No demonstrable benefit for coronal alignment outcomes in PSI knee arthroplasty: A systematic review and meta-analysis.

AIM: A systematic review and meta-analysis of clinical studies assessing alignment outcomes in patient-specific instrumented (PSI) knee arthroplasty was conducted. MATERIALS AND METHODS: PRISMA compliant data was extracted from literature databases up to January 2014. RESULTS: Twenty-six studies met the inclusion criteria, reporting a total of 1792 knees. Twenty-three studies reported alignment outcomes in the coronal plane, 11 in the sagittal plane. In all but three series, MRI was the preoperative imaging modality. Range of mean postoperative alignment (hip-knee-ankle [HKA] angle) was 176.5 to 181.70. The proportion of three degrees of outliers showed an overall mean of 18.6%. In total, fifteen studies compared alignment outcomes between standard and PSI. From these, four studies showed significantly higher accuracy of coronal plane alignment with PSI (HKA angle). Meta-analysis of seven high-quality comparative studies demonstrated no significant increased accuracy in postoperative mechanical axis (HKA angle) with PSI. Subgroup meta-analysis of both femoral and tibial rotation was not feasible due to a low number of inclusive high-quality series. CONCLUSIONS: PSI knee arthroplasty is shown not to confer increased accuracy in reconstituting the postoperative mechanical axis. Further studies are required to demonstrate both clinical and radiological alignment outcomes in PSI knee arthroplasty with focus upon tibial and femoral rotation.

Prospective randomized trial comparing absorbable and non-absorbable sutures in open carpal tunnel release.

A prospective randomized trial was undertaken to compare the influence of absorbable and non-absorbable sutures on pillar pain, scar tenderness, extent of wound inflammation and overall outcome of the surgery following open carpal tunnel release. Forty hands in 33 patients (mean age, 51 years; range, 31-74 years) were randomized into group A (absorbable sutures) or group B (non-absorbable sutures). Clinical assessment was done at 2, 6 and 12 weeks follow-up. The outcome of surgery in terms of improvement of severity of symptoms and functional status of patients was assessed using a self-administered Boston Questionnaire. There was no significant difference between the two groups for any of our outcome measures at the final follow-up.

Dome osteotomy with T-plate fixation for cubitus varus deformity in an adult patient.

Cubitus varus (gun stock deformity) is the most common long-term complication resulting from a malunion of a supracondylar fracture of the humerus in children. The reported series of complication varies from 9 to 58%. There are many published papers describing corrective supracondylar osteotomy mainly for children. We describe a method of performing supracondylar osteotomy that produced a very satisfactory result in an adult patient.

First metacarpal osteotomy for carpo-metacarpal osteoarthritis.

The results of basal osteotomy of the first metacarpal in the treatment of carpo-metacarpal osteoarthritis have been analysed from two small studies, one retrospective and one prospective. Assessment included clinical examination, standardised radiography and computerised pinch-grip analysis. Surgery reduces the subluxation at the first metacarpal base and provides good pain relief and restoration of function in the majority of cases. It is concluded that this relatively simple technique produces very good results without reducing power grip.

Acute carpal tunnel syndrome in haemophiliacs.

Acute median nerve compression at the wrist differs from the classical carpal tunnel syndrome in its aetiology and presentation. There is a rare association with haemophilia and such a case is reported in this paper. A review of the literature over the past 20 years revealed only nine cases. It is suggested that management should be conservative in the first instance, with factor VIII replacement continued for three to five days. Surgical decompression is indicated if symptoms fail to resolve in the first 24 hours.

Permanent anterior dislocation of the proximal tibiofibular joint.

We report two patients with permanent dislocation of the proximal tibiofibular joint and no history of trauma. Both needed operation, one for persistent pain and the other for common peroneal nerve involvement, and both had a good result.

An unusual presentation of inflammatory bowel disease.

A 32 year-old male presented to his general practitioner for a routine health check. Microscopic haematuria was noted in an otherwise asymptomatic and fit patient. Subsequent investigation was normal apart from abnormal liver function tests for which no cause was found. A cholecystectomy was performed for gallstones which were detected by ultrasound after the patient complained of upper right quadrant pain. Wedge biopsy of the liver at operation was suggestive of cholangitis. A barium enema was performed which revealed ulceration of the transverse colon suggestive of Crohn's disease. The association of cholangitis and inflammatory bowel disease is discussed.

A diagnostic test for carpal tunnel syndrome using ultrasound.

The paper describes the details of an ultrasound test for carpal tunnel syndrome and compares the results of this with E.M.G. studies in a series of 19 patients. The equipment used was a standard therapeutic ultrasound unit and the tests were performed by a physiotherapist. The results were encouraging, with a 90% correlation with E.M.G. results.