Does the presence of arthroscopically detected stage 1-2 glenohumeral osteoarthritis have any clinical impact on the outcome of arthroscopic rotator cuff repairs?

MakaleWOS:000941667500026PubMed ID: 36945963Background/aim: Rotator cuff rupture (RCR) and glenohumeral osteoarthritis (GHO) are two common disorders of the shoulder joint. However, there are very few reports that examine the relationship between them. This study aimed to present at least two years' clinical results of arthroscopic rotator cuff repair of full-thickness and massive tears accompanied by arthroscopically detected early-stage osteoarthritis.Materials and methods: From August 2016 to December 2017, three hundred and twenty patients with total or massive rotator cuff tears were evaluated retrospectively. Thirty-five patients who were determined as stage 1 and 2 according to the Outerbridge scale for cartilage lesions were found appropriate for investigation. Patients were assessed using the University of California Los Angeles (UCLA) score, and a visual analog scale (VAS) score before surgery and at the final follow-up. The American Shoulder and Elbow Surgeons (ASES) shoulder score was used to evaluate the final outcomes and compare the UCLA shoulder scores.Results: The UCLA scores increased from the preoperative value of 19.1 +/- 3.2 to 29.8 +/- 4.8 at the last follow-up and increased by an average of 10.7 +/- 6.0 (p < 0.001). The median VAS score decreased from the preoperative value of 3.0 to 1.0 (p < 0.001). Besides, the mean ASES score was found as 80.2 +/- 10.6. An excellent positive correlation was found between postoperative UCLA scores and ASES scores (r = 0.887; p < 0.001).Conclusion: To the best of our knowledge, this is one of the first arthroscopic comparative studies about the effect of early glenohumeral osteoarthritis on clinical outcomes after rotator cuff tear treatment. Finding good and excellent results up to 71% after RCR repair in patients with early-stage osteoarthritis was an indication that arthroscopic repair could be planned as the first-line treatment option for RCR pathologies in patients with early-stage degenerative arthritis without considering the rerupture rate.Department of Public Health, Gazi University Medical Facult

Effect of cartilage thickness mismatch in osteochondral grafting from knee to talus on articular contact pressures: A finite element analysis

Objectives: The aim of this study was to investigate the effect of cartilage thickness mismatch on tibiotalar articular contact pressure in osteochondral grafting from femoral condyles to medial talar dome using a finite element analysis (FEA). Materials and methods: Flush-implanted osteochondral grafting was performed on the talar centromedial aspect of the dome using osteochondral plugs with two different cartilage thicknesses. One of the plugs had an equal cartilage thickness with the recipient talar cartilage and the second plug had a thicker cartilage representing a plug harvested from the knee. The ankle joint was loaded during a single-leg stance phase of gait. Tibiotalar contact pressure, frictional stress, equivalent stress (von Mises values), and deformation were analyzed. Results: In both osteochondral grafting simulations, tibiotalar contact pressure, frictional stress, equivalent stress (von Mises values) on both tibial and talar cartilage surfaces were restored to near-normal values. Conclusion: Cartilage thickness mismatch does not significantly change the tibiotalar contact biomechanics, when the graft is inserted flush with the talar cartilage surface

Investigation of the relationship of osteoarthritis and osteoporosis radiologically and pathologicly in total knee arthroplasty patients

Amaç: Bu çalışmada popülasyonun yaşlanması ile sıklıkları giderek artmakta olan osteoartrit ve osteoporozun ilişkisi ve trabeküler kalınlığın bu hastalıkların mekanizmasındaki yerinin araştırılması amaçlanmıştır. Gereç ve Yöntem: Bu çalışma hastanemize başvuran ve primer osteoartrit tanısı konularak eklem rekonstrüksiyonu yapılan hastalarla yapılmıştır. Hastalar radyolojik görüntüleri ile Kellgren Lawrence sınıflandırmasına göre gruplandırılmıştır. Hastalara kemik mineral yoğunluğu ölçümü yapılmış ve cerrahi işlem sırasında kemik örneği alınarak osteoporoz incelemesi yapılmak üzere patoloji laboratuvarına gönderilmiştir. Kemik doku incelemesi konusunda uzman iki ayrı patolog tarafından çift kör olarak yapılmıştır. İstatistiksel analizlerde Ki-kare, Kruskal-Wallis testleri kullanılmıştır. Bulgular: Çalışmaya yaşları 50 ile 84 arasında değişen toplam 62 hasta dâhil edilmiştir. Yaş arttıkça osteoporoz seviyesinin de arttığı tespit edilmiş (p: 0,031) ve vücut kitle indeksi fazla olan hastalarda ise osteoporoz istatistiksel olarak daha az tespit edilmiştir (p: 0,033). Osteoartrit seviyesi ile trabekül kalınlığı karşılaştırıldığında ise trabekül kalınlığı ortalamanın üzerinde olan deneklerin sayısının osteoartrit seviyesi arttıkça arttığı görülmüştür (p: 0,045). Tartışma: Denekler radyolojik olarak incelendiğinde %35,3’ü osteoporotik %52,9’u ise osteopenik seviyede çıkmıştır. Osteoporozun osteoartrit hasta grubunu da es geçmediği görülmektedir. Çalışmada yapılan ölçümlerde osteartritin erken evrelerinde trabeküler kalınlığın ince olduğu tespit edilmiş ve bu sonuç bize osteoartritin tüm subkondral bölgede trabeküler mikro mimarinin 82 bozulması ile başlıyor olabileceğini düşündürmüştür. Bifosfonatların erken evre osteoartrit olgularında ağrı ve progresyonu yavaşlatması da böylece açıklanabilir.Objective: Osteoarthritis and osteoporosis prevelances are increased with the aging of population. It was aimed to investigate relation between osteoarthritis and osteoporosis also mechanism of trabecular thickening. Material and Method: This study was performed on patients who had joint reconstruction with primary osteoarthritis were included. Patients grouped according to Kellgren Lawrence classification. Bone mineral density of the patient was measured; subchondral bone sample was taken during the surgery and sent to pathology laboratory for examination. Specimen was analysed by two pathologist with double blind tecnique. Chi-square and Kruskal-Wallis tests were used as analysis method. Result: A total of 62 patients, aged between 50 and 84 years, were included in the study. It was determined that osteoporosis level increased with aging (p: 0,031) and decreased in patients with higher body mass index (p: 0.033). When osteoarthritis level and trabecular thickness were compared, it was seen that the number of subjects, above the mean of trabecular thickness, increased as the level of osteoarthritis increased (p: 0,045). Discussion: When the subjects were examined radiologically, 35.3% of the patients were osteoporotic and 52.9% of the patients were osteopenic. It is understood that osteoporosis is frequently seen in the osteoarthritis patient group. It was determined that the trabecular thickness was thin in early stages of osteoarthritis and the result showed to us that osteoarthritis may be starting with the disruption of the trabecular micro-architecture in the entire subchondral region. It can also be explained that bisphosphonates retard pain and progression in early stage osteoarthritis cases

Is Hyperbaric Oxygen Therapy Effective in Patients With Avascular Necrosis of the Femur Head?

INTRODUCTION: The aim of this study was to investigate the clinical and radiological results of exposure to high level of oxygen under high level of atmospheric pressure [Hyperbaric Oxygen (HBO) Therapy] in patients with Ficat Stage 1 and 2a avascular necrosis of the femoral head (AVNFH). METHODS: A retrospective examination was performed on the patients, who were administered HBO therapy and followed up due to Ficat Stage 1 and 2a AVNFH between February 2016 and November 2019.The Harris Hip Score forms, conventional radiography of the hip, and MRI were analyzed. The Ficat classification was used for grading of the aascular necrosis. RESULTS: A total of 25 patients with a mean age of 45.4 +- 11.4 years were evaluated. It was observed that the patients were administered an average of 30.4 +- 3.55 (range: 27-47) sessions of HBO therapy within an average of 40.6 +- 5.32 (range: 36-65) days. After the HBO therapy, it was found that the Ficat stage of 11 patients progressed, while the stages of two patients regressed, and seven patients remained stable (p: 0.002). While the mean total Harris Hip Score was 43.82 +- 18.55 before the procedure, it was found to be 78.47 +- 17.05 after the procedure. After the procedure, a statistically significant difference was observed in Harris Hip Scores, VAS and the range of motion measurements compared to the values obtained before the procedure (p&lt;0.001). DISCUSSION AND CONCLUSION: HBO can be suggested as an option to be considered by the clinicians as a supportive treatment method, especially in young patients

Multiple cervical spinous process fracture (clay shoveler fracture): Case report

Clay-Shoveler’s is fracture of one or more spinous processes to include lower cervical or upper thoracic vertebrae. In this article, it was aimed to investigate possible mechanisms of Clay-Shoveler’s fracture and share radiological results of q case of 11 years (2003) follow-up after the traffic accident. A 25-year-old male patient complained of neck pain spreading to both shoulders, andthere was an in-car traffic accident two weeks ago. Patient’s motion restriction was 50% for active flexion, lateral flexion and rotation, and 20% for active extension movement. Imaging revealed a minimal inferior displaced avulsion fracture in C6, C7 and T1 vertebra spinous processes. Patient returned to daily activities in 3rd month after immobilization with medical treatment and neck collar.Clay-Shoveler’s fracture is most commonly seen in T1, then C7, T2, T3 and C6. Surgical treatment is not planned because patient has no limitation of neck movements and neck pain which responds to medical treatment

Endoscopic treatment of bilateral hallux saltans in an ordinary woman.

In this article, we present a 47-year-old female patient applying with pain in posteromedial of ankle and trigger toe complaints. There was no predisposing factor such as dance or sports or any radiological sign such as os trigonum. Posterior ankle endoscopy technique was used for evaluation and it was observed that the FHL tendon was triggered. Fibrous thickening around the tendon was released with endoscopic instruments. After release, it was observed that the FHL tendon was not triggered with toe movements. Hallux saltans can be treated by posterior endoscopic methods with an attention to the tibial nerve such as other joint and soft tissue pathologies. To the best of our knowledge, this is the first case report of endoscopic treatment of bilateral HS in an ordinary female patient

Common musculoskeletal disorders in chronic liver disease patients

Chronic liver disease (CLD) is the commonest ailment affecting the hepatobiliary system. Six significant pathologies related to CLD include hepatic osteodystrophy (HO), increased infection susceptibility, sarcopenia, osteonecrosis of the femoral head (OFH), increased risk of periprosthetic complications and fracture. Hepatic osteodystrophy, which comprises osteopenia, osteoporosis, and osteomalacia, refers to alterations in bone mineral metabolism found in patients with CLD. The HO prevalence ranges from 13 to 95%. Low complement levels, poor opsonization capacity, portosystemic shunting, decreased albumin levels, and impaired reticuloendothelial system make the cirrhotic patients more susceptible to developing infectious diseases. Septic arthritis, osteomyelitis, prosthetic joint infection, and cellulitis were common types of CLD-associated infectious conditions. The incidence of septic arthritis is 1.5 to 2-fold higher in patients with cirrhosis. Sarcopenia, also known as muscle wasting, is one of the frequently overlooked manifestations of CLD. Sarcopenia has been shown to be independent predictor of longer mechanical ventilation, hospital stay, and 12-month mortality of post-transplantation. Alcohol and steroid abuse commonly associated with CLD are the two most important contributory factors for non-traumatic osteonecrosis. However, many studies have identified cirrhosis alone to be an independent cause of atraumatic osteonecrosis. The risk of developing OFH in cirrhosis patients increases by 2.4 folds and the need for total hip arthroplasty increases by 10 folds. Liver disease has been associated with worse outcomes and higher costs after arthroplasty. Cirrhosis is a risk factor for arthroplasty complications and is associated with a prolonged hospital stay, higher costs, readmission rates, and increased mortality after arthroplasty. Greater physician awareness of risk factors associated with musculoskeletal complications of CLD patients would yield earlier interventions, lower healthcare costs, and better overall clinical outcomes for this group of patients

A review of the efficacy of intraarticular hip injection for patients with hip osteoarthritis: to inject or not to inject in hip osteoarthritis?

Hip injection (HI) for osteoarthritis (OA) are in vogue nowadays. Corticosteroids (CSs) and hyaluronic acid (HA) gel are the two most common agents injected into the hip. Off late, platelet-rich plasma (PRP), mesenchymal stem cell (MSC), bone marrow aspirate concentrate (BMAC), local anesthetic (LA) agents, non-steroidal anti-inflammatory drugs (NSAIDs) and their different combinations have also been injected in hips to provide desired pain relief. However, there is a group of clinicians who vary of these injections. A search of the literature was performed on PubMed, Cochrane Library, and DOAJ using the keywords “hip osteoarthritis injection”. Data were analyzed and compiled. Intraarticular CSs are effective in providing the desired pain relief in OA hip, but repeated injections should be avoided and the interval between HI and hip arthroplasty must be kept for more than three months. Methylprednisolone or triamcinolone are combined with 1% lidocaine or 0.5% bupivacaine. Chondrotoxic effects of LA is a concern. Although national guidelines do not favor the use of HA for hip OA, numerous publications have favored its usage for a moderate grade of OA. The PRP, MSC, and BMAC are treatment options with great potential; however, currently, the evidence is conflicting on their role in hip OA. There is always a risk of septic arthritis, particularly when aseptic precautions are not followed, and clinicians must vary of this complication. The use of hip injection (HI) in the treatment of osteoarthritis (OA) has gained wide popularity. The relatively low cost, fast and simple method of pain relief are amongst its many advantages. Over time, the content of the injection has also evolved from local anesthetic (LA) agents to corticosteroids (CSs), hyaluronic acid (HA) and platelet-rich plasma (PRP).[1] The scope of use of injections in the hip region has grown from traditional aspiration to therapeutic injections. The two main substances used in recent times for pain relief are CSs and HA gel. For decades, low doses of CS were given to surgically unfit patients and to those who are not keen on joint replacement surgery.[2] The recent surge in the use of high-molecularweight HA for knee OA has been expanded as a treatment option for hip OA. The popularity of the administration of HA has been mounting with very little outcome data to support its use. Administration of HA injections has shown some promise in a selected subset of patients suffering from early OA of the hip.[3,4] Most papers report insufficient sample size and had a varied follow-up period which results in difficulty formulating and implementing national guidelines and clinical recommendations. Current literature advocates the safe use of CS injections for early hip OA.[5] Although there is no concrete evidence supporting HA injections, this has not dissuaded researchers from injecting PRP, mesenchymal stem cells (MSCs), LA agents, NSAIDS and many different combinations into the hip. The true extent of their benefits is still being debated.[6] In this review, we outline recent trends, discuss the role of HIs, and summarize complications of the technique