Acta Orthopaedica Belgica
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Patellar instability - An update
No full textThis review is a current concept on the topic of patellofemoral instability purposing to highlight, reflect and in cooperate both recent important findings regarding the patellofemoral joint. In the past decade numerous studies have significantly contributed to our understanding of both the epidemiology, symptomatology and underlying pathomorphology of patella instability. The topic of patella instability is very complex and several biomechanical important factor have been elucidated and consequently treatment strategies are changing. Both non-surgical as well as surgical algorithms are evolving, but still there is a lot of controversies and generally there is lack of consensus. Many different surgical options exist primarily based upon repair what have been torn, or by correcting the underlining pathomorphology. Reconstruction of the medial patellofemoral ligament is the most commen surgical procedure, nevertheless in cases with more severe underlining pathomorphologic factors such as trochlear dysplasia, patella alta and increased femoral anteversion, subsequent procedures correcting those abnormalities should be corrected.
Treatment of distal radius fractures with palmar plates and locking screws. Comparisson of two different types of plate
No full textVarious plating systems are available to fix distal radius fractures, each with a specific design. The purpose of this study was to compare radiological outcome and complications of the Variable Angle LCP Plate 2.4-mm (DePuy Synthes) with the VariAx volar locking plate (Stryker). One hundred patients (103 wrists) operated on for a distal radius fracture were retrospectively reviewed with a mean follow-up of 3.5 years. Seventy-three patients were treated with a DePuy Synthes plate and 30 with a VariAx plate. The overall complication rate was 32%. Nineteen cases underwent revision surgery, 18 had malunion and 3 complex regional pain syndrome. Complicaton rate was 43% with DePuy Synthes plates and 27% with Variax plates, but the difference was not significant.
Ten-year outcomes of the Arpe prosthesis for the treatment of osteoarthritis of the trapeziometacarpal joint
No full textOutcomes of 66 Arpe prostheses in 50 patients treated for osteoarthritis of the trapeziometacarpal joint were investigated with a mean follow-up of ten years. Ten-year survival was 87% when failure was defined as implant removal followed by trapeziectomy and tendon interposition. Ten-year survival was 82% when revision of the cup was also considered as failure and it was 80% when replacement of the neck alone was also chosen as an endpoint. Of the 52 prostheses that were not revised mean DASH score was 11, mean pain score 1.2 and mean score for satisfaction 9.5 It can be concluded that the majority of patients who did not underwent revision surgery were satisfied and had little or no pain. However, long-term survival of the Arpe prosthesis was moderate and patients should be warned that after ten years the risk for reoperation might be up to 20%.
“Less is More” for Low Grade Lumbar Spondylolytic Spondylolisthesis
No full textWe analysed if in-situ posterior stabilization and posterolateral fusion without decompression is appropriate for low grade lumbar spondylolytic spondylolisthesis (LLSS). Patients in whom posterior stabilization and interbody fusion with decompression was performed were Group 1 [n = 27; Age = 48.7±13] and those in whom in-situ posterior stabilization and posterolateral fusion without decompression was performed were Group 2 [n = 37; Age = 46.3±16.4]. All preoperative parameters, intra-operative blood loss, duration of surgery and period of hospitalization were similar between the groups. Statistical comparison of outcomes at 2-years follow-up demonstrated no significant difference in back pain score [p = 0.61], sciatic pain score [p = 0.23] and functional assessment [p = 0.71]. Even though we do much less on performing in-situ posterior stabilization and posterolateral fusion without decompression, it offers similar results as that of posterior stabilization and interbody fusion with decompression in selective LLSS patients.
Clinical and radiological characteristics of 82 solitary benign peripheral nerve tumours
No full textBenign peripheral nerve tumours are rare lesions. The surgical treatment and clinical outcomes depend on the resectability. The aim of this retrospective study was to identify clinical or radiological features that may predict the surgical technique that should be used to improve clinical outcome. Eighty-two patients were diagnosed with solitary benign peripheral nerve tumours. Fifty-five tumours were surgically resectable, and 27 were nonresectable. Pre-operative magnetic resonance imaging and ultrasound were used, which were predictive of the neural origin of the tumours in 87% (39/45) of cases imaged. In 78% (50/64) of cases imaged, an origin from the nerve sheath (peripheral nerve sheath tumour), or from non-neural elements was possible. However, no imaging or clinical criteria were identified that could determine tumour resectability preoperatively. The diagnosis of solitary peripheral nerve tumour still relies on the macroscopic appearance and definitive histology after epineurotomy.
Sesamoid arthrodesis for moderate metacarpophalangeal hyperextension associated with trapeziometacarpal osteoarthritis treated by total arthroplasty.
No full textA total of 32 (12.5%) thumbs were treated with trapeziometacarpal osteoarthritis and moderate metacarpophalangeal hyperextension (30º-50º), placing the Arpe® implant and sesamoid arthrodesis of the metacarpophalangeal joint in the metacarpal bone head. In 28 patients were treated with radial sesamoid arthrodesis at the metacarpal head and 4 patients with ulnar sesamoid arthrodesis.All patients were functionally stable at final follow-up, with a correction of the hyperextension deformity, although 2 patients with ulnar sesamoid arthrodesis had a new surgical procedure due to reproduction of the metacarpophalangeal hyperextension deformity.The mean pinch strength increased significantly. The preoperative VAS score was 6.7 and the postoperative was 1.4. The preoperative DASH score was 51.8 and in the last review it was 12.6.The purpose of the study is to evaluate the results of the sesamoid arthrodesis as a treatment of moderate (30º-50º) metacarpophalangeal hyperextension in patients undergoing type Arpe® total trapeziometacarpal arthroplasty
The Influence of Local Infiltration Analgesia After Total Hip Replacement. A randomized clinical trial
No full textPurpose To determine whether local infiltration analgesia by catheter infusion was superior to conventional analgesia in terms of postoperative pain control after THR. Methods A randomized double-blind clinical trial was performed. There were four groups based on catheter placement and the infusion constituents: 1) Intraarticular catheter + anesthetics; 2) Intraarticular catheter +placebo; 3) Subfascial catheter + anesthetics; 4) Subfascial catheter + placebo. The anesthetic infusion contained bupivacaine (bolus + continuous perfusion up to 36 hours). The placebo solution was physiological serum. The same conventional analgesic schedule was prescribed to all patients. Pain was evaluated by means of PCA shots and the VAS. Side effects, time to start rehabilitation and time to discharge were also analyzed.Results 100 patients (25 for group). Mean age was 67 years old (SD 12 y/o) and 53% were male. Mean PCA shots was 27 [range 2-87] and mean VAS was 1 [range 0-7]. No differences were found (p>0.05) when these variables were compared between the groups.ConclusionsThe use of LIA with bupivacaine using a catheter infusion does not provide better pain control after THR.
Total ankle replacement: Comparison of the outcomes of STAR and Mobility
No full textTotal Ankle Replacement is a recognised treatment for end-stage ankle arthritis and an alternative to arthrodesis. This study reviews a single centre series of prospectively collected outcome measures to determine whether the Mobility performs better than the Scandinavian ankle replacement. The primary outcome measure was the survivorship. Secondary outcome measures consisted of complications and international scoring systems.147 Scandinavian and 162 Mobility ankle replacements were reviewed at a mean follow up of 12.4 and 7.7 years respectively. The revision rate, which included liner exchange, component exchange or removal of implant was at 7 years 12.3% (18) for Scandinavian and 5.2% (8) for Mobility. The complication rate was 16.5% (22) for Scandinavian compared to 9.9 % (15) for Mobility.The results of our unit compare favourably with previous published studies. In this study the Mobility has been shown to have more favourable results at 7 years compared to the Scandinavian.
Comparison of corticosteroid injection and ozone injection for relief of pain in chronic lateral epicondylitis
No full textAbstractPurpose: To evaluate and compare the therapeutic effects of corticosteroid and ozone injections in the alleviation of pain associated with chronic lateral epicondylitis .Methods: Data was collected from the medical records of 80 patients (56 women, 24 men; average age: 45.8±7.5). Corticosteroid injection was performed once a week for three times, and ozone was injected 6-8 times at 3 day intervals. No additional analgesics were given. Pain assessment was made by means of Verhaar scores before and after the first injection, on 3rd, 6th and 9th months.Results: The duration of pain was 24.4±12.5 months and the right side was more commonly affected (47, 58.8% vs. 33, 41.2%). Corticosteroid and ozone groups were similar with respect to age (p=0.45), gender distribution (p=0.43) and side of epicondylitis (p=0.88). Pain scores at rest, at compression and on activity were not different in two groups before and following injection. Notably, ozone group displayed better scores compared to corticosteroid in terms of pain on 3rd, 6th and 9th months after injection (p<0.001 for all).Conclusion: Our results demonstrated that ozone injection can be an effective therapeutic option for CLE patients who are refractory to conservative treatment
Manipulation under anesthesia for frozen shoulders: a retrospective cohort study
No full textBackground Manipulation under anesthesia is a well-established, but controversial, treatment for frozen shoulders. We will evaluate our results of manipulation and physiotherapy in stage two frozen shoulders.Materials and methods Questionnaires were sent to 65 patients with stage 2 frozen shoulders, treated with manipulation under anaesthesia between January 2012 and January 2014. Outcome parameters consisted of SPADI, OSS, EQ-5D, pain and satisfaction. Results A response rate of 75% was obtained. Mean follow up was 21 months (range 11-36). The median SPADI score was 11.2 (IQR 0.8-25.2) and median OSS was 39.0 (IQR 30-43). Only 72% of patients reported that they reached their pre injury level of functioning. A satisfaction rate of 92% was reported.Conclusions Manipulation is a relatively easy intervention with a high satisfaction rate. We assume that manipulation could shorten the duration of symptoms. However, this needs to be confirmed in a randomized trial with a control group.