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The incidence of total hip arthroplasty after hip arthroscopy in osteoarthritic patients
Barak Haviv, John O'Donnell
Sports Medicine, Arthroscopy, Rehabilitation, Therapy & Technology , 2010, DOI: 10.1186/1758-2555-2-18
Abstract: Retrospective clinical seriesFollow-up data and surgical reports were retrieved from 564 records of osteoarthritic patients that have had hip arthroscopy between the years 2002 to 2009 with a mean follow-up time of 3.2 years (range, 1-6.4 years). The time interval between the first hip arthroscopy to THA was modelled as a function of patient age; level of cartilage damage; procedures performed and repeated arthroscopies with the use of multivariate regression analysis.Ninety (16%) of all participants eventually required THA. The awaiting time from the first arthroscopy to a hip replacement was found to be longer in patients younger than 55 years and in a milder osteoarthritic stage. Patients that experienced repeated hip scopes had a longer time to THA than those with only a single procedure. Procedures performed concomitant with debridement and lavage did not affect the time interval to THA.In our series of arthroscopic treatment of hip osteoarthritis, 16% required THA over a period of 7 years. Factors that influence the time to arthroplasty were age, degree of osteoarthritis and recurrent procedures.Currently there are various options to treat osteoarthritis (OA) and certain evidence based recommendations have been developed [1,2]. According to these propositions in young adults with symptomatic OA one should consider a joint preserving surgical procedure while replacement is usually reserved for older patients. With the evolution of hip arthroscopy, it has been used as joint preserving surgery for OA among various other indications, yet there are only a few reports on its efficacy in treating OA [3-8]. In a controlled trial involving patients with osteoarthritis of the knee [9], the outcomes after arthroscopic lavage or arthroscopic debridement were no better than those after a placebo procedure. There are, however, times when arthroscopic treatment of the osteoarthritic joint can be of benefit, particularly in that patient who has relatively mild to moderate ost
Arthroscopic debridement of the osteoarthritic knee combined with hyaluronic acid (Orthovisc?) treatment: A case series and review of the literature
Xinning Li, Agam Shah, Patricia Franklin, Renee Merolli, Jill Bradley, Brian Busconi
Journal of Orthopaedic Surgery and Research , 2008, DOI: 10.1186/1749-799x-3-43
Abstract: Thirty consecutive patients who met inclusion and exclusion criteria underwent arthroscopic debridement by a single surgeon and concomitant delivery of 6 ml/90 mg HA (Orthovisc?). These patients were evaluated preoperatively, at 6 weeks, 3 and 6 months post-operatively. Evaluations consisted of WOMAC pain score, SF-36 Physical Component Summary (PCS) score and complications.No complications occurred during this study. Pre-op average WOMAC pain score was 6.8 +/- 3.5 (n = 30) with a reduction to 3.4 +/- 3.1 at 6 weeks (n = 27). Final average WOMAC pain score improved to 3.2 +/- 3.8 at six months (n = 23). No patients had deterioration of the WOMAC pain score. Mean pre-operative SF-36 PCS score was 39.0 +/- 10.4 with SF-36 PCS score of the bottom 25th percentile at 29.9 (n = 30). Post procedure and HA delivery, mean PCS score at 6 weeks improved to 43.7 +/- 8.0 with the bottom 25th percentile at 37.5 (n = 27). At 6 months, mean PCS score was 48.0 +/- 9.8 with the bottom 25th percentile improved to 45.8 (n = 23).The results show that concomitant delivery of high molecular weight hyaluronan (Orthovisc? – 6 ml/90 mg) is safe when given at the time of arthroscopic debridement of the osteoarthritic knee. By delivering HA (Orthovisc?) at the time of the arthroscopic debridement, there may be a decreased risk of joint infection and/or injection site pain. Furthermore, the combination of both procedures show efficacy in reducing WOMAC pain scores and improving SF-36 PCS scores over a six month period.Osteoarthritis (OA) is the most prevalent musculoskeletal disorder and the leading cause of disability in adults over the age 45 years [1-3]. OA of the knee is extremely common, with some studies showing that OA of the knee occurs in at least 30% of people after the age of 50 years, and in 80% of people older than 75 years [4,5]. Of the patients with OA, over 80% will have limitation of movement and greater than 25% can not perform their activities of daily living [3]. Traditional
The effect of arthroscopic debridement on life quality of mild and moderate gonarthrosis patients
Serdar Hakan Ba?aran,H. Nadir ?ne?,G?khan Peker,Erdem Edipo?lu
Medical Journal of Bakirk?y , 2011,
Abstract: Objective: Osteoarthritis is the most seen type of arthritis and forms more than 6% of all symptomatic knee diseases. A lot of treament modalities are used and the treatment algorithm acts from conservative precedures to surgical procedures. Material and Methods: Fourty patients who had symptomatic primary osteoarthritis for ACR (American College of Rheumatology) criteria, who were in mild and moderate stages for IKDC (International Knee Documentation Committee) and who were symptomatic in spite of at least six months of treatment were integrated to the study. The quality of life and functional evaluation of patients are done before and at least six months after the surgery by SF-36 quality of life and Lysholm scores. All patients are evaluated with patient pleasure scala at their last visits. Results: The increase of mean Lysholm knee score after arthroscopic debridement was statistically significiant (p<0.01). The increase of total SF-36 score and short physical health score at the last visit after arthroscopic debridement was statistically significiant (p<0.05). The mean score for patient pleasure scala was 6.6±2.24. Conclusion: Arthroscopic debridement can be used as an effective treatment method for patients who have mild to moderate gonarthrosis and mechanical symptoms which is resistant to the medical treatment.
Arthroscopic cartilage regeneration facilitating procedure for osteoarthritic knee  [cached]
Lyu Shaw-Ruey,Hsu Chia-Chen,Lin Chih-Wen
BMC Musculoskeletal Disorders , 2012, DOI: 10.1186/1471-2474-13-226
Abstract: Background The effectiveness of arthroscopic treatment for osteoarthritic knee is a controversy. This study presents the technique of a novel concept of arthroscopic procedure and investigates its clinical outcome. Method An arthroscopic procedure targeted on elimination of focal abrasion phenomenon and regaining soft tissue balance around patello-femoral joint was applied to treat osteoarthritis knees. Five hundred and seventy-one knees of 367 patients with osteoarthritis received this procedure. There were 70 (19%) male and 297 (81%) female and the mean age was 60 years (SD 10). The Knee Society score (KSS) and the knee injury and osteoarthritis outcome score (KOOS) were used for subjective outcome study. The roentgenographic changes of femoral-tibial angle and joint space width were evaluated for objective outcomes. The mean follow-up period was 38 months (SD 3). Results There were 505 knees in 326 patients available with more than 3 years follow-up and the mean follow-up period was 38 months (SD 3). The subjective satisfactory rate for the whole series was 85.5%. For 134 knees with comprehensive follow-up evaluation, the KSS and all subscales of the KOOS improved statistically. The femoral-tibial angle improved from 1.57 degrees (SD 3.92) to 1.93 degrees (SD 4.12) (mean difference: 0.35, SD 0.17). The joint space width increased from 2.02 millimeters (SD 1.24) to 2.17 millimeters (SD 1.17) (mean difference: 0.13, SD 0.05). The degeneration process of the medial compartment was found being reversed in 82.1% of these knees by radiographic evaluation. Conclusions Based on these observations arthroscopic cartilage regeneration facilitating procedure is an effective treatment for osteoarthritis of the knee joint and can be expected to satisfy the majority of patients and reverse the degenerative process of their knees.
The Efficacy of Intra-Articular Injection of Hyaluronic Acid With Supplemental Peroral Vitamin E Following Arthroscopic Debridement in the Treatment of Knee Osteoarthritis: A Prospective, Randomized, Controlled Study  [cached]
Ahmet Aslan,Vecihi K?rdemir,Tolga Atay,Yakup Barbaros Baykal
Türkiye Fiziksel Tip ve Rehabilitasyon Dergisi , 2012,
Abstract: Objective: We evaluated clinical results of intra-articular injection of hyaluronic acid and peroral Vitamin E treatment after arthroscopic debridement in patients with knee osteoarthritis who got no cure with medical treatment previously. Materials and Methods: A total of 44 patients with knee pain, who were diagnosed as having knee osteoarthritis according to the American College of Rheumatology criteria, were included in this study. The subjects were randomly divided into 3 groups after arthroscopic debridement: Group S was given intra-articular Hylan G-F 20 treatment; Group S+E - intraarticular Hylan G-F 20 treatment plus oral vitamin E; and Group C underwent only arthroscopic debridement. Pain, stiffness and functional capacity scores were evaluated preoperatively and 6 and 12 months postoperatively according to the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Results: In all groups, 6- and 12-month postoperative WOMAC scores were lesser than the preoperative ones. The WOMAC scores at 6 and 12 months were statistically lower in the S+E and S groups than in the group C (p<0.05). The S+E group demonstrated better results in terms of improvement in symptoms than the S-group at 6 and 12 months postoperatively (p<0.05). Conclusion: We believe that arthroscopic debridement is beneficial in suitable knee osteoarthritis cases and vitamin E and intra-articular hyaluronic acid may reduce the symptoms of knee osteoarthritis. Turk J Phys Med Re-hab 2012;58:199-203.
Massive rotator cuff tears: functional outcome after debridement or arthroscopic partial repair
Alexander Berth,Wolfram Neumann,Friedemann Awiszus,Géza Pap
Journal of Orthopaedics and Traumatology , 2010, DOI: 10.1007/s10195-010-0084-0
Abstract: During the follow-up period all patients in our series had good or satisfactory outcome after rotator cuff surgery. Regardless of high rates of structural failure of the partial rotator cuff repair, the results of arthroscopic partial rotator cuff repair demonstrated slightly better functional outcome than debridement.
Total arthroscopic debridement and suture for meniscus cysts under local anesthesia:a report of 42 cases  [cached]
Xu CHEN,Yu-jie LIU,Zhong-li LI,Zhi-gang WANG
Medical Journal of Chinese People's Liberation Army , 2011,
Abstract: Objective To evaluate the effects of total arthroscopic debridement and suture for meniscus cysts under local anesthesia.Methods Forty-two patients with meniscus cysts hospitalized from March 2005 to November 2009(27 males and 15 females,aged 15 to 46 years with mean of 31.2±6.3 years) were involved in present study,and all of them underwent arthroscopic debridement and meniscus suture under local anesthesia.Patient satisfaction rate for operation was evaluated,the Lysholm score and pain visual analogue scale(VAS) of patients before and after operation were compared,and the postoperative complications and cyst recurrence were recorded.Results Follow-up data were available for all the 42 patients,the duration was 13 months to 5 years(mean 26.4±11.8 months).No postoperative complication or cyst recurrence was found.The postoperative Lysholm score(90.63±9.45) was significantly higher than that of preoperative(40.75±11.39,P=0.00),while the postoperative pain VAS score(1.63±2.29) was significantly lower than that of preoperative(7.50±2.82,P=0.00).According to Molster’ classification for Lysholm score,27 of the 42 patients were classified as excellent,12 as good,3 as fair and 0 as poor,thus the total excellent and good proportion was 92.9%.The ratio of satisfaction for operation was 95.2%.Conclusion Total arthroscopic debridement and suture under local anesthesia is an effective surgical procedure for treatment of meniscus cysts with small incision,less tissue trauma,high degree of safety,and beneficial for early rehabilitation.
A Comparative Study between Use of Arthroscopic Lavage and Arthrocentesis of Temporomandibular Joint Based on Computational Fluid Dynamics Analysis  [PDF]
Yue Xu, Han Lin, Ping Zhu, Wenyan Zhou, Yi Han, Youhua Zheng, Zhiguang Zhang
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0078953
Abstract: Arthroscopic lavage and arthrocentesis, performed with different inner-diameter lavage needles, are the current minimally invasive techniques used in temporomandibular joint disc displacement (TMJ-DD) for pain reduction and functional improvement. In the current study, we aimed to explore the biomechanical influence and explain the diverse clinical outcomes of these two approaches with computational fluid dynamics. Data was retrospectively analyzed from 78 cases that had undergone arthroscopic lavage or arthrocentesis for TMJ-DD from 2002 to 2010. Four types of finite volume models, featuring irrigation needles of different diameters, were constructed based on computed tomography images. We investigated the flow pattern and pressure distribution of lavage fluid secondary to caliber-varying needles. Our results demonstrated that the size of outflow portal was the critical factor in determining irrigated flow rate, with a larger inflow portal and a smaller outflow portal leading to higher intra-articular pressure. This was consistent with clinical data suggesting that increasing the mouth opening and maximal contra-lateral movement led to better outcomes following arthroscopic lavage. The findings of this study could be useful for choosing the lavage apparatus according to the main complaint of pain, or limited mouth opening, and examination of joint movements.
腓骨近端截骨联合膝关节镜清理术治疗伴内翻畸形的膝关节骨关节炎
PROXIMAL FIBULAR OSTEOTOMY COMBINED WITH ARTHROSCOPIC DEBRIDEMENT FOR TREATING MEDIAL KNEE OSTEOARTHRITIS WITH VARUS
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郝亮,简蔚泓,杨锋,刘春龙,唐强
- , 2016, DOI: 10.7507/1002-1892.20160279
Abstract: 目的探讨腓骨近端截骨联合膝关节镜清理术治疗伴内翻畸形的膝关节骨关节炎(osteoarthritis,OA)临床疗效。 方法2013年12月-2015年6月,收治61例伴内翻畸形的膝关节OA患者,其中32例采用单纯关节镜下膝关节清理术(A组),29例采用腓骨近端截骨联合膝关节镜清理术(B组)。患者年龄、性别、侧别、病程、OA分期、术前疼痛视觉模拟评分(VAS)及膝关节学会评分系统(KSS)比较,差异均无统计学意义( P > 0.05),具有可比性。术后1周、3个月、12个月采用VAS评分及KSS评分分别评价患膝疼痛及患肢功能恢复情况。 结果两组患者均获随访12个月。患者切口均Ⅰ期愈合;A、B组并发症发生率分别为0、3.4%,差异无统计学意义(χ 2=0.723, P=0.432)。两组术后1周、3个月、12个月VAS评分均明显低于术前( P < 0.05);A组术后1周VAS评分显著低于B组,但3、12个月时却显著高于B组,比较差异有统计学意义( P < 0.05)。术后两组患者膝关节功能均显著恢复,术后1周、3个月、12个月KSS评分均明显优于术前( P < 0.05);A组术后1周KSS评分与B组比较差异无统计学意义( P > 0.05),但术后3、12个月评分显著低于B组( P < 0.05)。 结论腓骨近端截骨联合膝关节镜清理术能同时处理膝关节力线不良及关节内病变,是治疗伴内翻畸形的膝关节OA的一种安全、有效方法。
ObjectiveTo evaluate the effectiveness of proximal fibular osteotomy combined with arthroscopic debridement in the treatment of medial knee osteoarthritis with varus. MethodsBetween December 2013 and June 2015, 61 patients with medial knee osteoarthritis with varus were treated by arthroscopic debridment in 32 cases (group A) and by proximal fibular osteotomy combined with arthroscopic debridement in 29 cases (group B). No significant difference was found in gender, age, side, disease duration, OA stage, visual analogue scale (VAS) score, and knee society score (KSS) between 2 groups ( P > 0.05). The clinical outcome was evaluated by VAS score and KSS score at 1 week, 3 months, and 12 months after operation. ResultsThe patients in 2 groups were followed up 12 months. All incisions healed by first intention. There was no significant difference in complication incidence between groups A and B (0 vs. 3.4%; χ 2=0.723, P=0.432). The VAS scores were significantly decreased at 1 week, 3 months, and 12 months after operation when compared with preoperative score in 2 groups ( P < 0.05). The VAS score of group A was significantly lower than that of group B at 1 week after operation ( P < 0.05), but the VAS score of group A was significantly higher than that of group B at 3 months, and 12 months after operation ( P < 0.05). The knee function was obviously improved in 2 groups, and the KSS scores at 1 week, 3 months and 12 months after operation were significantly better than preoperative score ( P < 0.05). The KSS score of group A was significantly lower than that of group B at 3 months, and 12 months after operation ( P < 0.05). ConclusionProximal fibular osteotomy combined with arthroscopic debridement can treat knee malalignment and disease in knee, it is an effective and safe method to treat the medial knee osteoarthritis with varus.
关节镜下清理术联合 Ilizarov 牵伸术治疗膝关节骨关节炎近期疗效观察
Short-term effectiveness of joint distraction by Ilizarov combined with arthroscopic debridement in treatment of knee osteoarthritis
 [PDF]

董佩龙,唐晓波,王健,蒋逸秋,姚旺祥,桂鉴超
- , 2017, DOI: 10.7507/1002-1892.201701099
Abstract: 目的 探讨关节镜下清理术联合 Ilizarov 牵伸术治疗膝关节骨关节炎(knee osteoarthritis,KOA)的近期疗效。 方法 2014 年 1 月—2015 年 1 月,采用关节镜下清理术联合 Ilizarov 牵伸术治疗 KOA 患者 15 例(15 膝)。其中男 7 例,女 8 例;年龄 45~64 岁,平均 55 岁。左膝 6 例,右膝 9 例。病程 2.0~9.5 年,中位病程 6 年。患者均经 6 个月保守治疗,临床症状无明显改善。术前疼痛视觉模拟评分(VAS)为(76.2±8.8)分,美国西部 Ontario 与 McMaster 大学骨关节炎指数评分(WOMAC)为(59.3±5.7)分,膝关节损伤和骨关节炎评定量表评分(KOOS)为(44.3±7.2)分,膝关节活动度(range of motion,ROM)为(75±21)°。X 线片测量关节间隙为(2.5±0.4)mm。根据 Kellgren-Lawrence 分级标准,Ⅲ 级 11 例、Ⅳ 级 4 例。 结果 术后切口均 Ⅰ 期愈合,外固定支架钉道无感染,无下肢深静脉血栓形成等相关并发症发生。患者均获随访,随访时间 12~18 个月,平均 15.5 个月。术后患者膝关节疼痛症状及关节活动明显改善,术后 12 个月 VAS 评分、WOMAC 评分、KOOS 评分分别为(20.9±7.8)、(38.2±5.5)、(92.1±6.9)分,膝关节 ROM 为(118±14)°,均优于术前,比较差异有统计学意义( t=18.213, P=0.000; t=10.317, P=0.000; t=18.564, P=0.000; t=6.599, P=0.000)。X 线片复查示,术后 12 个月关节间隙为(3.8±0.3)mm,与术前比较差异有统计学意义( t=10.070, P=0.000)。 结论 关节镜下清理术联合 Ilizarov 牵伸术治疗 KOA,可有效缓解关节疼痛,提高膝关节功能,利于软骨组织修复,延缓骨关节炎进展,近期疗效满意。
Objective To investigate the short-term effectiveness of joint distraction by Ilizarov combined with arthroscopic debridement in the treatment of knee osteoarthritis (KOA). Methods Between January 2014 and January 2015, 15 patients (15 knees) with KOA were treated using arthroscopic debridement assisting with the Ilizarov distraction technology. There were 7 males and 8 females, aged from 45 to 64 years (mean, 55 years). The left knee and the right knee were involved in 6 and 9 cases respectively. The disease duration was 2.0-9.5 years (median, 6 years). They all had received conservative treatment for 6 months and got poor clinical improvement. The preoperative visual analogue scale (VAS) score, the Western Ontario and McMaster University Osteoarthritis Index (WOMAC) score, the knee injury and osteoarthritis outcome score (KOOS), the range of motion (ROM) for knee, and the radiographic joint space width were 76.2±8.8, 59.3±5.7, 44.3±7.2, (75±21)°, and (2.5±0.4) mm respectively. According to Kellgren-Lawrence grade system, 11 cases were rated as grade III and 4 cases as grade IV. Results There was no poor incision healing, infection, and deep vein thrombosis. All the 15 patients were followed up 12-18 months (mean, 15.5 months). Patients achieved pain relief. The knee activity was obviously improved. The postoperative VAS score, WOMAC score, KOOS score, and ROM at 12 months were 20.9±7.8, 38.2±5.5, 92.1±6.9, and (118±14)° respectively, showing significant difference when compared with preoperative ones ( t=18.213, P=0.000; t=10.317, P=0.000; t=18.564, P=0.000; t=6.599, P=0.000). Postoperative X-ray film showed that joint space width at 12 months was (3.8±0.3) mm, showing significant
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