Adipose Tissue ; pathology ; Adult ; Arthroscopy ; methods ; Female ; Humans ; Joint Diseases ; diagnosis ; pathology ; surgery ; Knee Joint ; pathology ; Male ; Middle Aged

Adult ; Arthritis, Rheumatoid ; epidemiology ; pathology ; surgery ; Female ; Humans ; Joint Diseases ; diagnosis ; pathology ; Male ; Middle Aged ; Shoulder Dislocation ; epidemiology ; pathology ; surgery ; Shoulder Fractures ; epidemiology ; pathology ; surgery ; Shoulder Joint ; pathology ; surgery ; Shoulder Pain ; epidemiology ; pathology ; surgery

BACKGROUND: We analyzed the clinical and radiologic results of patients with spontaneous osteonecrosis of the knee treated by minimally invasive medial unicompartmental arthroplasty using Oxford Uni. METHODS: We reviewed 22 knees in 21 patients which were treated for spontaneous osteonecrosis between 2002 and 2006. Patients included one male and 20 females. The mean age was 70.8 years (range, 53 to 82 years). The mean follow-up period was 70.3 months (range, 48 to 93 months). The clinical results were evaluated using the Hospital for Special Surgery (HSS) knee score and the range of motion of the knee preoperatively and at the final follow-up. Preoperative plain radiographs and magnetic resonance images were analyzed to determine the size and stage of osteonecrotic lesions. RESULTS: The mean HSS knee score was 64.3 (range, 54 to 75) preoperatively and 92.0 (range, 71 to 100) at the final follow-up. The mean preoperative flexion contracture was 8.9degrees (range, 0 to 15degrees) and 0.2degrees (range, 0 to 5degrees) at the final follow-up. The mean further flexion increased from 138.6degrees (range, 100 to 145degrees) preoperatively to 145.6degrees (range, 140 to 150degrees) at the final follow-up. Active full flexion was possible within 2 months of the operation. The squatting position was possible in 16 patients (84.2%) out of 19, except one case of bronchiectasis and one case of spine fracture. The cross-leg posture was possible in 19 patients (90.5%) out of 21. The mean tibiofemoral angle was improved from varus 0.98degrees to valgus 3.22degrees. Meniscal bearing dislocation occurred in 2 cases and femoral component loosening occurred in 1 case. CONCLUSIONS: Unicompartmental knee arthroplasty using Oxford Uni could be an alternative treatment option in spontaneous osteonecrosis of the knee.
Aged ; Aged, 80 and over ; Arthroplasty, Replacement, Knee/*methods ; Female ; Humans ; Joint Diseases/pathology/*surgery ; *Knee Joint/pathology ; Male ; Middle Aged ; Osteonecrosis/*surgery ; Retrospective Studies

Adult ; Asymptomatic Diseases ; China ; Chondromatosis, Synovial ; diagnostic imaging ; pathology ; physiopathology ; surgery ; Hip Joint ; diagnostic imaging ; pathology ; physiopathology ; surgery ; Hospitals ; Humans ; Male ; Tomography, X-Ray Computed

Adult ; Arthroplasty, Replacement, Hip ; methods ; Bone Diseases, Developmental ; complications ; pathology ; physiopathology ; surgery ; Female ; Follow-Up Studies ; Hip Joint ; pathology ; surgery ; Humans ; Male ; Middle Aged ; Reconstructive Surgical Procedures ; methods

OBJECTIVETo investigate the method and result of arthroscopic trans-septal approach (ATS).

METHODSTen fresh cadaveric knees were prepared for anatomical study about the posterior septum, and 65 posterior compartment arthroscopy of the knees were performed to view the structure of the posterior septum. The initial diagnosis included: rheumatoid arthritis, pigmented villonodular synovitis, osteoarthritis, loose body or foreign body in the posterior compartment, posterior cruciate ligament (PCL) injury or avulsion fracture, posterior horn tear of meniscus, undiagnosed swollen knee with pain and effusion, osteochondritis dissecans, pyogenic arthritis, gout. From January 2002 to June 2005, 22 cases of ATS were applied. Anterolateral portal was initially created, followed by posterolateral portal under the viewing of arthroscopy which was located at the anterolateral portal. Anteromedial and posteromedial portals were also created using the same technique. Arthroscopy was then transferred to the posteromedial portal, and blade was introduced from the anteromedial portal to gradually remove the synovium covering PCL. Arthroscopy was relocated to the anteromedial portal, Wissinger rod was introduced from the posteromedial portal and pointed to the posterior septum adjacent to the posterior edge of the midportion of PCL. The Wissinger rod was pushed carefully to pierce through the posterior septum under the sight of arthroscopy which was located at the posterolateral portal. ATS was finally created.

RESULTSThe posterior septum was in the middle of posterior compartment of the knee, which was film screen-like at the sagittal plane and sandwich-like at the transverse plane. The synovium covered the posterior septum at arthroscopic inspection. Twenty-two cases of ATS were successfully created, amounting to 34% (22/65) of all cases at the same period which had received the arthroscopy of posterior compartments of the knees. Synovectomy of the posterior compartments of the knees was performed in 7 cases, loose body removal was in 6 cases, PCL reconstruction was in 4 cases, reduction and fixation of PCL avulsion fracture was in 2 cases. Chondroplasty, inflammatory synovectomy, and meniscectomy were performed accordingly in 6 osteoarthritis cases. No vascular or nervous injury was encountered. At an average of 20 months follow-up (range, 4 to 45 months), 9 cases still had mild knee pain or swelling, 2 cases had severe pain and were recommended for total knee replacement, the other 11 cases had no recurrence of knee pain or swelling.

CONCLUSIONSATS has no blind area under arthroscopic vision and facilitate trans-septal operation. It is a safe and effective method to treat the diseases of the posterior compartment of the knee. The direction of inside to outside to create ATS is comparatively reliable, and PCL could be identified as an interior landmark during the passage of Wissinger rod through posterior septum to create ATS.

Adult ; Arthroscopy ; methods ; Female ; Follow-Up Studies ; Humans ; Joint Diseases ; surgery ; Knee Injuries ; surgery ; Knee Joint ; pathology ; surgery ; Male ; Middle Aged ; Posterior Cruciate Ligament ; pathology ; Reproducibility of Results ; Treatment Outcome

BACKGROUNDThe medial plica may be caused by direct trauma or joint degeneration, which also could be iatrogenic. There have been few reports in the literature discussing incidence of the medial plica caused by an operation on the knee joint, specifically after the reconstruction of anterior cruciate ligament (ACL). In this study, we aimed to evaluate and analyze the relationship between the incidence of the medial plica and reconstruction of the ACL.

METHODSA retrospective case series study was conducted to review the findings of 1085 patients between 2003 and 2007, who underwent second-look arthroscopy after reconstruction of the ACL (between 2002 and 2006). The correlation of the incidence of medial plica with the stability of the knee joint, the time from onset of injury to reconstruction surgery, the associated injuries, and the rate of progress during postoperative rehabilitation were analyzed.

RESULTSWe found that 722 patients had the structure of a medial plica. The incidence after reconstruction of the anterior cruciate ligament (66.5%) was significantly higher than usually reported. All these medial plica had avascular fibrotic and thickened edges. An excision of pathologic medial plica and fat pad synovial fringes were done. The incidences were significantly different between the two groups with their reconstruction operation time, from onset of injury to surgery (less than one month or over 2 years), and the progress rate of postoperative rehabilitation (knee flexion could not be over 90 degrees in four weeks). The incidence was not different between the groups with knee stable conditions.

CONCLUSIONSMedial plica is more common in patients after reconstruction of ACL. More associated injuries and more rehabilitation difficulties can increase the medial plica incidence.

Adolescent ; Adult ; Anterior Cruciate Ligament ; surgery ; Female ; Humans ; Joint Diseases ; etiology ; pathology ; Knee Joint ; pathology ; surgery ; Male ; Middle Aged ; Patella ; pathology ; Reconstructive Surgical Procedures ; methods ; Retrospective Studies ; Tendon Transfer ; methods ; Treatment Outcome ; Young Adult

OBJECTIVETo investigate the clinicopathologic features of calcium pyrophosphate dihydrate crystal deposition disease (CPPD-CDD).

METHODSThe clinical and pathologic profiles were retrospectively analysed in 20 cases of CPPD-CDD.

RESULTSCPPD-CDD was far more common in women, most frequently involving joints, especially the knees and presenting with various arthrisis. Abnormally calcified and the articular damages were characteristic features by imageing. Histologically, multifocal indigo granular calcinosis was seen in synovium and sometimes appeared as needle-shaped or rhomboid crystals, which characterized the CPPD.

CONCLUSIONSThough clinical symptoms of CPPD are quite variable, the definite diagnosis can be made by the abnormal calcification and joint damage radiographically and the indigo CPPD crystals histopathologically.

Adult ; Aged ; Aged, 80 and over ; Chondrocalcinosis ; diagnostic imaging ; pathology ; surgery ; Female ; Follow-Up Studies ; Hip Joint ; diagnostic imaging ; pathology ; surgery ; Humans ; Intervertebral Disc ; diagnostic imaging ; pathology ; surgery ; Knee Joint ; diagnostic imaging ; pathology ; surgery ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Retrospective Studies ; Spinal Diseases ; diagnostic imaging ; pathology ; surgery ; Synovial Membrane ; pathology ; Tomography, X-Ray Computed

OBJECTIVETo compare the long-term outcomes of arthroscopy and non-surgical therapy in patients with knee synovial plica syndrome (SPS).

METHODSThirty-one patients with knee SPS undergoing arthroscopic surgery and 27 SPS patients undergoing conservative treatment with articular cavity injection of sodium hyaluronate (control group) were compared for visual pain score (VAS) and the Lysholm score before and after the operation. The patients were followed-up for more than 5 years, and the long-term outcomes were compared using Kaplan-Meier survival analysis.

RESULTSs VAS and the Lysholm scores in both groups were significantly lowered after treatment (P<0.05). The postoperative VAS score was significantly lower while the Lysholm score significantly higher in arthroscopic surgery group than in the control group (P<0.05). Arithmetic mean and the median time of curative effect maintenance were 49 and 43 months in arthroscopic surgery group, as compared with 33 and 29 months in the control group, respectively; the cumulative effect maintenance rate in arthroscopic surgery group was significantly higher than that in the control group (Χ2=4.933, P=4.933).

CONCLUSIONArthroscopic treatment produces better therapeutic effect on knee joint SPS and ensures longer long-term therapeutic effect maintenance than conservative treatment.

Adult ; Arthroscopy ; Female ; Follow-Up Studies ; Humans ; Hyaluronic Acid ; administration & dosage ; Injections, Intra-Articular ; Joint Diseases ; surgery ; Knee Joint ; pathology ; surgery ; Male ; Pain, Postoperative ; Postoperative Period ; Synovectomy ; Synovial Membrane ; pathology ; Treatment Outcome

OBJECTIVETo explore effect and the application value of continuous douche and vacuum sealing drainage (VSD) in refractory tissue, and joint infections after complete debridement.

METHODSAs retrospective analysis of treatment time and restoration or recurrence, from Jan. 2006 to Dec. 2007, 61 cases of refractory tissue, bone and joint infections underwent continuous douche and VSD combined with the treatment of anti-inflammatory and rehabilitation training after debridement in our hospital. The 61 patients included 39 males and 22 females with age ranging from 10 to 58 years with an average of (35 +/- 12) years, among whom 61 identified to have ankle ulcers combined with infections,open fracture combined with infections, sacrococcygeal pressure ulcers combined with infections, infections after hip replacement, infections after open fracture, and infections after skin avulsion postoperation were 11, 15, 9, 3, 5 and 18 cases respectively. The course was from 2 weeks to 11 months with an average of 4 months.

RESULTSIn all 61 patients,the mean healing time was 17, 36, 42, 24, 32, 29 and 28 days in ankle ulcers and infections, tibia and fibula open fracture and infections, femoral shaft fracture and infections, sacrococcygeal pressure ulcers and infections, infections after hip replacement, infections after open fracture, and infections after skin avulsion postoperation respectively. The replacement of VSD was 1, 2-4, 3-5, 1-3, 2-4, 2-3 and 1-3 times in each group respectively. There was no wound recurrence except for 2 cases with recurrent in 61 cases with external fixation nail hole semi-pathological fracture in 1 case of femoral shaft fracture and infection and 1 case of tibia and fibula fracture and infection after follow-up at least one year.

CONCLUSIONApplication of continuous douche and VSD can effectively decrease incidence of complications and promote the refractory tissue, bone and joint infections wound growth, healing and considerably shorten the healing time.

Adolescent ; Adult ; Bone Diseases ; pathology ; physiopathology ; surgery ; Child ; Debridement ; adverse effects ; Female ; Follow-Up Studies ; Humans ; Joint Diseases ; pathology ; physiopathology ; surgery ; Male ; Middle Aged ; Retrospective Studies ; Suction ; methods ; Therapeutic Irrigation ; methods ; Time Factors ; Wound Healing ; Young Adult