The Experts below are selected from a list of 360 Experts worldwide ranked by ideXlab platform
Kevin C Chung - One of the best experts on this subject based on the ideXlab platform.
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a multicenter clinical trial in rheumatoid arthritis comparing silicone Metacarpophalangeal Joint arthroplasty with medical treatment
Journal of Hand Surgery (European Volume), 2009Co-Authors: Kevin C Chung, Frank D Burke, E Shaw F Wilgis, Myra H Kim, Patricia B Burns, Marian Regan, David A FoxAbstract:Purpose Metacarpophalangeal (MCP) Joint deformities caused by rheumatoid arthritis can be treated using silicone Metacarpophalangeal Joint arthroplasty (SMPA). There is no consensus as to whether this surgical procedure is beneficial. The purpose of the study was to prospectively compare outcomes for a surgical and a nonsurgical cohort of rheumatoid arthritis patients. Methods The prospective study was conducted from January 2004 to May 2008 at 3 referral centers in the United States and England. Over a 3-year period, 70 surgical and 93 nonsurgical patients were recruited. One year data are available for 45 cases and 72 controls. All patients had severe ulnar drift and/or extensor lag of the fingers at the MCP Joints. The patients all had 1-year follow-up evaluations. Patients could elect to have SMPA and medical therapy or medical therapy alone. Outcomes included the Michigan Hand Outcomes Questionnaire (MHQ), Arthritis Impact Measurement Scales, grip and pinch strength, Jebson-Taylor test, and ulnar deviation and extensor lag measurements at the MCP Joints. Results There was no difference in the mean age for the surgical group (60) when compared to the nonsurgical group (62). There was also no significant difference in race, education, and income between the 2 groups. At 1-year follow-up, the mean overall MHQ score showed significant improvement in the surgical group but no change in the nonsurgical group, despite worse MHQ function at baseline in the surgical group. Ulnar deviation and extensor lag improved significantly in the surgical group, but the mean Arthritis Impact Measurement Scales scores and grip and pinch strength showed no significant improvement. Conclusions This prospective study demonstrated significant improvement for RA patients with poor baseline functioning treated with SMPA. The nonsurgical group had better MHQ scores at baseline, and their function did not deteriorate during the 1-year follow-up interval. Type of study/level of evidence Therapeutic III.
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could preoperative preferences and expectations influence surgical decision making rheumatoid arthritis patients contemplating Metacarpophalangeal Joint arthroplasty
Plastic and Reconstructive Surgery, 2008Co-Authors: Lisa A Mandl, Frank D Burke, E Shaw F Wilgis, Stephen Lyman, Jeffrey N Katz, Kevin C ChungAbstract:Background:The goals of this assessment were to elicit rheumatoid arthritis patients’ expectations of Metacarpophalangeal Joint arthroplasty and to explore how preoperative preferences might influence patients’ surgical decision making.Methods:Rheumatoid arthritis patients who were appropriate metac
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a prospective outcomes study of swanson Metacarpophalangeal Joint arthroplasty for the rheumatoid hand
Journal of Hand Surgery (European Volume), 2004Co-Authors: Kevin C Chung, Sandra V Kotsis, Myra H KimAbstract:Abstract Purpose Destruction and dislocation of the Metacarpophalangeal (MCP) Joints are common occurrences in patients with rheumatoid arthritis (RA). Disruption of the support ligaments around the MCP Joints and ulnar deviation of the fingers affect hand function and hamper the ability to perform activities of daily living. A common surgical intervention is the Swanson Metacarpophalangeal Joint Arthroplasty (SMPA), which restores alignment of the fingers. Methods We conducted a prospective study with 16 patients to determine outcomes of this procedure. We present our data from the 6-month and 1-year follow-up periods. Results Functional assessment by grip strength, pinch strength, and Jebsen-Taylor Test did not improve significantly when compared with preoperative values. Subjective assessment by the Michigan Hand Outcomes Questionnaire (MHQ), however, did improve significantly. Large improvements were seen in the function, activities of daily living, aesthetics, and patient satisfaction domains, with preoperative to 1-year postoperative score improvements of 26, 42, 57, and 43 points, respectively, based on a 100-point scale. Ulnar drift significantly decreased 1 year after surgery by an average of 24° and MCP Joint range of motion increased, but this change was not significant. Conclusions Our data show that patients with RA who underwent SMPA had significant improvements in patient-reported outcomes at the 1-year interval. Continued follow-up evaluation of this cohort will determine whether these improvements are maintained in the long term.
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patient outcomes following swanson silastic Metacarpophalangeal Joint arthroplasty in the rheumatoid hand a systematic overview
The Journal of Rheumatology, 2000Co-Authors: Kevin C Chung, Christine P Kowalski, Hyungjin Myra Kim, Irene S KazmersAbstract:Objective To investigate the effectiveness of Swanson silastic Metacarpophalangeal Joint arthroplasty (SMPA) in improving hand function for patients with rheumatoid arthritis. Methods A systematic overview of all published series in the literature on SMPA from 1966 to 1999. Results Research design deficiencies were quite prevalent in the literature on SMPA. However, SMPA was effective in correcting ulnar drift and in improving the arc of motion of the fingers. Health related quality of life was improved in the domains of hand function, pain, activities of daily living, aesthetics, and satisfaction. Conclusion SMPA appeared to be an effective procedure in correcting rheumatoid hand deformities. Future research must establish objective, quantifiable measures of hand function improvement by using standardized hand function tests and validated hand outcome questionnaires.
Thomas E Trumble - One of the best experts on this subject based on the ideXlab platform.
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repair of acute ulnar collateral ligament injuries of the thumb Metacarpophalangeal Joint a retrospective comparison of pull out sutures and bone anchor techniques
Plastic and Reconstructive Surgery, 2008Co-Authors: Leonid I Katolik, Jeffrey B Friedrich, Thomas E TrumbleAbstract:Background:The use of intraosseous suture anchors in the treatment of ruptures of the ulnar collateral ligament of the thumb Metacarpophalangeal Joint has previously been described. However, no direct comparisons exist of ulnar collateral ligament repair with bone anchor versus repair with a pull-ou
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repair of acute ulnar collateral ligament injuries of the thumb Metacarpophalangeal Joint a retrospective comparison of pull out sutures and bone anchor techniques
Plastic and Reconstructive Surgery, 2008Co-Authors: Leonid I Katolik, Jeffrey B Friedrich, Thomas E TrumbleAbstract:BACKGROUND: The use of intraosseous suture anchors in the treatment of ruptures of the ulnar collateral ligament of the thumb Metacarpophalangeal Joint has previously been described. However, no direct comparisons exist of ulnar collateral ligament repair with bone anchor versus repair with a pull-out button and immobilization. METHODS: Two cohorts of patients with complete rupture of the ulnar collateral ligament of the thumb Metacarpophalangeal Joint were compared. Thirty patients in each cohort underwent repair of the ulnar collateral ligament with either an intraosseous suture anchor followed by early mobilization or a pull-out suture tied over a button with cast immobilization. Average follow-up was 29 months. RESULTS: At follow-up, range of motion at the Metacarpophalangeal and interphalangeal Joints for the anchor group averaged 97 percent of that of the contralateral side compared with 86 percent and 87 percent, respectively, for the button group. For the anchor group, pinch strength averaged 101 percent that of the contralateral side compared with 95 percent for the button group. No significant difference was noted between the groups for grip strength. Average tourniquet time for the anchor group was 28 minutes compared with 43 minutes for the button group. Soft-tissue complications were present in 27 percent of patients (eight of 30) in the pull-out button group compared with 7 percent (two of 30) in the anchor group. Cost analysis demonstrates an approximately $140-per-patient savings when using the suture anchor. CONCLUSIONS: Both repair methods are safe and effective for treating thumb ulnar collateral ligament injuries. Suture anchors allow for an accelerated rehabilitation protocol, which may account for the improved range of motion and pinch strength at follow-up.
Leonid I Katolik - One of the best experts on this subject based on the ideXlab platform.
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repair of acute ulnar collateral ligament injuries of the thumb Metacarpophalangeal Joint a retrospective comparison of pull out sutures and bone anchor techniques
Plastic and Reconstructive Surgery, 2008Co-Authors: Leonid I Katolik, Jeffrey B Friedrich, Thomas E TrumbleAbstract:Background:The use of intraosseous suture anchors in the treatment of ruptures of the ulnar collateral ligament of the thumb Metacarpophalangeal Joint has previously been described. However, no direct comparisons exist of ulnar collateral ligament repair with bone anchor versus repair with a pull-ou
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repair of acute ulnar collateral ligament injuries of the thumb Metacarpophalangeal Joint a retrospective comparison of pull out sutures and bone anchor techniques
Plastic and Reconstructive Surgery, 2008Co-Authors: Leonid I Katolik, Jeffrey B Friedrich, Thomas E TrumbleAbstract:BACKGROUND: The use of intraosseous suture anchors in the treatment of ruptures of the ulnar collateral ligament of the thumb Metacarpophalangeal Joint has previously been described. However, no direct comparisons exist of ulnar collateral ligament repair with bone anchor versus repair with a pull-out button and immobilization. METHODS: Two cohorts of patients with complete rupture of the ulnar collateral ligament of the thumb Metacarpophalangeal Joint were compared. Thirty patients in each cohort underwent repair of the ulnar collateral ligament with either an intraosseous suture anchor followed by early mobilization or a pull-out suture tied over a button with cast immobilization. Average follow-up was 29 months. RESULTS: At follow-up, range of motion at the Metacarpophalangeal and interphalangeal Joints for the anchor group averaged 97 percent of that of the contralateral side compared with 86 percent and 87 percent, respectively, for the button group. For the anchor group, pinch strength averaged 101 percent that of the contralateral side compared with 95 percent for the button group. No significant difference was noted between the groups for grip strength. Average tourniquet time for the anchor group was 28 minutes compared with 43 minutes for the button group. Soft-tissue complications were present in 27 percent of patients (eight of 30) in the pull-out button group compared with 7 percent (two of 30) in the anchor group. Cost analysis demonstrates an approximately $140-per-patient savings when using the suture anchor. CONCLUSIONS: Both repair methods are safe and effective for treating thumb ulnar collateral ligament injuries. Suture anchors allow for an accelerated rehabilitation protocol, which may account for the improved range of motion and pinch strength at follow-up.
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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a comparative study of outcome between the neuflex and swanson Metacarpophalangeal Joint replacements
Journal of Hand Surgery (European Volume), 2005Co-Authors: R Delaney, I A Trail, D NuttallAbstract:This prospective double blind trial compares the clinical findings of Swanson and Neuflex Metacarpophalangeal Joint replacements in patients with rheumatoid arthritis, up to 2 years follow-up. There were 37 Joints (10 patients) in the Swanson group and 40 Joints (12 patients) in the Neuflex group. Assessments of range of movement, grip strength and hand function were undertaken in a double blind fashion, preoperatively and up to 2 years following implantation. The mean and standard deviation of the data were calculated. A two-tailed student’s t-test was used when comparing groups of data. An X-ray analysis was also undertaken to identify any implant failure.There was no significant difference between the two groups with respect to flexion and extension before surgery. At follow-up there was also no significant difference in the extensor lag, with mean extension lags of 19° and 16° for the Swanson and Neuflex implants, respectively. However, there was a significant difference in flexion, with mean active f...
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seventeen year survivorship analysis of silastic Metacarpophalangeal Joint replacement
Journal of Bone and Joint Surgery-british Volume, 2004Co-Authors: I A Trail, J A Martin, D Nuttall, J K StanleyAbstract:We reviewed the records and radiographs of 381 patients with rheumatoid arthritis who had undergone silastic Metacarpophalangeal Joint replacement during the past 17 years. The number of implants was 1336 in the course of 404 operations. Implant failure was defined as either revision or fracture of the implant as seen on radiography. At 17 years, the survivorship was 63%, although on radiographs two-thirds of the implants were seen to be broken. Factors which improved survival included soft-tissue balancing, crossed intrinsic transfer and realignment of the wrist. Surgery to the thumb and proximal interphalangeal Joint had a deleterious effect and the use of grommets did not protect the implant from fracture.
Myra H Kim - One of the best experts on this subject based on the ideXlab platform.
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a multicenter clinical trial in rheumatoid arthritis comparing silicone Metacarpophalangeal Joint arthroplasty with medical treatment
Journal of Hand Surgery (European Volume), 2009Co-Authors: Kevin C Chung, Frank D Burke, E Shaw F Wilgis, Myra H Kim, Patricia B Burns, Marian Regan, David A FoxAbstract:Purpose Metacarpophalangeal (MCP) Joint deformities caused by rheumatoid arthritis can be treated using silicone Metacarpophalangeal Joint arthroplasty (SMPA). There is no consensus as to whether this surgical procedure is beneficial. The purpose of the study was to prospectively compare outcomes for a surgical and a nonsurgical cohort of rheumatoid arthritis patients. Methods The prospective study was conducted from January 2004 to May 2008 at 3 referral centers in the United States and England. Over a 3-year period, 70 surgical and 93 nonsurgical patients were recruited. One year data are available for 45 cases and 72 controls. All patients had severe ulnar drift and/or extensor lag of the fingers at the MCP Joints. The patients all had 1-year follow-up evaluations. Patients could elect to have SMPA and medical therapy or medical therapy alone. Outcomes included the Michigan Hand Outcomes Questionnaire (MHQ), Arthritis Impact Measurement Scales, grip and pinch strength, Jebson-Taylor test, and ulnar deviation and extensor lag measurements at the MCP Joints. Results There was no difference in the mean age for the surgical group (60) when compared to the nonsurgical group (62). There was also no significant difference in race, education, and income between the 2 groups. At 1-year follow-up, the mean overall MHQ score showed significant improvement in the surgical group but no change in the nonsurgical group, despite worse MHQ function at baseline in the surgical group. Ulnar deviation and extensor lag improved significantly in the surgical group, but the mean Arthritis Impact Measurement Scales scores and grip and pinch strength showed no significant improvement. Conclusions This prospective study demonstrated significant improvement for RA patients with poor baseline functioning treated with SMPA. The nonsurgical group had better MHQ scores at baseline, and their function did not deteriorate during the 1-year follow-up interval. Type of study/level of evidence Therapeutic III.
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a prospective outcomes study of swanson Metacarpophalangeal Joint arthroplasty for the rheumatoid hand
Journal of Hand Surgery (European Volume), 2004Co-Authors: Kevin C Chung, Sandra V Kotsis, Myra H KimAbstract:Abstract Purpose Destruction and dislocation of the Metacarpophalangeal (MCP) Joints are common occurrences in patients with rheumatoid arthritis (RA). Disruption of the support ligaments around the MCP Joints and ulnar deviation of the fingers affect hand function and hamper the ability to perform activities of daily living. A common surgical intervention is the Swanson Metacarpophalangeal Joint Arthroplasty (SMPA), which restores alignment of the fingers. Methods We conducted a prospective study with 16 patients to determine outcomes of this procedure. We present our data from the 6-month and 1-year follow-up periods. Results Functional assessment by grip strength, pinch strength, and Jebsen-Taylor Test did not improve significantly when compared with preoperative values. Subjective assessment by the Michigan Hand Outcomes Questionnaire (MHQ), however, did improve significantly. Large improvements were seen in the function, activities of daily living, aesthetics, and patient satisfaction domains, with preoperative to 1-year postoperative score improvements of 26, 42, 57, and 43 points, respectively, based on a 100-point scale. Ulnar drift significantly decreased 1 year after surgery by an average of 24° and MCP Joint range of motion increased, but this change was not significant. Conclusions Our data show that patients with RA who underwent SMPA had significant improvements in patient-reported outcomes at the 1-year interval. Continued follow-up evaluation of this cohort will determine whether these improvements are maintained in the long term.