BACKGROUNDSevere valgus deformity often has bone defect and laxity of the medial ligamentous, and total knee arthroplasty in severe valgus knee is, in most cases, more challenging for surgeons. The usefulness of a computer assisted navigation system in reestablishing the mechanical axis has been well established. Hence, the interest for surgeons is how the navigation system makes the procedure of total knee arthroplasty with severe valgus knee easier.

METHODSFrom June 2006 to March 2008 in Department of Joint Surgery, Shanghai Sixth People's Hospital, 6 patients (7 knees) with severe valgus knee underwent total knee arthroplasty using the Stryker Navigation system, which is an active wireless and imageless system. All the patients were followed up for 12 to 18 months after surgery. The X-ray radiographs for whole limbs were obtained on all patients to determine preoperative and postoperative alignments.

RESULTSA primary, posterior stabilized prosthesis was utilized in all cases. The average preoperative overall mechanical axis of the seven knees was 19.6° ± 4.6° of valgus (range 16° to 29°), and the average postoperative mechanical axis was 0.4° ± 0.7° (range 0.8° varus to 1.4° valgus).

CONCLUSIONSThe navigation system is a very effective and useful tool for accurate intraoperative restoration of alignment in the face of significant deformity with valgus knee. To prevent component malposition, we did not reduce the knee before solidification of bone cement but controlled alignment using the navigation system up to implantation of the final component.

Aged ; Arthritis, Rheumatoid ; surgery ; Arthroplasty, Replacement, Knee ; methods ; Female ; Humans ; Knee Joint ; surgery ; Male ; Middle Aged ; Osteoarthritis ; surgery ; Surgery, Computer-Assisted ; methods

Recently, the incidence of pulmonary cryptococcosis is gradually increasing in rheumatoid arthritis (RA) patients. Pulmonary rheumatoid nodules (PRN) are rare manifestations of RA. Eighteen months ago, a 65-year old woman was admitted to hospital due to multiple nodules (2.5x2.1x2 cm) with cavitations in the right lower lobe. She was diagnosed with RA three year ago. She had been taking methotrexate, leflunomide, and triamcinolone. A video-assisted thoracoscopic surgery biopsy was performed and PRN was diagnosed. However, a newly growing huge opacity with cavitation was detected in the same site. Pulmonary cryptococcal infection was diagnosed through a transthoracic computed tomograpy guided needle biopsy. Cryptococcus antigen was detected in serum but not in cerebrospinal fluid. The patient was treated with oral fluconazole which resulted clinical improvement and regression of the nodule on a series of radiography. Herein, we report the case of pulmonary cryptococcosis occurring in the same location as that of the PRN.
Arthritis, Rheumatoid* ; Biopsy ; Biopsy, Needle ; Cerebrospinal Fluid ; Cryptococcosis* ; Cryptococcus ; Female ; Fluconazole ; Humans ; Incidence ; Methotrexate ; Radiography ; Rheumatoid Nodule* ; Thoracic Surgery, Video-Assisted ; Triamcinolone

Human adjuvant disease means the autoimmune disease or autoimmune disease like syndrome developed after plastic surgery using foreign body implantation. After first report of HAD by Miyoshi at 1964, a number of cases have been reported especially from Japan. Silicone has been known as biologically inert material, but a couple of side reaction and experimental data argue against such conventional idea. It is impossible to identify the exact role of implanted substance in the occurrence of autoimmune disease, but there are a few indirect evidences for adjuvant effect of silicone. The spectrum of HAD are as follows: unclassifiable connective disease like syndrome, rheumatoid arthritis, SLE, polymyositis, adult Still's disease, ITP, Hashimoto's thyroiditis, etc. We experienced two cases of HAD manifesting as SLE who had been injected with silicone fluid with for augmentation mammoplasty and report this with a review of the literature.
Adult ; Arthritis, Rheumatoid ; Autoimmune Diseases ; Female ; Foreign Bodies ; Humans* ; Japan ; Mammaplasty ; Polymyositis ; Silicones ; Surgery, Plastic ; Thyroid Gland ; Thyroiditis

Humans ; Arthroplasty, Replacement, Knee/adverse effects* ; Arthritis, Rheumatoid/surgery* ; Risk Factors ; Patients ; Arthroplasty, Replacement, Hip/adverse effects*

OBJECTIVE: Metatarsophalangeal joint is an important joint for daily weight-bearing walking. Osteoarthritis, osteochondrosis of the metatarsal head, rheumatoid arthritis can often cause the destruction of 2-5 metatarsophalangeal joint, leading to pain, limited joint movement and toe deformities, severely affecting the forefoot function. The purpose of this study is to report the results of middle-long term follow-up after performing Swanson double-stem silicon implant arthroplasty in patients with diseases of 2-5 metatarsophalangeal joint. METHODS: From January 2010 to October 2015, 21 patients with 2-5 metatarsophalangeal joint replacement were performed with Swanson double-stem silicone prosthesis. In the study, 16 cases were successfully followed up, 2 men and 14 women with an average age (66.7±5.5) years. There were 9 cases diagnosed with rheumatoid arthritis, 5 cases with severe osteoarthritis and 2 cases with osteochondrosis of the metatarsal head. The American Association of foot and ankle surgery Maryland foot scoring system and visual analogue score (VAS) were used to evaluate the walking function, metatarsophalangeal joint mobility and pain degree before and after surgery. RESULTS: The follow-up time ranged from 17 months to 5 years, with an average of 3.2 years. According to Maryland foot scoring system of the American Association of foot and ankle surgery, the preoperative score was (60.69±6.12) points and postoperative score was (88.13±5.84) points. Range of motion of metatarsophalangeal joint: preoperative: back extension 5.4°±3.1°, plantar flexion 4.4°±2.7°; postoperative: back extension 15.7°±4.5°, plantar flexion 12.2°±4.3°, the motion of 2-5 metatarsophalangeal joint after operation was significantly improved compared with that before operation (P < 0.01). The preoperative VAS was (6.8±0.9) points and the last follow-up was (2.3±0.8) points, the pain symptom of metatarsophalangeal joint was improved obviously after operation. The postoperative score was significantly higher than the preoperative score according to Maryland foot scoring system (P < 0.01), the excellent rate was 81.3%. CONCLUSIONS With the advantages of alleviating pain, preserving the length and alignment of metatarsophalangeal joint, improving the function of walking, and correcting the deformity, Swanson double-stem silicon implant arthroplasty is a reproducible and safe option for the reconstruction of the 2-5 metatarsophalangeal joint. However, there is still some probability of adverse reactions and still room for improvement.
Aged ; Arthritis, Rheumatoid ; Arthroplasty ; Female ; Follow-Up Studies ; Humans ; Joint Prosthesis ; Male ; Metatarsophalangeal Joint/surgery* ; Middle Aged ; Treatment Outcome

Baker's cysts are rare cause of peripheral nerve entrapment and only a few cases of tibial nerve entrapment resulting from the popliteal cyst in the calf muscle have been reported in the literature. We present a case of rheumatoid arthritis complicated by a Baker's cyst with a tibial nerve entrapment. It is important to diagnose a Baker's cyst early and to differentiate it from thrombophlebitis, a popliteal aneurysm, tumor or muscle tear to effect optimal therapy and to obviate a potential neuropathy. Prompt recognition of these cases may save the patients unnecessary procedures and delay in treatment.
Arthritis, Rheumatoid/diagnosis ; Arthritis, Rheumatoid/complications ; Biopsy, Needle ; Case Report ; Electromyography ; Female ; Follow-Up Studies ; Human ; Magnetic Resonance Imaging ; Middle Age ; Popliteal Cyst/surgery ; Popliteal Cyst/diagnosis ; Popliteal Cyst/complications+ACo- ; Tibial Neuropathy/etiology+ACo- ; Tibial Neuropathy/diagnosis ; Treatment Outcome

OBJECTIVETo introduce the procedure of the 1st ray stabilization combined with resection of the lesser metatarsal heads for patient with severe forefoot deformity caused by rheumatoid arthritis (RA) and evaluate the short to mid-term clinical results.

METHODSFrom Oct. 2006 to Aug. 2010,97 patients (129 feet) aged from 36 to 67 years (average 54), with forefoot deformity caused by rheumatoid arthritis were reviwed. There were 88 males and 9 females,65 single lateral involved and 32 bilateral involved, the average duration of disease was 17 years (6 to 32 years). The 1st ray instability and lesser metatarsophalangeal (MTP) joint stiff dislocation were found in all cases. The first ray stabilization combined with resection of the lesser metatarsal head procedure were performed for all cases. The radiographic Hallux valgus angle (HVA) and intermetatarsal angle (IMA) were measurde and the JSSF (Japanese Society for Surgery of the Foot) score were evaluated before operation and every follow up.

RESULTSThe average followed-up was 37 months (6 to 52 months) for all patients except 5 (7 feet) and 1 died for acute cardiac infarction 1 year after operation. The average JSSF score improved from (33.2 +/- 8.2) points preoperative to (67.3 +/- 3.1) points at final followed-up (P < 0.01); the average HVA was corrected from (50.0 +/- 11.8) degrees preoperative to (21.2 +/- 3.2) degrees at final follow up (P < 0.01); the average IMA was corrected from (15.5 +/- 3.6) degrees preoperative to (9.7 +/- 6.6) degrees at final follow up (P < 0.01). MTP joint nonunion was found in 4 feet. A radiographic high density mass was found in the 1st cuneiform bone during 8 to 11 months followed-up in 3 feet; delayed wound healing was happened in 9 feet; MTP joint infection was happened in 2 feet; tarsometatarsal joint infection was happened in 1 foot; lesser MTP joints deformity recurrence were found in 16 feet.

CONCLUSIONThe characters of forefoot with RA in later stage are the 1st ray deformity and instability compound with the lesser toes deformity. The 1st ray stability procedure which include the 1st MTP arthrodesis and the Lapidus procedure can correct the 1st ray deformities and rebuilt its stability. The lesser toes metatarsal head resection is effective in correct their deformity. This combined procedure is reliable. It is suitable for patients with severe Hallux valgus, increased IMA, tarsometatarsal joint instability and the lesser MTP joint stiff dislocation.

Adult ; Aged ; Arthritis, Rheumatoid ; complications ; surgery ; Female ; Foot Deformities, Acquired ; surgery ; Forefoot, Human ; abnormalities ; surgery ; Hallux Valgus ; surgery ; Humans ; Joint Instability ; surgery ; Male ; Metatarsal Bones ; surgery ; Metatarsophalangeal Joint ; surgery ; Middle Aged

OBJECTIVETo continuously observe the long-term effects of synovectomy for improving joint damage and quality-of-life in patients with the rheumatoid knee.

METHODSTwenty-one consecutive patients with rheumatoid arthritis (RA) involving 24 knees underwent open synovectomy from November 1988 to January 1997 between November 1988 and January 1997. The changes in radiographic damage were assessed with Larsen score on plain films before and 6 months after surgery with subsequent annual assessment for 8 years, and the functional recovery of the patients was also evaluated with Health Assessment Questionnaire (HAQ) at the same time.

RESULTSThe radiographic joint damage and juxta-articular osteoporosis or bone erosion was ameliorated after surgery in all the patients. Larsen score began to decrease 6 months after the operation, and the best effects were achieved at one year and maintained for at least 5 years after the operation, but then followed by recurrence of joint lesions. HAQ scores were improved after the surgery with the best effects observed 6 months after the operation lasting for over 2 years. HAQ score gradually decreased 4 years after the operation till reaching the preoperative scores.

CONCLUSIONSynovectomy in the patients with rheumatoid knee not only reverses progressive joint damage, but also improves juxta-articular bone erosions and the patients' quality of life. However, radiographic joint damage and functional deterioration may recur due to hyperplasia of the inflammatory synovium in the long term after operation, suggesting that the inflammatory synovium participates in local joint damage with bone erosions and systemic pathologic process of RA.

Adult ; Arthritis, Rheumatoid ; diagnostic imaging ; surgery ; Female ; Follow-Up Studies ; Humans ; Knee Joint ; diagnostic imaging ; surgery ; Male ; Middle Aged ; Radiography ; Synovectomy ; Time Factors

OBJECTIVETo investigate the correct method of bone resection and posterior capsular soft tissue releasing in total knee arthroplasty (TKA) for the patients with rheumatoid arthritis with stiff knee in flexion.

METHODSFrom November 2009 to January 2012,15 patients with rheumatoid arthritis with stiff knee in flexion underwent primary TKA and releasing of the posterior soft tissues. There were 7 males and 8 females,aged 22 to 75 years old (58.7 years old on average). The preoperative range of movement(ROM) was (3.2 ± 1.7)°. According to Knee Society score (KSS) criterion, the preoperative clinical score was 23.3 ± 12.5 and functional score was 35.2 ± 9.8. Based on the correct osteotomy, effective releasing of posterior structures was used for different degrees of flexion contracture during the TKA procedure.

RESULTSAll the patients were followed up, and the average duration was 2.3 years (1.6 to 3 years). At the latest follow-up,the KSS clinical score was 81.7 ± 6.5 and functional score was 82.8 ± 9.3. The flexion and extension ROM of the knee joint was (103.5 ± 13.1). Three knees remained 50 flexion contracture deformity, but the function of the affect knees was good.

CONCLUSIONThe effective releasing of the soft tissue of posterior capsule is a major management for correction of the flexion contracture in TKA. The correct releasing of posterior structure can not only achieve fundamental gap of TKA but also effectively avoid bone over-resection.

Adult ; Aged ; Arthritis, Rheumatoid ; complications ; physiopathology ; surgery ; Arthrogryposis ; surgery ; Arthroplasty, Replacement, Knee ; methods ; Female ; Humans ; Joint Capsule Release ; methods ; Male ; Middle Aged ; Range of Motion, Articular

OBJECTIVETotal knee arthroplasty (TKA) has been widely used in China. More and more attentions are paid to the development of knee prosthesis that fit for the anatomy of Chinese knee. This study is to summarize the surgical techniques and clinical outcome of domestic posterior-stabilized total knee arthroplasty.

METHODSFifty-one patients including 19 males and 32 females underwent TKA by using TC-Dynamic from Jan. 2003 to Dec. 2004 were reviewed. The average age at the time of operation was (76.4 +/- 4.1) years (range, 71 to 84 years). Thirty-seven patients suffered from osteoarthritis and 14 patients were rheumatism arthritis. The courses of the disease ranged from 5 to 40 years and the symptoms were pain and limitation of motion. The knee rating score system (HSS) as well as X-rays of the lower extremity was used to evaluate the clinical results.

RESULTSAll patients were followed up at the 3rd month after TKA and the duration of follow-up of 32 patients ranged from 48 to 61 months. The HSS scores before TKA was (53.3 +/- 6.7) (40 to 59) points. At the 3rd month and 48th month of follow-up, the HSS scores were (86.1 +/- 7.7) (63 to 95) and (83.5 +/- 8.1) (60 to 95) points respectively. The stress X-rays showed preoperative varus deformities from 9 degrees to 30 degrees with the average of (21.0 +/- 5.8) degrees and normal alignment of the lower extremities postoperative. There were no complications related to TC-Dynamic prosthesis and other complications such as infection, prosthetic loosening and dislocation of patella.

CONCLUSIONThere is a good mid-term clinical result of TC-Dynamic knee system, which is designed according to anatomical characteristic of Chinese knee joint. More attention should be paid to this knee system about the long term follow-up.

Aged ; Aged, 80 and over ; Arthritis, Rheumatoid ; surgery ; Arthroplasty, Replacement, Knee ; methods ; Female ; Humans ; Male ; Middle Aged ; Osteoarthritis, Knee ; surgery ; Treatment Outcome