Operation notes were analysed to confirm the type of procedure, underlying diagnosis, and thickness of tibial insert. Information was derived from patient records and postal questionnaire to all surviving patients, which included: WOMAC, SF-36, satisfaction scale and history of revision surgery.
As at September 2003 there were 153 patients (25%) still alive, using revision as an endpoint survivorship was 59.3% at a mean time since implantation of 17 years 8 months. Pain and function portions of the WOMAC questionnaire revealed mean scores of 37 and 47 out of 100.
Survival was significantly better in females, no effect from pre-operative diagnosis was seen. 73% of these patients had 6mm tibial inserts, we postulate that the deterioration in survival is related to accelerated poly-ethylene wear beyond 10 years.
We have undertaken to review Bankart stabilisations performed by the senior author in Newcastle since 1998. We employ a modification of the technique as described by Rowe et al, but without a coracoid osteotomy and using suture anchors. Where there is also an element of inferior instability this was combined with a capsular shift at the same time. We performed a retrospective case note review of all patients in the study period, following this all patients were sent out a postal questionnaire based on the Oxford Instability Score (OIS). A total of 50 Bankart repairs were performed in the study period, no significant wound infections or haematomas were recorded. 3 patient had further dislocations and required revision surgery; a further 2 patients had ongoing symptoms of instability one of which has had revision. Response rate to the questionnaire was 62%. Mean OIS for patients following primary stabilisation was 21.7 (possible scores from 12 – excellent outcome to 60 – poor outcome). OIS following Bankart stabilisation of the shoulder has not been previously reported. These results compare favourably to original scores published by Carr et al (1999) who included both patients treated by surgery and physiotherapy alone. The OIS was shown to be very sensitive in detecting instability symptoms noted at clinical review. The response pattern of the scores closely mirrored that from Carr and co-workers.
Concern over long term outcomes in patients with silastic metatarsophalangeal implants prompted an assessment of such patients. We reviewed 21 single-stemmed silastic metatarsophalangeal arthroplasties in 18 patients with a mean follow-up of 18 years and 9 months. Eight operations were performed for hallux valgus, and 13 for hallux rigidus. Patients were assessed by clinical scoring, patient satisfaction, and radiographic grading. Patients treated for hallux rigidus achieved higher clinical scores than those treated for hallux valgus. This difference was statistically significant (p <
0.02). There was no correlation between radiographic appearance and clinical score, patient satisfaction, or time since implantation. Long-term changes to the bone stock did not cause clinical detriment, and in no case was late revision surgery necessary. There has been widespread concern regarding silicone synovitis associated with early clinical detriment, together with progressive erosive bony changes seen with these implants. In our very long term review outcomes were surprisingly good, particularly in the surgical treatment of hallux rigidus in the over fifty age group.
