Hirofumi Taira

Synovectomy, debridement, and continuous irrigation for infected total knee arthroplasty

Since 1990, a total of ten joints in nine patients with infected total knee arthroplasty have been treated in our department within 21 days of the onset of infection. Their radiographs showed no evidence of implant loosening or “moth-eaten” appearance. They underwent synovectomy, debridement, and continuous irrigation without implant removal. Continuous irrigation was maintained for 7–29 days. It was possible to retain implants in eight joints of seven patients. Two joints of two patients were removed. Pain disappeared in all eight joints in which the implants were retained. Four patients could walk with one cane; one patient could walk with one crutch. Range of motion in five joints remained over 100°. We recommend synovectomy, debridement, and continuous irrigation to cure an early stage infection of total knee arthroplasty.RésuméDepuis 1990, dix articulations chez neuf malades avec une arthroplastie totale infectée du genou ont été traité dans notre département dans les 21 jours après le début de l’infection. Les radiographies n’ont pas montré de descellement d’implants ou d’anomalie de la texture osseuse. Ils ont subi synovectomie, débridement et irrigation continue sans ablation de l’implant. L’irrigation continue a été maintenue pour sept à 29 jours. Il a été possible de conserver les implants de huit articulations chez sept malades. Deux articulations de deux malades ont subi l’ablation de l’implant. La douleur a disparu de toutes les articulations ou les implants avaient été conservés. Quatre malades devaient marcher avec une canne et un avec une béquille. L’amplitude de mobilité est restée au-dessus de 100° pour cinq articulations. Nous recommandons la synovectomie, le débridement et l’irrigation continue pour traiter une infection précoce d’arthroplastie totale du genou.

Idiopathic Heterotopic Ossification Within the Tibial Nerve

Heterotopic ossification has been reported to occur following burns, musculoskeletal trauma, and tetanus and in association with metabolic and neurologic disorders. Heterotopic ossification is found most commonly in the muscles, and histopathologically identical lesions have been described in tendons, subcutaneous fat, ligaments, fasciae, aponeuroses, and joint capsules1. Heterotopic ossification can also cause clinically relevant peripheral nerve entrapment2-4. Heterotopic ossification or calcification within a peripheral nerve is a rare lesion and may arise in association with neurofibroma5, leprosy6, CREST syndrome (calcinosis, Raynaud phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasia)7, diabetic neuropathy8-10, and chronic renal failure11. In a recent review of the literature, we found only two cases of idiopathic intraneural heterotopic ossification12,13. We describe here an unusual case of a painful ossifying lesion arising from the tibial nerve in a man. The radiographic and histopathologic findings were similar to those of myositis ossificans. A forty-two-year-old male truck driver had persistent discomfort in the right popliteal fossa for four months. Previously, he had been healthy and he had no history of trauma. He reported the gradual onset of severe pain and tenderness and had noticed swelling in the right popliteal fossa and calf with paresthesias and decreased sensation in the right leg. He was referred to our hospital in January 2000. Physical examination disclosed a hard, …

Extraosseous calcified plasmacytoma causing thoracic myelopathy

Abstract We report on a rare, calcified, plasma cell tumor of the spine causing progressive myelopathy. Other unusual features were the lack of an osseous lesion at the site of the mass, considerable calcified amyloid within the mass but no identifiable amyloid elsewhere, and normal serum immunoelectrophoresis.