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Knee Exam

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13021. Spontaneous recurrent hemarthrosis of the knee in the elderly: arthroscopic treatment and etiology. (Abstract)

on 17 cases. For 2 PF OA cases, synovectomy and a histologic examination of synovium were performed. Remission was obtained for 18 cases. The unsuccessful case had cirrhosis of the liver.A majority of the patients (17 of 19) had degenerative torn lateral menisci confirmed with MRI and at arthroscopy. Successful outcomes were achieved by meniscectomy and coagulation. Most so-called spontaneous recurrent hemarthroses in OA knee joints appear to be attributable to torn lateral menisci.Level IV (...) Spontaneous recurrent hemarthrosis of the knee in the elderly: arthroscopic treatment and etiology. To elucidate the etiology of and find a preferable surgical treatment for spontaneous recurrent hemarthrosis in osteoarthritic knee joints arthroscopically.Nineteen patients referred to our institution from affiliate hospitals between April 1998 and October 2006 were involved in this study. Their demographics, preoperative radiographic findings, preoperative magnetic resonance imaging (MRI

2008 Arthroscopy

13022. C-reactive protein, metabolic syndrome and incidence of severe hip and knee osteoarthritis. A population-based cohort study. Full Text available with Trip Pro

C-reactive protein, metabolic syndrome and incidence of severe hip and knee osteoarthritis. A population-based cohort study. To explore the relationships between C-reactive protein (CRP), metabolic syndrome (MetS) and incidence of severe knee or hip osteoarthritis (OA) in a prospective study.A population-based cohort (n=5171, mean age 57.5+/-5.9 years) was examined between 1991 and 1994. Data was collected on lifestyle habits, measures of overweight, blood pressure as well as high-density (...) lipoprotein (HDL) cholesterol, triglycerides, glucose and CRP measured with high-sensitive methods. Incidence of severe OA, defined as arthroplasty due to knee or hip OA, was monitored over 12 years of follow-up, in relation to CRP levels and presence of the MetS according to the adult treatment panel III-national cholesterol education program (ATPIII-NCEP) definition.A total of 120 participants had severe hip OA and 89 had knee OA during the follow-up. After adjustment for age, sex, smoking, physical

2008 Osteoarthritis and Cartilage

13023. A New Approach Yields High Rates of Radiographic Progression in Knee Osteoarthritis. Full Text available with Trip Pro

A New Approach Yields High Rates of Radiographic Progression in Knee Osteoarthritis. Progression of knee osteoarthritis (OA) has typically been assessed in the medial tibiofemoral (TF) compartment on the anteroposterior (AP) or posteroanterior (PA) view. We propose a new approach using multiple views and compartments that is likely to be more sensitive to change and reveals progression throughout the knee.We tested our approach in the Multicenter Osteoarthritis Study, a study of persons with OA (...) or at high risk of disease. At baseline and 30 months, subjects provided PA (fixed flexion without fluoro) and lateral weight-bearing knee radiographs. Paired radiographs were read by 2 readers who scored joint space (JS) using a 0-3 atlas-based scale. When JS narrowed but narrowing did not reach a full grade on the scale, readers used half-grades. Change was scored in medial and lateral TF compartments on both PA and lateral views and in the patellofemoral (PF) joint on lateral view. A knee showed

2008 Journal of Rheumatology

13024. Diagnosis of Infected Total Knee: Findings of a Multicenter Database. Full Text available with Trip Pro

Diagnosis of Infected Total Knee: Findings of a Multicenter Database. Although total knee arthroplasty (TKA) is an effective and successful procedure, the outcome is occasionally compromised by complications including periprosthetic joint infection (PJI). Accurate and early diagnosis is the first step in effectively managing patients with PJI. At the present time, diagnosis remains dependent on clinical judgment and reliance on standard clinical tests including serologic tests, analysis (...) the current status of diagnosis of the infected TKA utilizing commonly available tests. Intraoperative cultures should not be used as a gold standard for PJI owing to high percentages of false-negative and false-positive cases. When combined with clinical judgment, total white cell count and percentage of neutrophils in the synovial fluid more accurately reflects PJI and when combined with hematologic exams safely excludes or confirms infection.Level II, prognostic study. See Guidelines for Authors

2008 Clinical Orthopaedics and Related Research

13025. Abnormal and cumulative loading in knee osteoarthritis. (Abstract)

Abnormal and cumulative loading in knee osteoarthritis. This review examines recent advances in understanding the abnormal mechanics characteristic of knee osteoarthritis and provides a rationale to assess the total exposure to knee loading during daily activity.The abnormal loading environment in knee osteoarthritis is represented by the knee adduction moment. While knee osteoarthritis gait research focuses on this variable, emerging evidence supports a critical role for knee kinematics (...) , muscle activation patterns and the kinematics and kinetics of other lower extremity joints in the development and progression of this disease. Nevertheless, abnormal knee loading is not the only cause of articular cartilage disruption. Excessive and repetitive loading, together creating a total exposure to loading, are critical factors in knee pathomechanics. To assess excessive and repetitive loading, cumulative load is a biomechanical approach that integrates loading exposures to represent

2008 Current Opinion in Rheumatology

13026. Tibial Post Wear in Posterior-stabilized Knee Replacements is Design-dependent. Full Text available with Trip Pro

Tibial Post Wear in Posterior-stabilized Knee Replacements is Design-dependent. Polyethylene tibial post wear in posterior-stabilized knee designs is a major problem. The Insall-Burstein II (IB PS II) reportedly has severe anterior wear of the post in retrieved implants. We hypothesized the more anterior placement in the IB PS II would be reflected in greater wear at the anterior face than the IB PS I. We examined 234 retrieved inserts using subjective scales to grade post damage and wear (...) and changes in implant design to anticipate contact on the anterior post should be considered for future posterior stabilized knee replacements. These changes cannot occur in isolation, however, because changes in post placement and design also depend on their relation to the shape and location of the tibial bearing surfaces.

2008 Clinical Orthopaedics and Related Research

13027. Men versus Women : Does Size Matter in Total Knee Arthroplasty? Full Text available with Trip Pro

to a measurable improvement in knee flexion and Knee Society scores or pain. We retrospectively examined two groups of consecutive knees of patients who underwent primary TKA using similar techniques and constraint: Group 1 (93 men and 90 women) who had available four original sizes and Group 2 (106 men and 106 women) after the introduction of three new smaller sizes. More than twice as many new smaller sizes were used in women (52.3%, 56 of 106) compared to men (17.9%, 19 of 106). At the scheduled 6-month (...) Men versus Women : Does Size Matter in Total Knee Arthroplasty? The role played by femoral component sizing in the clinical outcome of primary TKA is currently debated. Oversizing the femur in patients with smaller knees could lead to overstuffing the knee capsule with resulting pain and reduced range of motion. We asked whether the distribution of femoral component sizes differed between genders and whether the availability of additional sizes benefited genders differently and led

2008 Clinical Orthopaedics and Related Research

13028. Stemmed Implants Improve Stability in Augmented Constrained Condylar Knees. Full Text available with Trip Pro

Stemmed Implants Improve Stability in Augmented Constrained Condylar Knees. We previously combined experimental and computational measures to ascertain whether tibial stem augmentation reduces bone strains beneath constrained condylar implants. Using these same integrated approaches, we examined the benefit of a stem when a wedge is used. Implants were removed from the eight paired cadaver specimens from our previous experiment, and oblique defects created that were restored with 15 degrees (...) metallic wedges cemented in place. We applied a varus moment and an axial load and monitored relative motion between implant and bone. Specimen-specific 3-D finite element models were constructed from CT scans and radiographs to examine bone stress in the proximal tibia. Implants with a wedge but no stem had greater motion than the previous control with no stem or wedge. Use of a modular stem with a wedge maintained the same level of motion as the primary case, suggesting that a stem is preferable when

2008 Clinical Orthopaedics and Related Research

13029. The natural history of bone marrow lesions in community based adults with no clinical knee osteoarthritis. (Abstract)

The natural history of bone marrow lesions in community based adults with no clinical knee osteoarthritis. Although bone marrow lesions (BML) have been implicated in the pathogenesis of osteoarthritis, their natural history in a healthy population is unknown. This study in a healthy, pain-free population aimed to examine the natural history of BML; factors associated with incidence and progression of BML over 2 years and whether incident BML are associated with the development of pain.271 (...) subjects with no clinical knee osteoarthritis, being pain free at baseline, underwent magnetic resonance imaging of their dominant knee at baseline and 2 years later. The presence of BML was assessed.In knees initially free of BML, incident BML developed in 14% of people over the study period. Increased body mass index (BMI; odds ratio (OR) 1.15, 95% CI 1.06 to 1.2, p = 0.001) was associated with incident BML. Those who developed a BML were more likely to develop knee pain compared with those in whom

2008 Annals of the Rheumatic Diseases

13030. Ultrasound validity in the measurement of knee cartilage thickness. Full Text available with Trip Pro

Ultrasound validity in the measurement of knee cartilage thickness. To assess the multiexaminer reproducibility and the accuracy comparing with cadaver anatomic specimens of ultrasound (US) measurement of femoral articular cartilage (FAC) thickness.In 8 flexed cadaver knees, FAC thickness was blindly, independently and consecutively measured twice by 10 rheumatologists at the lateral condyle (LC), medial condyle (MC) and intercondylar notch (IN) with US. After the US measurements, the knees (...) ) and higher than 0.75 for LC (p<0.01). Mean intraexaminer ICCs were 0.832 for MC (p<0.001), 0.696 for LC (p<0.001) and, 0.701 for IN (p<0.001). Agreement between US and anatomic FAC thickness measurements was good for MC (ICC 0.719; p = 0.020) and poor for LC (p = 0.285) and IN (p = 0.332). Bland-Altman analysis showed that the difference between US and anatomic values was considerably high in the one knee with severely damaged FAC. After eliminating this knee from the analysis, ICCs were 0.883 (p<0.001

2008 Annals of the Rheumatic Diseases

13031. A new non-invasive method to assess synovitis severity in relation to symptoms and cartilage volume loss in knee osteoarthritis patients using MRI. Full Text available with Trip Pro

, using a 1.5T and a knee coil. For the synovial membrane, the MRI exam included two axial sequences: a T2-weighted (synovial fluid) and a gradient echo (GRE) (synovial membrane). Synovial membrane thickness was measured on four regions of interest (ROI): medial and lateral recesses, and medial and lateral suprapatellar bursa, with each graded/scored from 0 to 3, for a maximum of 12. A validation study was performed on a cohort of 27 knee OA patients having MRI at baseline. A subset of 14 patients had (...) A new non-invasive method to assess synovitis severity in relation to symptoms and cartilage volume loss in knee osteoarthritis patients using MRI. Synovitis in knee osteoarthritis (OA) patients is a significant risk factor for disease progression. This study aimed at developing a magnetic resonance imaging (MRI) scoring system allowing reliable and sensitive assessment of synovitis severity in knee OA patients without the use of a contrast agent.Imaging was performed without contrast agent

2008 Osteoarthritis and Cartilage

13032. Correlation between arthroscopic and histopathological grading systems of articular cartilage lesions in knee osteoarthritis. Full Text available with Trip Pro

Correlation between arthroscopic and histopathological grading systems of articular cartilage lesions in knee osteoarthritis. Arthroscopic and particularly histopathological assessments have been used to evaluate alterations of knee cartilage in osteoarthritis (OA). The aim of this study was to examine the correlation between an arthroscopic method to grade the severity of chondropathies and the histological/histochemical grading system (HHGS) applied to the corresponding articular cartilage (...) areas in knee OA.The articular cartilage surface was examined by chondroscopy using the Beguin and Locker severity criteria, analysing the lesions in 72 chondroscopic areas. Afterwards, samples were obtained by dividing the cartilage surface of the medial tibiofemoral compartment of three OA knee joints into equal squares and they were evaluated histologically using the HHGS. The correlation between both grading methods was assessed using the weighted Kappa coefficient (K(w)).The results obtained

2008 Osteoarthritis and Cartilage

13033. Obesity and adiposity are associated with the rate of patella cartilage volume loss over two years in adults without knee osteoarthritis. (Abstract)

Obesity and adiposity are associated with the rate of patella cartilage volume loss over two years in adults without knee osteoarthritis. The aim of this study was to determine whether measures of obesity and adiposity are associated with the rate of patella cartilage volume loss in healthy adults.297 community-based adults aged 50-79 years with no clinical knee osteoarthritis were recruited at baseline (2003-4). 271 (62% female) subjects were re-examined at follow-up (2006-7). Measures (...) for both sexes but the number of men examined was considerably smaller and the associations were not statistically significant. There were no significant associations observed between change in any of the obesity and adiposity measures and the rate of patella cartilage volume loss.This study demonstrated that increased levels of obesity and adiposity are associated with an increased annual rate of patella cartilage volume loss in healthy adults. Weight-loss interventions that reduce body mass

2008 Annals of the Rheumatic Diseases

13034. Proximal gait adaptations in medial knee OA. Full Text available with Trip Pro

Proximal gait adaptations in medial knee OA. The purpose of this study was to examine interlimb differences in gait kinematics and kinetics in patients with symptomatic medial knee OA. The main objective was to identify hip joint movement strategies that might lower the knee adduction moment and also compensate for decreased knee flexion during weight acceptance. Gait analysis was performed on 32 patients with moderate medial compartment knee OA. Kinetic and kinematic data were calculated (...) and side-to-side comparisons made. Radiographs were used to identify frontal plane alignment. No interlimb difference in the peak knee adduction moment was found (p = 0.512), whereas a greatly reduced hip adduction moment was seen on the involved side (p < 0.001) during the early part of stance. The involved limb flexed significantly less and hip and knee flexion moments were smaller compared to the uninvolved side. Gait adaptations involving a lateral sway of the trunk may successfully lead

2008 Journal of Orthopaedic Research

13035. Occupation-Related Squatting, Kneeling, and Heavy Lifting and the Knee Joint: A Magnetic Resonance Imaging-Based Study in Men. Full Text available with Trip Pro

Occupation-Related Squatting, Kneeling, and Heavy Lifting and the Knee Joint: A Magnetic Resonance Imaging-Based Study in Men. We examined the relation between occupational exposures to frequent squatting/kneeling and/or heavy lifting with cartilage morphology, based on magnetic resonance imaging (MRI), at the tibiofemoral and patellofemoral joints in men and determined which compartments are most affected.We evaluated 192 men with symptomatic knee osteoarthritis (OA). The more symptomatic knee (...) /kneeling and heavy lifting, or none of these activities numbered 7, 40, 47, and 98, respectively. Compared with men with no occupational exposure to these activities, and following adjustment for age, BMI, and history of knee injury or surgery, we found that men reporting occupational exposures to both squatting/kneeling and heavy lifting had a modest increased risk for worse cartilage morphology scores at the patellofemoral joint [odds ratio (OR) 1.8, 95% confidence interval (CI) 1.1 to 3.2

2008 Journal of Rheumatology

13036. Varus malalignment and its association with impairments and functional limitations in medial knee osteoarthritis. (Abstract)

Varus malalignment and its association with impairments and functional limitations in medial knee osteoarthritis. To examine the association of varus malalignment with impairments and functional limitations in people with medial knee osteoarthritis (OA).Anatomic radiographic knee alignment was assessed in 107 community volunteers with medial tibiofemoral knee OA. Impairments assessed included pain (Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC]), quadriceps and hamstring (...) isometric strength, and knee varus-valgus laxity. WOMAC, walking speed, step test, and stair climb test were used to assess functional limitations. Participants were categorized into tertiles according to knee alignment (least, moderate, and most varus). Impairments and functional limitations between groups were compared using analyses of variance with and without adjustment for age, sex, and disease severity. Regression analyses were also performed in the entire cohort to further determine

2008 Arthritis and Rheumatism

13037. Relationship of meniscal damage, meniscal extrusion, malalignment, and joint laxity to subsequent cartilage loss in osteoarthritic knees. (Abstract)

Relationship of meniscal damage, meniscal extrusion, malalignment, and joint laxity to subsequent cartilage loss in osteoarthritic knees. Progressive knee osteoarthritis (OA) is believed to result from local factors acting in a systemic environment. Previous studies have not examined these factors concomitantly or compared quantitative and qualitative cartilage loss outcomes. The aim of this study was to test whether meniscal damage, meniscal extrusion, malalignment, and laxity each predicted (...) tibiofemoral cartilage loss after controlling for the other factors.Laxity and alignment were measured at baseline in individuals with knee OA. Magnetic resonance imaging included spin-echo coronal and sagittal imaging for meniscal scoring and axial and coronal spoiled gradient echo sequences with water excitation for cartilage quantification. Tibial and weight-bearing femoral condylar subchondral bone area and cartilage surface were segmented. Cartilage volume, denuded bone area, and cartilage thickness

2008 Arthritis and Rheumatism

13038. Association between findings on delayed gadolinium-enhanced magnetic resonance imaging of cartilage and future knee osteoarthritis. (Abstract)

Association between findings on delayed gadolinium-enhanced magnetic resonance imaging of cartilage and future knee osteoarthritis. To examine the predictive value of the delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC) index with regard to future radiographic osteoarthritis (OA).In 1998, 17 knees in 11 men and 4 women with knee pain, normal results of weight-bearing radiography, and arthroscopic cartilage changes ranging from superficial fibrillation to fissuring (...) and softening were examined using dGEMRIC. Six years later, 16 of the 17 knees were reassessed for radiographic OA changes.At followup, 9 of the 16 knees showed radiographic OA changes. Two of them had undergone a knee joint replacement due to OA. In the knees with radiographic OA, the dGEMRIC index at baseline was lower than that in the knees without radiographic OA (P = 0.03).The results of the present study support the dGEMRIC index as a clinically relevant measure of cartilage integrity and suggest

2008 Arthritis and Rheumatism

13039. Hospitalization costs of total knee arthroplasty with a continuous femoral nerve block provided only in the hospital versus on an ambulatory basis: a retrospective, case-control, cost-minimization analysis. Full Text available with Trip Pro

Hospitalization costs of total knee arthroplasty with a continuous femoral nerve block provided only in the hospital versus on an ambulatory basis: a retrospective, case-control, cost-minimization analysis. After total knee arthroplasty (TKA), hospitalization may be shortened by allowing patients to return home with a continuous femoral nerve block (CFNB). This study quantified the hospitalization costs for 10 TKA patients receiving ambulatory CFNB versus a matched cohort of 10 patients who (...) received CFNB only during hospitalization.We examined the medical records (n = 125) of patients who underwent a unilateral, primary, tricompartment TKA with a postoperative CFNB by 1 surgeon at one institution in an 18-month period beginning January 2004. Each of the 10 patients discharged home with an ambulatory CFNB (cases) was matched with a patient with a hospital-only CFNB (controls) for age, gender, body mass index, and health status. Financial data were extracted from the hospital microcosting

2007 Regional Anesthesia and Pain Medicine

13040. Iyengar yoga for treating symptoms of osteoarthritis of the knees: a pilot study. Full Text available with Trip Pro

of B.K.S. Iyengar to treat the symptoms of osteoarthritis of the knee.Participants were instructed in modified Iyengar yoga postures during 90-minute classes once weekly for 8 weeks.Participants met ACR criteria for osteoarthritis of the knee and completed a medical history and physical examination, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Arthritis Impact Measurement Scale 2 (AIMS2), Patient Global Assessment (GA) by Visual Analog Scale (VAS), Physician GA by VAS, and 50 (...) Iyengar yoga for treating symptoms of osteoarthritis of the knees: a pilot study. The American College of Rheumatology (ACR) Guidelines for the medical management of osteoarthritis (OA) emphasize the use of nonpharmacologic interventions including exercise. Implementation of an exercise program can be difficult for patients, and little is known about the benefits of alternative therapies such as yoga. The aim of this pilot study was to assess the feasibility of using yoga in the tradition

2005 Journal of Alternative and Complementary Medicine

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