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Use of SPECT/CT (Single Photon Emission Computed Tomography/Computed Tomography) is increasing providing additional information in patients with inconclusive clinical examination and unremarkable imaging findings presenting with chronic pain after total ankle arthroplasty. To differentiate the cause of pain after total ankle arthroplasty can be challenging. SPECT/CT combines structural and metabolic imaging as a hybrid tool leading to higher specificity and overall diagnostic accuracy presumably in cases of gutter impingement, prosthetic loosening, and osteoarthritis of adjacent joints. Moreover, SPECT/CT can complement diagnostic work up in periprosthetic joint infections. Basal tracer enhancement has to be considered for the interpretation of imaging findings.
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Articulación del Tobillo , Artroplastia de Reemplazo de Tobillo , Humanos , Artroplastia de Reemplazo de Tobillo/efectos adversos , Articulación del Tobillo/cirugía , Articulación del Tobillo/diagnóstico por imagen , Tomografía Computarizada por Tomografía Computarizada de Emisión de Fotón Único , Osteoartritis/cirugía , Osteoartritis/diagnóstico por imagen , Tomografía Computarizada de Emisión de Fotón Único , Falla de Prótesis , Infecciones Relacionadas con Prótesis/diagnóstico por imagen , Infecciones Relacionadas con Prótesis/etiología , Prótesis Articulares/efectos adversosRESUMEN
Weight-bearing computed tomography has multiple advantages in evaluating the hindfoot and ankle. It can assess hindfoot and ankle alignment, pathology in ankle arthritis, and complications related to total ankle replacements. It is an essential tool in ankle osteoarthritis diagnostic, preoperative planning, and total ankle replacement outcomes. It allows for better accuracy and reproducibility of alignment and implant size. In addition, it has the potential to more assertively detect complications related to weight bearing.
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Articulación del Tobillo , Artroplastia de Reemplazo de Tobillo , Tomografía Computarizada de Haz Cónico , Osteoartritis , Soporte de Peso , Humanos , Artroplastia de Reemplazo de Tobillo/efectos adversos , Articulación del Tobillo/diagnóstico por imagen , Articulación del Tobillo/cirugía , Osteoartritis/diagnóstico por imagen , Osteoartritis/cirugíaRESUMEN
INTRODUCTION: Osteoarthritis (OA) is a progressive degenerative disease characterized by the gradual degradation of cartilage, remodeling of subchondral bone, synovitis, and chronic pain. This condition impacts various large and small joints, including the temporomandibular joint (TMJ). However, addressing OA, particularly in impeding or reducing disease progression, is challenging due to its clinical and imaging heterogeneity. Authors are increasingly suggesting that this heterogeneity involves different phenotypes or subpopulations, discernible by variations in the disease's pathophysiology and structural manifestations. Even within the TMJ, these phenotypes may display distinct clinical features, laboratory parameters, biochemical markers, and imaging criteria. Recent research has proposed MRI as a reference standard for TMJ OA, highlighting its substantial agreement with histopathological changes. MRI-based phenotypes offer a promising avenue for understanding disease progression and treatment response, potentially providing valuable insights for prognosis and treatment planning. OBJECTIVE: This article introduces the ROAMES-TMJ (Rapid OsteoArthritis MRI Eligibility Score for TMJ) to assess the structural eligibility of individuals for inclusion in TMJ OA clinical trials.
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Imagen por Resonancia Magnética , Osteoartritis , Fenotipo , Trastornos de la Articulación Temporomandibular , Articulación Temporomandibular , Humanos , Osteoartritis/diagnóstico por imagen , Osteoartritis/patología , Imagen por Resonancia Magnética/métodos , Trastornos de la Articulación Temporomandibular/diagnóstico por imagen , Trastornos de la Articulación Temporomandibular/patología , Articulación Temporomandibular/diagnóstico por imagen , Articulación Temporomandibular/patología , Progresión de la EnfermedadRESUMEN
Purpose: Multiple loose bodies (LBs) are often found in patients with varus ankle osteoarthritis (OA). This study aimed to investigate the characteristics of extra-articular posterior ankle LBs in patients with varus ankle OA. We also sought to determine whether there were variations in the characteristics of LBs according to the degree of ankle OA. Methods: We retrospectively reviewed 50 patients who had appeared posterior extraarticular LBs on preoperative ankle imaging among the patients who underwent operative treatment for varus ankle OA from March 2011 to February 2023. We categorized the entire patient cohort into four groups according to the degree of ankle arthritis (Takakura stage II, IIIA, IIIB, and IV). Size, number, and location of LBs were evaluated using preoperative computed tomography and magnetic resonance imaging. Results: 142 LBs were identified (mean size: 11.5 mm); 76.8% were located within the flexor hallucis longus (FHL) tendon sheath, 20.4% in the posterior recess, and 2.8% in the flexor digitorum longus tendon sheath. Average LB size was significantly larger in Takakura stage IIIB and IV patients (p < .05), and the LB number was significantly lower in stage II patients (p = .013). Conclusion: Extra-articular posterior LBs in varus ankle OA are predominantly located within the FHL tendon sheath and were larger in Takakura stages IIIB and IV patients.Level of Evidence: Level III. Retrospective comparative study.
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Articulación del Tobillo , Cuerpos Libres Articulares , Imagen por Resonancia Magnética , Osteoartritis , Tomografía Computarizada por Rayos X , Humanos , Estudios Retrospectivos , Femenino , Masculino , Persona de Mediana Edad , Osteoartritis/diagnóstico por imagen , Osteoartritis/cirugía , Articulación del Tobillo/diagnóstico por imagen , Articulación del Tobillo/cirugía , Articulación del Tobillo/patología , Anciano , Cuerpos Libres Articulares/diagnóstico por imagen , Cuerpos Libres Articulares/cirugía , AdultoRESUMEN
INTRODUCTION: In reverse shoulder arthroplasty (RSA) new designs enable greater amounts of lateralization to prevent instability and scapular notching and increase range of motion, however, excessive lateralization leads to stress upon the acromion that can result in scapular spine fatigue fractures. Aim of this study was to gender- and size-specifically assess the influence of glenosphere size and different humeral designs on lateralization, distalization, and bony impingement-free range of motion (ROM) in patients undergoing RSA. METHODS: Computed tomography scans from 30 osteoarthritic patients (f:15, m:15) and 20 cuff tear arthropathy patients (f:10, m:10) were used to virtually simulate RSA implantation. The efficacy of an inlay Grammont-type system vs. an onlay lateralizing system combined with different glenosphere sizes (36 mm vs. 42 mm) in achieving ROM, lateralization, and distalization was evaluated. Moreover, gender and patient's constitution were correlated to humeral size by radiologically measuring the best-fit circle of the humeral head. RESULTS: A different amount of relative lateralization was achieved in both genders using large glenospheres and onlay designs. Latter yielded a higher ROM in all planes for men and women with a 42 mm glenosphere; with the 36 mm glenosphere, an increased ROM was observed only in men. The 155° inlay design led to joint medialization only in men, whereas all designs led to lateralization in women. When adjusting the absolute amount of lateralization to humerus' size (or patient's height), regardless of implant type, women received greater relative lateralization using 36 mm glenosphere (inlay: 1%; onlay 12%) than men with 42 mm glenosphere (inlay: -3%; onlay: 8%). CONCLUSION: The relative lateralization achieved using onlay design is much higher in women than men. Small glenospheres yield greater relative lateralization in women compared to large glenospheres in men. Humeral lateralization using onlay designs should be used cautiously in women, as they lead to great relative lateralization increasing stress onto the acromion. LEVEL OF EVIDENCE: Basic Science Study, Computer Modeling.
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Artroplastía de Reemplazo de Hombro , Diseño de Prótesis , Rango del Movimiento Articular , Articulación del Hombro , Prótesis de Hombro , Humanos , Femenino , Masculino , Artroplastía de Reemplazo de Hombro/métodos , Artroplastía de Reemplazo de Hombro/instrumentación , Anciano , Persona de Mediana Edad , Articulación del Hombro/cirugía , Articulación del Hombro/diagnóstico por imagen , Articulación del Hombro/fisiopatología , Factores Sexuales , Osteoartritis/cirugía , Osteoartritis/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Anciano de 80 o más Años , Lesiones del Manguito de los Rotadores/cirugía , Lesiones del Manguito de los Rotadores/diagnóstico por imagenRESUMEN
Osteoarthritis (OA) is a prevalent cause of joint algesia, loss of function, and disability in adults, with cartilage injury being its core pathological manifestation. Since cartilage damage is non-renewable, the treatment outcome in the middle and late stages of OA is unsatisfactory, which can be minimized by changing lifestyle and other treatment modalities if diagnosed and managed in the early stages, indicating the importance of early diagnosis and monitoring of cartilage injury. Ultrasound technology has been used for timely diagnosis and even cartilage injury treatment, which is convenient and safe for the patient owing to no radiation exposure. Studies have demonstrated the effectiveness of ultrasound and its various quantitative ultrasound parameters, like ultrasound roughness index (URI), reflection coefficient (R), apparent integrated backscatter (AIB), thickness, and ultrasound elastography, in the early and accurate assessment of OA cartilage pathological changes, including surface and internal tissue, hardness, and thickness. Although many challenges are faced in the clinical application of this technology in diagnosis, ultrasound and ultrasound-assisted techniques offer a lot of promise for detecting early cartilage damage in OA. In this review, we have discussed the evaluation of ultrasonic cartilage quantitative parameters for early pathological cartilage changes.
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Cartílago Articular , Osteoartritis , Ultrasonografía , Humanos , Osteoartritis/diagnóstico por imagen , Ultrasonografía/métodos , Cartílago Articular/diagnóstico por imagen , Cartílago Articular/patologíaRESUMEN
Vitamin A derivatives have inhibitory effects on cartilage tissue, such as decreasing chondrocyte proliferation and collagen synthesis, and increasing the loss of glycosaminoglycans and proteoglycans. Therefore, isotretinoin (a vitamin A derivative) may play a role in the pathogenesis of cartilage-related diseases like osteoarthritis by affecting the balance of cartilage tissue. The aim of this study was to evaluate the distal femoral cartilage thickness in acne patients under the systemic isotretinoin therapy and to determine whether it constitutes a risk factor for the development of osteoarthritis. The study included 52 patients (42 female, 10 male, mean age 23.31 ± 3.89 years) who were prescribed systemic isotretinoin for acne and completed at least 3 months of treatment, along with 45 healthy controls ((35 female, 10 male, mean age 23.85 ± 4.77 years). Bilateral distal femoral cartilage thickness was measured by ultrasonography before isotretinoin treatment and after the completion of the third month of treatment. After treatment, a statistically significant increase was found in the thickness of the right medial, right lateral, left medial, left lateral, and left intercondylar cartilage (p = 0.014, 0.012, 0.019, 0.027, 0.002, respectively). There was also an increase in the right intercondylar cartilage thickness, but this was not statistically significant (p = 0.1). Systemic isotretinoin seems to make cartilage thicker. The increase in femoral cartilage thickness observed after short-term isotretinoin treatment might be an indicator of very early-stage osteoarthritis. Extended follow-up studies with larger participant pools are necessary to substantiate this result.
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Acné Vulgar , Cartílago Articular , Fémur , Isotretinoína , Humanos , Isotretinoína/efectos adversos , Isotretinoína/uso terapéutico , Isotretinoína/administración & dosificación , Femenino , Masculino , Acné Vulgar/tratamiento farmacológico , Acné Vulgar/patología , Acné Vulgar/diagnóstico , Adulto , Adulto Joven , Cartílago Articular/patología , Cartílago Articular/efectos de los fármacos , Cartílago Articular/diagnóstico por imagen , Fémur/diagnóstico por imagen , Fémur/efectos de los fármacos , Fémur/patología , Ultrasonografía , Fármacos Dermatológicos/efectos adversos , Fármacos Dermatológicos/uso terapéutico , Fármacos Dermatológicos/administración & dosificación , Osteoartritis/tratamiento farmacológico , Osteoartritis/patología , Osteoartritis/diagnóstico por imagen , Factores de Riesgo , Estudios de Casos y ControlesAsunto(s)
Imagen por Resonancia Magnética , Humanos , Femenino , Masculino , Prevalencia , Adulto , Persona de Mediana Edad , Osteoartritis/epidemiología , Osteoartritis/diagnóstico por imagen , Osteoartritis de la Rodilla/diagnóstico por imagen , Osteoartritis de la Rodilla/epidemiología , Enfermedades Asintomáticas , AncianoRESUMEN
BACKROUND: Trapeziometacarpal osteoarthritis has been treated with interposition of autologous fascia into the trapezial resection cavity to prevent scaphometacarpal impingement with suboptimal results. Autologous fascia may undergo necrosis and gradual shrinkage due to avascularity. We propose vascularization of the interposed fascia using microvascular techniques as a new alternative to achieve a durable graft with sufficient soft tissue volume. PATIENTS AND METHODS: In this retrospective study, 11 surgeries for 8 patients (6 women, 2 men) (5 primary and 6 revision cases) were performed using vascularized fascial grafts from the anterolateral thigh for interposition in the trapezial resection cavity with microvascular anastomosis for revascularization. Subjective assessment included the short version of the Quick Disabilities of the Hand, Shoulder and Arm and patient related hand wrist evaluation scores. Objective assessment included strength and range of motion measurements. Radiographs were obtained preoperatively and at each follow-up visit. An MRI was done at a mean of 19 months postoperatively. RESULTS: The size of the harvested fascial grafts was 2 × 2-3 cm with a thickness of 1.5-2 cm. There were no postoperative complications apart from one seroma in the graft harvest site. The mean clinical and radiologic follow-up was 2 years and 8 months. The procedure provided pain relief PRWHE pain 32 (SD 13)-9 (SD 12), p < 0.0001, increased tip pinch strength 4 kg (SD3)-6 kg (SD2), p < 0.05, and improved overall function PRWHE 60 (SD28)-16 (SD21), p < 0.0001 and QuickDash 50 (SD21)-13 (SD17), p < 0.0001. Radiographs demonstrated maintenance of the scaphometacarpal space, while MRI scans showed the presence of mildly edematous interposed tissue within the resection cavity. CONCLUSIONS: Although technically demanding, vascularized fascia presents an attractive alternative for the treatment of trapeziometacarpal osteoarthritis. It may be particularly advantageous in complex cases requiring revision surgery and in young patients with high functional demands.
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Osteoartritis , Hueso Trapecio , Humanos , Femenino , Masculino , Estudios Retrospectivos , Osteoartritis/cirugía , Osteoartritis/diagnóstico por imagen , Persona de Mediana Edad , Hueso Trapecio/cirugía , Anciano , Fascia/trasplante , Fascia/irrigación sanguínea , Resultado del Tratamiento , Huesos del Metacarpo/cirugía , Huesos del Metacarpo/irrigación sanguínea , Colgajos Tisulares Libres/irrigación sanguínea , Colgajos Tisulares Libres/trasplante , Articulaciones Carpometacarpianas/cirugía , Rango del Movimiento Articular , Adulto , Estudios de SeguimientoRESUMEN
BACKGROUND AND OBJECTIVE: Multi-grade osteoarthritis (OA) deterioration monitoring in the daily paradigm using Vibroarthrography (VAG) is very challenging due to two difficulties: (1) the composition of VAG signals is complex in the daily paradigm where friction is intensified because of weight-bearing movements. (2) VAG signal samples near the decision boundary of adjacent deterioration grades are easy to be misclassified. The majority of existing works only focus on the binary classification of OA, providing inadequate assistance in instructing physicians to develop treatment plans based on the presence or absence of OA. Thus, we propose a novel framework for fine-grained multi-grade OA deterioration monitoring in the daily paradigm. METHODS: We propose an end-to-end deep learning framework termed Fine-grained Multi-grade OA Deterioration Monitor (FMOADM), which consists of Multiscale-temporal Feature Extraction (MTFE) and Confusion-Free Master-Slave (CF-MS) Classification. Specifically, MTFE is adopted to extract multiscale-temporal discriminative features from the complicated VAG signals. And center loss is introduced by CF-MS to alleviate confusion at the boundary of adjacent deterioration grades in the feature space. Meanwhile, a master-slave structure is proposed for further fine-grained classification, where the master classifier integrates a channel attention mechanism and the slave classifier is designed to update MTFE parameters. As a result, the proposed method ensures fine-grained multi-grade OA monitoring performance via multiscale-temporal discriminative features and boundary confusion alleviation. RESULTS: Experimental results on the VAG-OA dataset demonstrate that our framework outperforms counterpart methods in the daily paradigm. The proposed framework achieved 78% in precision, obtaining an 8% improvement over the state-of-the-art method. CONCLUSION: The proposed framework benefits efficient multi-grade OA deterioration monitoring, empowering physicians to develop treatment plans based on fine-grained monitoring results. It takes knee joint health monitoring in daily activities a step further toward feasible.
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Osteoartritis , Humanos , Osteoartritis/fisiopatología , Osteoartritis/diagnóstico por imagen , Aprendizaje Profundo , Algoritmos , Monitoreo Fisiológico/métodos , Procesamiento de Señales Asistido por Computador , Vibración , Redes Neurales de la ComputaciónRESUMEN
Articular cartilage damage and degeneration are among hallmark manifestations of joint injuries and arthritis, classically osteoarthritis. Cartilage compositional MRI (Cart-C MRI), a quantitative technique, which aims to detect early-stage cartilage matrix changes that precede macroscopic alterations, began development in the 1990s. However, despite the significant advancements over the past three decades, Cart-C MRI remains predominantly a research tool, hindered by various technical and clinical hurdles. This paper will review the technical evolution of Cart-C MRI, delve into its clinical applications, and conclude by identifying the existing gaps and challenges that need to be addressed to enable even broader clinical application of Cart-C MRI.
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Cartílago Articular , Imagen por Resonancia Magnética , Humanos , Cartílago Articular/diagnóstico por imagen , Imagen por Resonancia Magnética/métodos , Osteoartritis/diagnóstico por imagenRESUMEN
OBJECTIVE: The present study aimed to assess the consistencies and performances of deep learning (DL) models in the diagnosis of condylar osteoarthritis (OA) among patients with dentofacial deformities using panoramic temporomandibular joint (TMJ) projection images. METHODS: A total of 68 TMJs with or without condylar OA in dentofacial deformity patients were tested to verify the consistencies and performances of DL models created using 252 TMJs with or without OA in TMJ disorder and dentofacial deformity patients; these models were used to diagnose OA on conventional panoramic (Con-Pa) images and open (Open-TMJ) and closed (Closed-TMJ) mouth TMJ projection images. The GoogLeNet and VGG-16 networks were used to create the DL models. For comparison, two dental residents with < 1 year of experience interpreting radiographs evaluated the same condyle data that had been used to test the DL models. RESULTS: On Open-TMJ images, the DL models showed moderate to very good consistency, whereas the residents' demonstrated fair consistency on all images. The areas under the curve (AUCs) of both DL models on Con-Pa (0.84 for GoogLeNet and 0.75 for VGG-16) and Open-TMJ images (0.89 for both models) were significantly higher than the residents' AUCs (p < 0.01). The AUCs of the DL models on Open-TMJ images (0.89 for both models) were higher than the AUCs on Closed-TMJ images (0.72 for both models). CONCLUSIONS: The DL models created in this study could help residents to interpret Con-Pa and Open-TMJ images in the diagnosis of condylar OA.
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Aprendizaje Profundo , Deformidades Dentofaciales , Cóndilo Mandibular , Osteoartritis , Radiografía Panorámica , Humanos , Osteoartritis/diagnóstico por imagen , Femenino , Masculino , Cóndilo Mandibular/diagnóstico por imagen , Adulto , Persona de Mediana Edad , Deformidades Dentofaciales/diagnóstico por imagen , Trastornos de la Articulación Temporomandibular/diagnóstico por imagen , Adolescente , Articulación Temporomandibular/diagnóstico por imagen , Anciano , Adulto JovenRESUMEN
PURPOSE: To assess the potential for accelerating continuous-wave (CW) T1ρ dispersion measurement with compressed sensing approach via studying the effect that the data reduction has on the ability to detect differences between intact and degenerated articular cartilage with different spin-lock amplitudes and to assess quantitative bias due to acceleration. METHODS: Osteochondral plugs (n = 27, 4 mm diameter) from femur (n = 14) and tibia (n = 13) regions from human cadaver knee joints were obtained from commercial biobank (Science Care, USA) under Ethical permission 134/2015. MRI of specimens was performed at 9.4T with magnetization prepared radial balanced SSFP (bSSFP) readout sequence, and the CWT1ρ relaxation time maps were computed from the measured data. The relaxation time maps were evaluated in the cartilage zones for different acceleration factors. For reference, Osteoarthritis Research Society International (OARSI) grading and biomechanical measurements were performed and correlated with the MRI findings. RESULTS: Four-fold acceleration of CWT1ρ dispersion measurement by compressed sensing approach was feasible without meaningful loss in the sensitivity to osteoarthritic (OA) changes within the articular cartilage. Differences were significant between intact and OA groups in the superficial and transitional zones, and CWT1ρ correlated moderately with the reference measurements (0.3 < r < 0.7). CONCLUSION: CWT1ρ was able to differentiate between intact and OA cartilage even with four-fold acceleration. This indicates that acceleration of CWT1ρ dispersion measurement by compressed sensing approach is feasible with negligible loss in the sensitivity to osteoarthritic changes in articular cartilage.
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Cartílago Articular , Imagen por Resonancia Magnética , Humanos , Imagen por Resonancia Magnética/métodos , Cartílago Articular/diagnóstico por imagen , Articulación de la Rodilla/diagnóstico por imagen , Anciano , Femenino , Masculino , Persona de Mediana Edad , Procesamiento de Imagen Asistido por Computador/métodos , Cadáver , Tibia/diagnóstico por imagen , Fémur/diagnóstico por imagen , Osteoartritis/diagnóstico por imagen , Algoritmos , Osteoartritis de la Rodilla/diagnóstico por imagenRESUMEN
BACKGROUND: Ankle symptoms are a common reason to consult the general practitioner and often persist for years. In a population referred for ankle radiography, the prevalence of radiographic osteoarthritis (OA) is substantial, but its additional predictive value for persistent symptoms is unknown. Therefore, we examined the prognosis of symptoms 2-3 years after referral for ankle radiography, assessed clinical prognostic factors, and the additional predictive value of radiographic OA for persistent ankle complaints. METHODS: We included 893 adults referred for ankle radiography and studied the following candidate prognostic factors at baseline: age, sex, body mass index (BMI), referral for chronic complaints (>3 months), pain during activity (NRS-11) and presence of stiffness and functional loss as predominant symptom. X-rays were scored for radiographic OA. After 2-3 years participants were invited for a follow-up questionnaire including persistence of ankle complaints. To assess prognostic factors for persistent complaints, uni- and multivariable logistic regression were used. RESULTS: Of the 194 responders at follow-up, ankle complaints persisted in 71(36.6 %). BMI (OR 1.08; 95 % CI 1.01-1.15), stiffness as predominant symptom (OR 1.69; 95 % CI 0.89-3.21), and chronic complaints (OR 2.84; 95 % CI 1.45-5.57) were in the initial model for persistent complaints (AUC=0.69). After adding radiographic OA (OR 2.36; 95 % CI 1.01-5.50), the AUC of the final model became 0.70. CONCLUSION: Ankle complaints persist in a considerable proportion of patients 2-3 years after referral for ankle radiography. BMI, chronic complaints and radiographic OA are prognostic factors for persistent complaints, but the additional predictive value of radiographic OA on top of clinical factors is negligible.
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Articulación del Tobillo , Osteoartritis , Radiografía , Derivación y Consulta , Humanos , Masculino , Femenino , Osteoartritis/diagnóstico por imagen , Persona de Mediana Edad , Pronóstico , Articulación del Tobillo/diagnóstico por imagen , Anciano , AdultoRESUMEN
PURPOSE: Total joint arthroplasty (TJA) has often been used to treat thumb carpometacarpal (CMC) osteoarthritis (OA). However, guidelines for the CMC prosthesis shape remain unclear. This study aimed to identify the effective shape of a ball-and-socket prosthesis in restoring the range of thumb motion after TJA. METHODS: The participants were 10 healthy young adult men (22-32 years; 26.8 ± 3.57 [mean ± SD]). CT scans were performed in eight static limb positions during abduction and flexion. We defined three design variables (offset R, height H, and neck rotation angle Φ) as the variables that determine the basic shape of the ball-and-socket prosthesis. The ideal values of these design variables were examined based on the results of a 3D motion analysis, which evaluated the change in the posture of the first metacarpal (r, h, and φ corresponding to R, H, and Φ, respectively) relative to the center of rotation (COR) during abduction and flexion. We also simulated the effect of these design variables on the range of thumb motion after TJA using 3D CAD. RESULTS: We found that the values of r and h averaged over all limb positions were 6.92 ± 1.60 mm and 51.02 ± 1.67 mm, respectively, showing that these values remained constant regardless of limb position. In contrast, φ changed significantly. The simulation results indicated that Φ affected the range of thumb motion after TJA, and Φ = 0° relatively reproduced all limb positions compared to other values. CONCLUSION: Our results suggested that the desirable values of R and H were the average of r and h over several limb positions and that Φ = 0° was effective in restoring the range of thumb motion after TJA. Our results will provide surgeons with new guidelines for selecting a prosthesis.
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Articulaciones Carpometacarpianas , Prótesis Articulares , Diseño de Prótesis , Rango del Movimiento Articular , Pulgar , Humanos , Masculino , Pulgar/cirugía , Pulgar/fisiología , Pulgar/diagnóstico por imagen , Articulaciones Carpometacarpianas/cirugía , Articulaciones Carpometacarpianas/diagnóstico por imagen , Articulaciones Carpometacarpianas/fisiopatología , Adulto , Adulto Joven , Imagenología Tridimensional , Tomografía Computarizada por Rayos X , Osteoartritis/cirugía , Osteoartritis/fisiopatología , Osteoartritis/diagnóstico por imagen , Artroplastia de Reemplazo/instrumentación , Artroplastia de Reemplazo/métodosRESUMEN
BACKGROUND: The Sauvé-Kapandji (S-K) method is a surgical procedure performed for chronic deformities of the distal radial ulnar joint (DRUJ). Changes to the joint contact surface from pre- to postoperatively under physiological in vivo conditions have not yet been determined for this useful treatment. The aim of the present study was therefore to compare the articular contact area of the wrist joint between before and after the S-K method for DRUJ disorders. METHODS: The SK method was performed for 15 patients with DRUJ osteoarthritis and ulnar impaction syndrome. We calculated the Mayo Wrist Score as the patient's clinical findings and created 3-dimensional bone models of cases in which the S-K method was performed and calculated the contact area and shift in the center of the contact area using customized software. RESULTS: The Mean modified Mayo Wrist Score improved significantly from 60.3 preoperatively to 80.3 postoperatively (P < 0.01). Scaphoid contact area to the radius increased significantly from 112.6 ± 37.0 mm2 preoperatively to 127.5 ± 27.8 mm2 postoperatively (P = 0.03). Lunate contact area to radius-ulna was 121.3 ± 43.3 mm2 preoperatively and 112.5 ± 37.6 mm2 postoperatively, but this decrease was not significant (P = 0.38). Contact area ratio of scaphoid to lunate increased significantly from 1.01 ± 0.4 preoperatively to 1.20 ± 0.3 postoperatively (P = 0.02). Postoperative translations of the center of the scaphoid and lunate contact areas were decomposed into ulnar and proximal directions. Ulnar and proximal translation distances of the scaphoid contact area were 0.8 ± 1.7 mm and 0.4 ± 0.6 mm, respectively, and those of the lunate contact area were 1.1 ± 1.7 mm and 0.4 ± 1.1 mm, respectively. This study revealed changes in wrist contact area and center of the contact area before and after the S-K method. CONCLUSION: These results may accurately indicate changes in wrist joint contact area from pre- to postoperatively using the S-K method for patients with DRUJ disorder. Evaluation of changes in contact area due to bone surface modeling of the wrist joint using 3DCT images may be useful in considering surgical methods.
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Radio (Anatomía) , Cúbito , Articulación de la Muñeca , Humanos , Articulación de la Muñeca/cirugía , Articulación de la Muñeca/diagnóstico por imagen , Masculino , Femenino , Persona de Mediana Edad , Cúbito/cirugía , Cúbito/diagnóstico por imagen , Radio (Anatomía)/cirugía , Radio (Anatomía)/diagnóstico por imagen , Adulto , Osteoartritis/cirugía , Osteoartritis/diagnóstico por imagen , Anciano , Procedimientos Ortopédicos/métodos , Resultado del TratamientoRESUMEN
Osteoarthritis (OA) is the leading joint disorder globally, affecting a significant proportion of the population. Recent studies have changed our understanding of OA, viewing it as a complex pathology of the whole joint with a multifaceted etiology, encompassing genetic, biological, and biomechanical elements. This review highlights the role of imaging in diagnosing and monitoring OA. Today's role of radiography is discussed, while also elaborating on the advances in computed tomography and magnetic resonance imaging, discussing semiquantitative methods, quantitative morphologic and compositional techniques, and giving an outlook on the potential role of artificial intelligence in OA research.
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Imagen por Resonancia Magnética , Osteoartritis , Humanos , Osteoartritis/diagnóstico por imagen , Imagen por Resonancia Magnética/métodos , Tomografía Computarizada por Rayos X/métodosRESUMEN
PURPOSE: Trapeziometacarpal (TMC) joint replacement has become a valid option in the therapeutic arsenal of TMC joint osteoarthritis in Europe. Good mid-term results of the MAÏA TMC joint prosthesis suggested that it is a reliable procedure. This study aimed to assess the long-term results of this modular uncemented ball-and-socket hydroxyapatite-coated implant. METHODS: This single-center retrospective study evaluated 92 MAÏA TMC joint prostheses in 76 patients with a minimum of 10 years of follow-up. Indications for the procedure were painful TMC joint osteoarthritis both at rest and during activity, despite nonsurgical treatment for more than six months. Pre- and postoperative clinical and radiographic outcomes were compared. RESULTS: Mean follow-up was 134 months (range: 120-158 months). Mean age at the time of surgery was 67 years (range: 53-84 years). The cohort comprised 86.8% of women (n = 66). The mean Quick Disabilities of the Arm, Shoulder, and Hand score improved from 61.3 ± 17.1 to 19.6 ± 16. Range of motion was restored, and postoperative mobility was comparable with that of the contralateral side. Final Kapandji opposition score was almost normal (9.2 ± 0.7). Final key pinch and grip strength improved by 26% and 39%, respectively. Eight implants were surgically revised, six for trapezium cup loosening and two for instability because of polyethylene wear. Three cases of traumatic fracture of the trapezium in older patients were successfully treated with a cast for eight weeks. Five of 26 (20.8%) cases of preoperative-reducible z-deformity were not totally corrected after surgery. The Kaplan-Meier survival over 10 years was 88% (95% confidence interval: 84-93) versus 93% (95% confidence interval: 87-98) over 5 years. CONCLUSIONS: MAÏA TMC joint prosthesis is a reliable long-term surgical procedure for TMC joint osteoarthritis, improving overall function beyond 10 years. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
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Artroplastia de Reemplazo , Articulaciones Carpometacarpianas , Prótesis Articulares , Osteoartritis , Rango del Movimiento Articular , Hueso Trapecio , Humanos , Femenino , Persona de Mediana Edad , Masculino , Anciano , Osteoartritis/cirugía , Osteoartritis/diagnóstico por imagen , Estudios Retrospectivos , Estudios de Seguimiento , Anciano de 80 o más Años , Hueso Trapecio/cirugía , Hueso Trapecio/diagnóstico por imagen , Articulaciones Carpometacarpianas/cirugía , Articulaciones Carpometacarpianas/diagnóstico por imagen , Radiografía , Diseño de Prótesis , Resultado del Tratamiento , Huesos del Metacarpo/cirugía , Huesos del Metacarpo/diagnóstico por imagen , Evaluación de la DiscapacidadRESUMEN
OBJECTIVES: The present study aimed to elucidate the pathogenesis of temporomandibular joint (TMJ) osteoarthritis (TMJ-OA) in a mouse model. We investigated morphological and histological changes in the head of mandible cartilage and early immunohistochemical (IHC) changes in transforming growth factor (TGF)-ß, phosphorylated Smad-2/3 (p-Smad2/3), a TGF-ß signaling molecule, and asporin. METHODS: TMJ-OA was induced in a mouse model through unilateral partial discectomy. Micro-computed tomography (micro-CT) and safranin-O staining were performed to morphologically and histologically evaluate the degeneration of the head of mandible caused by TMJ-OA. IHC staining for TGF-ß, p-Smad2/3, and asporin was performed to evaluate the changes in protein expression. RESULTS: In the experimental group, three-dimensional (3D) morphometry revealed an enlarged head of mandible and safranin-O staining showed degeneration of cartilage tissue in the early stages of TMJ-OA compared to the control group. IHC staining revealed that TGF-ß, p-Smad2/3, and asporin expression increased in the head of mandible cartilage before the degeneration of cartilage tissue, and subsequently decreased for a short period. CONCLUSION: The findings suggested a negative feedback relationship between the expression of asporin and the TGF-ß/Smad transduction pathway, which may be involved in the degeneration of the head of mandible in the early stages of TMJ-OA. Asporin is a potential biomarker of the early stages of TMJ-OA, which ultimately leads to the irreversible degeneration of TMJ tissues.
Asunto(s)
Modelos Animales de Enfermedad , Inmunohistoquímica , Osteoartritis , Factor de Crecimiento Transformador beta , Animales , Osteoartritis/metabolismo , Osteoartritis/patología , Osteoartritis/diagnóstico por imagen , Ratones , Factor de Crecimiento Transformador beta/metabolismo , Proteínas de la Matriz Extracelular/metabolismo , Microtomografía por Rayos X , Articulación Temporomandibular/metabolismo , Articulación Temporomandibular/patología , Articulación Temporomandibular/diagnóstico por imagen , Masculino , Trastornos de la Articulación Temporomandibular/metabolismo , Trastornos de la Articulación Temporomandibular/patología , Trastornos de la Articulación Temporomandibular/diagnóstico por imagen , Proteína smad3/metabolismo , Proteína smad3/genética , Proteína Smad2/metabolismoRESUMEN
OBJECTIVE: The paraspinal muscles play an essential role in the stabilization of the lumbar spine. Lumbar paraspinal muscle atrophy has been linked to chronic back pain and degenerative processes within the spinal motion segment. However, the relationship between the different paraspinal muscle groups and facet joint osteoarthritis (FJOA) has not been fully explored. METHODS: In this cross-sectional study, the authors analyzed adult patients who underwent lumbar spinal surgery between December 2014 and March 2023 for degenerative spinal conditions and had preoperative MRI and CT scans. The fatty infiltration (FI) and functional cross-sectional area (fCSA) of the psoas, erector spinae, and multifidus muscles were assessed on axial T2-weighted MR images at the level of the upper endplate of L4 based on established studies and calculated using custom-made software. Intervertebral disc degeneration at each lumbar level was evaluated using the Pfirrmann grading system. The grades from each level were summed to report the cumulative lumbar Pfirrmann grade. Weishaupt classification (0-3) was used to assess FJOA at all lumbar levels (L1 to S1) on preoperative CT scans. The total lumbar FJOA score was determined by adding the Weishaupt grades of both sides at all 5 levels. Correlation and linear regression analyses were conducted to assess the relationship between FJOA and paraspinal muscle parameters. RESULTS: A total of 225 patients (49.7% female) with a median age of 61 (IQR 54-70) years and a median BMI of 28.3 (IQR 25.1-33.1) kg/m2 were included. After adjustment for age, sex, BMI, and the cumulative lumbar Pfirrmann grade, only multifidus muscle fCSA (estimate -4.69, 95% CI -6.91 to -2.46; p < 0.001) and FI (estimate 0.64, 95% CI 0.33-0.94; p < 0.001) were independently predicted by the total FJOA score. A similar relation was seen with individual Weishaupt grades of each lumbar level after controlling for age, sex, BMI, and the Pfirrmann grade of the corresponding level. CONCLUSIONS: Atrophy of the multifidus muscle is significantly associated with FJOA in the lumbar spine. The absence of such correlation for the erector spinae and psoas muscles highlights the unique link between multifidus muscle quality and the degeneration of the spinal motion segment. Further research is necessary to establish the causal link and the clinical implications of these findings.