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T R C Davis - One of the best experts on this subject based on the ideXlab platform.
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TRAPEZIECTOMY FOR TRAPEZIOMETACARPAL JOINT OSTEOARTHRITIS: IS LIGAMENT RECONSTRUCTION AND TEMPORARY STABILISATION OF THE PSEUDARTHROSIS WITH A KIRSCHNER
2016Co-Authors: Wire Important, T R C Davis, Alistair PaceAbstract:This randomised prospective study compared two operations for trapeziometacarpal joint osteoarthritis: trapeziectomy with Flexor carpi radialis ligament reconstruction, tendon interposition and Kirschner wire insertion followed by splintage for 6 weeks (TþLRTI) and excision of the trapezium with no Kirschner wire and immobilisation of the thumb in a soft bandage for only 3 weeks (T). Sixty-seven thumbs with trapeziectomy (T) and 61 with trapeziectomy and ligament reconstruction and tendon interposition (TþLRTI) were assessed preoperatively and at 3-months and 1-year after surgery. Forty-seven percent and 73 % of patients reported no pain or only aching after use at 3-months and 1-year respectively and the DASH and Patient Evaluation Measure (PEM) outcome scores reduced postoperatively indicating improved function. However the pain, DASH and PEM scores, and also key and tip thumb pinch and all the other clinical outcome Measures, did not differ significantly between the two groups at either 3-months or 1-year after surgery
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six year outcome excision of the trapezium for trapeziometacarpal joint osteoarthritis is it improved by ligament reconstruction and temporary kirschner wire insertion
Journal of Hand Surgery (European Volume), 2012Co-Authors: H Salem, T R C DavisAbstract:This randomized prospective study compared the treatment of trapeziometacarpal joint osteoarthritis with a) trapeziectomy with no ligament reconstruction, no soft tissue interposition and no temporary Kirschner wire stabilization (Group T); b) trapeziectomy with flexor carpi radialis ligament reconstruction and interposition and temporary K-wire stabilization (Group T+LRTI). We followed 99 patients with 114 thumbs (59 T and 55 T+LRTI) for a mean of 6.2 (range, 4.2–8.1) years. There were no significant differences between the two treatments in any subjective or objective outcome Measure at 6 year follow-up. Eighty-two percent of the thumbs were painless or only ached after use. The DASH (Group T mean, 31; 95% CI, 26–42: Group T+LRTI mean 30; 95% CI, 22–35) and Patient Evaluation Measure (Group T mean, 35; 95% CI, 29–41: Group T+LRTI mean 34; 95% CI, 27–39) scores were significantly better than preoperatively. Thumb key pinch strength did not differ significantly between the two treatment groups (Group T me...
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trapeziectomy for trapeziometacarpal joint osteoarthritis is ligament reconstruction and temporary stabilisation of the pseudarthrosis with a kirschner wire important
Journal of Hand Surgery (European Volume), 2009Co-Authors: T R C Davis, Alistair PaceAbstract:This randomised prospective study compared two operations for trapeziometacarpal joint osteoarthritis: trapeziectomy with Flexor carpi radialis ligament reconstruction, tendon interposition and Kirschner wire insertion followed by splintage for 6 weeks (T+LRTI) and excision of the trapezium with no Kirschner wire and immobilisation of the thumb in a soft bandage for only 3 weeks (T). Sixty-seven thumbs with trapeziectomy (T) and 61 with trapeziectomy and ligament reconstruction and tendon interposition (T+LRTI) were assessed preoperatively and at 3-months and 1-year after surgery. Forty-seven percent and 73% of patients reported no pain or only aching after use at 3-months and 1-year respectively and the DASH and Patient Evaluation Measure (PEM) outcome scores reduced postoperatively indicating improved function. However the pain, DASH and PEM scores, and also key and tip thumb pinch and all the other clinical outcome Measures, did not differ significantly between the two groups at either 3-months or 1-year after surgery.
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trapeziectomy for trapeziometacarpal joint osteoarthritis is ligament reconstruction and temporary stabilisation of the pseudarthrosis with a kirschner wire important
Journal of Hand Surgery (European Volume), 2009Co-Authors: T R C Davis, Alistair PaceAbstract:This randomised prospective study compared two operations for trapeziometacarpal joint osteoarthritis: trapeziectomy with Flexor carpi radialis ligament reconstruction, tendon interposition and Kirschner wire insertion followed by splintage for 6 weeks (T+LRTI) and excision of the trapezium with no Kirschner wire and immobilisation of the thumb in a soft bandage for only 3 weeks (T). Sixty-seven thumbs with trapeziectomy (T) and 61 with trapeziectomy and ligament reconstruction and tendon interposition (T+LRTI) were assessed preoperatively and at 3-months and 1-year after surgery. Forty-seven percent and 73% of patients reported no pain or only aching after use at 3-months and 1-year respectively and the DASH and Patient Evaluation Measure (PEM) outcome scores reduced postoperatively indicating improved function. However the pain, DASH and PEM scores, and also key and tip thumb pinch and all the other clinical outcome Measures, did not differ significantly between the two groups at either 3-months or 1-ye...
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do young patients with malunited fractures of the distal radius inevitably develop symptomatic post traumatic osteoarthritis
Journal of Bone and Joint Surgery-british Volume, 2008Co-Authors: D. P. Forward, T R C Davis, J S SitholeAbstract:Fractures of the distal radius occurring in young adults are treated increasingly by open surgical techniques, partly because of concern that failure to restore the alignment of the fracture accurately may cause symptomatic post-traumatic osteoarthritis in future years. We reviewed 106 adults who had sustained a fracture of the distal radius between 1960 and 1968 and who were below the age of 40 years at the time of injury. We carried out a clinical and radiological assessment at a mean follow-up of 38 years (33 to 42). No patient had required a salvage procedure. While there was radiological evidence of post-traumatic osteoarthritis after an intra-articular fracture in 68% of patients (27 of 40), the disabilities of the arm, shoulder and hand (DASH) scores were not different from population norms, and function, as assessed by the Patient Evaluation Measure, was impaired by less than 10%. Ordinal logistic regression analysis showed a significant relationship between narrowing of the joint space and extra-articular malunion (dorsal angulation and radial shortening) as well as intra-articular injury. Multivariate analysis revealed that grip strength had fallen to 89% of that of the uninjured side in the presence of dorsal malunion, but no Measure of extra-articular malunion was significantly related to either the Patient Evaluation Measure or DASH scores. While anatomical reduction is the principal aim of treatment, imperfect reduction of these fractures may not result in symptomatic arthritis in the long term, and this should be considered when counselling patients on the risks and benefits of the many treatment options available.
Alistair Pace - One of the best experts on this subject based on the ideXlab platform.
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TRAPEZIECTOMY FOR TRAPEZIOMETACARPAL JOINT OSTEOARTHRITIS: IS LIGAMENT RECONSTRUCTION AND TEMPORARY STABILISATION OF THE PSEUDARTHROSIS WITH A KIRSCHNER
2016Co-Authors: Wire Important, T R C Davis, Alistair PaceAbstract:This randomised prospective study compared two operations for trapeziometacarpal joint osteoarthritis: trapeziectomy with Flexor carpi radialis ligament reconstruction, tendon interposition and Kirschner wire insertion followed by splintage for 6 weeks (TþLRTI) and excision of the trapezium with no Kirschner wire and immobilisation of the thumb in a soft bandage for only 3 weeks (T). Sixty-seven thumbs with trapeziectomy (T) and 61 with trapeziectomy and ligament reconstruction and tendon interposition (TþLRTI) were assessed preoperatively and at 3-months and 1-year after surgery. Forty-seven percent and 73 % of patients reported no pain or only aching after use at 3-months and 1-year respectively and the DASH and Patient Evaluation Measure (PEM) outcome scores reduced postoperatively indicating improved function. However the pain, DASH and PEM scores, and also key and tip thumb pinch and all the other clinical outcome Measures, did not differ significantly between the two groups at either 3-months or 1-year after surgery
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trapeziectomy for trapeziometacarpal joint osteoarthritis is ligament reconstruction and temporary stabilisation of the pseudarthrosis with a kirschner wire important
Journal of Hand Surgery (European Volume), 2009Co-Authors: T R C Davis, Alistair PaceAbstract:This randomised prospective study compared two operations for trapeziometacarpal joint osteoarthritis: trapeziectomy with Flexor carpi radialis ligament reconstruction, tendon interposition and Kirschner wire insertion followed by splintage for 6 weeks (T+LRTI) and excision of the trapezium with no Kirschner wire and immobilisation of the thumb in a soft bandage for only 3 weeks (T). Sixty-seven thumbs with trapeziectomy (T) and 61 with trapeziectomy and ligament reconstruction and tendon interposition (T+LRTI) were assessed preoperatively and at 3-months and 1-year after surgery. Forty-seven percent and 73% of patients reported no pain or only aching after use at 3-months and 1-year respectively and the DASH and Patient Evaluation Measure (PEM) outcome scores reduced postoperatively indicating improved function. However the pain, DASH and PEM scores, and also key and tip thumb pinch and all the other clinical outcome Measures, did not differ significantly between the two groups at either 3-months or 1-ye...
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trapeziectomy for trapeziometacarpal joint osteoarthritis is ligament reconstruction and temporary stabilisation of the pseudarthrosis with a kirschner wire important
Journal of Hand Surgery (European Volume), 2009Co-Authors: T R C Davis, Alistair PaceAbstract:This randomised prospective study compared two operations for trapeziometacarpal joint osteoarthritis: trapeziectomy with Flexor carpi radialis ligament reconstruction, tendon interposition and Kirschner wire insertion followed by splintage for 6 weeks (T+LRTI) and excision of the trapezium with no Kirschner wire and immobilisation of the thumb in a soft bandage for only 3 weeks (T). Sixty-seven thumbs with trapeziectomy (T) and 61 with trapeziectomy and ligament reconstruction and tendon interposition (T+LRTI) were assessed preoperatively and at 3-months and 1-year after surgery. Forty-seven percent and 73% of patients reported no pain or only aching after use at 3-months and 1-year respectively and the DASH and Patient Evaluation Measure (PEM) outcome scores reduced postoperatively indicating improved function. However the pain, DASH and PEM scores, and also key and tip thumb pinch and all the other clinical outcome Measures, did not differ significantly between the two groups at either 3-months or 1-year after surgery.
I A Trail - One of the best experts on this subject based on the ideXlab platform.
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pyrocarbon metacarpophalangeal joint arthroplasty in noninflammatory arthritis minimum 5 year follow up
Journal of Hand Surgery (European Volume), 2015Co-Authors: David R Dickson, D Nuttall, Ravi Badge, Adam C Watts, S C Talwalkar, M J Hayton, I A TrailAbstract:Purpose To report the outcomes, complications, and survivorship of pyrocarbon metacarpophalangeal joint arthroplasty in noninflammatory arthropathy at a minimum 5-year follow-up. Methods A retrospective review of 51 implants in 36 patients was undertaken. Patient demographics, complications, further surgery, and implant revision were recorded. Objective outcome was assessed by grip strength, range of motion, and radiological assessment of alignment, loosening, and subsidence. Subjective outcome was assessed by Patient Evaluation Measure, Quick Disabilities of the Arm, Shoulder and Hand score, and visual analog scores (0, best; 10, worst) for appearance, satisfaction, and pain. Results There were 35 index and 16 middle fingers. The average follow-up was 103 months (range, 60–172 months). The mean arc of motion was 54° (range, 20° to 80°). There was no difference in grip strength between operated and nonsurgical side. Six implants were revised, and 3 of these required additional surgery. The average Patient Evaluation Measure and Quick Disabilities of the Arm, Shoulder and Hand scores were 27 (range, 10–54) and 29 (range, 0–57), respectively. Mean visual analog scores for pain, satisfaction, and appearance were all 1 with the respective ranges being 0–7, 0–4, and 0–6. Most implants were Herren grade 1 lucency with the remaining 5 proximal and 12 distal implants being grade 2. Mean subsidence in the proximal component was 2 mm (range, 0–4 mm) and 1 mm (range, 0–3 mm) in the distal component. The degree of loosening or subsidence did not correlate with outcome. Implant survival as assessed by Kaplan–Meier was 88% at 10 years. Conclusions Good pain relief, a functional range of motion, and high satisfaction were seen in the majority of patients. All implant revisions were performed within 18 months of the index procedure. This may represent technical issues rather than problems with the implant. Type of study/level of evidence Therapeutic IV.
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pyrocarbon proximal interphalangeal joint arthroplasty minimum five year follow up
Journal of Hand Surgery (European Volume), 2012Co-Authors: David R Dickson, D Nuttall, Adam C Watts, S C Talwalkar, M J Hayton, I A TrailAbstract:Purpose To report the outcome and complications from pyrocarbon proximal interphalangeal (PIP) joint arthroplasty at a minimum of 2 years of follow-up. Methods A retrospective case review was performed on 72 patients with an average age of 57 years, and a total of 97 pyrocarbon PIP joint arthroplasties. Patient demographics, diagnosis, implant revisions, and other repeat surgeries were recorded. Subjective outcome was evaluated at latest follow-up with the Disabilities of the Arm, Shoulder, and Hand score; Patient Evaluation Measure; and visual analog scores of pain, satisfaction, and appearance. Objective outcomes included PIP joint range of motion, grip strength, and radiographic assessment of alignment and loosening. Results The principal diagnosis was primary osteoarthritis in 43 patients(60%), posttraumatic arthritis in 14 (19%), rheumatoid arthritis in 9 (13%), and psoriatic arthritis in 6 (8%). The average follow-up was 60 months (range, 24–108 mo). Twenty-two of 97 digits (23%) had repeat surgery without revision, and 13 digits (13%) had revision at an average of 15 months. There were no significant differences in preoperative and postoperative range of motion. The average Disabilities of the Arm, Shoulder, and Hand score was 22, and the average pain score was zero. Implant migration and loosening was observed but was not related to clinical outcome or revision. Conclusions The survival of pyrocarbon PIP joint arthroplasty was 85% (83 of 97) at 5 years of follow-up, with high patient satisfaction. Patients should be advised that the procedure achieves good relief of pain but does not improve range of motion. Type of study/level of evidence Therapeutic IV.
M J Hayton - One of the best experts on this subject based on the ideXlab platform.
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pyrocarbon metacarpophalangeal joint arthroplasty in noninflammatory arthritis minimum 5 year follow up
Journal of Hand Surgery (European Volume), 2015Co-Authors: David R Dickson, D Nuttall, Ravi Badge, Adam C Watts, S C Talwalkar, M J Hayton, I A TrailAbstract:Purpose To report the outcomes, complications, and survivorship of pyrocarbon metacarpophalangeal joint arthroplasty in noninflammatory arthropathy at a minimum 5-year follow-up. Methods A retrospective review of 51 implants in 36 patients was undertaken. Patient demographics, complications, further surgery, and implant revision were recorded. Objective outcome was assessed by grip strength, range of motion, and radiological assessment of alignment, loosening, and subsidence. Subjective outcome was assessed by Patient Evaluation Measure, Quick Disabilities of the Arm, Shoulder and Hand score, and visual analog scores (0, best; 10, worst) for appearance, satisfaction, and pain. Results There were 35 index and 16 middle fingers. The average follow-up was 103 months (range, 60–172 months). The mean arc of motion was 54° (range, 20° to 80°). There was no difference in grip strength between operated and nonsurgical side. Six implants were revised, and 3 of these required additional surgery. The average Patient Evaluation Measure and Quick Disabilities of the Arm, Shoulder and Hand scores were 27 (range, 10–54) and 29 (range, 0–57), respectively. Mean visual analog scores for pain, satisfaction, and appearance were all 1 with the respective ranges being 0–7, 0–4, and 0–6. Most implants were Herren grade 1 lucency with the remaining 5 proximal and 12 distal implants being grade 2. Mean subsidence in the proximal component was 2 mm (range, 0–4 mm) and 1 mm (range, 0–3 mm) in the distal component. The degree of loosening or subsidence did not correlate with outcome. Implant survival as assessed by Kaplan–Meier was 88% at 10 years. Conclusions Good pain relief, a functional range of motion, and high satisfaction were seen in the majority of patients. All implant revisions were performed within 18 months of the index procedure. This may represent technical issues rather than problems with the implant. Type of study/level of evidence Therapeutic IV.
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efficacy and tolerability of day 2 manipulation and local anaesthesia after collagenase injection in patients with dupuytren s contracture
Journal of Hand Surgery (European Volume), 2014Co-Authors: Christopher James Manning, R Delaney, M J HaytonAbstract:In clinical trials, treating Dupuytren's contracture with collagenase injection involves manipulation the day after injection, without local anaesthesia. We evaluated the efficacy and tolerability of manipulation 2 days after injection with local anaesthesia. Forty-five patients received 50 injections into cords contracting metacarpophalangeal and proximal interphalangeal joints; follow-up visits were at 3 and 14 weeks. For the metacarpophalangeal joints there were >90% reduction in contracture at both visits. The proximal interphalangeal joints that improved spontaneously after metacarpophalangeal injection or received direct injections showed 51-55% reduction in contracture. Changes in scores on the Patient Evaluation Measure suggest that patients perceived improvements in their hand function was good and they were satisfied with the procedure. Collagenase and local anaesthesia injections were well tolerated; adverse events were localized to the injection site and were mild and transient in nature. These findings provide another viable option for practising surgeons and may help with the logistics of patient care.
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pyrocarbon proximal interphalangeal joint arthroplasty minimum five year follow up
Journal of Hand Surgery (European Volume), 2012Co-Authors: David R Dickson, D Nuttall, Adam C Watts, S C Talwalkar, M J Hayton, I A TrailAbstract:Purpose To report the outcome and complications from pyrocarbon proximal interphalangeal (PIP) joint arthroplasty at a minimum of 2 years of follow-up. Methods A retrospective case review was performed on 72 patients with an average age of 57 years, and a total of 97 pyrocarbon PIP joint arthroplasties. Patient demographics, diagnosis, implant revisions, and other repeat surgeries were recorded. Subjective outcome was evaluated at latest follow-up with the Disabilities of the Arm, Shoulder, and Hand score; Patient Evaluation Measure; and visual analog scores of pain, satisfaction, and appearance. Objective outcomes included PIP joint range of motion, grip strength, and radiographic assessment of alignment and loosening. Results The principal diagnosis was primary osteoarthritis in 43 patients(60%), posttraumatic arthritis in 14 (19%), rheumatoid arthritis in 9 (13%), and psoriatic arthritis in 6 (8%). The average follow-up was 60 months (range, 24–108 mo). Twenty-two of 97 digits (23%) had repeat surgery without revision, and 13 digits (13%) had revision at an average of 15 months. There were no significant differences in preoperative and postoperative range of motion. The average Disabilities of the Arm, Shoulder, and Hand score was 22, and the average pain score was zero. Implant migration and loosening was observed but was not related to clinical outcome or revision. Conclusions The survival of pyrocarbon PIP joint arthroplasty was 85% (83 of 97) at 5 years of follow-up, with high patient satisfaction. Patients should be advised that the procedure achieves good relief of pain but does not improve range of motion. Type of study/level of evidence Therapeutic IV.
David R Dickson - One of the best experts on this subject based on the ideXlab platform.
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pyrocarbon metacarpophalangeal joint arthroplasty in noninflammatory arthritis minimum 5 year follow up
Journal of Hand Surgery (European Volume), 2015Co-Authors: David R Dickson, D Nuttall, Ravi Badge, Adam C Watts, S C Talwalkar, M J Hayton, I A TrailAbstract:Purpose To report the outcomes, complications, and survivorship of pyrocarbon metacarpophalangeal joint arthroplasty in noninflammatory arthropathy at a minimum 5-year follow-up. Methods A retrospective review of 51 implants in 36 patients was undertaken. Patient demographics, complications, further surgery, and implant revision were recorded. Objective outcome was assessed by grip strength, range of motion, and radiological assessment of alignment, loosening, and subsidence. Subjective outcome was assessed by Patient Evaluation Measure, Quick Disabilities of the Arm, Shoulder and Hand score, and visual analog scores (0, best; 10, worst) for appearance, satisfaction, and pain. Results There were 35 index and 16 middle fingers. The average follow-up was 103 months (range, 60–172 months). The mean arc of motion was 54° (range, 20° to 80°). There was no difference in grip strength between operated and nonsurgical side. Six implants were revised, and 3 of these required additional surgery. The average Patient Evaluation Measure and Quick Disabilities of the Arm, Shoulder and Hand scores were 27 (range, 10–54) and 29 (range, 0–57), respectively. Mean visual analog scores for pain, satisfaction, and appearance were all 1 with the respective ranges being 0–7, 0–4, and 0–6. Most implants were Herren grade 1 lucency with the remaining 5 proximal and 12 distal implants being grade 2. Mean subsidence in the proximal component was 2 mm (range, 0–4 mm) and 1 mm (range, 0–3 mm) in the distal component. The degree of loosening or subsidence did not correlate with outcome. Implant survival as assessed by Kaplan–Meier was 88% at 10 years. Conclusions Good pain relief, a functional range of motion, and high satisfaction were seen in the majority of patients. All implant revisions were performed within 18 months of the index procedure. This may represent technical issues rather than problems with the implant. Type of study/level of evidence Therapeutic IV.
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pyrocarbon proximal interphalangeal joint arthroplasty minimum five year follow up
Journal of Hand Surgery (European Volume), 2012Co-Authors: David R Dickson, D Nuttall, Adam C Watts, S C Talwalkar, M J Hayton, I A TrailAbstract:Purpose To report the outcome and complications from pyrocarbon proximal interphalangeal (PIP) joint arthroplasty at a minimum of 2 years of follow-up. Methods A retrospective case review was performed on 72 patients with an average age of 57 years, and a total of 97 pyrocarbon PIP joint arthroplasties. Patient demographics, diagnosis, implant revisions, and other repeat surgeries were recorded. Subjective outcome was evaluated at latest follow-up with the Disabilities of the Arm, Shoulder, and Hand score; Patient Evaluation Measure; and visual analog scores of pain, satisfaction, and appearance. Objective outcomes included PIP joint range of motion, grip strength, and radiographic assessment of alignment and loosening. Results The principal diagnosis was primary osteoarthritis in 43 patients(60%), posttraumatic arthritis in 14 (19%), rheumatoid arthritis in 9 (13%), and psoriatic arthritis in 6 (8%). The average follow-up was 60 months (range, 24–108 mo). Twenty-two of 97 digits (23%) had repeat surgery without revision, and 13 digits (13%) had revision at an average of 15 months. There were no significant differences in preoperative and postoperative range of motion. The average Disabilities of the Arm, Shoulder, and Hand score was 22, and the average pain score was zero. Implant migration and loosening was observed but was not related to clinical outcome or revision. Conclusions The survival of pyrocarbon PIP joint arthroplasty was 85% (83 of 97) at 5 years of follow-up, with high patient satisfaction. Patients should be advised that the procedure achieves good relief of pain but does not improve range of motion. Type of study/level of evidence Therapeutic IV.
