Aims

There are concerns regarding complications and longevity of total elbow arthroplasty (TEA) in young patients, and the few previous publications are mainly limited to reports on linked elbow devices. We investigated the clinical outcome of unlinked TEA for patients aged less than 50 years with rheumatoid arthritis (RA).

Aims

The aim of this study was to report the mid-term clinical outcome of cemented unlinked J-alumina ceramic elbow (JACE) arthroplasties when used in patients with rheumatoid arthritis (RA).

Purpose: Minimally invasive surgery (MIS) total knee arthroplasty (TKA) makes faster rehabilitation in many cases, but it was sometimes difficult to performed the precise osteotomy and place the implants correctly due to loss of view or orientation for its small exposure. The computer-assisted navigation TKA system (CAS) was reported to achieve the optimal alignment and placement. However, it had disadvantages of longer operation time and wider exposure to acquire the reference points than these of the conventional method. Now MIS technique needs the accuracy of implant placement, on the other hand, CAS needs less-invasive methods. Among CAS methods, CT-based navigation system would have the potential for MIS because it would be referred to preoperative CT images. This study examined the accuracy of the registration with CT-based navigation system and the possibility of its application for MIS.

Material and Methods: CT data were obtained from the femur and tibia of “Sawbone” (synthetic bone, Pacific Research Laboratories, Vashon, WA, USA) with a slice thickness of 1 mm. These data were transferred to Vector Vision Knee 1.5 (BrainLab Inc, Heimstettenm, Germany) and reconstructed to three-dimensional model. Two registrations were performed by a surface-matching algorithm. One is the conventional method as Vector Vision protocol; another is MIS approach which was allowed the limited area around the femoral notch and joint surface of tibia for registration. The accuracy of registration with these two methods was evaluated by Vector Vision Knee. And these registration points of these different methods were measured using a coordinate measuring machine, 3D surface scanner (Mitsutoyo, JAPAN) and were analyzed and calculated the distribution of points.

Results and Discussion: There was a high degree of reproducibility of the MIS approach compared with the conventional method in the femur. However, the reference points in the distal tibia were deviated 1.5 cm to medial and thus 2.39 degree in varus would be happened at the proximal tibia in both methods. Now this software should be improving to be more accurate.

Introduction Rheumatoid arthritis (RA) commonly affects the forefoot, and pain caused by the deformity of forefoot impairs the walking ability. We have performed resection arthroplasty for all metatarsal heads using modified Lelièvre procedure in affected feet. The aim of the current retrospective study was to investigate the long term results and problems of this procedure.

Patients and methods We investigated 45 feet treated by modified Lelièvre procedure in 29 women from 1985 to 2003 at our institute. Their average age at operation was 54.8 years (range 39 – 76 years). They were followed-up more than two years (26 – 203 months). Resection of all five metatarsal heads was performed for the RA forefoot which had severe deformity and persistent pain, using medial approach for first metatarsophalangeal (MTP) joint and plantar approach for lesser MTP joint. The results were evaluated by the rating scale of the American Orthopaedic Foot and Ankle Society (AOFAS), Foot Function Index (FFI), physical examination, radiographic evaluation, as well as subjective assessment using questionnaire for mental and physical disability.

Results Pain and walking ability were improved in all but 2 feet; one of which underwent additional surgical treatment. Eight out of 45 feet had recurrence of MTP joint dislocation of thumb at the final follow-up. Re-formation of callosities was seen in 69% of the patients, 50% of which were developed within 3 years after operation, and 78% within 5 years. No superficial infection or delayed wound-healing was noted in any case. Satisfactory surgical outcome was maintained for at least 2 years after operation in all cases, and deteriorated later. At an average of 96 months postoperatively, the average AOFAS forefoot score was 67.9 points. Seven cases were judged to have excellent (25%), 13 cases good (46%), 7 cases (25%) fair, and 1 case poor (4%) results. The average radio graphic hallux valgus angle was 31.3 degrees. Eventually, 70% of patients underwent total hip or knee arthroplasty.

Conclusion Resection arthroplasty of all five metatarsal heads using modified Lelièvre procedure in RA patients with pain and deformity of forefoot seemed to be an effective procedure over a long postoperative period, providing reasonable relief of symptoms. Because RA affects multiple joints including hip and knee joints, the forefoot reconstruction alone cannot sustain the improved walking ability.