Patella denervation in primary total knee arthroplasty - a randomized controlled trial with 2 years of follow-up.

We randomized 126 consecutive patients undergoing primary total knee arthroplasty into group 1: patella denervation (n = 63) and group 2: no patella denervation (n = 63). Assessment was performed preoperatively and at 3, 12 and 24 months post-operatively. Average follow-up of patients was 26.5 months for denervation group and 26.3 months for no denervation group (P = 0.84). Pain scores for anterior knee pain were significantly better in the denervation group at 3 months but not at 12 and 24 months. Patient satisfaction was higher in the denervation group. Flexion range was higher in the denervation group at 3, 12 and 24 months review (P < 0.01). There were, however, no statistically significant differences with other validated knee scores.

Surgical interventions for anterior shoulder instability in adults.

BACKGROUND: The shoulder is the most common joint to develop recurrent instability. Repair of labral tears of the joint and reconstruction of damaged capsule and torn ligaments either by open or arthroscopic methods remain the cornerstone of current management. OBJECTIVES: To compare the effectiveness of various surgical interventions performed to treat recurrent anterior instability of the shoulder in adults. SEARCH STRATEGY: We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (December 2007), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2008, Issue 1), MEDLINE (1950 to March 2008), EMBASE and other databases. We searched conference proceedings and the reference lists of papers. SELECTION CRITERIA: Randomised or quasi-randomised controlled trials comparing different surgical interventions for treating anterior shoulder instability in adults. DATA COLLECTION AND ANALYSIS: The authors independently selected trials, assessed methodological quality and extracted data. Only limited pooling was done. MAIN RESULTS: Included are three randomised controlled trials involving 184 people (predominantly active young men) with unidirectional anterior shoulder instability generally following a traumatic event. All three trials compared arthroscopic versus open surgery, generally involving the repair of Bankart lesions. The three trials were inadequately reported but appeared well-conducted with minimum follow-ups of two years.Pooled results showed no statistically significant difference between the two groups in recurrent instability or re-injury (7/92 versus 5/85, risk ratio (RR) 0.89, 95% confidence interval (CI) 0.09 to 8.72; random-effects model), in subsequent instability-related surgery (RR 0.66, 95% CI 0.05 to 8.97; random-effects model) or surgery for all reasons (RR 0.55, 95% CI 0.04 to 7.18; random-effects model). For other outcomes, including shoulder function, there were either no statistically significant differences between the two groups or the differences were clinically insignificant where statistically significant differences occurred. AUTHORS' CONCLUSIONS: There is insufficient evidence from randomised trials comparing arthroscopic with open surgery for treating anterior shoulder instability. Further research is needed on this subject and for other surgical interventions. Sufficiently powered, good quality, well reported randomised controlled trials with validated outcome measures and long-term follow up are required.

First metatarsophalangeal joint replacement using the bio-action great toe implant: intermediate results.

BACKGROUND: With improvements in biomaterials and design, implant arthroplasty is becoming a useful option for treatment of disorders of the hallux. METHODS: Forty-eight patients (53 implants) who had Bio-Action great toe implants (Osteomed, Addison, TX) for symptomatic advanced degenerative changes in the first metatarsophalangeal (MTP) joint have been followed prospectively since August of 1998. We reviewed the functional results of 32 patients (36 implants) at a minimum followup of 36 (range 36 to 69, mean 47) months. The scoring system designed by Kitaoka etal. was used to assess the functional results. Patient satisfaction, length of hospital stay, time to return to routine activities, footwear problems, radiographic appearances, and complications also were studied. RESULTS: With the numbers available, there was significant improvement in the range of motion achieved and hallux MTP scale after the operation. There was a positive correlation (r = 0.87) between patient satisfaction and the hallux MTP scale. However, there was no correlation between patient age and patient satisfaction or hallux MTP scale. Seventy-seven percent of patients considered the result of the operation to be good or excellent. CONCLUSION: Overall, the 5-year functional results of this total joint system appeared to be satisfactory.