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Rao S.,New York University | Rao S.,The New Motion | Ellis S.J.,Orthopedics | Deland J.T.,Orthopedics | Hillstrom H.,The New Motion
Current Opinion in Rheumatology | Year: 2010

Purpose of Review: The incidence of ankle osteoarthritis has increased in recent years, in part, secondary to vehicular trauma. This review describes conservative and operative intervention strategies along with current research related to the management of ankle osteoarthritis. Recent Findings: Self-reported physical function in patients with ankle osteoarthritis is equivalent to or worse than that of patients with endstage kidney disease, congestive heart failure, or cervical-spine pain and radiculopathy. Nonoperative-intervention strategies such as assistive devices, orthoses, and viscosupplements are frequently used in this clinical population. However, limited objective data are available examining outcomes following nonoperative intervention. Ankle fusion serves as a standard-surgical treatment for end-stage ankle osteoarthritis. The limitations of ankle fusion include prolonged immobilization, a relatively high risk of nonunion, and adjacent joint arthritis. Increasing evidence supports the safety and efficacy of total-ankle arthroplasty (TAA). Current (third generation) TAA prostheses feature cementless design and ligament preservation with reduced bone resection and improved instrumentation. Summary: Limited objective evidence exists to guide clinical decision-making related to nonoperative choices such as assistive devices, orthoses, and viscosupplements. Outcomes from prospective clinical trials indicate that newer total ankle-arthroplasty designs provide substantial pain relief in patients with end-stage ankle osteoarthritis. © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins.

Wiegant K.,Rheumatology and Clinical Immunology | Van Roermund P.M.,Orthopedics | Intema F.,Rheumatology and Clinical Immunology | Cotofana S.,Musculoskeletal Anatomy | And 3 more authors.
Osteoarthritis and Cartilage | Year: 2013

Background: Treatment of severe osteoarthritis (OA) in relatively young patients is challenging. Although successful, total knee prosthesis has a limited lifespan, with the risk of revision surgery, especially in active young patients. Knee joint distraction (KJD) provides clinical benefit and tissue structure modification at 1-year follow-up. The present study evaluates whether this benefit is preserved during the second year of follow-up. Methods: Patients included in this study presented with end-stage knee OA and an indication for total knee replacement (TKR); they were less than 60 years old with a VAS pain ≥60mm (n=20). KJD was applied for 2 months (range 54-64 days) and clinical parameters assessed using the WOMAC questionnaire and VAS pain score. Changes in cartilage structure were measured using quantitative MRI, radiography, and biochemical analyses of collagen type II turnover (ELISA). Results: Average follow-up was 24 (range 23-25) months. Clinical improvement compared with baseline (BL) was observed at 2-year follow-up: WOMAC improved by 74% (P<0.001) and VAS pain decreased by 61% (P<0.001). Cartilage thickness observed by MRI (2.35mm (95%CI, 2.06-2.65) at BL) was significantly greater at 2-year follow-up (2.78mm (2.50-3.09); P=0.03). Radiographic minimum joint space width (JSW) (1.1mm (0.5-1.7) at BL) was significantly increased at 2-year follow-up as well (1.7mm (1.1-2.3); P=0.03). The denuded area of subchondral bone visualized by MRI (22% (95%CI, 12.5-31.5) at BL) was significantly decreased at 2-year follow-up (8% (3.6-12.2); P=0.004). The ratio of collagen type II synthesis over breakdown was increased at 2-year follow-up (P=0.07). Conclusion: Clinical improvement by KJD treatment is sustained for at least 2 years. Cartilage repair is still present after 2 years (MRI) and the newly formed tissue continues to be mechanically resilient as shown by an increased JSW under weight-bearing conditions. © 2013 Osteoarthritis Research Society International.

Senders C.W.,Davis Medical Center | Tollefson T.T.,Davis Medical Center | Curtiss S.,Orthopedics | Wong-Foy A.,University of California at Davis | And 3 more authors.
Archives of Facial Plastic Surgery | Year: 2010

Objective: To determine the force requirements, optimal vector, and appropriate materials of a novel eyelid sling device that will be used to rehabilitate eyelid closure (blink) in congenital or acquired permanent facial paralysis with an artificial muscle. Methods: The force required to close the eyelids in human cadavers (n = 6) were measured using a load cell system. The eyelid sling using either expanded polytetrafluoroethylene (ePTFE) or temporalis muscle fascia was implanted. The ideal vector of force and placement within the eyelid for a natural eyelid closure were compared. Results: The eyelid sling concept was successful at creating eyelid closure in a cadaver model using an upper eyelid sling attached to the distal tarsal plate. Less force was necessary to create eyelid closure using a temporalis muscle fascia sling (627 ± 128 mN) than for the ePTFE eyelid sling (1347±318 mN). Conclusions: The force and stroke required to close an eyelid with the eyelid sling are well within the attainable range of the electroactive polymer artificial muscle (EPAM). This may allow the creation of a realistic and functional eyelid blink that is symmetric and synchronous with the contralateral, normally functioning blink. Future aims include consideration of different sling materials and development of both the EPAM device and an articulation between the EPAM and sling. The biocompatibility and durability studies of EPAM in a gerbil model are under way. The successful application of artificial muscle technology to create an eyelid blink would be the first of many potential applications.

Lucki M.M.,Grant Medical Center OhioHealth | Napier D.E.,Orthopedics | Wagner C.,Hospital OhioHealth
Orthopaedic Nursing | Year: 2012

BACKGROUND:: Recognizing a patient's needs during the emergency department to operating room interval is crucial to identify areas for improvement. A review of the literature provided no pertinent research regarding this phase of the preoperative experience. PURPOSE:: This descriptive study examined the preoperative care management of patients with hip fractures during the wait time between emergency department discharge and operating room admission. METHOD:: Data were collected through a systematic retrospective chart review. Demographic variables included gender, age, and comorbidities. Preoperative patient variables included type of analgesia, level of pain, antiembolism interventions, fluid intake, sensory perception/cognition, mobility, and nutritional intake. Subjects were patients cared for at 3 sites in a large multihospital system. A total of 137 charts were reviewed. FINDINGS:: Although findings were not statistically significant, opportunities to improve care were identified. More attention is needed to evaluate patients effectively for pain, particularly where there are cognitive deficits. Designing and implementing a program for increased bed mobility and protocols that closely monitor and manage fluid intake may offset postoperative complications. © 2012 by National Association of Orthopaedic Nurses.

Morabito R.,Messina University | Marino A.,Messina University | Romano P.,Laboratory | Rigano C.,Orthopedics | La Spada G.,Messina University
Cellular Physiology and Biochemistry | Year: 2013

Background: It has been reported that biologically active compounds extracted from Cnidaria venom may induce damage by oxidative stress. Erythrocytes are constantly exposed to oxidative stresses, which can contribute to sulphydril (SH-) group oxidation and cell membrane deformability accompanied with activation of K-Cl co-transport and inhibition of anion transport. In this regard, Band 3 protein is responsible for mediating the electroneutral exchange of chloride (Cl-) for bicarbonate (HCO3 -), particularly in erythrocytes, where it is the most abundant membrane protein. The aim of this study was to elucidate the effect of crude venom extracted from Pelagia noctiluca nematocysts on Band 3-mediated anion transport in human erythrocytes. Methods: Erythrocytes were tested for SO4 2- uptake, K+ efflux, glutathione (GSH) levels and concentration of SH-groups. Results: The rate constant of SO4 2- uptake decreased progressively to 58% of control with increasing venom doses, and showed a 28% decrease after 2 mM NEM treatment. These effects can be explained by oxidative stress, which was reflected by decreased GSH levels in venom-treated erythrocytes. Hence, the decreased efficiency of anion transport may be due to changes in Band 3 structure caused by SH-group oxidation and reduced GSH concentration. In addition, an increased Cl--dependent K+ efflux was observed in venom-treated erythrocytes. Conclusion: Our results suggest that crude venom from Pelagia noctiluca alters cell membrane transport in human erythrocytes. © 2014 S. Karger AG, Basel.

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