Lateral unicondylar knee arthroplasty (UKA): Contemporary indications,surgical technique,and results

Unicompartmental femoro-tibial osteoarthritis usually affects the medial compartment of the knee, but in 10 %, the lateral compartment is primarily involved. Femoral osteotomy is attractive to avoid TKA in younger patients with low-grade unicompartmental osteoarthritis and a valgus deformity. However, only limited functional results can be expected for patients with Ahlback grade 2 or greater osteoarthritis. Moreover, because of previous skin incisions and hardware removal, TKA after femoral osteotomy remains a complex procedure with poor functional results. Unicompartmental knee arthroplasty for both the medial and the lateral compartments has been performed since the 1970s. In a patient with involvement of only one compartment, a medial or a lateral UKA can provide a quicker recovery and enhanced function when compared to TKA. In addition, it preserves bone stock and can be “easily” revised by a TKA. Technical improvements, combined with strict patient selection, have resulted in ten year survivorships greater than 90 %. However, lateral UKA is technically more challenging than medial UKA due to the lower number of indications, as well as the functional anatomy of the lateral compartment. The goals of this article are to present up-to-date information concerning indications, patients’ selection, surgical technique and results of lateral compartment UKA.     

MOZ/TIF2-induced acute myeloid leukaemia in transgenic fish

The inv(8)(p11q13) chromosomal abnormality, described in acute myeloid leukaemias (AML), fuses the histone acetyl-transferase (HAT) MYST3 (MOZ) gene with another HAT gene, NCOA2 (TIF2). We generated a transgenic zebrafish in which the MYST3/NCOA2 fusion gene was expressed under control of the spi1 promoter. An AML developed in 2 of 180 MYST3/NCOA2-EGFP-expressing embryos, 14 and 26 months after injection of the fusion gene in a one-cell embryo, respectively. This leukaemia was characterised by an extensive invasion of kidneys by myeloid blast cells. This model, which is the first zebrafish model of AML, demonstrates the oncogenic potency of MYST3/NCOA2 fusion gene.     

A case of pericoronary pseudotumor due to localized Castleman's disease

BackgroundA 59-year-old male had a latent epicardial mass discovered at cardiovascular imaging during the assessment of an aortic murmur.ResultsThe resected mass surrounded the left anterior descending coronary artery. It was a well-limited pericoronary cellular lesion. It was made of a mixture of polytypic plasma cells, lymphocytes with lymphoid follicles, hyaline vascular hyperplasia, and focal eosinophils. No immunoglobulin and TCR-γ gene rearrangements were detected. In this immunocompetent patient, HHV-8 was negative.ConclusionThe pattern was consistent with a pericoronary localized Castleman's disease of composite histologic subtype.     

Indications for hepatic ultrasonography in breast cancer staging and follow-up

Retrospective analysis of the medical records of 6649 breast cancer patients seen over an 11-year period found 438 patients (6.6%) with liver metastases (LM) and 432 patients (6.5%) with benign liver lesions (BLL). Liver ultrasonography (LUS) and liver function tests had been performed for all patients. LM were the first manifestation of metastatic spread in 20.1% of the 438 patients; median survival was related to the presence (6.7 mo.) or absence (12.2 mo.) of extrahepatic metastases (EHM). Liver function tests were normal in 20.5% of the patients in whom LM were first diagnosed by LUS. Most LM were hypoechoic (70.9%). BLL corresponded to cysts, hemangiomas, calcifications, and focal fatty infiltration. LUS appears indicated for (i) pretherapy disease staging, and in particular for detection of BLL, and (ii) follow-up of patients without EHM for early diagnosis of LM.     

Long-term complete haematological and molecular remission after allogeneic bone marrow transplantation in a patient with a stem cell myeloproliferative disorder associated with t(8;13)(p12;q12)

A rare atypical myeloproliferative disorder (aMPD) associated with chromosomal translocations involving the short arm of chromosome 8, region p11-p12 has been described. In most patients, the cytogenetic abnormality is a t(8;13)(p12;q12) that fuses fibroblast growth factor receptor 1, the 8p12 key gene, to FIM/ZNF198 gene. Prognosis is poor with frequent evolution to acute myeloid leukaemia within 1 year of diagnosis. We report a new patient with aMPD with a t(8;13) translocation. Complete haematological, cytogenetic and molecular remission was demonstrated 39 months after allogeneic bone marrow transplantation. This is the first report to demonstrate a molecular remission in this disorder.     

Modern unicompartmental knee arthroplasty with cement: a three to ten-year follow-up study

BACKGROUND: Unicompartmental arthroplasty is a treatment alternative when only one compartment of the knee is affected with arthritis, but the reported results of this procedure have been variable. The purpose of the present study was to evaluate the results of a modern unicompartmental knee arthroplasty performed with use of a cemented metal-backed prosthesis and surgical instrumentation comparable with that used for total knee replacement. METHODS: The indications for the procedure were osteonecrosis or osteoarthritis associated with full-thickness loss of cartilage that was limited to one tibiofemoral compartment as evaluated on standing and stress radiographs. One hundred and sixty consecutive cemented metal-backed Miller-Galante prostheses in 147 patients were evaluated after a mean duration of follow-up of sixty-six months (range, thirty-six to 112 months). The mean age of the patients at the time of the index procedure was sixty-six years. RESULTS: Three knees were revised because of progression of osteoarthritis in the patellofemoral joint (two knees) or the lateral tibiofemoral compartment (one knee). Two knees had revision of the polyethylene liner. The average Hospital for Special Surgery knee score improved from 59 points preoperatively to 96 points at the time of the review. According to Kaplan-Meier analysis, the ten-year survival rate (with twenty-nine knees at risk) was 94% +/- 3% with revision for any reason or radiographic loosening as the end point. CONCLUSIONS: A modern unicompartmental knee arthroplasty is a valid alternative for patients with unicompartmental tibiofemoral noninflammatory disease. The patient selection must be strict with regard to the status of the patellofemoral joint. The preoperative planning includes stress radiographs to assess the correction of the deformity and the status of the uninvolved compartment. Continued long-term follow-up is necessary to evaluate long-term polyethylene wear.