Profile of Knee’s Bone and Joint Tuberculosis in Adults: About 33 Cases

The authors report toward a monocentric retrospective and descriptive study on a 08 year period, 33 cases of knee osteoarticular tuberculosis (OAT) of adult, certified by bacteriologic and/or histolological evidence proof of the sample (synovial biopsy) after a knee arthrotomy. There were 07 cases of arthritis and 26 cases of osteoarthritis. The treatment of knee OAT was medical (anti-tubercular poly-chemotherapy) on one year duration. The surgery was useful in front of some clinical presentations. After a minimum of 18 months, a functional evaluation was done following the Lequesne algo-functionnal index. None had signs of local recurrence testifying the adequacy of medical treatment, even if it is long and binding. The main of our case series is to establish an epidemiological, clinical and biological profile of the knee tuberculosis of adult and to research elements of prognosis through an analysis of results.

Evaluation of Lo＂wenstein-Jensen Medium Culture,MGIT 960 Culture and Different Specimen Types inDiagnosis of Bone and Joint Tuberculosis

Objective： The aim of this study was to evaluate L-J （Lo＂wenstein-Jensen） medium culture, MGIT 960 culture anddifferent specimen types in diagnosis of BJTB （bone and joint tuberculosis）. Methods：： Specimens of pus, caseous necrosis,tuberculous granuloma and sequestrum were collected from 52 BJTB patients. All specimens were cultured using both MGIT 960system and L-J medium; and all pus were amplified using real-time PCR to detect the presence of M. tuberculosis DNA. KeyFindings： A total of 191 specimens were collected. Granuloma had better chance to produce positive outcomes by L-J mediumculture, while for sequestrum MGIT 960 culture had higher yield, but there was no significant difference in the recovery rates amongdifferent types of specimen either by L-J culture （Z2 = 0.638, P = 0.888） or by MGIT960 culture （Z2 = 1.399, P = 0.706）. MGIT960culture had significantly higher recovery rate than L-J culture, With a combined culture and PCR-based test, the recovery rate of pusspecimen was significantly higher than that of either method alone （P 〈 0.05）. Conclusion： MGIT 960 culture is superior to L-Jculture in BJTB diagnosis; pus, sequestrum, granuloma and caseous necrosis are usable specimen for mycobacterial culture;combination of culture and molecular techniques can provide a better diagnostic significance.

Magnetic Resonance Imaging for Diagnosis and Analysis of Bone Tumors and Bone Tuberculosis

The purpose of the study is to explore the diagnostic value of magnetic resonance imaging in bone tuberculosis and bone tumors.Firstly,148 patients with bone tumor and bone tuberculosis were selected,74 cases in each group.Perform magnetic resonance imaging(MRI)examinations on all patients,relevant parameters were set and the changes in the value of the dispersion system were recorded to obtain T1-weighted imaging and T2-weighted imaging.The results showed that among 74 patients,41 cases were bone damage,38 cases were joint swelling,27 cases were sparse bone,10 cases were bone hyperplasia and 5 cases were dead bone and calcification.The imaging manifestations of bone tumors were 45 cases of fractures,26 cases of surrounding soft tissue infiltration,10 cases of hip duct enlargement and 11 cases of sacral foramen enlargement.After MRI diagnosis,the accuracy of diagnosing 74 cases of bone tumor was 100%,and the accuracy of diagnosing 65 cases of bone tuberculosis was 87.84%.The difference between the two groups was statistically significant(P<0.05).The diffusion sensitivity coefficient of MRI weighted imaging was 150 s/mm2,and there was no significant difference in ADC values between the two groups(P>0.05).When the diffusion sensitivity coefficient is 300 s/mm2,and the difference between the two groups was statistically significant(P<0.05).Therefore,MRI had a certain diagnostic value for bone tuberculosis and bone tumors,and MRI had a higher diagnostic value and richer information for bone tumors.Corresponding treatment can be performed to improve the prognosis.

A radiologic analysis of 136 cases of bone and joint lesions following burn

This paper reviewed 136 cases with definite bone and joint lesions selected froma total of 4286 burn patients.The clinical appearance,blood and urine biochemistry,blood cultures,gross and histological autopsy examination as well as surgical and biopsyspecimens were studied with emphasis on X-ray manifestations.The lesions were classi-fied,according to their X-ray appearances,into four types:alterations limited to thebone,alterations involving periarticular structures,changes of the joint and deformity ofthe bone and joint.The pathogenesis and radiological appearances of osteoporosis,mutila-tion of the fingers as well as incidence and pathogenesis of heterotopic para-articularossification were analysed and discussed.

One-stage Surgical Treatment for Thoracic and Lumbar Spinal Tuberculosis by Transpedicular Fixation, Debridement, and Combined Interbody and Posterior Fusion via a Posterior-only Approach

This study examined the clinical outcomes of one-stage surgical treatment for patients with spinal tuberculosis via a posterior-only approach. Twenty-four patients with thoracic or lumbar spinal tuberculosis whose lesions were confined to adjacent segments were admitted to our hospital and treated. The American Spinal Injury Association（ASIA） impairment scale was used to assess the neurological function. All patients were treated with one-stage surgical treatment via a posterior-only approach. The clinical efficacy was evaluated by the Japanese Orthopaedic Association（JOA） scores and oswestry disability index（ODI） of nerve function. Patients were evaluated preoperatively and postoperatively by measurement of spinal deformity using Cobb angle and radiological examination. All the patients were followed up for 13 to 27 months. They had significantly postoperative improvement in JOA score, ODI and ASIA classification scores. The kyphotic angles were significantly corrected and maintained at the final follow-up. Bone fusion was achieved within 4–12 months. It was concluded that one-stage surgical treatment via a posterior-only approach is effective and feasible for the treatment of spinal tuberculosis.

Tuberculosis Arthritis of the Sternoclavicular Joint

Tuberculosis remains a public health problem in developing country particularly in Tunisia. Bone location of tuberculosis infection is increasing and is often misdiagnosed due to the weakness of clinical presentation in early stages. Sternoclavicular joint tuberculosis is rare and unusual location of this disease. However, antibiotherapy and surgical debridement is still the basis of treatment. We report a case of sternoclavicular joint tuberculosis with a follow up of four years. The patient was treated surgically and put under antibiotherapy during twelve months. The site was sterilized. We report this case to show that debridement and antibiotherapy still efficient in tuberculous bone affection no matters the location.

Tuberculosis of the Sternoclavicular Joint: Report of 3 New Cases Observed in Abidjan

The sternoclavicular joint is a rare site of osteoarticular tuberculosis. We now report three new cases of sternoclavicular tuberculosis. The report concentrates mostly on immunocompromised patients, notably two with HIV infection and one case marked by its acute onset which is rather original because, in this case, there was a swollen sternoclavicular joint with normal X-ray and it was the CT-scan which showed the lesions. The etiological diagnosis was made in the first case by polymerase chain reaction and in the second case by identification of Mycobacterium tuberculosis. In the third case, the diagnosis was presumptive and the outcome on anti-tuberculous drugs was satisfactory. Sternoclavicular joint tuberculosis is unusual;the painful swelling of that joint should lead to realize a performed imaging such as CT-scan.

Multitrack and multianchor point screw technique combined with the Wiltse approach for lesion debridement for lumbar tuberculosis

BACKGROUND The incidence of lumbar tuberculosis is high worldwide,and effective treatment is a continuing problem.AIM To study the safety and efficacy of the multitrack and multianchor point screw technique combined with the contralateral Wiltse approach for lesion debridement to treat lumbar tuberculosis.METHODS The C-reactive protein(CRP)level,erythrocyte sedimentation rate(ESR),visual analogue scale(VAS)score,oswestry disability index(ODI)and American Spinal Injury Association(ASIA)grade were recorded and analysed pre-and postoperatively.RESULTS The CRP level and ESR returned to normal,and the VAS score and ODI were decreased at 3 mo postoperatively,with significant differences compared with the preoperative values(P<0.01).Neurological dysfunction was relieved,and the ASIA grade increased,with no adverse events.CONCLUSION The multitrack,multianchor point screw fixation technique combined with the contralateral Wiltse approach for debridement is an effective and safe method for the treatment of lumbar tuberculosis.

One-stage total hip arthroplasty for advanced hip tuberculosis combined with developmental dysplasia of the hip:A case report

BACKGROUND A patient with advanced tuberculosis of the hip joint combined with Crowe type IV developmental dysplasia of the hip(DDH)and a drainage sinus is a rare condition.There are no previous reports of this condition,and it is a complex challenge for surgeons to develop a treatment scheme.CASE SUMMARY We report a 73-year-old male patient with severe hip pain and drainage sinus of the left hip for one month.Approximately 40 years ago,a drainage sinus occurred at the lateral left hip was healed at the local hospital with anti-infectious therapy.After the sinus healed,gradual pain occurred in the left hip for 40 years.Approximately one month prior,hip pain was sharply aggravated,and a drainage sinus reoccurred in the left hip.The X-ray and computed tomography examinations showed destruction of the head and neck of the left femur,as well as an acetabular deformity.The results of Mycobacterium tuberculosis antibody and Xpert were positive.Therefore,the patient was diagnosed with advanced TH combined with Crowe type IV DDH.After 22 d of treatment with anti-tuberculosis chemotherapy,the sinus healed,and the patient underwent one-stage total hip arthroplasty(THA)surgery consisting of debridement,osteotomy,and joint replacement.After surgery,the patient received anti-tuberculosis chemotherapy drugs for nine months,with no recurrent infection.After one year of follow-up,the Harris score of the patient increased from 21 pre-THA to 86.CONCLUSION Although drainage sinuses are a contraindication to one-stage THA,one-stage THA is still an effective and safe surgical method after the sinus heals.

Mycobacterium tuberculosis joint infections:A case series

Tuberculosis is a chronic infectious disease,caused by Mycobacterium tuberculosis,that seriously endangers human health.Skeletal tuberculosis is the most common type of extrapulmonary tuberculosis and tuberculous arthritis is the second most common type of skeletal tuberculosis.We report a case series of patients with tuberculous arthritis,two of whom had no joint disease in the past and presented as monoarthritis.The final patient had a history of rheumatoid arthritis,with polyarthritis that was aggravated during treatment with glucocorticoids and immunosuppressive drugs.This series of cases can contribute to early diagnosis and treatment with appropriate infection control measures.

Effect of different hip replacement methods under minimally invasive anterolateral approach on bone metabolism and joint pain in patients with femoral neck fracture

Objective: To explore the effect of different hip replacement methods under minimally invasive anterolateral approach on bone metabolism and joint pain in patients with femoral neck fracture. Methods: A total of 110 patients with femoral neck fracture who were treated in Ruijin Hospital North, Shanghai Jiaotong University School of Medicine between July 2015 and January 2017 were collected and divided into control group and observation group by random number table, each with 55 cases. Control group accepted half hip replacement under minimally invasive anterolateral approach, and observation group accepted total hip replacement under minimally invasive anterolateral approach. The differences in contents of bone metabolism and joint pain-related indexes were compared between the two groups before and after surgery. Results: Before surgery, serum contents of bone formation indexes, bone resorption indexes, inflammatory indexes and pain mediators were not statistically significant between the two groups. 1 month after surgery, serum bone formation indexes PINP, BAP and BGP contents of observation group were higher than those of control group;serum bone resorption indexes β-CTX and TRACP-5b contents were lower than those of control group;serum inflammatory indexes IL-1 and TNF-α contents were lower than those of control group;serum pain mediators 5-HT and PGE2 contents were lower than those of control group. Conclusion: Total hip replacement under minimally invasive anterolateral approach is more effective to promote the formation of bone formation/bone resorption balance and reduce the joint pain.

Grafting of iliac bone flap with deep iliac circumflex vessel in treatment of femoral head ischemic necrosis and long-dated hip joint function observation

Objective To retrospect the long-dated curative effect of grafting of iliac bone fl ap with deep iliac circumflex vessel in treatment of femoral head ischemic necrosis.Methods79cases of femoral head ischemic nec rosis treated by promoted Smith-Petersen incision,neck of femur notch,focus cleaning decompression,grafting of iliac bone flap with deep iliac circumflex vessel and screw fixation.13cases treated by transplanting granular bone after d ecompression.Results Grafting of iliac bone flap with deep iliac circumflex vessel treatment g roup were followed up from 3to 9years,the planting bone healed 3to 6months averagely.Two cases suffered femoral head i schemic necrosis continuous-ly.Other cases received good results.Transplanting granular bone afte r decompression group were followed up 3to 9years,3cases suffered femoral head ischemic necrosis cont inuously,hip joint function was lim ited,patients received hip replacement finally.Conclusion Place of iliac bone flap with deep iliac circumflex vessel is fixed,curative effects ar e credible,which can become the firs t-choice therapy to femoral head is-chemic necrosis of middle age and you ng people(Ficat I ～III stage).

Atlantoaxial joint fusion using anterior transarticular screw fixation and bone grafting for atlantoaxial joint instability

Objective To evaluate the clinical application of atlantoaxial joint fusion using anterior transarticular screw fixation and bone grafting for atlantoaxial joint instability. Methods Twenty-three cases of atlantoaxial joint instability were

Polymethylmethacrylate bone cements and additives: A review of the literature

Polymethylmethacrylate(PMMA) bone cement technology has progressed from industrial Plexiglass administration in the 1950 s to the recent advent of nanoparticle additives. Additives have been trialed to address problems with modern bone cements such as the loosening of prosthesis, high post-operative infection rates, and inflammatory reduction in interface integrity. This review aims to assess current additives used in PMMA bone cements and offer an insight regarding future directions for this biomaterial. Low index(< 15%) vitamin E and low index(< 5 g) antibiotic impregnated additives significantly address infection and inflammatory problems, with only modest reductions in mechanical strength. Chitosan(15% w/w PMMA) and silver(1% w/w PMMA) nanoparticles have strong antibacterial activity with no significant reduction in mechanical strength. Future work on PMMA bone cements should focus on trialing combinations of these additives as this may enhance favourable properties.

A Biomimetic Hip Joint Simulator and its Application in in vitro Study of the Integrity of Replacement Cemented Hip

A biomimetic hip joint simulator that can be used to evaluate the outcome of the cemented total hip replacement has been designed, manufactured and evaluated. The simulator produces motion in the extension/flexion plane, with a socket to rotate internal/externally. At the same time a dynamic loading cycle is applied. A validation test was performed on a cemented femoral stem within a novel composite femur. The hone quality has a strong effect on the stem migration and on the integrity of the interfaces. The migration of the stem is a combination of 3-D translation and rotation of the stem. Under the same loading conditions, weak bone allows more stem migration than strong bone. There is a great decrease in the strength of the stem-cement interface after the dynamic test, and the weak bone composite exhibited a greater reduction in interfacial strength than the strong bone composite. The decrease of the interfacial strength indicates that the primary bonding between the stem and the cement mantle had deteriorated and the integrity of stem-cement interface was damaged. The study demonstrates the value of using a hip joint simulator to investigate stem migration and interface integrity within the cemented hip replacement, suggesting that method can be used for in vitro evaluation of the biomaterials used in the cemented hip replacements.

First Metatarsophalangeal Joint Arthrodesis: Comparison of Mesenchymal Stem Cell Allograft versus Autogenous Bone Graft Fusion Rates

With patients undergoing first time 1st metatarsophalangeal joint arthrodesis using graft material when it was required to fill cystic bone voids, we retrospectively compared the time to fusion (clinical and radiographic), and non-union rate between the patient’s own bone autograft (n = 62) versus a mesenchymal stem cell impregnated allograft group (n = 51). A third control group (n = 52) was included in which an end-to-end arthrodesis was performed and no graft interposition was used or necessary. The non-union rate was 4% (n = 2) in the control group, 5.9% (n = 4) in the autograft group, and 9.5% (n = 5) in the mesenchymal stem cell allograft group. The time for radiographic fusion was 6.46 weeks for the control group, 6.52 weeks for the autograft group, and 6.53 weeks for the mesenchymal stem cell allograft group. The difference in time to clinical and radiographic union and the non-union rate were not found to be statistically significant among all 3 groups. Patient comorbidities and their possible effects on union rates were also analyzed within the populations. Some comorbidities had statistically significantly non-unions within the population, notably smoking (p = 0.024) and Rheumatoid arthritis (p = 0.001), however the populations were fairly small. The use of allogeneic bone graft impregnated with mesenchymal stem cells yields a similar fusion rate as with the use of autologous bone graft harvested from the surrounding area. The allograft impregnated with mesenchymal stem cells is a viable alternative yielding similar results when local autogenous bone graft is not available, not obtainable, or conditions warrant its use.

Nuclear medicine and the failed joint replacement: Past, present, and future

Soon after the introduction of the modern prosthetic joint,it was recognized that radionuclide imaging provides useful information about these devices.The bone scan was used extensively to identify causes of prosthetic joint failure.It became apparent,however,that although sensitive,regardless of how the images were analyzed or how it was performed,the test was not specific and could not distinguish among the causes of prosthetic failure.Advances in anatomic imaging,notably cross sectional modalities,have facilitated the diagnosis of many,if not most,causes of prosthetic failure,with the important exception of infection.This has led to a shift in the diagnostic paradigm,in which nuclear medicine investigations increasingly have focused on diagnosing infection.The recognition that bone scintigraphy could not reliably diagnose infection led to the development of combined studies,first bone/gallium and subsequently leukocyte/bone and leukocyte/marrow imaging.Labeled leukocyte imaging,combined with bone marrow imaging is the most accurate(about90%)imaging test for diagnosing joint arthroplasty infection.Its value not withstanding,there are significant disadvantages to this test.In-vivo techniques for labeling leukocytes,using antigranulocyte antibodieshave been explored,but have their own limitations and the results have been inconsistent.Fluorodeoxyglucose(FDG)-positron emission tomography(FDG-PET)has been extensively investigated for more than a decade but its role in diagnosing the infected prosthesis has yet to be established.Antimicrobial peptides bind to bacterial cell membranes and are infection specific.Data suggest that these agents may be useful for diagnosing prosthetic joint infection,but large scale studies have yet to be undertaken.Although for many years nuclear medicine has focused on diagnosing prosthetic joint infection,the advent of hybrid imaging with singlephoton emission computed tomography(SPECT)/electronic computer X-ray tomography technique(CT)and the availability of fluorine-18 fluoride PET suggests that the diagnostic paradigm may be shifting again.By providing the anatomic information lacking in conventional radionuclide studies,there is renewed interest in bone scintigraphy,performed as a SPECT/CT procedure,for detecting joint instability,mechanical loosening and component malpositioning.Fluoride-PET may provide new insights into periprosthetic bone metabolism.The objective of this manuscript is to provide a comprehensive review of the evolution of nuclear medicine imaging of joint replacements.

Dual antibiotic loaded bone cement in patients at high infection risks in arthroplasty: Rationale of use for prophylaxis and scientific evidence

In view of the demographic changes and projected increase of arthroplasty procedures worldwide,the number of prosthetic joint infection cases will naturally grow.Therefore,in order to counteract this trend more rigid rules and a stricter implementation of effective preventive strategies is of highest importance.In the absence of a"miracle weapon"priorities should lie in evidence-based measures including preoperative optimization of patients at higher infection risks,the fulfilment of strict hygiene rules in the operating theatre and an effective antibiotic prophylaxis regimen.Instead of a"one size fits all"philosophy,it has been proposed to adjust the antibiotic prophylaxis protocol to major infection risks taking into account important patient-and procedure-related risk factors.A stronger focus on the local application mode via use of high dose dual antibioticloaded bone cement in such risk situations may have its advantages and is easy to apply in the theatre.The more potent antimicrobial growth inhibition in vitro and the strong reduction of the prosthetic joint infection rate in risk for infection patients with aid of dual antibiotic-loaded bone cement in clinical studies align with this hypothesis.

AN EXPERIMENTAL STUDY ON TRANSPLANTATION OF FROZEN CANINE PHALANGEAL JOINT ALLOGRAFTS INCORPORATED WITH AUTOGENIC BONE MARROW

目的 探讨经过多重钻孔并复合自体骨髓的冷冻异体犬足趾关节移植的疗效。方法 24只健康成年杂交犬，制备双侧后肢第2足趾近侧趾间关节1．5cm缺损模型，共48侧，随机分成A、B、C3组（n=16）。分别采用新鲜自体趾间关节（A组）、经钻孔并复合自体新鲜骨髓的冷冻异体趾间关节（B组）及单纯冷冻异体趾间关节（C组）修复缺损。于术后1、3、6和12个月分别行X线摄片和组织病理学检查，了解移植骨关节的成活情况。结果 根据移植关节术后X线片和组织学改变，犬趾骨关节移植后的病变可分为轻度、中度和重度变性3级。A组移植骨关节3～12个月始终表现为轻度变性；B组移植骨关节1～6个月为轻度变性，骨孔中央软骨内成骨现象明显，12个月部分移植骨关节为中度变性；C组从1个月出现移植骨关节中度变性，3个月移植骨关节重度变性。结论 冷冻异体犬足趾关节内多重钻孔并复合自体新鲜骨髓．能有效延缓异体骨关节的早、中期变性，单纯冷冻异体骨关节移植后早期可能发生严重变性。

The Application of Fat-Suppression MR Pulse Sequence in the Diagnosis of Bone-Joint Disease

Fat-suppression technology of magnetic resonance is very important in clinical practice.This article is written to interpret the principle, advantages/disadvantages and clinical applications of some regular fat-suppression sequences in the diagnosis of Bone-Joint Disease, including 1) frequency-selective saturation (FS);2) short-TI inversion recovery (STI-R);3)frequency selective inversion pulse;4) fat suppression water or fat selective excitation technique;5) Dixon technology and 6) magnetization transfer contrast (MTI).