[Ortho] joint distraction/chondrolysis

Пн Авг 18 04:14:05 YEKST 2008

Dear Aharon,

Thank you for reply on e-mail.
I would like to clarify for myself the influence of joint distraction on 
cartilage nutrition and respective consequencies. It is obviuos that with 
continous distraction applied to the joint the weeping lubrication( cycle 
sqeeze-out/ suck-in  of synovial fluid ) is ceased, stretching of joint 
capsule suppose to affect the blood circulation in it and synovoal fluid 
production/absorbtion, potentially affecting the cartilage nutrition and 
creating conditions for chondrolysis
. The question has come to me after observation of 15 yrs. old boy who was 
diagnosed with lower limb spastic monoparesis, 4cm leg shortening, rigid 
equinus foot deformity, pes cavus.
I have applied circular frame on the lower leg with half rings extension on 
the foot. Gradual stretching of achillis tendon, forefoot distraction was 
applied untill the foot columns and equinus deformity was not corrected then 
started with prox. tib. callotasis. 2cm lengthening was achieved and 
unfortunately had to remove the frame - poor patient's compliance. After 
frame was removed f/u xrays( appr.4 weeks later) revealed ankle joint space 
narrowing, posterior part of the ankle joint spontaneous fusion!!! while the 
midfoot joints remained unaffected. What could be the cause of such outcome?
Thank you in advance for your comments,

Kind Regards,
Evgueny

----- Original Message ----- 
From: "Dr. A. Liberson" <cishaifa@/unetvision.net.il>
To: "Orthoforum" <ortho на weborto.net>
Sent: Saturday, August 16, 2008 1:04 PM
Subject: [Ortho] Re: Застарелое повреждение голеностопа

> Dear Evgueny,
> I did it with a circular frame, distracted it on a table with an 
> arthroscopy
> and coninued the distraction for 3 month. The same did a Dutch group, If I
> recall well from Amsterdam also on small group of patients. There is also 
> an
> American one.
> I do not think there is a lot cartilage ther to be afraid of a lysis.
> I would appreciate a weight bearing AP film in order to answer on your
> second question-talar subluxation did not look very prominant-its about 1 
> nn
> if I SEE WELL. I beleive in a thick pseudocartilage -I distract 3-4 MM and
> do not imagine a reposition without an open intervention.
> I would be very cautious to plan an osteotomy with reposition in this
> destroyed joint-I might be wrong looking on radiographs provided. I did 
> some
> late repositions, though in an earlier phase. I would consult and explain
> the p-nt every one of those-agree.
> yours
> Aharon
>
> ----- Original Message ----- 
> From: "Evgueny" <evgueny на iway.na>
> To: "Orthoforum" <ortho на weborto.net>
> Sent: Saturday, August 16, 2008 11:09 AM
> Subject: Re: [Ortho] Застарелое повреждение голеностопа
>
>
>> Hello Arcady,
>>
>> How long do you keep the joint in distraction? Is there any risk of
>> chondrolysis correlated with duration of distraction?
>> Do you think it's going to work in this case as the talus remains
>> subluxated?
>> Probably the patient should be given an options to choose: ankle fusion
>> restoring painfree???( metatarsalgia) weight bearing function or ankle
>> anatomy reconstruction combined with joint distraction as there is 60%
>> functional improvement after 5 yrs.
>>
>> Kind Regards,
>> Evgueny Tchekashkine
>>
>> ----- Original Message ----- 
>> From: "Dr. A. Liberson" <cishaifa на netvision.net.il>
>> To: "Orthoforum" <ortho на weborto.net>
>> Sent: Friday, August 15, 2008 7:02 PM
>> Subject: [Ortho] Re: Застарелое повреждение голеностопа
>>
>>
>>> As I already wrote, a Distraction arthroplasty would fit taking into
>>> account
>>> the young age-I did some of them and at least 60% feel well after 5
>>> years.
>>> An endoprosthesis in 30 y old is only in case he understands that we do
>>> the
>>> endoprosthesis for last 20 years and he might need a reop at age of
>>> 45-50.
>>> We do not speak of endoprosthesis of hip.
>>> My youngest endoprosthesis of the ankle was 37 when I did it, He is a
>>> large
>>> man of 43 by now and he understands that he might be a "test case".
>>> AL
>>> ----- Original Message ----- 
>>> From: "Иван" <orthoforum на weborto.net>
>>> To: <ortho на weborto.net>
>>> Sent: Friday, August 15, 2008 5:34 PM
>>> Subject: Re: [Ortho] Застарелое повреждение голеностопа
>>>
>>>
>>>> Здравствуйте Михаил на действительно сустава та нет. на учитывая 
>>>> молодой
>>>> возраст рекомендовать артродез как то не хотелось бы. скорее
>>>> эндопротезирование. если по финансовым (парамедицинским) вопросам нет 
>>>> то
>>>> артродез избавит от боли. а функция за счет предплюсны будет хотя и
>>>> скудная. удачи.
>>>> Иван
>>>>
>>>>
>>>>
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>>>
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>>
>>
>>
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