The incidence of acute and chronic conditions
of the tendo Achillis appear to be increasing. Causation is multifactorial
but the role of inherited genetic elements and the influence of
environmental factors altering gene expression are increasingly
being recognised. Certain individuals’ tendons carry specific variations
of genetic sequence that may make them more susceptible to injury.
Alterations in the structure or relative amounts of the components
of tendon and fine control of activity within the extracellular
matrix affect the response of the tendon to loading with failure
in certain cases. This review summarises present knowledge of the influence of
genetic patterns on the pathology of the tendo Achillis, with a
focus on the possible biological mechanisms by which genetic factors
are involved in the aetiology of tendon pathology. Finally, we assess
potential future developments with both the opportunities and risks
that they may carry. Cite this article:
A retrospective analysis of first metatarsophalangeal joint arthrodesis with a minimum two year follow up was carried out. Twenty-four patients (33 feet) with an average age of 54 years (range, 31–68) were followed up at an average of 28 months (range, 16 to 40). All patients had first metatarsophalangeal joint fusion using a vitallium plate as described by Coughlin (1994). Patients were evaluated using the American Foot and Ankle Society clinical (Kitaoka 1994) and radiographic guidelines. They also completed a patient satisfaction questionnaire. Twenty three patients (32 feet) went on to complete fusion of their first metatarsophalangeal joints. One patient had an infected non-union, his fusion was repeated successfully after one year. One patient required plate removal because of prominence. There was one case of deep infection which went on to a non-union. Overall, hallux valgus angle was reduced by a mean of 11 degrees and intermetatarsal angle by a mean of two degrees. Clinical evaluation showed marked improvement in pain and functional scores. Patient satisfaction was high with relief of symptoms and improved appearance of the foot. First metatarso-phalangeal joint arthrodesis using a vitallium plate is a successful procedure with a high fusion rate, low complication rate and a high level of patient satisfaction.
Joint replacement in HIV-positive patients remains uncommon, with most experience gained in patients with haemophilia. We analysed retrospectively the outcome of 102 replacement arthroplasties in 73 HIV-positive patients from eight specialist haemophilia centres. Of these, 91 were primary procedures. The mean age of the patients at surgery was 39 years, and the median follow-up was for five years. The overall rate of deep sepsis was 18.7% for primary procedures and 36.3% for revisions. This is a much higher rate of infection than that seen in normal populations. A total of 44% of infections resolved fully after medical and/or surgical treatment. The benefits of arthroplasty in haemophilic patients are well established but the rates of complications are high. As this large study has demonstrated, high rates of infection occur, but survivorship analysis strongly suggests that most patients already diagnosed with HIV infection at the time of surgery should derive many years of symptomatic relief after a successful joint replacement. Careful counselling and education of both patients and healthcare workers before operation are therefore essential.
