Decompression for recurrent carpal tunnel syndrome provides significant functional improvement and patient satisfaction.

This prospective single-centre study describes the functional outcomes, satisfaction and health-related quality of life after open revision carpal tunnel decompression for recurrent carpal tunnel syndrome. The QuickDASH, patient satisfaction and EuroQol-5 dimensions questionnaires were collected preoperatively and postoperatively over a 5-year period (2013-2018). The median time to revision was 13.3 years (range 3.9-35.4 years; interquartile range 7.2-15.9 years). Outcomes were available for 14 hands in 13 patients at a mean of 20 months after revision surgery. The mean preoperative and postoperative QuickDASH scores were 55 and 29, respectively, and the mean improvement in QuickDASH was 26. The mean improvement in EuroQol-5 dimensions score was 0.1, and 13 of the 14 patients were satisfied. The net promoter score was 85. This study confirms that patients undergoing revision open carpal tunnel decompression for recurrent carpal tunnel syndrome experience a significant improvement in function and health-related quality of life. Level of evidence: IV.

Patient-reported outcomes after in situ cubital tunnel decompression: a report in 77 patients.

This prospective single-centre study describes the patient-reported outcomes following open in situ decompression for cubital tunnel syndrome. The Quick version of the Disabilities of the Arm, Shoulder and Hand questionnaire and patient satisfaction scores were collected over a 3-year period. Outcomes were available for 77 patients at a mean of 17 months (11-27 months) postoperatively. The mean scores improved significantly from 39 to 30 postoperatively. The score change correlated strongly and significantly with postoperative satisfaction. Sixty-six patients (86%) were satisfied. Patients with clinical evidence of weakness at presentation had significantly lower satisfaction scores than those without. By reporting functional improvement and high levels of patient satisfaction in a large series, this study supports the use of in situ decompression for cubital tunnel syndrome. The outcomes for the patients with weakness and atrophy of ulnar nerve innervated muscles before surgery are less satisfactory. Level of evidence: III.

The long-term outcome of simple trapeziectomy.

The aim of this study was to investigate the long-term outcome of simple trapeziectomy by a single surgeon and to compare this with pre-operative function. Two hundred and five patients completed the shortened disabilities of the arm, shoulder and hand questionnaire (QuickDASH) and the EuroQoL five-dimensional questionnaire (EQ-5D) scores at a mean of 8.2 (range 3.5-17) years after simple trapeziectomy. There were no pre-operative scores available, so case controls were selected from our prospective database to compare pre- and post-operative patient-reported outcome measures. The mean QuickDASH score of the post-operative matched group was 37 (SD 17.0) and the mean EQ-5D was 0.56 (SD 0.31). The mean QuickDASH score of the pre-operative group was 54 (SD 17.0). The mean difference in QuickDASH between the pre- and post-operative groups was 17 (95% CI: 8 to 26, p = 0.0003). This study demonstrated a significant and sustained improvement in patient-reported function after simple trapeziectomy. It supports that simple trapeziectomy is a simple, safe and effective treatment for advanced trapeziometacarpal joint arthritis. Level of evidence: IV.

A case control study of cemented acetabular total hip arthroplasty components in patients less than 50 with 5-year minimum follow-up.

BACKGROUND: This study investigates the outcomes of cemented sockets in young patients (<50 years) requiring a total hip replacement (THR) compared to older patients (>50 years) having the same procedure, under the same surgeon between June 2005 and May 2009. METHODS: Prosthesis survivorship rates, patient outcomes and radiological findings were compared between a consecutive series of 56 young patients (mean 42, range 25-49) and 56 older patients (mean 69, range 53-81) that underwent a primary THR using a cemented Stryker® Exeter™ Contemporary™ flanged cup. The minimum follow-up was 5 years. RESULTS: No significant difference was observed between the groups' Oxford Hip Scores (p = 0.078) or satisfaction scores (p = 0.67). Worst case scenario analysis for revision, failure or lost to follow-up showed 94.6% survival in the <50 year olds and 92.9% survival in the >50 year olds at 5 years. This study demonstrates no significant difference in patient outcomes, survivorship or radiographic findings at a minimum of 5 years between patients <50 years old and those >50 years old undergoing THR with a cemented socket. CONCLUSIONS: We believe the current trend towards uncemented cups may be driven by marketing rather than by evidence of improved outcomes. Cemented sockets provide very good outcomes for patients of all ages.

Case report: a modified 1-stage technique for the treatment of brachymetatarsia.

UNLABELLED: Brachymetatarsia is an abnormal shortening of a metatarsal. It causes disruption of the normal metatarsal parabola, resulting in metatarsalgia, calluses and dislocation of the digits. Patients often express discontent with the appearance of their feet. Lengthening by distraction osteogenesis and 1-stage intercalary bone grafting procedures are the mainstays of operative treatment. We present a modified 1-stage technique, combining the use of a Chevron osteotomy of the fourth metatarsal with shortening osteotomies of the second and third metatarsals. Bone removed from the third metatarsal was used to lengthen the fourth. The Chevron segments provided mediolateral, dorsoplantar, and rotational stability. The technique was used on both feet of 1 patient. The mean increase in AOFAS score was 34.5 (right foot, 46; left foot, 23.) There were no complications. A 1-stage technique does not require an external fixator or postoperative manipulation and has a quicker healing time. Taking the bone graft from neighboring metatarsals decreases the discrepancy between metatarsal lengths. A smaller increase in the length of the fourth ray is then required, and the chance of neurovascular injury as a result of soft-tissue stretching is minimized. This technique allows restoration of the metatarsal parabola and provides good correction, immediate stability, and good integration. LEVELS OF EVIDENCE: Therapeutic Level IV, Case Study.

Early post-operative results of neglected tendo-Achilles rupture reconstruction using short flexor hallucis longus tendon transfer: a prospective review.

BACKGROUND: Various repair techniques have been reported for neglected tendo-Achilles rupture. OBJECTIVE: This study aimed to prospectively investigate the impact of short flexor hallucis longus (FHL) transfer to the calcaneus for patients with neglected rupture secondary to trauma. METHODS: One surgeon operated on a series of patients with neglected tendo-Achilles rupture. Ankle function and patient health were assessed pre and post-operatively using the American Orthopaedic Foot and Ankle Score (AOFAS) and the SF-36 score. RESULTS: 11 patients (6 male; mean age 52.6) were included. Median time from injury to surgery was 13.3 weeks (range 6-104 weeks). The mean pre-operative AOFAS was 51.4 (range 26-87), 79.8 (range 64-94) at 3 months and 91.9 (range 77-100) at 6 months post-operatively. The mean pre-operative SF-36 score was 87.4 (range 75.4-109.5), 103.2 (range 74.1-115.4) at 3 months and 111.8 (range 103.9-116.2) at 6 months. All patients had improved SF-36 at 6 months. At 6 months 10 out 11 patients had resumed pre-injury daily activities. CONCLUSION: Direct transfer of FHL to the calcaneum with an interference screw allows correct tensioning and secure fixation. The procedure has low morbidity and reliable outcomes. The majority of patients were able to return to daily working activities with no restrictions.