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Hip & Pelvis Jun 2023The aim of this review is to conduct an analysis of existing literature on outcomes of application of various methods of joint decompression in management of septic... (Review)
Review
The aim of this review is to conduct an analysis of existing literature on outcomes of application of various methods of joint decompression in management of septic arthritis of the hip in children. A search of literature in PubMed, Embase, and Google Scholar was conducted for identification of studies reporting on the outcomes of intervention for septic arthritis of the hip in children. Of the 17 articles selected, four were comparative studies; two of these were randomized controlled trials while the rest were single arm studies. Statistical difference was observed between the proportion of excellent clinical and radiological outcomes in arthrotomy (90%, 95% confidence interval [CI] 81-98%; 89%, 95% CI 80-98%), arthroscopy (95%, 95% CI 91-100%; 95%, 95% CI 90-99%), and arthrocentesis (98%, 95% CI 97-100%; 99%, 95% CI 97-100%), respectively. The highest overall rate of additional unplanned procedures was observed in the arthrocentesis group (24/207, 11.6%). Patients who underwent arthrocentesis had a statistically greater chance of excellent clinical and radiological outcomes, although the highest level of need for additional unplanned surgical intervention was observed in the arthrocentesis group, followed by the arthroscopy group and the arthrotomy group. Future conduct of a prospective multicentric study focusing on the developed and developing world, along with acquisition of data. such as delay of treatment and severity of disease will enable assessment of the efficacy of one technique over the other by surgeons worldwide.
PubMed: 37323550
DOI: 10.5371/hp.2023.35.2.73 -
Journal of Maxillofacial and Oral... Mar 2023Internal derangement of the temporomandibular joint is defined as an abnormal position of the articular disc in relation with mandibular condyle and articular eminence...
INTRODUCTION
Internal derangement of the temporomandibular joint is defined as an abnormal position of the articular disc in relation with mandibular condyle and articular eminence presenting as disc displacement with or without reduction.
METHODOLOGY
This study was conducted on thirty patients diagnosed with Internal derangement of TMJ consisting of 8 males and 22 females averaging 34.6 years. Two groups Conventional Arthrocentesis (Group A) and Level 1 Arthroscopy (Group B) consisted of 15 cases each divided alternately. Clinical evaluation parameters included VAS for pain, maximal interincisal opening, deviation on mouth opening, range of motion including lateral excursion & protrusion movements recorded at 1 week, 1 month & 6 months postoperatively. Wilke's Staging according to MRI findings was recorded preoperatively and 6 months postoperatively.
RESULTS
At 6 month follow-up, average reduction in VAS for pain & deviation on mouth opening was 72.43% & 24.73% in Group A and 77.66% & 65.41% in Group B, respectively. Average increase in MIO, right & left excursion & protrusion movements was 29.55%, 31.33%, 20.12% & 32.45% in Group A and 34.94%, 41.37%, 39.29% and 36.51% in Group B, respectively. Improved results were obtained clinically for all Wilke's stages in both groups with more number of patients improving in Group B.
CONCLUSION
On comparing results, improvement was observed in various clinical evaluation parameters of both the groups at 6 months follow-up. However, statistically significant & better results were obtained for the Arthroscopy group.
PubMed: 36703649
DOI: 10.1007/s12663-021-01627-9 -
Academic Emergency Medicine : Official... Feb 2022Arthrocentesis is commonly performed in the emergency department, but success rates vary based on location. Presently, there is a paucity of data assessing the utility... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVES
Arthrocentesis is commonly performed in the emergency department, but success rates vary based on location. Presently, there is a paucity of data assessing the utility of ultrasound-guided (USG) medium-sized joint arthrocentesis. The objective of this study was to compare the success of USG and landmark-guided (LMG) medium-sized joint arthrocentesis.
METHODS
This was a single-center, prospective, randomized clinical trial (NCT03327584) of a convenience sample of adult patients who presented to an urban, university hospital with > 105,000 visits annually. Patients with a suspected medium-sized joint effusion (defined as elbow, wrist, or ankle) undergoing arthrocentesis were randomized into LMG or USG using the GE Logiq e linear transducer (4-10 MHz). The following patients were excluded: on anticoagulation, with soft tissue infection overlying the joint, or involving an artificial joint. Statistical analysis included the Fisher exact, Mann-Whitney U-test, and t-test.
RESULTS
Overall, 44 patients were enrolled with 23 patients randomized into the LMG group and 21 patients into the USG arm. USG was significantly better than LMG with an overall success of 94.1% versus 60% for LMG (difference = 34.1%, 95% confidence interval [CI] = 4.90 to 58.83). USG first-pass success was 82.4% versus 46.7% for LMG (difference = 35.7%, 95% CI = 2.76 to 60.37) and a mean of 1.35 attempts versus 2.00 for LMG (difference = 0.65, 95% CI = 0.005 to 1.296). Of the 14 LMG failures, eight had no effusion present on USG crossover. Four patients in the USG group had no effusion present.
CONCLUSIONS
Ultrasound guidance improved first-pass and overall successful arthrocentesis of medium-sized joint effusions.
Topics: Adult; Arthrocentesis; Emergency Service, Hospital; Humans; Prospective Studies; Ultrasonography; Ultrasonography, Interventional
PubMed: 34608713
DOI: 10.1111/acem.14396 -
Journal of Medicine and Life May 2022Temporomandibular joint disorders (TMDs) are ailments affecting the jaws and allied structures, resulting in many pathologies (TMJ hypermobility, internal disc...
Prognostic criteria for the management of temporomandibular disorders using arthrocentesis with normal saline and arthrocentesis with normal saline and platelet-rich plasma.
Temporomandibular joint disorders (TMDs) are ailments affecting the jaws and allied structures, resulting in many pathologies (TMJ hypermobility, internal disc derangement, bone changes, degenerative disorders, and ankylosis). Pain, clicking or crepitus, restricted range of motion, deranged jaw function, and deflected or deviated mouth opening and closing are the commonly observed manifestations in TMDs. Internal derangement refers to an aberrant relation of the articular disc to the condyle and fossa, respectively. Conventional therapies highlight the role of non-invasive conservative treatment strategies, namely joint unloading, anti-inflammatory drugs, and physiotherapy. Current literature has emphasized the use of corticosteroids and platelet-rich plasma (PRP) as treatment strategies in TMDs. This study aimed to evaluate whether intra-articular injection of PRP after normal saline lavage in TMJ minimizes the symptoms of TMDs, as compared to injection of normal saline. Thirty patients with TMD according to research diagnostic criteria (RDC) were selected. One group received arthrocentesis with normal saline, and the other group received arthrocentesis with PRP injection. The patients were assessed for pain, maximum inter-incisal mouth opening, bite force, and TMJ sounds. TMDs treated by PRP injection had slightly better results. More studies are required to substantiate the outcome. Injections of PRP were more effective in reducing the symptoms than arthrocentesis with normal saline.
Topics: Arthrocentesis; Humans; Pain; Platelet-Rich Plasma; Prognosis; Saline Solution; Temporomandibular Joint Disorders; Treatment Outcome
PubMed: 35815075
DOI: 10.25122/jml-2021-0240 -
Oral Surgery, Oral Medicine, Oral... Apr 2022The present double-blind randomized clinical trial aimed to compare the efficacy of conservative treatment and articular lavage, either alone or combined, to reduce... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
The present double-blind randomized clinical trial aimed to compare the efficacy of conservative treatment and articular lavage, either alone or combined, to reduce joint pain and improve mandibular opening.
STUDY DESIGN
The sample consisted of patients presenting with limited mouth opening and joint pain. The diagnosis was made according to the diagnostic criteria for temporomandibular disorders guideline and confirmed by magnetic resonance imaging. Sixty patients were selected and randomly allocated to 4 groups of 15 patients each with different treatments: group A (conservative), group B (conservative + medication), group C (arthrocentesis), and group D (arthrocentesis + medication). The groups were compared in terms of maximal interincisal opening and pain.
RESULTS
The average age of the patients was 34.17 ± 13.1 years, 88.1% were women, 72.9% had internal derangement, 54% had joint sounds, and 55.9% presented with locking. Clinical improvement was noted in all parameters compared with baseline in all groups (P < .005), but no significant differences were observed when the groups were compared (P > .05).
CONCLUSIONS
Both arthrocentesis and conservative modalities were efficient treatments to reduce joint pain and increase mandibular opening.
Topics: Adult; Arthrocentesis; Female; Humans; Middle Aged; Pain; Pain Measurement; Range of Motion, Articular; Temporomandibular Joint; Treatment Outcome; Young Adult
PubMed: 34373214
DOI: 10.1016/j.oooo.2021.06.020 -
ACR Open Rheumatology Apr 2022The study objective was to assess the efficacy of simulators in improving the competence of students in performing a knee and shoulder arthrocentesis on cadavers and to...
OBJECTIVE
The study objective was to assess the efficacy of simulators in improving the competence of students in performing a knee and shoulder arthrocentesis on cadavers and to determine the minimum number of simulator training procedures needed to achieve competence in arthrocentesis.
METHODS
Two groups of 15 medical students were each trained to perform a single joint arthrocentesis ("knee group" and "shoulder group") on a simulator to serve as a control for the other. The two groups received the same theoretical training (anatomy, arthrocentesis techniques, ultrasound, and hybrid simulation). Each student punctured the two joints on a cadaver. A student was considered "competent on the cadaver" if they succeeded at two or more arthrocentesis procedures out of the three tests on the joint on which they were trained. The minimum threshold value to be competent was calculated by a receiver operating characteristic curve and the Youden index. An assessment of theoretical knowledge and confidence level in joint arthrocentesis was carried out at the start and end of the study.
RESULTS
Twenty-two out of 29 students (75.8%) achieved competence in arthrocentesis at the joint for which they were trained. Of the students in the knee group, 79% were competent on the cadaver's knee versus 60% of the students in the shoulder group (P = 0.43). Of students in the shoulder group, 74% were competent on the cadaver's shoulder versus 57% of students in the knee group (P = 0.45). Four training punctures on a simulator are necessary to achieve competence on a cadaver. The students' confidence level in arthrocentesis increased significantly during the study, as did the students' theoretical knowledge.
CONCLUSION
Knee and shoulder arthrocentesis success rates were not statistically different between the two training groups. A minimum number of 4.0 training arthrocentesis on a simulator is needed to achieve competency on a cadaver.
PubMed: 34989181
DOI: 10.1002/acr2.11400 -
National Journal of Maxillofacial... 2023Platelet concentrate has become an increasingly popular alternative source of growth factors for several types of dental and surgical procedures. It improves healing and...
A comparative analysis between intra articular injections of injectable platelet rich fibrin versus platelet rich plasma in the management of temporomandibular disorders: A randomized control trial.
BACKGROUND
Platelet concentrate has become an increasingly popular alternative source of growth factors for several types of dental and surgical procedures. It improves healing and stimulates cell proliferation, matrix remodeling, and angiogenesis. The injectable platelet-rich fibrin (i-PRF) has various advantages over platelet-rich plasma (PRP). The aim of our study was to evaluate the efficacy of intra-articular injections of i-PRF versus PRP in the management of temporomandibular disorders (TDMs).
METHOD
The prospective randomized study involved 14 patients ( = 28 joints) of internal derangement between the age groups of 20 to 50 years divided randomly into two groups with seven patients ( = 14 joints) in each group. For all the patients, arthrocentesis was carried out in the first sitting followed by intra-articular injections of PRP and i-PRF in group I and group II, respectively, at 1-month interval for 6 months. A single surgeon has performed the procedure. All patients were assessed clinically for pain, maximal mouth opening (MMO), lateral movement, protrusive movement, and joint sounds and radiographically for disc position and joint effusion (JE).
RESULTS
Pain reduction, MMO, lateral movement, protrusive movement, and joint sounds were significant in both groups with more significance in group II. Disc position had improved toward normal in both groups and showed significant changes in both groups at the 9-month follow-up with better results in group II.
CONCLUSION
PRP and i-PRF injections are regarded as simple and safe methods with potential beneficial effects and are cost-effective. In this preliminary study, i-PRF has been found to be scoring better in terms of efficacy over PRP across all set parameters.
PubMed: 37661973
DOI: 10.4103/njms.njms_498_21 -
Journal of Dental Sciences Jan 2022Temporomandibular joint disc displacement is the most frequently reported temporomandibular disorder that may severely impair quality of life and can be challenging to...
BACKGROUND/PURPOSE
Temporomandibular joint disc displacement is the most frequently reported temporomandibular disorder that may severely impair quality of life and can be challenging to treat. This study aimed to evaluate and compare the efficiency of intra-articular injection of injectable platelet rich fibrin (i-PRF) following arthrocentesis or arthrocentesis alone in treatment of patients with TMJ disc displacement with reduction.
MATERIALS AND METHODS
Forty patients for a total of forty joints with reducible anterior disc displacement, as confirmed by Magnetic Resonance Imaging (MRI) were selected and divided into 2 equal groups. In group I (control group), arthrocentesis alone was performed with Ringer solution. In group II (study group), a combination of arthrocentesis and intra-articular injection with 1.5 ml i-PRF was performed. The outcome variables included pain intensity evaluated with a visual analogue scale, inter-incisal opening, lateral movement evaluated in millimeters, and clicking. Assessments were done pre-operatively, and 1 week, 3 months, and 6 months postoperatively.
RESULTS
There was statistically significant reduction in pain intensity and clicking sound and increase in mouth opening and lateral movement in i-PRF group when compared to arthrocentesis group. In addition, the differences between preoperative and postoperative status in all the measured parameters were statistically significant within the study and the control group throughout the postoperative period.
CONCLUSION
The combination of i-PRF with arthrocentesis is a safe and effective method in the treatment of TMJ disc displacement with reduction.
PubMed: 35028072
DOI: 10.1016/j.jds.2021.07.027 -
National Journal of Maxillofacial... Aug 2022One of the main causes of chronic facial pain is temporomandibular disorders (TMDs) which may turn out to be a major cause for disability. The two types of treatment...
A comparison of the outcomes following intra-articular steroid injection alone or arthrocentesis alone in the management of internal derangement of the temporomandibular joint.
CONTEXT
One of the main causes of chronic facial pain is temporomandibular disorders (TMDs) which may turn out to be a major cause for disability. The two types of treatment strategies may be undertaken to counter temporomandibular joint (TMJ) disorders, namely conservative management and surgical intervention. Surgical management can be classified into invasive open methods and minimally invasive procedures such as arthrocentesis, intra-articular steroid injection, and arthroscopy.
AIMS
The aim of this study is to compare the efficacy of Kenacort (Triamcinolone) as an intra-articular corticosteroid injection and arthrocentesis for lysis and lavage, for the treatment of the temporomandibular joint disorders.
SUBJECTS AND METHODS
Twenty patients with internal derangement of temporomandibular joint (IDTMJ) not responding to conservative management and meeting the inclusion criteria randomly underwent either intra-articular steroid injection or arthrocentesis and the results of the two procedures were evaluated and compared.
STATISTICAL ANALYSIS USED
Unpaired -test, repeated-measures ANOVA. A value of < 0.05 is considered to be statistically significant.
RESULTS AND CONCLUSION
Both procedures turned out to be successful in reducing pain and improving mouth opening, both in a short-term and a long-term use. Upon comparison in our series of patients, arthrocentesis was noted to be a better treatment modality in the long term for the management of IDTMJ.
PubMed: 36393924
DOI: 10.4103/njms.njms_291_21 -
Journal of Medical Education and... 2019Arthrocentesis of the ankle and elbow and brachial plexus nerve blocks are infrequently performed procedures; however, clinicians in specialties such as emergency...
BACKGROUND
Arthrocentesis of the ankle and elbow and brachial plexus nerve blocks are infrequently performed procedures; however, clinicians in specialties such as emergency medicine are required to be proficient in these procedures in the event of emergent or urgent necessity.
OBJECTIVES
The objective of this study was to create, implement, and assess a fresh cadaver-based educational model to help resident physicians learn how to perform ultrasound-guided arthrocentesis of the ankle and elbow and ultrasound-guided regional nerve blocks.
METHODS
This was a single-center cross-sectional study conducted at an academic medical center. After a brief didactic session, 26 emergency medicine residents with varying levels of clinical and ultrasound experience rotated through 4 fresh cadaver-based stations. The objective of each station was to understand the sonographic anatomy and to perform ultrasound-guided arthrocentesis or regional nerve block with hands-on feedback from ultrasound fellows and faculty. Participants were subsequently asked to complete a questionnaire which evaluated participants' experience level, opinions, and procedural confidence regarding the 4 stations.
RESULTS
A total of 26 residents participated in this study. All 26 residents agreed that the cadaver model (compared with clinical anatomy) was realistic regarding ultrasound quality of the joint space, ultrasound quality of the joint effusion, ultrasound quality of nerves, tissue density, needle guidance, and artifacts. Finally, there was a statistically significant difference between mean scores for pre-simulation and post-simulation session participant procedural confidence for all 4 procedures.
CONCLUSIONS
This fresh cadaver-based ultrasound-guided educational model was an engaging and well-received opportunity for residents to gain proficiency and statistically significant confidence in procedures which are uncommonly performed in clinical settings.
PubMed: 31799406
DOI: 10.1177/2382120519885638