Sudeck-type dystrophy in Paget's disease of bone. An anatomico-radiological approach

Summary Anatomico-radiological study of a humerus with Paget's disease and unhealed fracture makes it possible to demonstrate the uneven development of the disease according to local conditions. The possible role of a bone dystrophy similar to that in Sudeck's disease which might — along with a slow virus infection — be involved in the development of Paget's disease is discussed. The discussion is based on the present case, on two previous studies as well as on data found in the literature.     

Synovial haemangioma of the knee: a case report

Synovial haemangioma is a rare but important cause of knee symptoms, which, when undiagnosed, can lead to significant morbidity. Diagnosis is frequently difficult and delayed. We report on a case of synovial haemangioma, which demonstrates the difficulties inherent in diagnosis and the morbidity associated with diagnostic delay, in a young woman. Magnetic resonance imaging (MRI) is a useful tool for diagnosis, but detection on MRI can also be problematic, as shown by this case, demonstrating the need for greater awareness of this condition by both clinicians and radiologists. Arthroscopy is important in both the diagnosis and treatment of these lesions.     

Transient osteoporosis of the Hip: a densitometric study

Summary Three new cases of transient osteoporosis of the hip are reported. Diagnosis was achieved by plain radiographs, bone scintiscan, magnetic resonance imaging and X-ray absorptiometry of proximal femurs. The densitometry showed at the Ward's triangle a mean reduction of bone mineral density in the affected side of 36%. All subjects were treated with i.v. clodronate for ten consecutive days with a complete recovery of femoral density within 4 months. X-ray absorptiometry allows a quantification of the demineralization process and can be useful in the long term evaluation of this entity.     

Chondrocalcinosis: Sonographic study of the knee

Summary Sonography of the knee was performed in 28 patients with chrondrocalcinosis and in 46 normal subjects. In each joint the authors examined synovial membrane, articular cartilage of femoral condyles, synovial fluid and menisci; they also searched for Baker's cysts. A significant thickening of synovial membrane was present. In 43 joints sonography showed linear hyperechoic images within condylar cartilage; they were parallel to bone surface and were interpreted as calcifications because of the coincidence with radiographic images. A significant thinning of articular cartilage was also found. Sonography of the knee is a useful method of examination for the evaluation of articular changes in chondrocalcinosis.     

Acute pseudoseptic arthritis after viscosupplementation of the knee: a case report

Intra-articular injections of hyaluronan are generally well tolerated; the most common adverse event associated with their use is an inflammatory reaction or a flare at the injection site. Naturally derived sodium hyaluronates have not been associated with pseudosepsis; we describe a case of severe arthritis mimicking acute septic arthritis after naturally hyaluronan. A 70-year-old woman had a medial femorotibial and patellofemoral compartment knee osteoarthritis. Hyaluronic acid injection was indicated because of the persistence of a pain while walking and restricted ability to walk 100 m, as well as the installation of a flessum. She was admitted for an evaluation of a joint effusion occurring within 48 h after the first hyaluronic acid intra-articular injection (first course), with no fever or chills. Joint fluid was found to be cloudy and contained 24,000 cells per mm(3). A knee aspiration was performed to evaluate the possibility of a joint infection. The examination of synovial fluid under phase contrast and polarizing microscopes showed no crystals, and culture on standard media was negative. Acute septic arthritis was considered to be the most likely diagnosis, and probabilistic antibiotic therapy was started. The result of the bacteriological examinations also returned negative. The absence of general signs, particularly fever and chills, with fast effusion regression in less than 4 days did not plead in favor of a septic origin. In front of this beam of arguments, antibiotic therapy was stopped after 4 days. The nonsteroidal anti-inflammatory drug (Nimésulide) was given. The clinical and laboratory test abnormalities were normalized within 2 weeks. Our case has the particularity to occur after using Curavisc, which is known as producing no allergenic reactions. Moreover, the described reaction occurred with the very first infiltration within the very first course.     

Bone mineral density is not related to severity of osteoarthritis in the knee in postmenopausal women

Although some studies have suggested that osteoporosis and osteoarthritis are inversely related in epidemiologic terms, a spectrum of relations between the two diseases has been described in this study. In 95 postmenopausal women (mean age 64.4 ± 8.49 years, range 49–83 years), we investigated the relation between bone mineral density (BMD) in the femoral neck and lumbar vertebrae (L2–L4) and osteoarthritis in the knee. BMD was measured with dual X-ray absorptiometry. Osteoarthritis was evaluated with anterior–posterior weight-bearing radiographs with the knee in extension, and these were graded for severity on a 5-point scale according to the Kellgren–Lawrence criteria. We found no clear statistical relation between BMD in the femoral neck or lumbar vertebrae and osteoarthritis in the knee. Given that some studies have found BMD to be significantly higher in patients with osteoarthritis, the lack of such relation in our patients may be due to environmental and/or genetic factors.     

Risk factors for knee osteoarthritis in Morocco. A case control study

Osteoarthritis (OA) of the knee is the most common form of arthritis. A positive association between obesity and several occupational factors and knee OA has been observed in previous studies in populations of different ethnicity. The aim of this study was to examine the relation between knee OA and body weight and occupational factors in a Moroccan sample of patients with knee OA. Our cases were consecutive patients diagnosed in our department with knee OA utilizing radiography in a 1-year period. No cases displayed established causes of secondary OA. Controls were selected randomly from the general population and were individually matched to each case for age and sex. Interviews were obtained from 95 cases and controls. Detailed information on general health status, height, weight, smoking habits, specific physical loads from occupation and housework, and sports activities was collected. The risk of knee OA increased with higher body mass index, odds ratio (OR) = 3.12 (95% confidence interval [CI] = 1.67–5.81; p < 0.0001). Sitting more than 3 h/day and climbing stairs more than 50 steps/day were associated with decreased risk of knee OA, OR = 0.29 (95% CI = 0.15–0.56; p = 0.02) and 0.48 (95% CI = 0.26–0.91; p < 0.0001), respectively. Overweight is a risk factor for knee OA, whereas sitting and climbing stairs are inversely associated with knee OA.     

Saline washout for knee osteoarthritis: Results of a controlled study

Summary Twenty patients with persistent symptoms due to osteoarthritis of the knee were randomly allocated to a saline washout or control group. Both groups showed improvement. Knee washout conferred no more benefit than intra-articular saline injection.     

Locking of the knee caused by localized pigmented villonodular synovitis: a case report

Abstract

Pigmented villonodullar synovitis (PVS) occurs in two forms: diffuse PVS and localized pigmented villonodular synovitis. In this report, a 40-year-old woman presented with a history of recurrent episodes of knee locking and pain. Arthroscopy revealed a nodular pedunculated mass occupying the area anterior to the intercondylar notch of the femur. Histological examination of the tissue confirmed the diagnosis of PVS. After surgery, the patient’s symptoms of pain and recurrent locking promptly resolved.     

Locking of the knee caused by localized pigmented villonodular synovitis: a case report

Pigmented villonodullar synovitis (PVS) occurs in two forms: diffuse PVS and localized pigmented villonodular synovitis. In this report, a 40-year-old woman presented with a history of recurrent episodes of knee locking and pain. Arthroscopy revealed a nodular pedunculated mass occupying the area anterior to the intercondylar notch of the femur. Histological examination of the tissue confirmed the diagnosis of PVS. After surgery, the patients symptoms of pain and recurrent locking promptly resolved.     

Randomised controlled trial of extraarticular gold bead implantation for treatment of knee osteoarthritis: a pilot study

The primary objective of this double-blind, randomised, controlled trial was to determine if implanting gold beads at five acupuncture points around the knee joint improves 1-year outcomes for patients with osteoarthritis (OA) of the knee. Participants were 43 adults aged 18–80 years with pain and stiffness from non-specific OA of the knee for over a year. The intervention was blinded implantation of gold beads at five acupuncture points around the affected knee through a hypodermic needle, or needle insertion alone. Primary outcome measures were knee pain, stiffness and function assessed by the patient at 0, 1, 3, 6, 9 and 12 months and knee score and knee function assessed by an orthopaedic surgeon at 0, 6 and 12 months. Within the first month, three patients dropped out. The remaining 21/19 patients in the intervention/control groups generally improved, but there was no statistically significant difference between the groups. The improvement was shown in the patients’ self-assessment scores that decreased from randomisation until 1 year later (intervention/control group, medians): pain −1.92/−2.18 (P = 0.95, F test, general linear mixed model); stiffness −0.93/−0.43 (P = 0.11); function −7.23/−3.36 (P = 0.63). The surgeon’s scores also generally improved, i.e. increased: knee score +16.4/+8.2 (P = 0.65); knee function +10.5/+5.8 (P = 0.79). In the protocol-based subgroup analysis, the 15 intervention patients of the 32 patients who had a positive response to the initial conventional acupuncture had greater relative improvements in self-assessed outcomes. The treatment was well tolerated. This 1-year pilot study indicates that extraarticular gold bead implantation is a promising treatment modality for patients with OA of the knee. The new treatment should be tested in a larger trial including only patients who respond positively to initial conventional acupuncture. Trial registration: ClinTrials.gov ID NCT00487370     

Reflex sympathetic dystrophy syndrome of one finger

Summary Reflex sympathetic dystrophy syndrome (RSDS) is a common but often unrecognized syndrome. It usually affects a leg or arm but may also be limited to parts of the extremity. We report a case of a 48-year-old patient who developed RSDS of only one finger. Especially, a limited form may delay recognition and therapy of a disease which can be treated successfully in an early phase.     

Hydrotherapy after total knee arthroplasty. A follow-up study

The study evaluated the subjective functional outcome following total knee arthroplasty (TKA) in participants who underwent hydrotherapy (HT) six months after discharge from a rehabilitation unit. A total of 70 subjects, 12 of which were lost at follow-up, were randomly assigned to either a conventional gym treatment (N = 30) or HT (N = 28). A prospective design was performed. Participants were interviewed with Western-Ontario McMasters Universities Osteoarthritis Index (WOMAC™) at admission, at discharge and six months later. Kruskal-Wallis and Wilcoxon tests were applied for statistical analysis. Both groups improved. The WOMAC™ subscales, namely pain, stiffness and function, were all positively affected. Statistical analysis indicates that scores on all subscales were significantly lower for the HT group. The benefits gained by the time of discharge were still found after six months. HT is recommended after TKA in a geriatric population.     

Transient osteoporosis of the hip with joint effusion detected by ultrasonography

Summary Three cases of transient osteoporosis of the hip and their ultrasonographic findings are presented. Transient osteoporosis of the hip is an uncommon condition with pain in the hip area and limping. The diagnosis is supported by local radiological osteoporosis and other imaging methods. Exclusion of more common entities is required. Effusion of the hip joint detected by ultrasonography is also related to this condition, which must be taken into account in patients with hip pain.     

复元胶囊对膝骨关节炎的疗效及机制

目的观察复元胶囊治疗膝骨关节炎(KOA)的临床疗效及机制。方法将60例辨证为肝肾不足、筋脉瘀滞证的KOA患者随机分为两组,治疗组予以复元胶囊口服,随机对照组予以仙灵骨葆胶囊口服。在治疗前后评定KOA严重性指数(ISOA)及中医症候积分,观察临床疗效和不良反应。治疗前后收集血清,采用酶联免疫吸附试验检测透明质酸(HA)的表达变化。结果治疗组、对照组均可明显缓解疼痛,改善膝关节功能。治疗组总有效率90.00%,对照组总有效率86.67%;两组治疗前后ISOA积分、中医症候积分均显著下降(P<0.05),组间无显著性差异(P>0.05)。治疗前治疗组、对照组血清HA水平较健康组明显增高(P<0.05);治疗后治疗组和对照组血清HA水平较治疗前明显降低(P<0.05)。治疗过程中,患者未出现严重不良反应。结论复元胶囊能有效缓解肝肾不足、筋脉瘀滞证KOA患者症状,可能通过降低HA的表达起作用。     

Intra-articular steroids in knee osteoarthritis: a comparative study of triamcinolone hexacetonide and methylprednisolone acetate

The aim of this study was to compare the effectiveness of triamcinolone hexacetonide (THA) and methylprednisolone acetate (MPA), given via the intra-articular route at equipotent dosage to patients with symptomatic knee OA with effusion, in a double-blind randomized comparative trial. Consecutive hospital-referred patients who fulfilled the American College of Rheumatology criteria for knee OA (clinical and radiographic) were randomly allocated to receive either THA 20 mg (1 ml) or MPA 40 mg (1 ml). All patients had synovial fluid aspirated from their knee joint at the time of injection. Assessments were made at 0, 3 and 8 weeks by a second operator, thus blinding both patient and assessor. Outcomes measured at each visit were: knee pain in the previous 48 h (expressed on a 100 mm visual analog scale; VAS), stair climb time (SCT) and Lequesne index score (LEQ). Changes in VAS, SCT and LEQ were compared between the groups using a Students paired t test. Fifty-seven patients were studied (44 female, 13 male) with a mean age of 62.5 years. Both steroids gave significant pain relief (VAS) at week 3 (p<0.01) but only MPA showed an effect on VAS and LEQ scores at week 8 compared to baseline (p<0.05). THA was more effective than MPA at pain reduction at week 3 (p<0.01); this difference was lost at week 8 (p=0.17). There was no significant difference between the two drugs in functional endpoints (SCT, LEQ) at either 3 or 8 weeks. Both THA and MPA offer at least temporary symptomatic benefit in knee OA. THA is more effective than MPA at week 3, but its effect is lost by week 8. MPA still has an effect at week 8.Abbreviations i.a. Intra-articular - LEQ Lequesne index score - OA Osteoarthritis - MPA Methylprednisolone acetate - SCT Stair climb time - THA Triamcinolone hexacetonide - VAS Visual analog scale     

A case of rheumatoid arthritis with methotrexate related lymphoproliferative diseases of the knee

Methotrexate (MTX) is the first choice disease-modifying antirheumatic drug (DMARD) for rheumatoid arthritis (RA) and is referred to as an “anchor drug”; its use has been steadily increasing annually. However, MTX-related lymphoproliferative diseases (MTX-LPDs) have emerged as important complications in the patients with RA. There have been no reports of intra-articular MTX-LPDs of the patients with RA.

Atypical cells were found in the patient’s joint fluid by cytological examinations, and MTX-LPDs were suspected. The patient discontinued MTX and open synovectomy was performed. The histological findings and immunohistochemical staining of the specimens confirmed the diagnosis of diffuse large B-cell lymphoma (DLBCL) of MTX-LPDs. After the operation of the patient’s left knee joint, pains and swollen joint disappeared with no relapse. The cytological examinations of the synovial fluid followed by knee operation were effective for early diagnosis of MTX-LPD. MTX discontinuation with no chemotherapy followed up with a knee operation improved the recovery of the MTX-LPD.     

Osseous mastocytosis of the knee

Mastocytosis is a rare pathology with possible bone involvement. This report describes an unusual case of solitary osteolytic lesion of the proximal right tibia, revealing an osseous mastocytosis, treated by bone cement injection. Follow-up showed a good clinical and radiological outcome, and the patient remains symptom-free 9 months after her surgery. To our knowledge, this is the first case reported in the literature.     

Differential strength decline in patients with osteoarthritis of the knee: revision of a hypothesis

A quadriceps-to-hamstring isometric peak torque ratio (Q/H ratio) of approximately 2.0 is considered necessary for appropriate knee biomechanics. Lower ratios may affectthe function of persons with osteoarthritis (OA) and the progression of the disease. This study examined theisometric Q/H ratio in subjects with and without OA of the knee and explored the effect of age, pain, and joint enlargement on the ratio. Twenty-one pairs of subjects (OA, control) were matched on age (X = 62.6 years; SD = 13.9), gender (F = 17, M = 4), and leg dominance (Dominant = 10, Nondominant = 11). Isometric quadriceps and hamstring peak torque, knee pain, and joint enlargement were measured. Paired t-tests demonstrated that the OA group had significantly lower quadriceps peak torque than the control group but did not have significantly lower hamstring peak torque or gravity-corrected isometric Q/H ratio. Age correlated with the ratio in subjects without OA (p = −0.46; P = 0.03) but not in subjects with OA. Pain was not significantly correlated with the ratio in either group. Joint enlargement correlated with the ratio in the OA group (p = −0.45; P = 0.03). The gravity-corrected isometric Q/H ratio appears to decrease with age in subjects without OA. In subjects with OA, the Q/H ratio appears not to change with disease, pain, or age. Joint enlargement may decrease the ratio and merits further study.