Added value of ultrasound-guided percutaneous needle tenotomy over hydrodissection and physiotherapy in chronic lateral elbow tendinopathy: a pilot randomized controlled trial.

Aim of the study: There is no consensus on the most suitable non-surgical treatment of chronic lateral elbow tendinopathy. The aim of this pilot randomized controlled trial was to evaluate the size of effect of ultrasound-guided percutaneous needle tenotomy. Material and methods: Three intervention arms were formed: 1) percutaneous needle tenotomy, hydrodissection, and physiotherapy; 2) hydrodissection and physiotherapy; and 3) physiotherapy alone. Patients with chronic lateral elbow tendinopathy were randomized. Clinical endpoints included multiple questionnaires after three months: Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH), Numeric Rating Scale (NRS) pain at rest and during activity, and EuroQol 5D-5L (EQ-5D-5L). Results: Thirty patients were included of 128 screened. The QuickDASH score improved in the percutaneous needle tenotomy and physiotherapy group, but not in the hydrodissection group. The NRS pain at rest and during activity improved more in the percutaneous needle tenotomy (resp. -2 and -2) and hydrodissection (resp. -3 and -3) groups than in the physiotherapy (resp. +1 and -1) group. The EQ-5D-5L improved similarly in all groups. Conclusions: Patients receiving percutaneous needle tenotomy and/or hydrodissection may show better results in terms of pain but not in their functional outcomes compared to those who received physiotherapy alone. The size of effect, however, is small, so a large sample size is needed for a future randomized controlled trial to further investigate these results.

Late Onset Metallosis after Revision Total Knee Arthroplasty with Metal-Backed Patellar Component In Situ.

We describe a small case series with severe metallosis after revision total knee arthroplasty (TKA) due to metal-backed patellar component failure. Metallosis is a rare complication after TKA, which may cause systemic and local symptoms. In our cases, diagnosis of metallosis was supported by radiographic imaging and aseptic aspiration. Two of our 3 cases were successfully revised; in the remaining case surgery was not desired because of her poor general condition. Based on these cases, we recommend performing regular checkups in case of a metal-backed patellar component to detect metallosis in an early stage, to prevent extensive revision surgery. Moreover, we recommend applying a low threshold to revise a metal-backed patellar component because of the severe consequences of metallosis that might occur.