Arthrodesis or arthroplasty, complete or partial: where are we at in the 21st century?

Osteoarthritis of the wrist presents complex surgical challenges. A wide variety of surgical options are available when conservative management fails to provide adequate pain relief. Despite advancements in management, such as modifications of partial wrist arthrodesis techniques and increasing use of total wrist replacements, in most scenarios there is no single preferred option.

Revision wrist arthroplasty strategies.

Wrist arthrodesis performed to salvage a failed total wrist arthroplasty can be challenging owing to bone loss and poor soft tissue quality. This article focuses on the evidence base and our experience as a tertiary unit in managing this cohort of patients. A systematic and meticulous approach is required to attempt to minimize complications.

Proximal interphalangeal joint arthroplasty: current trends and evidence-based practice.

Arthroplasty of the proximal interphalangeal joint (PIPJ) has evolved since its inception over 60 years ago. This review examines the indications for surgery, highlights the differences in current arthroplasty designs, variances in surgical techniques, clinical controversies, current implant outcomes data and salvage options for the failed implant. Overall, PIPJ implant arthroplasty is a good and reliable option for symptomatic PIPJ degenerative, post-traumatic or inflammatory arthritis given the proper clinical setting.

Genomic characterization of vulvar squamous cell carcinoma reveals differential gene expression based on clinical outcome.

Objective: The greatest challenge in the management of vulvar squamous cell carcinoma (VSCC) is treatment of recurrent disease where options for surgery and radiation have been exhausted, or treatment of disease where distant metastasis is present. Identification of mutations differentially expressed between tumor from patients who died of aggressive disease and tumor from patients with an indolent course could reveal novel prognostic indicators and guide development of therapeutic drugs.

Methods: From 202 consecutive patients with VSCC, patients who recurred and died of disease (group A) were identified and matched by age, tumor size, depth of invasion and nodal status with those whose disease did not recur (group B).

Total wrist arthroplasty with the Freedom® prosthesis: a short-term follow-up.

We retrospectively reviewed our series of primary total wrist arthroplasty with the Freedom® prosthesis. The primary outcome measure was revision, and secondary measures included radiographic loosening, pain, complications, movement range, grip strength and patient-reported measures. We reviewed 12 implants in 11 patients (mean age 59 years, range 45-80) with a mean radiological and clinical follow-up of 2.

Elective Ambulatory Unit: Experience of Local Anesthetic Only Surgery During the Pandemic.

Background: The second COVID-19 wave severely limited access to elective surgery.

Methods: Between December 2020 and May 2021, 530 patients underwent a procedure in the elective ambulatory unit (EAU), a walk-in and walk-out model of surgery, and we used a prepandemic cohort of day-case patients for comparison.

Results: We have had no confirmed cases of COVID-19 transmission on-site.

Long-term outcomes of the Universal 2 total wrist replacement: revision and loosening at 10 years and beyond.

The aim of this study was to ascertain the long-term revision rates of the Universal 2 wrist prosthesis in a previously published cohort of patients with rheumatoid arthritis. The time to, and reasons for revision were determined. Radiographs were analysed to determine whether loosening had occurred in the long-term according to the Wrightington zonal classification of loosening.

Pyrocarbon Lunate Replacements Perform Well at Two Years: A Retrospective Case Series and Technique from Two UK Tertiary Centres.

We report medium-term results in our case series of patients with Kienböck disease receiving a pyrocarbon lunate replacement (Integra, Smith and Nephew, Watford, UK). Patients with Kienböck receiving a pyrocarbon lunate between September 2012 and November 2020, with stage 3b and above were included. Patients were staged preoperatively with radiographs and MRIs.

Arthroplasty in thumb trapeziometacarpal (CMC joint) osteoarthritis: An alternative to excision arthroplasty.

Trapeziectomy for base of thumb arthritis is well established, but base of thumb arthroplasty offers potential advantages. The review covers the development of arthroplasty for the thumb from interposition arthroplasty to total joint replacement. It discusses contemporary prosthesis designs and results, including trapezial component geometry, bearing surfaces, and dual mobility.

MatOrtho Proximal Interphalangeal Joint Arthroplasty via Lateral Approach: Minimum 2-Year Follow-Up.

The MatOrtho implant is a cementless, mobile-bearing surface arthroplasty with a cobalt-chromium metal-on polyethylene articulation designed to treat osteoarthritis of the PIP joint. Early results for the prosthesis inserted through a dorsal approach have demonstrated good pain relief but no significant improvement in range of motion. In an attempt to improve the range of motion the senior author has changed his surgical practice to inserting the MatOrtho implant via a lateral approach.

Bare bones: Fundamentals of diagnostic wrist arthroscopy.

Diagnostic wrist arthroscopy is an essential component of the modern orthopaedic wrist surgeon's skill set. Fundamental elements of diagnostic wrist arthroscopy include pre-operative planning and consent, operative set up, surface anatomy, a systematic approach and applied clinical anatomy, and closure. These fundamentals are described, including options and preferences for implementation.

COVID-19 consent and return to elective orthopaedic surgery: allowing a true patient choice?

Aims: The exact risk to patients undergoing surgery who develop COVID-19 is not yet fully known. This study aims to provide the current data to allow adequate consent regarding the risks of post-surgery COVID-19 infection and subsequent COVID-19-related mortality.

Methods: All orthopaedic trauma cases at the Wrightington Wigan and Leigh NHS Foundation Trust from 'lockdown' (23 March 2020) to date (15 June 2020) were collated and split into three groups.

Which Headless Compression Screw Produces the Highest Interfragmentary Compression Force in Scaphoid Fracture?

Background: Interfragmentary compression at the fracture site facilitates healing. Headless compression screws used to treat scaphoid fractures can be grouped as shank screws, conical tapered screws and double component screws. There has been no meta-analysis of biomechanical studies to compare interfragmentary compression produced by the above screws.

Performance evaluation of surgical techniques for treatment of scapholunate instability in a type II wrist.

We investigated the performance of three tenodesis techniques, modified Brunelli, Corella, and scapholunate axis (SLAM) methods in repairing scapholunate interosseous ligament (SLIL) disruption for a type II wrist using finite element-based virtual surgery and compared the results with those of a previous investigation for a type I wrist. In addition, a comparison of the carpal mechanics of type I and type II wrists was undertaken in order to elucidate the difference between the two types. For the type II wrist, following simulated SLIL disruption, the Corella reconstruction technique provided a superior outcome, restoring dorsal gap, volar gap, and SL angle to within 3.

Survivorship of Revision Wrist Replacement.

 This study aims to report the 5-year survivorship of revision wrist arthroplasties and to report midterm clinical and radiological results.  All patients receiving a revision wrist arthroplasty in our unit between January 1, 1997 and October 31, 2010 were identified, and clinical notes retrospectively analyzed for Quick Disabilities of the Arm, Shoulder and Hand (quickDASH), Patient Evaluation Method (PEM), Patient-Rated Wrist Evaluation (PRWE), the range of movement, and visual analog score (VAS). In cases where patient review had not occurred within the past year, they were invited for assessment, and this data was included in the analysis.

Evaluation of the performance of three tenodesis techniques for the treatment of scapholunate instability: flexion-extension and radial-ulnar deviation.

Chronic scapholunate ligament (SL) injuries are difficult to treat and can lead to wrist dysfunction. Whilst several tendon reconstruction techniques have been employed in the management of SL instability, SL gap reappearance after surgery has been reported. Using a finite element model and cadaveric study data, we investigated the performance of the Corella, scapholunate axis (SLAM) and modified Brunelli tenodesis (MBT) techniques.

Early results of Latitude primary total elbow replacement with a minimum follow-up of 2 years.

Background: The aim of this study was to present outcomes of primary Latitude total elbow replacement (TER) with a minimum follow-up of 2 years.

Methods: A retrospective cohort study was undertaken with prospective outcome data collection for the latest outcome. Included were 63 consecutive primary Latitude TERs in 58 patients performed during a period of 5 years at a specialist orthopedic hospital.

Analysis of tenodesis techniques for treatment of scapholunate instability using the finite element method.

Chronic scapholunate ligament (SL) injury is a common disorder affecting the wrist. Despite advances in surgical techniques used to treat this injury, SL gap re-emergence may occur postoperatively. This paper presents an investigation into the performance of the Corella, schapolunate axis (SLAM), and modified Brunelli tenodesis (MBT) surgical reconstruction techniques used to treat scapholunate instability.

Antiparasitic and disease-modifying activity of Nyctanthes arbor-tristis Linn. in malaria: An exploratory clinical study.

Background: An unceasing threat of drug resistance continuously poses demand for new antimalarial drugs. A scientific assessment of traditionally used antimalarial plants through reverse pharmacology is crucial for a fast track drug discovery. An Ayurvedic plant Nyctanthes arbor-tristis Linn.

Medium-term outcomes of the Universal-2 total wrist arthroplasty in patients with rheumatoid arthritis.

Aims: The aims of this study were to evaluate the clinical and radiological outcomes of the Universal-2 total wrist arthroplasty (TWA) in patients with rheumatoid arthritis.

Patients And Methods: This was a retrospective review of all 95 Universal-2 TWAs which were performed in our institution between 2003 to 2012 in patients with rheumatoid arthritis. A total of six patients were lost to follow-up and two died of unrelated causes.

Double minute chromosomes in acute myeloid leukemia, myelodysplastic syndromes, and chronic myelomonocytic leukemia are associated with micronuclei, MYC or MLL amplification, and complex karyotype.

Double minute chromosomes (dmin) are small, paired chromatin bodies that lack a centromere and represent a form of extrachromosomal gene amplification. Dmin are rare in myeloid neoplasms and are generally associated with a poor prognosis. Most studies of dmin in myeloid neoplasms are case reports or small series.

Evaluating the Surface Topography of Pyrolytic Carbon Finger Prostheses through Measurement of Various Roughness Parameters.

The articulating surfaces of four different sizes of unused pyrolytic carbon proximal interphalangeal prostheses (PIP) were evaluated though measuring several topographical parameters using a white light interferometer: average roughness (Sa); root mean-square roughness (Sq); skewness (Ssk); and kurtosis (Sku). The radii of the articulating surfaces were measured using a coordinate measuring machine, and were found to be: 2.5, 3.

Pyrocarbon Proximal Interphalangeal Joint Arthroplasty: Minimum Five-Year Follow-Up.

Purpose: To report the outcomes, complications, and survivorship of pyrocarbon proximal interphalangeal joint arthroplasty at a minimum of 5-year follow-up.

Methods: A review of 97 implants in 72 consecutive patients from our joint arthroplasty database was undertaken. Patient demographics, complications, further surgery, and implant revision were recorded.

Pyrocarbon Metacarpophalangeal Joint Arthroplasty in Noninflammatory Arthritis: Minimum 5-Year Follow-Up.

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.