ISSN:0885-9698    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

SummaryMetacarpophalangeal (MCP) joint arthroplasty is commonly performed in patients with rheumatoid arthritis to minimize pain, correct ulnar drift, and improve hand function. Silicone implants for joint replacement have been used since the early 1960s, and this procedure is still regarded as the gold standard for MCP joint arthroplasty. The drawbacks of this technique are limited range of motion, subsidence of the implants, and wearing of the silicone. Nonconstrained implants used with or without cement fixation have been introduced to overcome these drawbacks. The function of these implants is relying on the stabilizing soft tissues around the joints. The use of nonconstrained implants is thus limited to patients without severe deformity of their MCP joints.

ISSN:0885-9698    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

SummaryOnly a stable pain-free wrist joint makes the use of the hand effective. Stability and mobility, which are in inverse relationship, will guide therapeutic indications. Indication of fusion, extension, and position of the wrist are important to define and discuss preoperatively with the patient. Stabilization is done by fusion as limited as possible to preserve as much as possible of mobility in flexion–extension and radial–ulnar deviation. Total wrist fusion can be accepted as a “winning operation” in advanced rheumatoid cases. However, today it is not accepted to offer the patient a bilateral total wrist fusion. The combination total wrist fusion on one side and arthroplasty or partial wrist fusion on the other side seems to be the best solution to offer to the patient. Radiolunate (RL), Radioscapholunate (RSL), and total wrist fusion are the possibilities that can be offered to patients, depending of the importance of the wrist destruction and instability. The corticocancellous gliding technique can be used for RL, RSL, and total wrist fusion. This technique gives postoperative stable fusion with a low profile fixation and avoids harvesting of bone transplant in another localization than the wrist itself.

ISSN:0885-9698    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

SummaryThe distal radioulnar (DRU) joint is the keystone weight-bearing joint of the distal forearm. The classic excision of the ulnar head described in many procedures has to be evaluated carefully. In rheumatoid arthritis, the ulnar column of the carpus tends to slide anteriorly with supination of the carpus. The DRU joint can dislocate with accentuation of the prominence of the ulnar head as a result of the anterior dislocation of the carpus and the radius. This creates caput ulnae syndrome. The main goal of surgery of the rheumatoid wrist is a pain-free wrist with restoration of painless pronation/supination. This can be achieved by synovectomy and ulnar head resection. However, the complications with ulnar stump instability are not negligible, and the stabilization of the ulna remains the major concern of this surgery. DRU joint fusion, according to Sauvé-Kapandji, does not reduce the ulna stump problems, but gives a better residual anatomy of the wrist and is recommended in younger patients. DRU joint prostheses are under development and today are only indicated as a salvage procedure. However, in the near future, the DRU joint will be treated with synovectomy and stabilization by resurfacing implant.

ISSN:0885-9698    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

SummaryArthroplasty of the wrist joint was previously performed mainly with silicone implants, which in many studies have shown high frequencies of wearing. In the beginning of the 1980s, early reports of nonconstrained spherical implants, used both with and without cement fixation, were encouraging, despite the difficulties in balancing the implants into the center of movement of the wrist joint. The introduction of biaxial implants has improved these results, which are reliable in terms of functional range of motion, stability, and pain relief. The biaxial implant introduced by Beckenbaugh is used without cement with stemmed components for both the radial and carpal parts. Loosening of the distal component has been reported, and a revision implant with a longer stem has been designed. The Universal Total Wrist Implant designed by Menon has a stemmed radial component, but the carpal component is fixated to the fused distal carpal bones with titanium screws. Loosening has not been reported, but instead, a rather high frequency of early dislocations. A new implant design (UTW2) has recently been introduced to overcome these difficulties. Arthroplasty of the distal radioulnar joint is, in most cases, performed with a hemiarthroplasty replacing only the ulnar head. Arthroplasty of the wrist joint is today a common and reliable procedure, which could be performed mainly in patients with rheumatoid arthritis as an alternative to wrist fusion.

ISSN:0885-9698    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

SummaryTotal elbow replacement has become perhaps the most frequent surgical procedure for the rheumatoid elbow. It has become increasingly popular despite the lack of long-term follow-up reports for many implants, and it can be anticipated that more patients will demand the operation in the future. The stability of nonconstrained implants depends on the approach. In the lateral approach, the medial collateral ligament and the main part of the triceps tendon are preserved, which allows for proper soft tissue balancing. Wound complications are few and the lateral approach seems safe to use with the capitellocondylar type of prosthesis in rheumatoid elbows with reasonably well-preserved bone stock. The minimal amount of bone resection makes revision relatively easy regardless of whether you go for resection arthroplasty or exchange of the prosthesis.

ISSN:0885-9698    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

SummaryThe rheumatoid shoulder and elbow should be assessed in an early stage concerning the possibility of surgical intervention. The cause of the shoulder pain can be localized elsewhere in the shoulder girdle or in the neck. In patients with glenohumeral pain, resurfacing of the humeral head with a cup seems to be a good alternative to conventional stemmed prostheses. It diminishes the risk of peroperative complications involving the humeral shaft and late periprosthetic fractures. Revision or arthrodesis can be undertaken easily because the bone stock has been maintained with no loss of length. The main advantages of humeral head resurfacing are preservation of bone and the relatively simple surgical technique.

ISSN:0885-9698    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

SummaryControl of hip disease is very important for maintaining mobility and independence in patients with juvenile idiopathic arthritis (JIA). Hip deformity and pain must be treated early by drugs and physiotherapy and, if necessary, by arthroscopic joint lavage and corticosteroids. Core decompression is a minor procedure that can provide considerable relief from aching pain. Soft tissue releases as well as intertrochanteric osteotomy can affect the loading situation of the whole lower extremity, and also give the possibility of regeneration of cartilage in children with clinical deformities and radiographic growth disturbances of the hip. Minor surgical procedures should always be considered if they can delay the requirement for total joint replacement.

ISSN:0885-9698    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

SummaryIt has been generally accepted that residual cartilage and subchondral bone has to be removed to get bony fusion in arthrodeses. In 1998, we reported successful fusion of 11 rheumatoid ankles, all treated with percutaneous fixation only. This method is restricted for ankles with normal or at least functional alignment. Animal studies confirmed that it is possible to achieve arthrodesis without removal of cartilage and that synovial depletion is the possible mechanism behind cartilage disappearance. The stability of the fixation achieved at arthrodesis surgery is an important factor in determining success or failure. A good fit of the bone surfaces appears necessary. The results of our biomechanical studies indicate that the arch shape and the subchondral bone should be preserved performing ankle arthrodesis. The importance of this is likely to increase in weak rheumatoid bone. Overall, inserting the 2 screws at a 30° angle with respect to the long axis of the tibia and crossing them above the fusion site improves stability for ankle arthrodesis. In conclusion, the percutaneous technique is suitable for patients with rheumatoid arthritis and a painful ankle with complete loss of joint space but with no deformity to correct.

ISSN:0885-9698    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

SummaryInterest in total ankle arthroplasty has been reawakened by the introduction of the mobile-bearing designs. The Scandinavian total ankle replacement (STAR) is 1 such design, and the author has used it regularly over the past 10 years for 150 patients with rheumatoid arthritis. The author describes some modifications to the surgical technique and some new instruments that he has found of value. It is his opinion that it is essential to obtain excellent exposure of the lateral compartment of the ankle joint before making the distal tibial resection. Preoperative varus or valgus deformity is associated with an increased incidence of complications. The author advises extreme caution in undertaking ankle replacement when the deformity is greater than 20°.

ISSN:0885-9698    

出版商:OVID    

年代:2003

数据来源: OVID