A comparison of fusion, trapeziectomy and silastic replacement for the treatment of osteoarthritis of the trapeziometacarpal joint.

This retrospective study compares three of surgical treatments for osteoarthritis of the trapeziometacarpal joint of the thumb. We assessed the outcomes of a total of 83 operations at a follow-up of between 1 and 5 years. The types of treatment were, fusion of the carpometacarpal joint (36 operations), excision of the trapezium with or without a sling ligament reconstruction (25 operations), and silastic trapezial replacement (22 operations). Assessments included patient satisfaction, pain measurement, range of movement, tip and key pinch, and complication rates. There were no significant differences between the clinical outcome of the treatments, though there was higher rate of complications and reoperation in the fusion group.

Treatment of patello-femoral arthritis using the Lubinus patello-femoral arthroplasty: a retrospective review.

There are few published results in the literature on patello-femoral arthroplasty. The aim of this study was to help to define the place of patello-femoral arthroplasty in the treatment of isolated patello-femoral arthritis. All patients who underwent patello-femoral arthroplasty using the Lubinus prosthesis for patello-femoral arthritis between 1992 and 1998 in two neighbouring district general hospitals were studied. There were 34 patients who underwent 45 arthroplasties. The modified Hungerford and Kenna scoring system and the Insall and Crosby scoring system were used to clinically evaluate the patients. Serial radiographs were assessed for patellar malalignment, mechanical failure and progressive arthritic change. Twenty-three knees (64%) had a good or excellent result, six (17%) had an unsatisfactory result and seven (19%) were revised to either a total knee arthroplasty (5 knees) or patellofemoral arthroplasty (2 knees). Although the results do not compare favourably with those of total knee replacement for generalised arthritis of the knee; we believe that with careful patient selection coupled with careful surgical technique, patello-femoral arthroplasty can be successfully used to treat isolated patello-femoral osteoarthritis.

Fracture of the polyethylene tibial post in posterior stabilized (Insall Burstein II) total knee arthroplasty.

Polyethylene wear is a well-recognized complication of total knee arthroplasty (TKA). To our knowledge, fracture of the polyethylene tibial post in a posterior stabilized TKA system has not been described as a complication or cause of failure in TKA. We report a case of a fractured polyethylene tibial post in an 85-year-old woman within 3 years of Insall Burstein II TKA, causing instability that necessitated revision surgery.

Low-friction arthroplasty with Boneloc bone-cement: outcome at 2 to 4 years.

We report the clinical and radiologic outcome of 109 Chamley low-friction arthroplasties implanted with Boneloc bone-cement (Biomet, Bridgend, South Wales, UK) into 104 patients. The mean follow-up was 30 months (range, 2-48 months). There were 72 women (mean age, 71 years) and 32 men (mean age, 72). Cartridge-packed cement was used in 37 cases and vacuum-packed cement in 72 cases. Survivorship analysis based on revision for aseptic loosening showed 79% survival at 4 years. Seventeen (15.5%) hips have been revised for aseptic loosening to date, in which all stems and 4 cups were loose. Extensive femoral osteolysis was always present and resulted in 4 cases of femoral cortical perforation at revision. Survivorship analysis based on revision and radiologic failure showed only 55% survival over the same period. When radiologic loosenings were included as failures, the vacuum-packed cement performed significantly worse than the cartridge-packed cement it replaced. These poor results were consistent with the withdrawal of Boneloc from clinical use in 1995, and we recommend indefinite follow-up for surviving prostheses.

The tourniquet in total knee arthroplasty. A prospective, randomised study.

We assessed the influence of the use of a tourniquet in total knee arthroplasty in a prospective, randomised study. After satisfying exclusion criteria, we divided 77 patients into two groups, one to undergo surgery with a tourniquet and one without. Both groups were well matched. The mean change in knee flexion in the group that had surgery without a tourniquet was significantly better at one week (p = 0.03) than in the other group, but movement was similar at six weeks and at four months. There was no significant difference in the surgical time, postoperative pain, need for analgesia, the volume collected in the drains, postoperative swelling, and the incidence of wound complications or of deep-venous thrombosis. We conclude that the use of a tourniquet is safe and that current practice can be continued.

The non-operative management of radial head fractures: a randomized trial of three treatments.

Ninety-eight consecutive patients with Mason type 1 and 2 radial head fractures were randomized into three treatment groups to compare early mobilization with immobilization in flexion and extension. Eighty-one patients were reviewed on average 25 months following fracture and assessed for pain, disability and range of movement. Loss of full extension was the most frequent restriction of movement and was found in 17 patients. Two patients had restricted flexion without limited extension. Patients immobilized in a flexion cast had a significantly reduced range of movement compared with patients immobilized in extension (P = 0.02). Nineteen patients had residual pain and again the flexion group fared worse than the extension group (P = 0.06). Results from early mobilization in a sling were not significantly different from the other two groups. Treatment of radial head fractures in flexion casts should be avoided.

Stabilisation of the wrist in rheumatoid disease.

Internal splintage was undertaken of fifteen wrists for pain and instability, using an intramedullary Rush nail. The patients were examined at an average of thirty-three months after operation. Spontaneous fusion in a useful position had occurred in all but one. The operation is simple and external immobilisation is unnecessary.