ISSN:1041-9918    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Osteoarthritis (OA) is the most common type of arthritis affecting synovial joints. Recent advances have altered the traditional progression of medical therapy for OA and have supplied new alternatives for the treatment of refractory OA. The new selective cyclooxygenase-2–inhibitory nonsteroidal anti-inflammatory drugs, celecoxib and rofecoxib, have significantly improved safety profiles, particularly with respect to serious gastrointestinal side effects and platelet inhibition. They should be used preferentially in higher-risk patients. Intra-articular viscosupplementation of the knee with exogenous hyaluronic acid has been approved by the US Food and Drug Administration as a medical device for the treatment of OA of the knee. It is reportedly as effective as nonsteroidal anti-inflammatory drugs for moderate OA of the knee. Finally, arthroscopic knee-joint lavage, with or without steroids, is another alternative for the treatment of knee OA; it should be considered before surgery is contemplated. Agents that may prevent cartilage degradation, such as the nutraceuticals (glucosamine sulfate, chondroitin sulfate, and collagen hydrolysate) or inhibitors of nitric oxide or metalloproteinases, may prove beneficial but are still under investigation.

ISSN:1041-9918    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Arthroscopy is a useful tool in the diagnosis of osteoarthritis. It is an excellent method for assessing the condition of the articular cartilage surfaces, the menisci, and the synovium. Its role in the management of osteoarthritis, however, has been more controversial. Despite earlier inconsistent results, arthroscopic management of degenerative arthritis of the knee has become an attractive alternative to osteotomy or total knee arthroplasty, at least partly because it is associated with lower costs and lower morbidity. Although it is clear that arthroscopic intervention does not alter the course of the osteoarthritic process, several reliable predictors of outcome have been delineated. Knees with varus or valgus deformity do worse than those without deformity. Patients with mechanical symptoms of relatively short duration will, statistically, fare better than those with chronic, persistent pain. Knees that have undergone previous arthroscopy do not do as well as those having first-time surgery. Knees with early-stage degenerative disease fare better than those with advanced disease. However, no evidence indicates that arthroscopic procedures can predictably serve as long-term treatment options in the management of the arthritic knee.

ISSN:1041-9918    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Arthrodesis of the knee as a treatment for primary arthritis is most often indicated for young, active patients with high functional demands, neuropathic arthropathy, and major soft tissue deficiencies. Failure of total knee arthroplasty is currently the most common indication for knee fusion. Intramedullary fixation is the procedure of choice for most patients. External fixation and dual plating may also be used if access to the medullary canal is not possible. Multiple revisions for total knee replacements that fail may result in conditions that preclude successful clinical outcome with any arthrodesis technique.

ISSN:1041-9918    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Patellofemoral arthritis is often encountered by those who treat patients with knee pain. When conservative treatment of patellofemoral arthritis fails, many surgical treatment options, ranging from isolated debridement procedures to total knee arthroplasty, are available. This article reviews the various treatment options that have been suggested in the recent literature.

ISSN:1041-9918    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

High tibial valgus osteotomy for varus gonarthrosis is a time-honored procedure in the treatment of medial compartment arthritis of the knee joint. The results of high tibial osteotomies have traditionally been shown in the literature to delay total knee arthroplasty from 5 to 10 years, on average. The ideal patient has classically been an active young person with a varus deformity of less than 10 to 12 degrees with primarily medial compartment arthrosis and uninvolved patellofemoral lateral compartments. Good bone stock is also desirable and, given that the osteotomy is performed through metaphyseal bone, healing has not been a problem with this procedure. The literature reports wide variations in the approach used for the high tibial osteotomy, implants used for fixation of the osteotomy, and ultimate outcome. Certainly, wide variations exist in the ultimate correction and alignment obtained from the osteotomy. This review focuses on the anatomic goals of the osteotomy, as well as recent and more classic reports of the results of this procedure.

ISSN:1041-9918    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Unicompartmental knee arthroplasty (UKA) has been done for more than 30 years with variable results and evolving indications and techniques. It is indicated in sedentary, non-obese patients with isolated unicompartmental arthritis, mild to moderate deformity, and an intact anterior cruciate ligament. The most commonly used implants are fixed-bearing devices, which are resurfacing components on the femoral and tibial side with at least 8 mm of polyethylene on the tibial side and minimally conforming topography. The surgical technique uses an exposure similar to that of total knee arthroplasty (TKA). Recent interest in minimally invasive techniques may transform this procedure from an inpatient to an outpatient or short-stay procedure. Short-term results with respect to pain relief and function are equal to or better than those of TKA. However, with longer-term follow-up, the failure rate is higher than that of TKA. The most common mechanism of failure is component loosening and progression of disease in the unresurfaced compartment. Conversion of failed modern UKA to TKA is usually straightforward and may or may not require particulate grafting of contained defects. The results of revision of failed UKA to TKA approach the results seen after primary TKA. The indications for UKA continue to evolve, and the procedure remains a valuable option for patients with unicompartmental osteoarthritis.

ISSN:1041-9918    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

In the year 2000, total knee arthroplasty is an accepted, reliable form of treatment of the end-stage arthritic knee, and there is a wealth of literature available to support its widespread success. For modern implants to be regarded as bona fide improvements over their predecessors, however, long-term prosthesis survival and patient satisfaction must be demonstrated.The ancestor of most contemporary implants was the Total Condylar Knee prosthesis, a posterior cruciate–sacrificing design. From this design, a multitude of different cruciate-substituting and cruciate-retaining designs have evolved, many of which have proven durable, reliable, and successful over the long term.Other, less popular designs have also been used with published long-term success. The concept of bicruciate retention continues to be implemented in an attempt to use minimal constraint and to allow for normal knee kinematics with reduced wear. Although cemented fixation has become the “gold standard,” various cementless implants have emerged in an attempt to improve upon fixation. Mobile-bearing designs have been developed to lower contact stresses and decrease interface stress and component loosening.The younger arthritic patient has traditionally represented a frustrating dilemma for the knee surgeon, but recent literature supports the decision to proceed with arthroplasty when end-stage disease is identified in this population.This article presents a brief overview of the available long-term data for the various designs of total knee arthroplasty applied to a variety of different patient populations.

ISSN:1041-9918    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Fibromyalgia was almost completely absent from an urban affluent population compared with poor urban and rural communities. Seventeen percent of Gulf War veterans with soft tissue syndromes had fibromyalgia, a much higher rate than was seen in previous studies of rheumatic disease in the military population. A state of central hyperexcitability in the nociceptive system was reported in fibromyalgia. Altered functioning of the stress-response system has been further documented in fibromyalgia and chronic fatigue syndrome. Administration of growth hormone to patients with fibromyalgia who have low levels of insulinlike growth factor 1 resulted in improvement in their symptoms and tenderness. An association between chronic fatigue syndrome and initial infections was demonstrated. A correlation between particular immunologic abnormalities and measures of disease severity was documented in chronic fatigue syndrome. Concomitant fibromyalgia in other rheumatic diseases was a major contributor to poor quality of life. A favorable outcome of fibromyalgia in children was reported; the majority of patients improved over 2 to 3 years of follow-up. Treatment of patients with fibromyalgia continues to be of limited success.

ISSN:1041-9918    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Chronic elbow tendinitis (medial or lateral epicondylitis and triceps tendinitis) are common disorders that, overall, have a good prognosis but, even with optimum management, require a minimum of 3 to 6 months to resolve. Patient education, activity modification, splinting, and corticosteroid injections each serve a role in symptom resolution; surgery is required in less than 10% of cases and has a similarly long period (3 to 6 months) of recovery. Acute tendon injuries (biceps and triceps ruptures) require early (<4 weeks) surgical repair but may be misdiagnosed, thus delaying management and requiring more involved surgical reconstruction. With appropriate treatment, the prognosis for each of these disorders is very good.

ISSN:1041-9918    

出版商:OVID    

年代:2000

数据来源: OVID