Bulletin of the Hospital for Joint Disease (2013)
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Bull Hosp Jt Dis (2013) · Jan 2013
ReviewUpdate on methotrexate as the anchor drug for rheumatoid arthritis.
Methotrexate has become the "anchor drug" for rheumatoid arthritis (RA), taken by many more patients than any other disease modifying anti-rheumatic drug (DMARD) or biological agent. Methotrexate has greater efficacy and effectiveness than any other non-biologic DMARD, and greater tolerability and safety than other DMARDs. The efficacy of methotrexate is comparable to biologic agents in parallel clinical trials of DMARD-naïve patients. ⋯ Interpretation of significantly lower radiographic progression between methotrexate and biologic agents in clinical trials is over- stated regarding clinic consequences. The admonition to patients to refrain entirely from consumption of alcohol while taking methotrexate may be unnecessary. Accurate information concerning methotrexate as the anchor drug for RA should lead to better understanding of optimal use and better to patient outcomes in usual clinical care.
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Post-traumatic ankle arthritis can be a very disabling condition especially in young patients. Localization of the pain is important to allow appropriate treatment. Non-surgical treatment options include anti-inflammatory medications and use of bracing. ⋯ Arthrodesis remains the gold standard and is the procedure of choice for younger patients who are heavy laborers and in patients with severe arthritis who are not candidates for a total ankle replacement. Joint sparing operations include allograft resurfacing, arthroscopic debridement and osteophyte resection, joint distraction arthroplasty, and supramalleolar osteotomy. In older low demand patients, the surgeon may consider a total ankle arthroplasty as an alternative to arthrodesis.
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Bull Hosp Jt Dis (2013) · Jan 2013
Comparative StudyRapid mobilization decreases length-of-stay in joint replacement patients.
Physiotherapy after total joint replacement enhances postoperative recovery. Implementing a pathway to include earlier postoperative mobilization can reduce the hospital length-of-stay as well as cost. ⋯ Rapid mobilization of total joint replacement patients in the recovery room can be accomplished safely and reduces the overall length of hospital stay for over 70 % of patients.
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Bull Hosp Jt Dis (2013) · Jan 2013
ReviewPlatelet rich placebo? Evidence for platelet rich plasma in the treatment of tendinopathy and augmentation of tendon repair.
Platelet rich plasma (PRP), an autologous sample of blood with a platelet concentration above baseline values, is hypothesized to augment soft tissue healing. Its use in sports medicine has risen dramatically, with common applications including the treatment of refractory tendinopathy and augmenting tendon repair. Many commercial preparation systems are available, but the optimal preparation remains unknown. ⋯ Its use in tendon repair is currently not supported. Randomized, controlled studies with documentation of platelet, white blood cell, and growth factor concentration in the PRP preparation are necessary for future comparative research. Use of PRP should be approached judiciously until further evidence is available.
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Bull Hosp Jt Dis (2013) · Jan 2013
Comparative StudyComparison of outcomes using anatomic and reverse total shoulder arthroplasty.
Worldwide, the usage of both anatomic total shoulder arthroplasty (aTSA) and reverse total shoulder arthro- plasty (rTSA) has increased significantly due, in part, to the predictability of acceptable outcomes achieved with each prosthesis type. This study quantifies outcomes using five different metrics and compares results using one platform total shoulder arthroplasty system that utilizes the same humeral component and instrumentation to perform both aTSA or rTSA. ⋯ Significant improvements in outcome scores were observed for both aTSA and rTSA using one platform shoulder system at a mean follow-up of 31.4 months. Significant differences were observed between prosthesis type and between scoring metrics, particularly between the Constant and ASES scoring metrics. Additional and longer term follow-up is required to confirm these observed differences.