Bulletin of the NYU hospital for joint diseases最新文献

Unlabelled: Although the presence of patellar tilt usually implies a tight lateral retinaculum and unhealthy pressure distributions within the patellar cartilage, it is possible for the bony portion of the patella to appear tilted while the articular cartilage is in fact fully congruous in a medial-lateral direction. We call this "congruous tilt." In such cases, a patient may not suffer from an excessive lateral pressure phenomenon, despite the presence of tilt.

Materials and methods: One hundred and forty-nine knee MRIs were evaluated with respect to patellar tilt and Wiberg morphology.

Results: Thirty-one patellae were tilted (tilt angle > 10°). Twenty-five of 31 patellae demonstrated normal morphology in the axial plane (Wiberg 2). One of these 25 tilted patellae demonstrated congruous tilt. Three of 31 patellae were of the Wiberg type 3(a long lateral facet, a very short medial facet). In two out three of these, the tilt was deemed to be congruous.

Conclusion: Based on this preliminary study, a tilted patella of the Wiberg 3 variety is likely to demonstrate congruous tilt. It remains to be determined whether patients with congruous tilt are less prone to pain but more prone to instability than their incongruous counterparts.

Spine Tango is currently the only international spine registry in existence. It was developed under the auspices of Eurospine, the Spine Society of Europe, and is hosted at the University of Bern, Switzerland. The HJD Spine Center successfully tested Spine Tango during a 3-month pilot study and has since expanded documentation activities to more surgeons. Workflow integration and dedicated research staff are key factors for such an endeavor. Participation enables benchmarking against national and international peers and outcome research and quality assurance of surgical and non-surgical treatments.

A 29-year-old female presented with pain and a palpable mass in the left wrist. Imaging demonstrated a multiloculated cystic mass adjacent to the radial aspect of the scaphoid, which was intimately associated with and appeared to arise from the wall of the radial artery and its dorsal branch. The mass was surgically resected. The histological analysis confirmed the presence of adventitial cystic disease (ACD) of the radial artery. In addition, within a year time span, a second 34-year-old male patient presented with a palpable mass in the right hand. Imaging demonstrated a cystic mass encasing the dorsal carpal branch of the radial artery and its terminal vessels to the thumb and index finger. The diagnosis of ACD was raised based on MR imaging. Histological analysis confirmed the presence of an adventitial cyst. ACD of the arteries is a rare disorder of unknown etiology, which usually involves the popliteal artery. Less common sites of involvement include the external iliac, common femoral, radial, and ulnar arteries. To our knowledge, there have only been six previous case reports of adventitial cystic disease involving the radial artery. The imaging features, histology, differential diagnosis, pathogenesis, and treatment are discussed.

Indications for the use of osteochondral allografts for orthopaedic surgical applications are increasing with improved surgical techniques and advancing experience. Modern tissue banks have developed harvesting, processing, and storage methods that ensure an adequate, safe supply of grafts. Continued research is necessary to find a technique that maximizes chondrocyte viability and metabolism both during storage and implantation. The majority of published data on the use of osteochondral allografts has focused on the management of osteochondral defects about the knee. Successful outcomes following these procedures have led to increased interest in their application to pathology affecting other joints including the shoulder and ankle. The current paper aims to review the basic science and clinical applications of osteochondral allografts.

Hibernoma is an uncommon, benign tumor of brown fat origin. The distribution of this tumor originally was described as following the location of persistent brown fat within the subcutaneous tissue of the thorax (especially the periscapular and interscapular regions), neck, axilla, shoulder, and retroperitoneum. Recently, hibernoma was described as being most common in the thigh.

Background: Pregnancy in patients with Wegener's granulamotosis (WG) is rare, and differential diagnosis of WG flare and preeclampsia is difficult.

Case: A pregnant 35 year old with WG was referred with diagnosis of severe preeclampsia; caesarean section was performed. Intubation of the patient was difficult due to subglottic stenosis. Because of the clinical symptom, the case was considered preeclampsia, but p-ANCA of the patient was positive. In pregnancies with WG, differential diagnosis of WG flare-ups from preeclampsia should be made from clinical symptoms and laboratory findings. Serum ANCA titers are not useful in the differential diagnosis of WG flare-ups and preeclampsia because it may be positive in preeclampsia.

Conclusion: Differential diagnosis of WG flare-up and preeclampsia should be made by clinical features. In the patients with subglottic stenosis, general anesthesia should not be preferred due to the probability of difficult intubation.

Purpose: Our aim was to determine whether the administration of intravenous tranexamic acid is a safe and effective means of reducing blood loss associated with hip and knee replacement surgery.

Method: Sequential cohort study analysing hemoglobin titers, transfusion rates, and the occurrence of venous thromboembolism in patients undergoing hip and knee replacements with and without the administration of tranexamic acid at the time of induction. Finally, a cost benefit analysis was performed.

Results: Two hundred and seventy-three patients were included in our study. We demonstrated that 1 gram of tranexamic acid administered intravenously at the time of induction significantly reduces operative blood loss and transfusion rates (p < 0.05). Moreover, the use of tranexamic acid reduces the costs associated with surgery.

Conclusions: The administration of 1 gram of intravenous tranexamic acid is a safe and effective means of reducing operative blood loss and blood transfusion rates in patients undergoing hip and knee replacements.

Juvenile idiopathic arthritis (JIA) comprises a collection of all forms of chronic arthritis in childhood with no apparent cause. JIA is the most common rheumatic disease in children, and may result in significant pain, joint deformity, and growth impairment, with persistence of active arthritis into adulthood. Prior to the mid 1990s, the therapeutic armamentarium for JIA was more limited, utilizing non- specific agents, many with significant adverse effects. With the relatively recent use of biologics, one can provide more target-specific therapy, which may be better tolerated. Through continued translational research and clinical trials, one better understands the biology mediating disease, with the hope of offering safer, more effective medicine, and potential cure. This review will outline the clinical features of JIA, as well as provide the latest updates in current and future pharmacotherapy.

Epidural spinal injections can be administered via a translaminar or transforaminal route, depending on the clinical scenario. When it is more desirable to target a specific nerve root, a transforaminal approach is typically used, and when the target is more diffuse, a translaminar method is chosen. Both are commonly used and can be utilized similarly in the lumbar or cervical spine. However, it is essential that the clinician understand the risks and benefits of these injections. In the lumbar spine, both translaminar epidural steroid injections (TLESI) and transforaminal epidural steroid injections (TFESI) have been shown to provide up to 6 months of pain relief, though long-term benefits are less reliable. In the cervical spine, translaminar injections may provide longer relief and have a lower complication rate than cervical transforaminal injections. Proper technique is essential to minimize the rate of these rare but occasionally severe complications.