Minimally invasive technique in total knee arthroplasty--history, tips, tricks and pitfalls.

Minimally invasive surgery (MIS) in Total Knee Arthroplasty (TKA) has been evolving since the early 1990s and was first described by several authors from the USA in early 2003-4. The evolution was driven from patients and clinicians alike and the technique has been used by several experienced knee surgeons worldwide. Although the procedure is demanding and the learning curve long, the benefits outweigh the difficulties faced during the learning process. Our experience with minimally invasive techniques started in 2003. At the beginning only a few procedures were carried out as rigorous exclusion criteria were applied. However, as confidence grew the number of operations has significantly increased. The average surgical time for minimally invasive technique is longer than for the standard technique, particularly in the early stages. More attention needs to be paid to the alignment, sizing and positioning of the prosthesis. According to our early experience, functional recovery is faster with MIS compared with standard technique. The MIS group achieved better knee flexion during the first three months (average of 116 degrees ) compared to open access surgery (average of 97 degrees ). There was no significant difference in alignment and component sizing between the two groups.

Silastic single-stem implants in the treatment of hallux rigidus.

Forty cases of hallux rigidus treated by Silastic hemiarthroplasty over an average period of 110 months have been reviewed here. As many as 36% (14 feet) of the patients were unhappy with the results of their operation. Six implants had to be removed because of increasing pain and fragmentation of the prosthesis. These patients improved after the prosthesis was removed. It is concluded that Silastic hemiarthroplasty does not give an acceptable level of good results when compared with published reports of other forms of treatment. The probable causes of the high dissatisfaction rate are discussed.

Comminuted Colles' fractures: a prospective trial of management.

Patients suffering from comminuted fractures of the lower end of the radius were treated by one of two protocols and followed for 6 months. One group was treated by a regime of percutaneous wiring based on the technique described by DePalma. This was compared with the results obtained from the conventional treatment of manipulation and application of plaster of Paris for similar injuries. Final function was found to be closely related to anatomical results and this was obtained earlier and with greater predictability in the wired group. There were statistically significant differences between the two groups at 6 months in extension (P less than 0.001), ulnar deviation (P greater than 0.05), grip strength (P less than 0.001), radial angle (P less than 0.0001), radial length (P less than 0.0001), and dorsal/volar angle (P greater than 0.0001). Using a modified McBride's system of scoring, the results were found to be directly correlated to the anatomical findings at the end of 6 months.

Mallet finger: long-term review of 100 cases.

One hundred cases of mallet finger are reviewed to assess the significance of the results of treatment. This study revealed that the mallet fingers with chip fractures and those without fractures showed satisfactory results in 85% of cases in the long term (32 months) with conservative treatment. Even though there was a statistically significant difference between the satisfied and unsatisfied patients in extensor lag (P less than 0.0001), arc of movement (P greater than 0.001) and pinch grip (P greater than 0.001), none of these patients was willing to undergo surgery to improve their fingers.

Hinged silastic implants of the great toe.

Since 1982, hinged silastic implants have been used in the treatment of hallux valgus and hallux rigidus in preference to excision arthroplasty or metatarsophalangeal joint fusion. The results of this treatment in 106 feet in 89 patients are satisfactory to subjective and objective assessment over an average follow-up period of 27.7 months (range, 12-60 months). Hinged prosthesis overcomes the problems associated with resection arthroplasty.

An unusual case of diaphyseal aclasis arising in fingers.

Diaphyseal aclasis (multiple hereditary exostoses) occurs in the bones developed in cartilage and gives rise to cartilage-capped exostoses. It usually affects the ends of the diaphyses of long bones of extremities (McKusick, 1972). Although the phalanges of the fingers may be shorter than normal, no record could be found of significant deformity. A case of digital deformity is described below.