Arthritis, Gouty ; Foot ; Humans ; Tendons/surgery*

Humans ; Endocarditis, Bacterial/surgery* ; Arthritis/etiology* ; Endocarditis/surgery*

Septic arthritis requires an early diagnosis and proper treatment to prevent the destruction of articular cartilage and joint contracture. This paper presents a rare case of septic arthritis of the acromioclavicular joint that was treated with arthroscopic debridement and resection of the distal clavicle.
Acromioclavicular Joint/radiography/*surgery ; Arthritis, Infectious/radiography/*surgery ; *Arthroscopy ; Clavicle/surgery ; Humans ; Male ; Middle Aged

OBJECTIVE: To establish the finite element model of varus-type ankle arthritis and to implement the finite element mechanical analysis of different correction models for tibial anterior surface angle (TAS) in supramalleolar osteotomy. METHODS: A female patient with left varus-type ankle arthritis (Takakura stage Ⅱ, TAS 78°) was taken as the study object. Based on the CT data, the three-dimensional model of varus-type ankle arthritis (TAS 78°) and different TAS correction models [normal (TAS 89°), 5° valgus (TAS 94°), and 10° valgus (TAS 99°)] were created by software Mimics 21.0, Geomagic Wrap 2021, Solidworks 2017, and Workbench 17.0. The 290 N vertical downward force was applied to the upper surface of the tibia and 60 N vertical downward force to the upper surface of the fibula. Von Mises stress distribution and stress peak were calculated. RESULTS: The finite element model of normal TAS was basically consistent with biomechanics of the foot. According to biomechanical analysis, the maximum stress of the varus model appeared in the medial tibiotalar joint surface and the medial part of the top tibiotalar joint surface. The stress distribution of talofibular joint surface and the lateral part of the top tibiotalar joint surface were uniform. In the normal model, the stress distributions of the talofibular joint surface and the tibiotalar joint surface were uniform, and no obvious stress concentration was observed. The maximum stress in the 5° valgus model appeared at the posterior part of the talofibular joint surface and the lateral part of the top tibiotalar joint surface. The stress distribution of medial tibiotalar joint surface was uniform. The maximum stress of the 10° valgus model appeared at the posterior part of the talofibular joint surface and the lateral part of the top tibiotalar joint surface. The stress on the medial tibiotalar joint surface increased. CONCLUSION With the increase of valgus, the stress of ankle joint gradually shift outwards, and the stress concentration tends to appear. There was no obvious obstruction of fibula with 10° TAS correction. However, when TAS correction exceeds 10° and continues to increase, the obstruction effect of fibula becomes increasingly significant.
Humans ; Female ; Tibia/surgery* ; Finite Element Analysis ; Ankle ; Arthritis ; Fibula/surgery* ; Ankle Joint/surgery*

Ankle arthritis affects approximately 1% of the adult population worldwide and represents a serious global disease burden. However, compared with hip arthritis and knee arthritis, the clinical understanding and treatment of ankle arthritis are still in their infancy. For end-stage ankle arthritis, ankle arthrodesis was considered as the "gold standard" in the past. However, ankle arthrodesis will result in loss of joint mobility, altered gait, limited daily activities, and accelerated degeneration of adjacent joints. Therefore, how to preserve the range of motion of the ankle joint while relieving pain is the key to the treatment of ankle arthritis. Currently, the surgical treatment of ankle arthritis includes arthroscopic debridement, periarticular osteotomies, osteochondral transplantation, ankle distraction arthroplasty, ankle arthrodesis, and total ankle arthroplasty. The choice of treatment should be individualized and based on various factors such as the patient's symptoms, signs, imaging performance, complaints, and financial situation. However, there are no guidelines that give clear treatment recommendations. Therefore, it is necessary to conduct extensive and in-depth discussions on the diagnosis and treatment of ankle arthritis.
Adult ; Humans ; Ankle/surgery* ; Arthritis/surgery* ; Arthroplasty, Replacement, Ankle ; Ankle Joint/surgery* ; Physical Therapy Modalities ; Arthrodesis/methods* ; Treatment Outcome

Humans ; Ankle ; Ankle Joint/surgery* ; Arthritis ; Arthrodesis ; Lower Extremity ; Hemophilia A/complications*

Arthritis ; surgery ; Arthroplasty ; methods ; Arthroplasty, Replacement, Hip ; Female ; Humans ; Middle Aged

BACKGROUND: Management of the patella during total knee arthroplasty (TKA) is controversial. Multiple studies have examined mechanical and clinical results of TKA with native and resurfaced patellae with no clear consensus. METHODS: We surveyed a large cohort of consultant surgeons in a questionnaire based study in order to assess the indications for patella resurfacing and to correlate practice with degree of specialization, experience and volume of procedures performed. RESULTS: Six hundred and nineteen surgeons were included. The main indication for patella resurfacing was patellofemoral arthritis. The ratio of those who always:sometimes:never resurfaced was 1:2:1 irrespective of experience or volume performed. There was no difference between knee specialists and non-specialists (p = 0.977) or between high and lower volume surgeons (p = 0.826). Senior and high volume surgeons tended to always resurface. CONCLUSIONS: The majority of surgeons only sometimes resurfaced the patella. The number who always and never resurfaced were similar. There was a tendency for more experienced and high volume surgeons to always resurface.
Arthritis/*surgery ; Arthroplasty, Replacement, Knee/*methods/statistics & numerical data ; Cohort Studies ; Great Britain/epidemiology ; Humans ; Knee Joint/*surgery ; Orthopedics/*statistics & numerical data ; Patella/*surgery ; Patellofemoral Joint/surgery ; Questionnaires

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

OBJECTIVETo study the efficacy of total knee anhmplasty (TKA) for the treatment of hemophilic knee arthropathy, and to explore the operative characteristics, the selection of prothesis, the effectiveness and safety of clotting factor replacement treatment.

METHODSFrom January 2008 to June 2010, 10 patients (12 knees)with hemophilic anhropathv underwent TKA. The average age was 33.6 years old (ranged, 17 to 49 years). There was 8 cases of type A hemophilia and 2 cases of type B hemophilia. According to Arnold and Hilgartner classification: 7 knees were IV degree and 5 knees were V degree. The level of VIII factor for replacement treatment was more than 80% on operation day, more than 60% within 3 days after operation, more than 40% from the third day to the second week after operation. Added prothrombin complex concentrate (PCC) to improve the level of IX factor, and the level of IX factor for replacement treatment was more than 40% on operation day, more than 30% within 3 days after operation, more than 20% from the third day to the second week after operation. Functional training was mainly based on continuous passive motion (CPM) device after surgery. Clinical assessment included hospital for special surgery knee score (HSS) and the individual scores (including pain, function, activity, muscle strength, flexion deformity and stability).

RESULTSTen patients (12 knees) were followed-up, and the average duration was 11 months (ranged, 6 to 24 months). The average preoperative HSS score was (44.9 +/- 12.5) (ranged, 29 to 62 scores), whereas the average postoperative HSS score was (84.4 +/- 10.2) (ranged 72 to 96 scores) (P < 0.01). The preoperative individual score including pain, function, activity, muscle strength flexion deformity and stability were significantly improved compared with pre-operation, the differences between them were statistically significant (P < 0.01 ). TKA had the distinct role in relieving pain from preoperative (8.5 +/- 4.1) to postoperative (24.5 +/- 4.4).

CONCLUSIONUnder the strict perioperative coagulation factor replacement therapy, TKA is a safe and an effective treatment for hemophmc anhmpathy of knee joint, whicht can effectively relieve pain and improve joint function.

Adolescent ; Adult ; Arthritis ; surgery ; Arthroplasty, Replacement, Knee ; methods ; Female ; Hemarthrosis ; surgery ; Hemophilia A ; complications ; drug therapy ; Humans ; Male ; Middle Aged