Nail patella syndrome (NPS) is a skeletal dysplasia with patellofemoral
dysfunction as a key symptom. We present the first in-depth radiological
evaluation of the knee in a large series of NPS patients and describe
the typical malformations. Conventional radiological examination of 95 skeletally mature
patients with NPS was performed. Patellar morphology was classified
according to the Wiberg classification as modified by Baumgartl
and Ficat criteria, and trochlear shape was classified according
to the Dejour classification.Aim
Patients and Methods
A total of 187 patients with primary osteoarthritis
(OA) of the knee undergoing total knee replacement (TKR) were randomly
divided into two groups, one of which underwent synovectomy. The
patients and assessors were blinded to the randomisation both before
and after surgery. The duration of surgery, hospitalisation period,
concealed bleeding, drainage volume, blood transfusion rate and
range of movement of the knee at three days after the operation
were analysed. Patients were followed up at four weeks and 12 months
after their operation, and a visual analogue score (VAS) for pain,
Knee Society score (KSS) and a patellar ballottement test were compared
between the groups. The mean amount of concealed bleeding was higher in the synovectomy
group compared with the control group (1.24 l (0.08 to 3.28) Cite this article:
We suggest that different mechanisms underlie joint pain at rest and on movement in osteoarthritis and that separate assessment of these two features with a visual analogue scale (VAS) offers better information about the likely effect of a total knee replacement (TKR) on pain. The risk of persistent pain after TKR may relate to the degree of central sensitisation before surgery, which might be assessed by determining the pain threshold to an electrical stimulus created by a special tool, the Pain Matcher. Assessments were performed in 69 patients scheduled for TKR. At 18 months after operation, separate assessment of pain at rest and with movement was again carried out using a VAS in order to enable comparison of pre- and post-operative measurements. A less favourable outcome in terms of pain relief was observed for patients with a high pre-operative VAS score for pain at rest and a low pain threshold, both features which may reflect a central sensitisation mechanism.