Acta Orthopaedica Belgica
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Differences in Outcomes According to the Primary Treatment Options Chosen by Patients With Carpal Tunnel Syndrome and negative neurophysiological studies: Conservative Versus Operative Treatment. Do we need neurophysiological studies?
No full textThe purpose of this study is to compare the outcomes of conservative versus operative treatment in patients with a positive history and clinical findings forCarpal Tunnel Syndrome (CTS) and negative nerve conduction studies (NCS). A cohort of 126 consecutive patients (34 males, 92 females) with mean age of 48 years old, positive history and clinical findings for CTS but negative NCS was studied. The mean duration of symptoms was 9.1 months. Group I (94 patients) underwent conservative treatment, whereas group II (32 patients) underwent mini open carpal tunnel release. The clinical diagnosis was based on the Harrington criteria. Patients were evaluated at baseline and at 12-months follow-up using the Boston Carpal Tunnel Questionnaire (BCTQ) and the Disabilities of the Arm, Shoulder and Hand (DASH) instrument. At baseline, group I had lower BCTQ and DASH scores, compared to the respective scores of group II. At the final 12-month follow-up, patients in group I had higher BTCQ scores. Post-treatment, group II showed significant improvement of BTCQ score (p< 0.001) and DASH score (p<0.05).The additional value of NCS is limited when there is strong clinical suspicion
Total hip arthroplasty using the direct anterior approach and intraoperative neurophysiological monitoring for Crowe III hip dysplasia: surgical technique and case series
No full text Nerve palsy rates following THA in dysplastic hips are higher by ten times or more compared to the general population. We report a new technique to perform THA in high congenital dislocations.Between 2013 and 2015, 3 consecutive patients (4 hips) with severe hip pain and Crowe III hip dysplasia were treated. Surgeries were performed on a standard table using the DAA and intraoperative neurophysiological monitoring. At final follow-up (mean 24 months, range 15-43), all 3 patients reported excellent pain relief and radiographs showed the components to be solidly fixed. Average postoperative leg lengthening was 24 mm (range 20-36) without an acute or delayed neurologic deficit. Total hip arthroplasty can be safely performed using this technique. Significant lengthening could be obtained without neurological complications
An evaluation of the influence of force- and weight bearing (a)symmetry on patient reported outcomes after total knee arthroplasty
No full textBackgroundIt has been reported that balance impairments and asymmetrical movement patterns occur in patients after total kne arthroplasty (TKA). The purpose of this study was to evaluate if force- and weight-bearing asymmetry correlate with patient-reported outcomes (PROMs).MethodsTwenty patients were prospectively analysed up to 6 months after TKA. Quadriceps- and hamstring force were measured using a hand-held dynamometer. Vertical ground reaction forces during sit-to-stand, stair descending and squatting were assessed by force plates. Patients were asked to complete the KOOS, OKS and 2011 KSS.ResultsThe symmetry-ratios during sit-to-stand, squat and stair-descent improved significantly. Preoperative quadriceps-force was positively correlated with KOOS-Symptoms (r=0.583, p=0.037). The preoperative load-symmetry ratio during STS was negatively correlated with improvement in KOOS Pain (r=-0.675, p=0.011) and Symptoms (r=-0.674, p=0.008). In deep flexion, preoperative bodyweight ratio was positively correlated with postoperative OKS (r=0.601, p=0.039), KSS-Satisfaction (r=0.675, p=0.011) and improvement in KSS-Satisfaction (r=0.684, p=0.029).ConclusionWeight bearing and force asymmetry do exist before TKA and take up to at least 6-months to fully recover. The more symmetry in muscle-force and weight-bearing is found preoperatively, the better the PROMs will be at 6 months after surgery
Trends in the utilisation rates and acute hospital capacity needs for total hip replacements: results of an analysis of administrative data
No full textTotal hip replacement surgery is the mainstay of treatment for end-stage hip arthritis. In 2014, there were 28227 procedures (incidence rate 252/100000 population). Using administrative data, we projected the future volume of total hip replacement procedures and incidence rates using two models.The constant rate model fixes utilisation rates at 2014 levels and adjusts for demographic changes. Projections indicate 32248 admissions by 2025 or an annual growth of 1.22% (incidence rate 273).The time trend model additionally projects the evolution in age-specific utilisation rates. 34895 admissions are projected by 2025 or an annual growth of 1.95% (incidence rate 296). The projections show a shift in performing procedures at younger age.Forecasts of length of stay indicate a substantial shortening. By 2025, the required number of hospital beds will be halved. Despite more procedures, capacity can be reduced, leading to organisational change (e.g. elective orthopaedic clinics) and more labour intensive stays
Are unilateral or staged bilateral total knee arthroplasty really safer than simultaneously bilateral TKA, or is it a myth?
No full textPurpose: To evaluate feasibility of simultaneous TKA in comparison with staged and unilateral procedures. Patients and methods: 72 simultaneous bilateral, 61 staged bilateral and 222 unilateral TKAs were included. Results: Mean age in the simultaneous group was lower than the other groups. Heart failure as comorbidity was observed less in the simultaneous TKA group than the other two groups. There was no significant difference between simultaneous and staged groups with respect to postoperative WOMAC and SF36 scores. Rates of thrombotic complications and mortality were not different. There was no significant difference in terms of wound healing, periprosthetic infection and TKA revision rates. Conclusions: Younger age and heart failure as a comorbidity were found to be decisive in the selection of simultaneous procedure. Thus, in the case of advanced bilateral knee osteoarthritis, simultaneous bilateral TKA should be performed after a proper preoperative risk assessment when there is a medical rationale, or the patient’s personal preference. In the light of aforementioned conditions, hesitancy about simultaneous TKA seems unnecessary
Open meniscus repair in full and partial horizontal meniscal lesions: a biomechanical cadaver study
No full textPurposeHorizontal meniscal tears are often treated by partial meniscectomy. Some clinical studies have shown successful repair. The purpose of this study was to show that axial loading causes less horizontal displacement in partial than in total horizontal lesions and that suture of those lesions prevents horizontal displacement.MethodsForty menisci were tested: sutured partial horizontal lesions (ten), sutured total horizontal lesions (ten) and matched unsutured control groups (ten each). Samples were put in a custom made fixation device. 1000 cycles with axial loading, simulating partial weight-bearing of 15kg, were applied. Displacement was measured and construct stiffness was calculated.ResultsNo suture failure or pullout occurred. Horizontal displacement was insignificantly lower in partial then in full lesions as well as in sutured samples than in the control groups.ConclusionHorizontal displacement is low in both sutured and unsutured menisci in our test setting. Further studies with higher loads are required
Joint needle aspiration compared to tissue samples in septic arthritis of the native knee
No full textCulturing the causative infectious agent is the only definitive method of diagnosing septic arthritis and can be identified by culturing synovial fluid or tissue cultures obtained by surgery. The aim of this study is to compare the cultures of joint needle aspiration with the tissue cultures obtained by surgery. 52 patients treated under a suspicion of a septic arthritis of the knee were retrospectively reviewed. In 84% tissue cultures were equal to joint needle aspiration. Median Gächter classification was 1.0 (range 1-3). 60% of the patients underwent multiple procedures. All patients were successfully treated with 2.0 (range 1-6) arthroscopies. Our results showed that if a patient with a clinical suspicion of septic arthritis is treated, starting antibiotic therapy prior to surgery can be considered. Arthroscopic surgery must be the treatment of choice in Gächter stage 1 to 3, although it might be necessary to perform multiple procedures
Internal fixation of displaced fractures of the proximal humerus with a locked intramedullary blade nail.
No full textBackground: The purpose of this study was to report 1 year functional and radiological outcomes after intramedullary nailing for displaced proximal humerus fractures using the Marquardt Locking Blade Nail (LBN) system. Methods: Cases of displaced proximal humeral fractures treated with locking blade fixation under the care of a single surgeon from July 2011 to June 2015 were identified. The fracture pattern was classified according to Neer. The cases were predominantly 2 and 3 part fractures with only four 4 part fractures. The primary outcome measures were the Constant score and the Oxford Shoulder Score (OSS) at 1 year. Complication data and re-operations were also reviewed. Results: 62 patients were identified. The mean Constant score at 1 year was 76.0±15.3 (range 44 - 100) and a mean OSS at 1 year of 41.6±5.1 (range 27 - 48). The mean post-operative humeral neck-shaft angle post-operatively was 130.6°±9.6° (range 101° - 145°). All patients achieved bony union. Conclusion: Fixation using the LBN achieved robust fixation and satisfactory clinical outcomes at one year follow up in 2 and 3 part fractures. Younger patients had better functional outcome compared to the elderly
Outcome after arthroscopically assisted percutaneous reconstruction of lateral ankle ligaments using a gracilis tendon autograft.
No full text(It is currently impossible to copy&paste text into your online form. I hereby refer to my Word document for the abstract and references.
Air Arthrograms for Intra-articular Injections of the Hip
No full textIntra-articular hip injection is a widely used technique for diagnostic investigation and therapeutic modality in patient with femoral acetabular impingement (FAI) and other pathology around the hip joint.We describe our technique and experience in performing hip injection using a lateral approach and confirmation of the correct position inside the joint with an air arthrogram.This technique is a simple, safe, and accurate alternative to the other methods based on the using an iodine contrast arthrogram, that can cause possible severe reactions.