UK epidemiologists presenting at the annual meeting of the British Society for Rheumatology recently reported that X-ray evidence of rapid rheumatoid arthritis (RA) progression during the first 12 months of the disease can help predict the need for later surgery of hand, foot, hip, and knee joints. Lewis Carpenter and colleagues analyzed data from the Early Rheumatoid Arthritis Study and found that a change in the Larsen radiographic score of four units during the first 12 months of RA was associated with an 80% increased risk of subsequent surgery on joints of the hand and foot, and a 50% increase in the risk of later hip or knee surgery. (The 0 to 5 Larsen score includes both joint-erosion and joint-space narrowing components.) Carpenter told MedPage Today that these findings help “build the case for early treatment in rheumatoid arthritis” and support the argument that a “therapeutic window of opportunity” exists with RA.
Selected patients with osteomyelitis from diabetic foot infections can be treated medically or surgically with equal effectiveness, according to a small randomized study in Diabetes Care, purportedly the first study to prospectively compare the two treatments. Fifty-two patients with diabetic foot ulcers complicated by osteomyelitis received either a 90-day course of antibiotics or had the infected bone removed surgically, followed by a short course of antibiotics. Healing (complete epithelialization) occurred in 75% of the antibiotic group and 86% of the surgery group (p=0.33), and complications during treatment were also similar in the two groups. Clinical guidelines from the Infectious Diseases Society of America for dealing with diabetes-related foot osteomyelitis can be found here.
Ankle & Foot Pro III is one of the highest-rated apps for orthopaedic surgeons, according to TopOrthoApps, a mobile app review site. This app receives outstanding ratings in functionality, coolness, and overall features. Ankle & Foot Pro III gives a visual look at anatomy with high-level, 3-D views into muscles, tendons, nerves, vessels, ligaments and bones. The app features easily manipulated views, a “pen” feature for drawing on the screen, “pins” that identify structures of different layers, and videos demonstrating surgical procedures.