Patient's satisfaction after outpatient forefoot surgery: Study of 619 cases.

INTRODUCTION: The number of outpatient surgical procedures performed in France on the forefoot has grown rapidly in recent years. OBJECTIVES: The goal of this study was to evaluate experience and satisfaction of patients undergoing outpatient foot surgery using a telephone questionnaire developed for this purpose. MATERIAL AND METHODS: In 2012 and 2013, every patient who was admitted to the day surgery unit at our hospital for an open procedure on their forefoot was called the morning after the procedure. A nurse went through the 14-item questionnaire with the patient. The same perioperative protocol, written instructions and treatment were used for all patients. RESULTS: Six hundred nineteen patients were included. The questionnaire response rate was 89% (n=540). Isolated hallux valgus surgery was performed on 319 patients (61%); 107 patients (20%) underwent hallux valgus surgery with lateral metatarsal osteotomy; 57 patients (10.5%) underwent first metatarsophalangeal fusion and 47 patients (8.5%) underwent a procedure on the lateral rays only. In the postoperative phase, 65% reported having satisfactory sleep quality, 32% had experienced nausea, 16% had experienced vomiting and 17% had experienced bleeding. Eighty percent of patients experienced pain (VAS ≥ 1); 80% of these patients had their pain relieved by the prescribed treatment and 4% had not taken it. Nearly all the patients (99%) were satisfied with the outpatient care; the overall satisfaction score was 9.4 out of 10. There was a significant relationship between the type of procedure and vomiting, pain, bleeding and fever. DISCUSSION: Outpatient care is becoming more common in response to economic challenges. The development of outpatient foot surgery appears to have satisfied the vast majority of operated patients. However, adjustments should be made to improve their tolerance to the pain management protocol. Although the logistics of performing follow-up call can be complicated, the patients appreciate receiving this call the next day. The call also seems to reassure both the patients and care providers.

Proximal tibial osteotomy for osteoarthritis with varus deformity. A ten to thirteen-year follow-up study.

The results in ninety-three knees that had been treated by proximal tibial opening-wedge osteotomy for varus deformity and osteoarthritis of the medial compartment were evaluated after a mean length of follow-up of 11.5 years (range, ten to thirteen years). After ten years, only forty-two (45 per cent) of the ninety-three knees had an excellent or good result, and in fifty-one knees there was recurrent pain for which seventeen had another operation. At five years, on the other hand, 90 per cent of the knees had a good result. Deterioration occurred at an average of seven years after the osteotomy and was always associated with recurrence of pain. Although the results deteriorated with time, time was not the only determinant of the result. Alignment, measured as the hip-knee-ankle angle on radiographs of the whole limb that were made with the patient bearing weight, was also a determinant of long-term results. The best results were obtained in the twenty knees that had a hip-knee-ankle angle of 183 to 186 degrees. In these knees, there was no pain and no progression of the arthrosis in either the medial or the lateral tibiofemoral compartment. Of the five knees that had an angle of more than 186 degrees, all five had progressive degenerative changes in the lateral compartment. In the sixty-eight undercorrected knees (an angle of less than 183 degrees), the results were less satisfactory, and there was a tendency toward recurrence of the varus deformity and progression of the arthritis of the medial compartment. However, when the correction was insufficient the deterioration was slow (average, seven years), and it was not associated with lateral laxity and deterioration of the lateral compartment, which are the changes that characterize the natural course of gonarthrosis as described by Hernborg and Nilsson. Therefore, proximal tibial osteotomy is a very suitable operation for patients who have gonarthrosis of the medial compartment, but a rigidly standardized and precise operative technique is required as well as accurate radiographic measurements of the mechanical axis of the limb, because exact postoperative alignment is the prerequisite for the longest possible period of relief of symptoms after osteotomy.

[Outcome at more than 10 years of 93 tibial osteotomies for internal arthritis in genu varum (or the predominant influence of the frontal angular correction)]. / Devenir à plus de 10 ans de 93 ostéotomies tibiales effectuées pour gonarthrose interne sur genu-varum (ou l'influence prédominante de la correction angulaire frontale).

Ninety three high tibial valgus osteotomies have been performed by the authors for degenerative arthritis and reviewed more than 10 years later. The mean age of the 66 patients was 70 years. The results were somewhat disappointing. Seventeen knees had to be operated on before the tenth post-operative year and only 42 knees were painless at the time of review. Radiological improvement in the medial tibio-femoral joint was rarely seen. Fortunately, deterioration in the lateral tibio femoral joint was exceptional and joint laxity was rarely troublesome. The authors conclude that the amount of correction at the time of the osteotomy is of extreme importance. The results were satisfactory only in cases where valgus ranging between 3 and 6 degrees had been obtained. When an osteotomy produced a greater amount of valgus, deterioration of the lateral tibio-femoral joint was seen. When the osteotomy produced less than 3 degrees of valgus, recurrence of the varus deformity developed. In these cases, functional deterioration was noted after seven years. Thus, the osteotomy appeared to have slowed down the natural evolution of the disease. The results of valgus osteotomy were satisfactory in most of the cases, but they were excellent only in cases in which a valgus ranging from 3 to 6 degrees had been produced. The importance of a precise radiological measurement is stressed, the accuracy of measurement being doubtful in cases with associated flexion deformity or joint laxity. The precision of the surgical procedure is also very important.

[Long-term results of the treatment of medial femoro-tibial gonarthrosis by tibial valgisation osteotomy. Outcome of 93 osteotomies after more than 10 years]. / Résultat à long terme du traitement de la gonarthrose fémoro-tibiale interne par ostéotomie tibiale de valgisation. Devenir à plus de 10 ans de 93 ostéotomies.

Amongst the 250 tibial valgisation osteotomies performed for medial femoro-tibial osteoarthrosis of the knee between 1970 and 1973, only 93 in 66 patients could be followed up for 10 years or more (10-13 years). The long term outcome of the operation is dominated by frontal angular correction. The radiological and clinical result was regularly satisfactory after ten years only when the valgus was between 3 and 6 degrees. With more than 6 degrees valgus, there was deterioration of the lateral femoro-tibial compartment in all cases. Clinical and radiological results were variable with more than 3 degrees varus and were all the worse when there was considerable persistent varus. However functional impairment of those knees in which correction was inadequate occurred only after a mean latent period of 7 years. It remained slow and moderate, offering the possibility of a new osteotomy in case of failure. This would confirm that tibial osteotomy has at least two actions: a trophic action which disappears at about 7 years and a mechanical action, the importance of which appears in the long term. It is therefore felt that tibial valgisation osteotomy is a sufficiently reliable operation to be proposed in all cases of symptomatic and progressive osteoarthrosis with genu varum. Correction and results are all the more satisfactory when the operation is carried out before flexion deformity or laxity interfere with the accuracy of the correction. A preference for the insertion of a prosthesis may be preferred only in the elderly (the authors preferring the medial unicompartmental type), the principal advantage being to decrease the relatively long period of postoperative immobilisation following osteotomy.

Ulnar neuritis in Hansen's disease results of fifty neurolyses in the arm and elbow.

Fifty cases of ulnar nerve neuritis in Hansen disease are reported. The authors analyse the type of lesion, the clinical feature, the treatment, and the results of neurolysis. Many points are emphasized: the requirement to an association antileprosy, chemotherapy and corticotherapy with a careful neurolysis; pain and paresthesia were relieved immediately after neurolysis, recovery within two years after neurolysis; the amount of recovery was directly related to the extent and stage of involvement of the nerve; and thus the sooner procedure give the best result.