Long-term effects of lateral wedge orthotics on hip and ankle joint space widths

BackgroundLateral wedge insoles have been used for the treatment of medial knee osteoarthritis (OA) and have been shown to reduce loading of the medial compartment of the knee. However, as the entire lower extremity acts as a single kinetic chain, altering the biomechanics of the knee may also have significant effects at the ankles or hips. We aimed to evaluate the effects of lateral wedge orthotics on ankle and hip joints, compared to neutral orthotics, by assessing the changes in joint space width (JSW) during 36 months of continuous use.MethodsWe prospectively enrolled 109 subjects with symptomatic osteoarthritis of the medial knee according to the American College of Rheumatology criteria. The trial was double blind and patients were randomized to either wedged or neutral orthotic shoe inserts. Hip and ankle JSWs were quantified using plain radiographies at baseline and at 36-months follow-up.Findings45 patients completed the 36 month study. 31 of those who completed the study were using the lateral wedge versus 14 were using neutral orthotics. 2 patients in the wedge group had missing radiographs and were not included in the JSW analyses. There were no significant differences between the wedge and the neutral orthotics groups in the magnitude of JSW change at either the hip or the ankles at 36 month.InterpretationWe found no significant adverse effects of the lateral wedges on ankles or hips. (ClinicalTrials.gov NCT00076453).     

Direct magnetic resonance arthrography of the knee: utility of axial traction

The purpose of this study was to determine the impact of axial traction during acquisition of direct magnetic resonance (MR) arthrography examination of the knee in terms of joint space width and amount of contrast material between the cartilage surfaces. Direct knee MR arthrography was performed in 11 patients on a 3-T MR imaging unit using a T1-weighted isotropic gradient echo sequence in a coronal plane with and without axial traction of 15 kg. Joint space widths were measured at the level of the medial and the lateral femorotibial joint with and without traction. The amount of contrast material in the medial and lateral femorotibial joint was assessed independently by two musculoskeletal radiologists in a semiquantitative manner using three grades (‘absence of surface visualization, ‘partial surface visualization or ‘complete surface visualization’). With traction, joint space width increased significantly at the lateral femorotibial compartment (mean = 0.55 mm, p = 0.0105) and at the medial femorotibial compartment (mean = 0.4 mm, p = 0.0124). There was a trend towards an increased amount of contrast material in the femorotibial compartment with axial traction. Direct MR arthrography of the knee with axial traction showed a slight and significant increase of the width of the femorotibial compartment with a trend towards more contrast material between the articular cartilage surfaces.     

The validity of radiographic assessment of childhood transient synovitis of the hip

The diagnostic significance of some radiographic signs (abnormal hip 'joint space' and periarticular fat layers) as indicators of hip joint effusion or hip complaints without effusion was studied with ultrasonography and radiography in 47 children (58 examinations), of whom 40 had acute unilateral transient synovitis. It was found that 'joint depth' was not influenced by presence of intra-articular fluid collections; blurring and/or displacement of the periarticular fat pads medial and lateral to the hip joint occurred more frequently when joint effusion was present than in symptom-free hips or in painful hips without effusion. The radiographic signs provided, however, too low diagnostic accuracy to be of practical value. It is suggested that ultrasonography of the hip joint is a valuable means in obtaining a better definition of the diagnosis transient synovitis.     

Study of the joint space of the hip on supine and weight-bearing digital radiographs.

AIM: To compare hip joint space on supine and weight-bearing anteroposterior digital radiographs. MATERIALS AND METHODS: Fifty anteroposterior views of the hip in 25 patients were taken in supine and weight-bearing positions on a fluoroscopic unit. Two observers in a double-blind study assessed the width of the joint space on an Easy Vision unit with an indirect method of measurement (metric index). RESULTS: Inter-observer and intra-observer variabilities of the metric index were less than 4.1%. There was no significant difference of the metric index of the hip (P>0.05), between supine and weight-bearing positions. CONCLUSION: There is no significant difference of the width of the joint space of the hip between supine and weight-bearing anteroposterior radiographs. Measuring joint space loss in osteoarthritis of the hip with anteroposterior views should be done with radiographs of the hip in the supine position to improve image quality.     

Radiological and computed tomographic studies of the width of the normal hip joint in men aged 30-60 years

We made an attempt to evaluate the width of the joint space of the normal hip joint in men aged 30-60 years. We analysed 164 roentgenograms and 68 CT scans of the pelvis measuring the width of the right and left hip joint in four segments of the frontal plane (roentgenograms) and in three segments of the horizontal plane (CT scans). In each segment we determined the mean width of the joint space and mutual relation between the measurements by an analysis of variance and correlation coefficient. It was shown that with advancing age of the patient the joint space increased bilaterally in the inferoposterior part (segment IV on the roentgenograms and segment III on the CT scans). The width of the joint space did not change significantly with age in the remaining segments of the hip joint.     

Painful infection at the site of hip prosthesis: CT imaging

PURPOSE: To prospectively determine the accuracy of computed tomography (CT) in the detection of painful infection at the site of hip prosthesis before surgery. MATERIALS AND METHODS: Helical CT examinations of hip prostheses were prospectively performed before surgery after a standard clinical and radiologic examination of 65 patients. CT scans and conventional radiographs were reviewed for periprosthetic bone abnormalities, and CT scans were reviewed for periprosthetic soft-tissue abnormalities (joint distention, fluid-filled bursae, and fluid collection in muscles and perimuscular fat). Patients subsequently underwent revision arthroplasty within 1 month, and infection was diagnosed in 12 (19%) patients. RESULTS: Infection was detected clinically in 25% of patients. Periprosthetic bone abnormalities did not allow differentiation of infection from complications not related to sepsis, except for periostitis, with 100% specificity but only 16% sensitivity. Soft-tissue findings were accurate for detection of infection, with 100% sensitivity and 87% specificity. Fluid collection in muscles and perimuscular fat had a 100% positive predictive value, and absence of joint distention had a 96% negative predictive value. CONCLUSION: CT is accurate in the diagnosis of painful infection at the site of a hip prosthesis on the basis of soft-tissue findings, whereas periprosthetic bone abnormalities are not useful.     

强直性脊柱炎髋关节改变的X线、CT和MRI对比研究

目的 探讨强直性脊柱炎(AS)髋关节受累的影像表现,比较X线平片、CT和MRI显示AS髋关节受累的敏感度.方法 对55例AS患者行骨盆X线平片和MR检查,其中29例行髋关节CT检查.MR平扫均包括冠状面T1WI、T2WI、STIR、附加水激励的三维稳态快速梯度回波序列(3D-BTFE-WATS),其中24例同时行脂肪抑制T1WI增强检查.分析患者的影像资料,应用x2检验对X线平片、CT和MRI显示AS髋关节受累改变的敏感度进行分析.结果 55例AS患者110侧髋关节中,X线平片和MRI显示异常分别为13侧和85侧;X线平片改变包括关节面下骨侵蚀破坏13侧、关节间隙变窄4侧、韧带骨赘5侧;MRI显示关节面下骨侵蚀破坏31侧、关节间隙变窄4侧、关节少量积液80侧、骨髓水肿32侧、脂肪沉积28侧、韧带附着点炎21侧,24例行MR增强检查患者中19例见双侧滑膜异常强化.CT检查29例共58侧髋关节,CT在显示X线平片和MRI所显示的骨破坏同时,发现X线平片未能显示的10侧骨破坏和MRI未显示的1侧骨破坏.X线平片、CT、MRI显示异常分别为10.3％ (6/58)、27.6％ (16/58)和77.6％ (45/58),MRI显示髋关节受累的敏感度优于X线平片和CT(x2值分别为53.22和29.08,P值均＜0.05).MRI除显示X线平片和CT所能显示的慢性骨结构改变外,还发现X线平片和CT未能显示的急性炎症改变.结论 MRI能显示X线平片和CT不能显示的AS髋关节受累的急性炎症改变,滑膜炎所致的少量积液和滑膜异常强化是髋关节受累最常见的MRI表现.     

Digital radiographic evaluation of medial joint space narrowing after partial meniscectomy of bucket-handle medial meniscus tears in anterior cruciate ligament-intact knees

BACKGROUND: Few studies exist that evaluate the effect of partial medial meniscectomy in knees with intact anterior cruciate ligaments. HYPOTHESIS: Partial meniscectomy of bucket-handle medial meniscus tears will cause joint space narrowing. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Between 1982 and 2001, 135 patients met the study criteria of a partial medial meniscectomy, intact ligaments, no surgery to the contralateral knee, and no chondromalacia greater than grade II. Seventy-nine patients living within 150 miles of the clinic were asked to return for physical examination. Joint space narrowing was measured from the middle of the femoral condyle to the middle of the tibial plateau using digitally magnified weightbearing 45 degrees flexed posteroanterior and full-extension anteroposterior radiographs. Measurements were performed twice with the observer blinded to the previous measurements. Subjective follow-up was obtained prospectively on an annual basis with International Knee Documentation Committee and modified Noyes knee questionnaires. RESULTS: Forty-nine patients were examined at a mean of 11.8 years postoperatively. Mean medial joint space narrowing was 1.2 +/- 0.5 mm on 45 degrees flexed posteroanterior radiograph and 0.2 +/- 0.9 mm on full-extension anteroposterior radiographs (P < .001). Four patients had 2 mm or more of joint space narrowing. Subjective surveys obtained from 95 patients showed a mean subjective score of 89.9 points. Subjective scores did not decrease through time, and there was no correlation of joint space narrowing to lower subjective scores. CONCLUSION: Partial medial meniscectomy in stable knees causes only mild joint space narrowing (mean, 1.2 mm) at a mean 12-year follow-up. Digitally magnified 45 degrees flexed posteroanterior radiographs are more likely to demonstrate joint space narrowing than are full-extension anteroposterior radiographs.     

Meniscal allograft transplantation: long-term clinical results with radiological and magnetic resonance imaging correlations

Long-term data on the clinical outcome and the fate of the meniscus allograft after transplantation are scarce. In this study we present the clinical, radiological and MRI outcome of the meniscus graft and the articular cartilage after 42 meniscus allograft transplantations in 41 patients with a minimum follow-up of 10 years. A total of 27 medial and 15 lateral meniscal allografts were transplanted. Eleven of the medial allograft procedures were associated with a high tibial osteotomy. The patients were evaluated clinically at the time of transplantation and at the final follow-up using the modified HSS scoring system. The knee injury and osteoarthritis outcome score (KOOS) was used as an evaluation tool for patient-related outcome at the final follow-up. Joint space width narrowing and Fairbank changes were radiological outcome parameters, which were available for 32 patients. Femoral and tibial cartilage degeneration, graft extrusion and signal intensity were scored on MRI scans obtained in 17 patients approximately 1 year after transplantation and at the final follow-up (>10 years). For statistical analysis the patients were divided into three groups: lateral meniscal allograft (LMT), medial meniscal allograft transplantation with a high tibial osteotomy (MMT+HTO) and without (MMT). The modified HSS score revealed a significant improvement in pain and function at the final follow-up for all groups. Further analysis also revealed that an MMT+HTO procedure resulted in a greater improvement at the final follow-up when compared to MMT. Nonetheless, the KOOS scores obtained at the final follow-up revealed the presence of substantial disability and symptoms, in addition to a reduced quality of life. Radiographical analysis revealed no further joint space narrowing in 13/32 knees (41%). Fairbank changes remained stable in 9/32 knees (28%). MRI analysis showed no progression of cartilage degeneration in 6/17 knees (35%). An increased signal intensity of the allograft was present, as was partial graft extrusion in the majority of patients at the final follow-up. Seven cases had to be converted to a total knee arthroplasty during the follow-up; the overall failure rate was 18%. Long-term results after viable meniscus allograft transplantation are encouraging in terms of pain relief and improvement of function. Despite this significant improvement, substantial disability and symptoms were present in all investigated subgroups. Progression of further cartilage degeneration or joint space narrowing was absent in a considerable number of cases, indicating a potential chondroprotective effect. Level of evidence is therapeutic study, Level IV and retrospective analysis of prospectively collected data.     

Changes in temporomandibular disc position during growth in young Japanese

PURPOSE: To detect the initial changes in temporomandibular disc position during growth with MRI examination in a prospective longitudinal study of a young Japanese population. METHODS: Forty-four temporomandibular joints in 22 healthy asymptomatic volunteers, mean age 11.8 years, age range 9-16 years, were examined by MRI. They were re-examined 2-3 years later. The mean age and age range at the second examination were 14.5 years and 12-19 years, respectively. The discs were assessed at three different locations by oblique sagittal planes at the lateral, central and medial parts, and the displacement was evaluated as a partial anterior or total anterior position. RESULTS: Six joints already had a partial anterior position of the disc at the initial examination and no developmental change in disc position was observed during the examination period. Nine joints developed partial disc displacement during the examination period. Every partial displacement was observed at the lateral part of the disc. One joint developed a total anterior position from the lateral to the medial images. CONCLUSIONS: Initial changes in the disc position are likely to start from the lateral part of the joint in the early teenage years and are often asymptomatic.     

寰枢关节类风湿关节炎的CT 评价

目的：探讨C T及三维后处理技术在诊断类风湿性关节炎累及寰枢关节中的临床价值。方法分析15例临床类风湿性关节炎确诊病例的寰枢关节CT图像,并利用工作站分别进行多平面重建（M PR）和容积再现（VR）成像等进行CT图像的三维后处理,分析寰枢关节骨质、关节间隙、是否半脱位及方向等CT表现。结果类风湿性关节炎累及寰枢关节的主要CT表现为骨质稀疏（6／15）,骨质破坏（9／15）,关节间隙的变窄或增宽;半脱位7例,其中前半脱位3例,侧方半脱位2例,前后脱位伴侧方脱位2例;2例出现颅底凹陷伴神经病变和椎动脉供血不足,4例因寰枢关节前半脱位引起椎管狭窄,造成脊髓压迫。结论 CT及三维后处理技术在类风湿性关节炎累及寰枢关节的诊断中发挥着重要的临床作用。     

The fate of the joint space in Legg–Calvé–Perthes’ disease

Objective

This study was undertaken to identify variations in the hip joint space in patients with healed Legg–Calvé–Perthes’ disease (LCPD) and to correlate these changes with the radiological outcome of treatment.

Methods

The width of the joint space was measured on radiographs of 121 skeletally mature individuals with healed LCPD. The joint space width at the stage of healing in 79 patients was compared with the joint space at skeletal maturity. The hips were graded by the Stulberg classification and the femoral head radius was measured. Associations between the joint space width, the Stulberg class and the femoral head radius were tested. The reproducibility of measurement was tested by measuring 30 radiographs twice and computing the intra-class correlation coefficient (ICC). The joint space width was measured on radiographs of 25 patients taken both while recumbent and standing, to determine if the joint space alters on weight-bearing.

Results

The reproducibility of measurements was satisfactory; no difference was noted in the joint space in recumbent and weight-bearing films. Increased joint space was noted both at healing of the disease and at skeletal maturity; the width was minimally increased in Stulberg Class I hips and considerably increased in Class III, IV and V hips. There was a significant correlation between the increase in joint space and enlargement of the femoral head.

Conclusions

An increase in joint space width occurs quite frequently following LCPD; the increase is most evident in hips with a poor outcome. The implications of this observation need to be elucidated.     

全髋关节置换术中髋关节偏心距重建对临床效果的影响

目的探讨全髋关节置换(THA)术中偏心距的恢复和重建在髋关节软组织张力平衡中的作用,分析重建髋关节偏心距与术后双下肢不等长以及髋关节功能恢复的关系。方法随机选择2008年1月~2012年5月收治的单侧THA患者98例,采用髋关节后外侧入路。全部使用Depuy(强生)公司(Pinnacle Acetabular System)髋系统和Corail人工关节柄。手术前后影像学检查:骨盆前后位X线片,髋关节三维CT扫描,双下肢全长X线片;测量双下肢全长、股骨偏心距的长度、髋臼偏心距的长度、髋关节外展肌力矩关节偏心距和其他指标的相关性。结果 (1)髋关节偏心距与髋关节外展肌力矩有正相关性(r=0.558,P0.001);(2)髋关节术后的活动度Harris评分与髋关节偏心距具有明显的回归相关关系(r=0.439,P0.001);(3)髋关节偏心距的重建对双下肢长度的影响存在着显著的意义(χ2=4.83,P0.01)。结论 THA术中偏心距的重建,可增加髋关节外展肌力矩和髋关节的活动度,与功能的改善及稳定性增加呈正相关。     

鼻咽癌咽旁间隙CT与MRI对照观察

目的准确认识鼻咽癌(NPC)咽旁间隙改变的CT征象。方法收集病理确诊的初诊NPC30例,同时行治疗前的CT和MRI检查。结果30例NPC咽旁间隙表现按CT所见分为以下四种情况,与其MRI表现作对照观察统计如下(1)CT所见咽旁间隙正常者MRI表现为前窄后宽的三角形线条状连续高信号脂肪影;(2)咽旁间隙CT表现为变窄伴线样低密影,在MRI上表现为咽旁间隙的高信号脂肪影受压,但仍连续无中断;(3)CT所见咽旁间隙变窄且密度增高,在MRI上表现为高信号脂肪影极度变窄,但仍可见连续;(4)CT所见咽旁间隙消失者,在MRI上咽旁间隙被肿块占据,翼外肌推移,其内侧脂肪间隙消失,但翼内、外肌信号正常或不正常。结论(1)CT上咽旁间隙变窄,且密度增高,但仍可见低于肌肉的线样影,肿块未突破咽旁间隙;(2)CT上咽旁间隙完全消失者,肿块可能跨过咽旁间隙达颞下窝。     

Quantitative CT of the orbit in Graves' disease

In order to determine the value of quantitative CT of the orbit in patients with Graves' disease, we clinically examined 174 orbits of 87 patients with Graves' disease and evaluated them by CT in respect to the density and size of the extraocular muscles, the globe position and the width of the optic nerve-sheath complex. We also determined the normal ranges for density of extraocular muscles in 200 normal orbits of 100 patients for comparison. Normal ranges for the density of extraocular muscles were (mean +/- 2 SD) medial rectus, 28-63 HU; lateral rectus, 24-78 HU; inferior rectus, 20-64 HU; superior muscle group, 28-62 HU. 51 of 77 (66%) patients with Graves' disease had extraocular muscle density changes. Some extraocular muscles showed fatty infiltration on CT. 50 of 87 (57%) patients had at least one enlarged extraocular muscle, 47 (54%) patients had exophthalmos and 59 (68%) patients had either exophthalmos and/or extraocular muscle enlargement. A diagnosis of Graves' ophthalmopathy was made in 69 of 87 (79%) patients using CT and in 50 (57%) patients by clinical examination. We conclude that quantitative CT imaging of the orbit with evaluation of the size and density values of extraocular muscles and the globe position may be very helpful in detecting ophthalmopathy in patients with Graves' disease.     

A primer for physical examination of the elbow

The elbow is a complex joint consisting of 3 separate but important articulations: the ulnohumeral, radiohumeral, and proximal radioulnar joints. The elbow assists in positioning the hand in space through 2 important motions, flexion-extension and pronation-supination. Although the elbow is not a weightbearing joint, it is subjected to significant loads, especially in overhead and throwing athletes. An accurate knowledge of the anatomy and physiology of the elbow joint is critical for conducting a focused physical examination and arriving at an accurate diagnosis. The goal of this article is to review general and focused physical examination of the elbow in a systematic manner based on medial, lateral, anterior, and posterior aspects.     

CT三维重组诊断寰枢关节不全脱位的实验及临床研究

目的 比较寰枢关节的影像检查方法及技术，评价CT三维重组（CT3D）诊断寰枢关节不全脱位的临床价值。方法 实验研究寰枢关节骨标本1套，模拟出寰枢关节正常及脱位的模型，进行X线、常规CT及CT3D检查。前瞻性分析影像学特点及诊断准确率。临床患者87例进行中立位CT3D检查，其中28例加行左、右旋转位。分析CT3D显示脱位征象的特点及诊断寰枢关节不全脱位的临床效果。结果 实验组CT3D能清楚、直观的显示寰枢关节不全脱位各种征象，诊断准确率达100％。表面阴影法（SSD）CT3D显示寰枢外侧关节面错位最清楚，寰椎下关节面错位程度测量值与标本测量值差异无统计学意义（P〉0．05）。87例患者中诊断为寰枢关节不全脱位72例，其中旋转型脱位52例，前脱位13例，后脱位7例。中立位显示寰枢外侧关节面错位72例，旋转位显示为旋转固定8例，旋转不对称15例。结论 CT3D能显示寰枢关节不全脱位的各种征象，特别是寰枢外侧关节面错位。其中SSD法3D较X线、常规CT的诊断准确率高，具有成为诊断寰枢关节不全脱位金标准的条件。     

侧卧位和仰卧位PFNA治疗肥胖患者股骨转子间骨折的临床疗效对比研究

目的比较侧卧位和仰卧位股骨近端抗旋髓内钉(PFNA)手术治疗肥胖患者股转子间骨折的临床疗效。方法回顾性分析笔者医院2011年5月~2015年4月收治的35例肥胖的股骨转子间骨折患者临床资料,其中男性14例,女性21例;平均年龄(62.54±10.32)岁。依据不同的PFNA手术操作体位划分仰卧组(16例)及侧卧组(19例),对比分析两组患者手术切口长度、术中失血量、手术操作时间、住院天数、骨折临床愈合时间、并发症,并根据Harris髋关节功能评分系统评价患髋功能。结果侧卧组患者手术切口长度、术中失血量、手术操作时间均分别少于仰卧组,差异有统计意义(P0.05);而两组患者在住院天数、并发症、骨折临床愈合时间和患髋功能评分上差异无统计学意义(P0.05)。结论对于肥胖患者,采用侧卧位PFNA手术治疗股骨转子间骨折比采用仰卧位更具有优势,值得临床推广。     

A cadaveric model for ligamentum teres function: a pilot study

Purpose

Despite the prevalence and clinical consequences of ligamentum teres pathology, its function is poorly understood. The purpose of this study was to help define the role the ligamentum teres may have in hip joint stabilization and determine whether a ball and string model could be used to describe the function of the ligamentum teres.

Methods

Eight embalmed cadavers were dissected to remove all soft tissue from around the hip, leaving only the ligamentum teres intact. Available hip abduction, adduction, medial rotation, and lateral rotation range of motion were measured for three repeated trials. The position of the ligamentum teres in relation to the femoral head was recorded at the endpoint position of these movements.

Results

An endpoint position as limited by the ligamentum teres for abduction, medial rotation, and lateral rotation was identified at a mean of 73°(SD 11°), 64°(SD 11°), and 58°(SD 10°), respectively. Hip adduction was limited by bony contact and therefore was not measured. The ligamentum teres wrapped around the femoral head to prevent inferior, posterior, and anterior subluxation with abduction, medial rotation, and lateral rotation, respectively. Repeated measures ANOVA indicated no significant difference in endpoint position based on trial number for the three movements (n.s.).

Conclusion

The ligamentum teres consistently tightened to limit hip abduction, medial rotation, and lateral rotation. These results support a ball and string model for the femoral head and ligamentum teres. This information could be important for those with hip instability and ligamentum teres pathology.     

跟骨距骨桥的诊断及形态分型

目的：探讨跟距骨桥的形成机制与解剖形态特点。方法：本组25例均摄正侧位X线片，其中4足行CT横断扫描，10足行斜位X线点片，单侧21例，双侧4例，共有跟距骨桥29足。结果：关节增生硬化型：共17足，X线平片上可见跟、距关节内侧的骨性突起，跟、距骨的异常骨块表面光滑、致密，距骨内结节增大，呈帽状覆盖于异常增大的载距突上，跟、距两骨间有一间隙。CT片可见跟、距关节间隙变窄，边缘变尖、硬化、翘起，尤以跟、距后关节为著。关节融合型：共10足，在X线平片及CT上可见跟、距关节间隙消失，跟、距骨间呈骨性连接。骨桥型：2足，跟、距关节间隙存在，跟距两骨间有一带状骨影相连，正位片呈拱桥状弧形内突。结论：跟距骨桥的X线形态分型，对本病的临床诊断、治疗具有指导意义。