Preoperative Thresholds of Pain and Function to Achieve a Minimal Important Change and Patient Acceptable Symptom State After Proximal Interphalangeal Joint Arthroplasty.

PURPOSE: There is ongoing discussion about the level of symptoms patients with proximal interphalangeal (PIP) joint osteoarthritis should have to undergo surgery. The aims of our study were to determine the minimal important change (MIC) and patient acceptable symptom state (PASS) for PIP joint range of motion (ROM), and define clinically relevant thresholds of preoperative pain and function at which patients have the greatest chance to achieve a MIC and PASS in these outcomes 1 year after PIP arthroplasty. METHODS: We analyzed registry data that included patients with PIP joint osteoarthritis who underwent an arthroplasty for this condition and had a 1-year follow-up. Patients indicated pain on a numeric rating scale (0-10) and completed the brief Michigan Hand Outcomes Questionnaire (MHQ). Active total PIP ROM was measured. The preoperative thresholds, predictive of achieving the MIC and PASS for each outcome measure of pain, function, and ROM, were determined using receiver operating characteristics curves. RESULTS: We included 196 patients who experienced a relevant improvement in ROM (= MIC) when there was an increase by ≥8° compared with the ROM preoperatively. Patients were satisfied with their postoperative ROM (= PASS) if they achieved PIP mobility of at least 66°. Pain at rest and during activities was predictive for achieving a MIC but not a PASS. Due to an insufficient area under the curve for the brief MHQ and ROM, their baseline values cannot predict the postoperative achievement of MIC or PASS. We suggest that patients with preoperative pain at rest ≥4.5 or pain during activities ≥5.5 have the greatest chance of achieving a subjectively relevant change 1 year after surgery. CONCLUSIONS: The determined thresholds may support surgeons in the preoperative process of deciding for or against a surgical intervention and explain the probability of achieving sufficient postoperative symptom relief for the patient. LEVEL OF EVIDENCE: Prognostic I.

Three-Dimensionally Planned and Printed Patient-Tailored Plates for Corrective Osteotomies of the Distal Radius and Forearm.

PURPOSE: We evaluated the 1-year postoperative clinical and patient-reported outcomes in patients who had a 3-dimensional planned corrective osteotomy of their distal radius, radial shaft, or ulnar shaft using a printed, anatomical, patient-tailored plate to determine the feasibility and effectiveness of this methodology. METHODS: Simulations in computer-assisted preoperative planning of corrective osteotomies resulted in 3-dimensionally printed surgical guides, surgical models, and anatomically customized plates for application at the distal radius and forearm. Patients with malunions of the distal radius or forearm who underwent fixation with the custom-made plates were documented in our registry. Grip strength and range of motion assessments were made before surgery (baseline), as well as at 6 weeks and 3 and 12 months. Additionally, patients rated their wrist-related pain and disability using the Patient-Rated Wrist Evaluation. RESULTS: Fifteen patients underwent corrective surgery, and the 1-year follow-up data of 14 patients with a median age of 56 years (interquartile range, 24-64 years) were available for analysis. The median baseline Patient-Rated Wrist Evaluation score improved from 47 to 7 after 1 year. The flexion-extension arc of motion of the wrist increased from 90° at baseline to 130° at 1 year and the pronation-supination arc of motion of the wrist increased from 135° to 160° in the same time period. Differences in radiological measurements for palmar and radial inclinations, as well as for ulnar variance between the affected and contralateral wrists, were reduced with the osteotomy. In 1 case, the plate was removed 11 months after the osteotomy. No severe adverse events were reported. CONCLUSIONS: Three-dimensionally planned and printed patient-tailored plates offer a reliable method for correcting even complex malunions of the distal radius and forearm. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Bioabsorbable poly-L/D-lactide (96/4) scaffold arthroplasty as a salvage procedure in the metacarpophalangeal joint.

We report the case of a 69-year-old female patient, who developed an impressive foreign body reaction around broken metacarpophalangeal silicone implants, including serious axillary lymphadenopathy 3 years after surgery. Possible revision arthroplasties were evaluated but, due to poor bone stock, no regular implants could be used. Instead, a double RegJoint™ (Scaffdex Oy, Finland), a bioabsorbable poly-L/D-lactide implant, was used for each of the 4 metacarpophalangeal joints. At follow-up, we observed no recurrence of synovitis, lymphadenopathy, or any other adverse events. The patient was highly satisfied with the results of the surgery, and painless functional joint movement could be achieved. The restorable RegJoint™ implant seems to be a valid revision option in case of failed silicone arthroplasty.

Can anti-gravity running improve performance to the same degree as over-ground running?

This study examined the changes in running performance, maximal blood lactate concentrations and running kinematics between 85%BM anti-gravity (AG) running and normal over-ground (OG) running over an 8-week training period. Fifteen elite male developmental cricketers were assigned to either the AG or over-ground (CON) running group. The AG group (n = 7) ran twice a week on an AG treadmill and once per week over-ground. The CON group (n = 8) completed all sessions OG on grass. Both AG and OG training resulted in similar improvements in time trial and shuttle run performance. Maximal running performance showed moderate differences between the groups, however the AG condition resulted in less improvement. Large differences in maximal blood lactate concentrations existed with OG running resulting in greater improvements in blood lactate concentrations measured during maximal running. Moderate increases in stride length paired with moderate decreases in stride rate also resulted from AG training. The use of AG training to supplement regular OG training for performance should be used cautiously, as extended use over long periods of time could lead to altered stride mechanics and reduced blood lactate.