full-thickness tears of the triangular fibrocartilage complex (TFCC). Twenty-four consecutive patients who had ulnar-sided wrist pain and clinical suspicion of TFCC tear were included in the study. All patients underwent direct MR arthrography and then wrist arthroscopy, and the results of MR arthrography were compared with the arthroscopic findings. The positive predictive value of MR arthrography in detecting TFCC full-thickness tear was 0.95, and the negative predictive value was 0.50. The sensitivity of MR arthrography in detecting a TFCC full-thickness tear was 74% (15/19), and specificity was 80% (4/5). The overall accuracy of MR arthrography in detecting a full-thickness tear of the TFCC in our study was 79% (19/24). We believe that diagnosis of tears in the TFCC by direct MR arthrography is not entirely satisfactory, although MR arthrography has a high positive predictive value for detecting TFCC tears. Negative results of MR arthrography in patients with clinical suspicion of TFCC tear should be interpreted with caution

Effect of intra-articular steroids on deep infections following total knee arthroplasty

Intra-articular steroids have been commonly used for the treatment of arthritis. The aim of our study was to discover any relation between deep infections following total knee arthroplasty and intra-articular steroid use before the arthroplasty. We undertook a retrospective matched cohort study. In the study group there were 32 patients with confirmed deep infection following total knee replacement. The control group consisted of 32 patients with no evidence of infection in the knee. There was no significant difference between the numbers of patients who received intra-articular steroid injection between the groups (P=1). We believe that infection following total knee replacement is due to multiple factors and that the use of intra-articular steroids does not alter the incidence of deep infections following total knee arthroplasty

Ethnic differences in preoperative function of patients undergoing total knee arthroplasty

The prevalence of osteoarthritis is high in all ethnic and demographic groups. The timing of surgery is important because poor preoperative functional status is related to poor postoperative function. The aim of our study was to compare the preoperative knee function in patients of Asian origin with that of Caucasians living in the same community. We carried out a prospective study of 63 consecutive Asian patients and 63 age- and gender-matched Caucasian patients undergoing total knee arthroplasty. Preoperative Knee Society Clinical Rating System scores were recorded as a separate knee score and knee function score. The mean preoperative knee score in Asian patients was 37.6 compared with 41.5 in Caucasians (p<0.12); this difference was not statistically significant. The mean preoperative knee function score in Asian patients was 32.5 compared with 45.0 in Caucasians (p<0.00015); this difference was highly statistically significant. We conclude that patients of Asian origin undergoing total knee arthroplasty have lower preoperative knee function than Caucasians do. Cultural beliefs and social support partially explain this discrepancy, but health care providers must attempt to educate patients and close family members about the importance of timing the surgery to obtain the optimum benefits of pain relief and function