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Published in Henry J. Woodford, Essential Geriatrics, 2022
Non-pharmacological interventions include physiotherapy, weight reduction and increased exercise.24 Non-steroidal anti-inflammatory drugs (NSAIDs) are often used in younger patients, but carry a high risk of toxicity in older adults (including gastric bleeding, renal impairment, hypertension and heart failure). Cyclooxygenase 2 (COX-2) inhibitors may be less prone to cause gastric bleeding, but have all the other risks of harm plus a possible increase in cardiac ischaemic events. For these reasons all NSAIDs should be avoided in older adults unless absolutely necessary. Paracetamol (acetaminophen) and weak opioids are safer options for analgesia. Joint replacement surgery may be considered in those who have significant disability despite other therapeutic measures. In a cohort of older adults (mean age 75) with severe OA who underwent hip or knee replacement, post-operative complications occurred in 17% (none fatal), median time to independent walking was 12 days, and surgery was associated with significant symptomatic benefits at 12 months.25
Experimental Arthritis
Published in Thomas F. Kresina, Monoclonal Antibodies, Cytokines, and Arthritis, 2020
Wim B. van den Berg, Maries F. van den Broek, Levinus B. A. van de Putte, Mieke C. J. van Bruggen, Peter L. E. M. van Lent
To get an impression of common concepts within the various models, we have summarized important details in Table 1. It is clear that T cell responses play a dominant role in chronic arthritis. This is also true in the human situation. Therapies like immunosuppression, lymphapheresis, or total lymphoid irradiation all are of benefit to the rheumatoid arthritis (RA) patient. The second important lesson from the models is that there are two forms of continuous stimuli in the joint: either the local persistence of exogenous antigens, like the nondegradable cell walls or antigen trapped in collagenous reservoirs, or articular cartilage autoantigens, like collagen type II and proteoglycans. Apart from the SCW, which are trapped in the synovium, all other stimuli focus on the cartilage as the main source of potential antigens. In the case of SCW, the cartilage could as well function as the antigenic reservoir because of cross-reactivity between SCW and cartilage proteoglycan (PG). Of interest is that destructive forms of rheumatoid arthritis tend to decline at the moment the cartilage is fully destroyed. Moreover, total joint replacement often results in a complete remission of the arthritis in that joint, without the need for concomitant synovectomy. These are strong arguments for a direct role of cartilage in the pathogenesis of RA.
Principles of management of osteoporotic fractures
Published in Peter V. Giannoudis, Thomas A. Einhorn, Surgical and Medical Treatment of Osteoporosis, 2020
Seth M. Tarrant, Zsolt J. Balogh
When initial osteosynthesis fails, arthroplasty is also advocated as a reliable and definitive solution in the periarticular area. With a “cut-out” or “cut-through” complication from femoral nailing of intertrochanteric fractures, several revision options exist: screw exchange, revision nailing, and joint replacement (Figure 15.6). Adhering to the principle of minimizing operative intervention in the osteoporotic patient, arthroplasty can have the most predictable outcome in a fragile population in certain fracture patterns. Despite the “predictability,” functional outcomes after joint replacement still tend to be worse than those of patients who do not experience complications from primary fixation (182). This highlights the importance of making a concerted and calculated effort to plan and execute the most appropriate operation for this fragile patient cohort.
Telerehabilitation versus face-to-face rehabilitation in the management of musculoskeletal conditions: a systematic review and meta-analysis
Published in Physical Therapy Reviews, 2023
Natalia Krzyzaniak, Magnolia Cardona, Ruwani Peiris, Zoe A. Michaleff, Hannah Greenwood, Justin Clark, Anna Mae Scott, Paul Glasziou
Musculoskeletal conditions such as spinal pain and osteoarthritis are among the leading causes of years lived with disability worldwide [1]. These often chronic conditions are associated with significant impact on the individual, due to pain and reduced function, and society due to work absenteeism and reduced work productivity. Musculoskeletal conditions are also associated with substantial financial costs [1]. According to 2008/2009 data, in Australia, musculoskeletal conditions accounted for 9% of health care expenditure, making them the fourth most costly health condition, behind cardiovascular, oral health and mental disorders [1]. Treatment is the dominant component of this expenditure which includes hospital admitted patient services (e.g. joint replacements), out of hospital expenses (e.g. outpatient clinics) and pharmaceuticals (e.g. pharmaceutical benefits scheme) [2]. Guideline management for most musculoskeletal conditions begins with advice, condition-specific education and exercise [2, 3]. Surgical treatment options such as joint replacement surgery for knee or hip osteoarthritis should only be considered following conservative management and when symptoms are no longer responsive to noninvasive approaches [3]. With the prevalence and treatment costs of musculoskeletal conditions increasing, there is growing recognition for the need to identify effective treatment options that enable timely and equitable access to services irrespective of location, accessibility or public health policies, such as lockdowns or quarantine, in response to COVID-19 [4].
Analytical review on the biocompatibility of surface-treated Ti-alloys for joint replacement applications
Published in Expert Review of Medical Devices, 2022
Joint replacement is a surgical procedure in which an artificial joint surgically replaces arthritic or damaged joints made up of metals or plastic components. Damage to the joint may be caused due to several reasons such as aging, accident, or osteoarthritis. So, such damage causes orthopedic surgery that generally requires internal fixation of joints to provide stability during the bone healing process. Historically, cemented and cementless implant designs were used for total joint replacement (TJR) [1]. Cementless techniques are achieving more attention and popularity for TJR due to the removal of the second surgery requirement in cemented implants [2]. In cemented technique, initially, implants possess excellent mechanical strength, but later osteolysis causes loosening of implants. The biological response of cementless implants provides long-term mechanical stability. These implants’ stability depends on several parameters, such as corrosion behavior, debris created, and ions released from the implant. So, bone adaptation to implant and stress shielding is the central areas of concern [3].
Molecular sequencing technologies in the diagnosis and management of prosthetic joint infections
Published in Expert Review of Molecular Diagnostics, 2022
Zakareya Gamie, Dileep Karthikappallil, Emane Gamie, Stavros Stamiris, Eustathios Kenanidis, Eleftherios Tsiridis
Joint replacement is an orthopedic surgical procedure carried out in order to improve joint mobility, relieve pain, and ultimately improve the patient’s quality of life [1,2]. This has proven to be a successful procedure; however, prosthetic joint infection (PJI) is a serious complication arising from arthroplasty, and although occurring in 1–2% of cases, PJI results in high morbidity and mortality with a rate of 5–8% at 1 year [3–6]. This can depend on patient age, sex, type of infecting organism (higher with enterococci), and type of surgical treatment [6]. As well as the clinical impact for patients such as prolonged hospitalization and treatment, complex patient care, and poor clinical outcomes, PJI is also associated with a significant economic impact such as increased healthcare costs [2,4,7]. With an increasing and aging population, the demand for arthroplasty is also increasing, and indeed because of this, the incidence of PJI is also expected to rise placing a burden on healthcare systems [1,7,8].