ABSTRACT
BACKGROUND: Interposition arthroplasty (IA) is mostly performed in younger patients where total joint replacement is contraindicated and an arthrodesis is unattractive. The outcome and complications of an IA were evaluated. METHODS: We retrospectively reviewed 18 consecutive cases of interposition arthroplasty (IA) (one case was excluded as a result of incomplete records). Pre- and postoperative pain and function were evaluated. Complications, re-operations and revisions were recorded. RESULTS: The mean age was 41 years (range 19 years to 59 years) at time of surgery. The primary diagnosis was post-traumatic osteoarthritis in 12 cases and inflammatory arthritis in five cases. The median follow-up was 54 months (range 8 months to 120 months). In 15 cases, at least one re-operation was performed. Seven cases were revised, with four of these to a total elbow replacement, an arthrodesis was performed in two cases and a re-do interposition was carried out in one case. The median interval from the interposition to revision was 23 months (range 8 months to 88 months). In 10 patients with the interposition currently in situ, mean visual analogue scale score for pain improved from 7.4 to 2.4 and mean Mayo Elbow Performance Score improved from 42 to 76 points. CONCLUSIONS: IA offered an improvement in pain and function but at a high cost. It is associated with a high complication rate the need for revision surgery.
ABSTRACT
BACKGROUND: We describe late anatomic repair of complete distal ulnar collateral ligament (UCL) avulsions of the thumb in the absence of metacarpophalangeal joint arthritis using a dissolvable polylactic acid (PLA) bone anchor in two cases, one of which had a Stener lesion. METHODS: Patients presented for surgery respectively at 5 months and 2 years after injury. Preoperative X-ray films showed subtle volar subluxation of the proximal phalanx. Volar plate release corrected this in both cases and a transarticular k-wire was not used. Satisfactory repair was achieved in both cases using a dissolvable PLA bone anchor. Flexion-extension mobilization was supervised by a hand therapist from day 1 after surgery. A low profile radial-sided thermoplastic splint to prevent reinjury of the UCL repair was used allowing interphalangeal joint and base of thumb movement, and was worn between therapy sessions for 4 weeks. RESULTS: In both patients, satisfactory UCL stability was maintained at 3-year follow-up after surgery. DISCUSSION: Dissolvable PLA bone anchors may be used to satisfactorily restore stability and function in late presenting complete distal UCL avulsions of the thumb with or without accompanying Stener lesions.
