A 18-year-old woman patient suffering from
Pain and disability following wrist trauma are highly prevalent, however the mechanisms underlying painare highly unknown. Recent studies in the knee have demonstrated that altered joint contact may induce changes to the subchondral bone density and associated pain following trauma, due to the vascularity of the subchondral bone. In order to examine these changes, a depth-specific imaging technique using quantitative computed tomography (QCT) has been used. We've demonstrated the utility of QCT in measuring vBMD according to static jointcontact and found differences invBMD between healthy and previously injured wrists. However, analyzing a static joint in a neutral position is not necessarily indicative of higher or lower vBMD. Therefore, the purposeof this study is to explore the relationship between subchondral vBMDand kinematic joint contact using the same imaging technique. To demonstrate the relationship between kinematic joint contact and subchondral vBMDusing QCT, we analyzed the wrists of n = 10 participants (n = 5 healthy and n = 5 with previous wrist trauma). Participantsunderwent 4DCT scans while performing flexion to extension to estimate radiocarpal (specifically the radiolunate (RL) and radioscaphoid (RS)) joint contact area (JCa) between the articulating surfaces. The participantsalso underwent a static CT scan accompanied by a calibration phantom with known material densities that was used to estimate subchondral vBMDof the distal radius. Joint contact is measured by calculatinginter-bone distances (mm2) using a previously validated algorithm. Subchondral vBMD is presented using mean vBMD (mg/K2HPO4) at three normalized depths from the subchondral surface (0 to 2.5, 2.5 to 5 and 5 to 7.5 mm) of the distal radius. The participants in the healthy cohort demonstrated a larger
Juvenile Chronic Arthritis results in the early degeneration of multiple joints with severe pain and deformity. Treatment of ankle arthritis is complex and ankle replacement is indicated because of adjacent and distant joint involvement. Materials and Methods. We reviewed 25 total ankle replacements in 13 young adults suffering the generalised consequences of Juvenile Chronic Arthritis (JCA) between 2000 and 2009. 12 had bilateral disease, 20 had anklylosis or prior fusion of the hind- or midfoot, and 16 had substantial fixed inversion of the hindfoot. All had previous prosthetic arthroplasty of between 1 and 15 joints. Surgery comprised corrective triple fusion where required, with staged total ankle arthroplasty at an interval of 3 or more months. Results. All patients reported significant reduction in pain, and increased mobility with increased stride length, however severe co-morbidity limited the usefulness of routine outcome scores. No ankles have required revision to date. We noted that the dimensions of the distal tibia and talus are markedly reduced in patients with
Between 1971 and 1991 we performed Charnley low-friction arthroplasty (LFA) on 116 patients (186 hips) with juvenile chronic arthritis (JCA). We have now carried out a survival study, taking endpoints as revision, death or the end of the year 1993. Overall survival was 91.9% at ten years and 83.0% at 15 years. That of the femoral component was 95.6% at ten years and 91.9% at 15 years and of the acetabulum 95.0% and 87.8%, respectively. Only the use of steroids significantly impaired the survival. We therefore recommend the use of Charnley LFA for young patients with
Scarf osteotomy improves hallux valgus and can be used for deformities with large intermetatarsal angles. It is designed to minimise shortening of the first ray. The aim of this radiographic analysis was to assess the outcome of patients undergoing Scarf osteotomy at the Royal Cornwall Hospital. The initial 18 consecutive cases performed by the senior author were analysed using the guidelines recommended by the American Foot and Ankle Society. Standardised anterior-posterior radiographs of the foot were compared pre-operatively and at 6 weeks postoperatively. Measurements of the intermetatarsal angle (IMA), hallux valgus angle (HVA), joint congruency angle (JCA), distal metatarsal articular angle (DMAA), sesamoid position and metatarsal length were used to assess any improvement. The results showed a significant median reduction of the IMA of 70, HVA of 180,
The SCARF osteotomy is a three dimentional osteotomy for hallux valgus. It combines a lateral release of the adductor hallucis with a lateral and plantar displacement of the first metatarsal. The osteotomy is ‘z’ shaped in the lateral view and displacement of the distal fragment is followed by internal fixation. In this study we set out to determine whether the SCARF osteotomy was an effective method in the correction of moderate to severe hallux valgus deformity. A prospective radiographic study was performed on 22 cases of SCARF osteotomy with an average age of 52 years (range 25–78). Standardised weight bearing anterior-posterior radiographs were taken preoperatively and at six months post operatively. The American Foot and Ankle Society guidelines were used for all measurements. Measurements were made using overlay acetate sheets to minimise inter and intra observer error. These were compared to determine changes in the intermetatarsal angle (IMA), hallux valgus angle (HVA), distal metatarsal articular angle (DMAA) and joint congruency angle (JCA). Correction of sesamoid position and metatarsal length changes were also assessed. The results showed a median reduction of IMA of 6 degrees, HVA of 16 degrees, DMAA of 6 degrees and an improvement in
We report a consecutive series of 16 revision total knee arthroplasties using the Total Condylar III system in 14 patients with inflammatory arthritis which were performed between 1994 and 2000. There were 11 women and three men with a mean age of 59 years (36 to 78). The patients were followed up for 74 months (44 to 122). The mean pre-operative Knee Society score of 37 points (0 to 77) improved to 88 (61 to 100) at follow-up ( These results suggest that the Total Condylar III system can be used successfully in revision total knee arthroplasty in inflammatory arthritis.