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Orthopaedic Proceedings
Vol. 105-B, Issue SUPP_2 | Pages 110 - 110
10 Feb 2023
Kim K Wang A Coomarasamy C Foster M
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Distal interphalangeal joint (DIPJ) fusion using a k-wire has been the gold standard treatment for DIPJ arthritis. Recent studies have shown similar patient outcomes with the headless compression screws (HCS), however there has been no cost analysis to compare the two. Therefore, this study aims to 1) review the cost of DIPJ fusion between k-wire and HCS 2) compare functional outcome and patient satisfaction between the two groups.

A retrospective review was performed over a nine-year period from 2012-2021 in Counties Manukau. Cost analysis was performed between patients who underwent DIPJ fusion with either HCS or k-wire. Costs included were surgical cost, repeat operations and follow-up clinic costs. The difference in pre-operative and post-operative functional and pain scores were also compared using the patient rate wrist/hand evaluation (PRWHE).

Of the 85 eligible patients, 49 underwent fusion with k-wires and 36 had HCS. The overall cost was significantly lower in the HCS group which was 6554 New Zealand Dollars (NZD), whereas this was 10408 NZD in the k-wire group (p<0.0001). The adjusted relative risk of 1.3 indicate that the cost of k-wires is 1.3 times more than HCS (P=0.0053). The patients’ post-operative PRWHE pain (−22 vs −18, p<0.0001) and functional scores (−38 vs −36, p<0.0001) improved significantly in HCS group compared to the k-wire group.

Literatures have shown similar DIPJ fusion outcomes between k-wire and HCS. K-wires often need to be removed post-operatively due to the metalware irritation. This leads to more surgical procedures and clinic follow-ups, which overall increases the cost of DIPJ fusion with k-wires.

DIPJ fusion with HCS is a more cost-effective with a lower surgical and follow-up costs compared to the k-wiring technique. Patients with HCS also tend to have a significant improvement in post-operative pain and functional scores.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXVIII | Pages 59 - 59
1 Sep 2012
Prud'homme-Foster M Louati H Pollock J Papp S
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Purpose

Based on anatomic studies, it appears that the short head (SH) and long head (LH) of the distal biceps tendons have discreet distal attachments on the radial tuberosity. The SH attaches distally and therefore may function as a stronger flexor, whereas the LH attaches more proximal and ulnar which would make it a greater supinator. The contribution of each of the two heads to flexion and supination has not yet been defined. The rationale of this study was to directly measure the contribution of the SH and LH of the biceps to elbow flexion and forearm supination and provide biomechanical evidence for what is inferred in the anatomical studies.

Method

Twelve fresh-frozen cadaveric arms were secured using in vitro elbow simulator, while controlled loads were applied to the individual biceps tendons short and long heads. Isometric supination torque and flexion force were recorded with the forearm in 45 degrees supination, neutral rotation and 45 degrees pronation.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXVIII | Pages 25 - 25
1 Sep 2012
Prud'homme-Foster M Louati H Parai M Dervin G
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Purpose

Unicompartmental knee replacement (UKR) is an established, bone preserving surgical treatment option for medial compartment osteoarthritis (OA). Early revision rates appear consistently higher than those of total knee replacement (TKR) in many case series and consistently in national registry data. Failure with progression of OA in the lateral compartment has been attributed, in part, to surgical technical errors. In this study we used navigation assisted surgery to investigate the effects of improper sizing of the mobile bearing and malrotation of the tibial component on alignment and lateral compartment loading.

Method

A total of eight fresh frozen cadaveric lower limbs were used in the study. After thawing overnight, a Brainlab navigation system with an Oxford (Biomet, Inc) medial UKR module was used to capture the native knee anatomy and alignment using a digitizing probe. Following registration, the case was performed with navigation verified neutral cuts and an ideal insert size was selected to serve as a baseline. The bearing thickness was subsequently increased by 2 mm increments to simulate progressive medial joint overstuffing. Excessive tibial internal rotation of 12 was also simulated at each of the intervals. Knee alignment in varus or valgus was recorded in real time for each surgical scenario with the knee in full extension and at 20 of flexion. Lateral compartment peak pressure was measured using a Tekscan pressure map.


Orthopaedic Proceedings
Vol. 88-B, Issue SUPP_II | Pages 322 - 322
1 May 2006
Foster M Jones DG Taylor P
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The aim of this study was to prospectively audit the results of carpal tunnel decompression using a subjective patient derived outcome score (modified Boston Symptom Severity Score) and to examine the relationship between symptom severity scores and nerve conduction studies.

Prospective cohort study of all patients undergoing open carpal tunnel decompression at Dunedin Hospital over a 13-month period from December 2003 – January 2005. Demographic details collected included age, sex, duration of symptoms, diabetes, occupation and ACC status. Pre-operative investigations consisted of nerve conduction studies and a modified version of the Boston Symptom Severity Score developed for this study. Symptom severity scores were reassessed six months post-operatively.

One hundred and ten patients participated in the study. Mean pre-operative Boston Symptom Severity Score was 3.35 (1= normal, 5=severe). Post-operatively this improved to mean 1.66, median 1.45. Ninety three percent of patients were “very satisfied” or “satisfied” with their results. Age and duration of symptoms were not significant predictors of poor outcome.

The majority of patients undergoing carpal tunnel decompression were satisfied with the outcome and had excellent or good outcomes as determined by symptom severity score. The use of preoperative nerve conduction studies help in diagnosis and prognosis.


Orthopaedic Proceedings
Vol. 87-B, Issue SUPP_I | Pages 29 - 29
1 Mar 2005
Foster M Lynskey T
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This is a retrospective study on the Taranaki experience with the Harris-Galante uncemented total hip joint replacement.

Ninety-six Harris-Galante total hip joint replacements were performed in ninety patients between September 1986 and September 1989. Twenty-nine patients died during the study and thirteen patients left the Taranaki area and were lost to follow-up. This left forty-eight patients (fifty hips) for evaluation with an average follow-up of fourteen years (range, thirteen to sixteen years). Results were analysed by questionnaire, clinical examination and x-rays.

Four hips were revised giving a Kaplan-Meier survivorship analysis of 89% at 14 years. Two femoral component was revised due to aseptic loosening at six and eleven years and two acetabular components were revised at 10 and 11 years due to liner dissociation.

The average Harris Hip score improved from 47 points preoperatively to 90 points at six years follow-up then declined to 83 at 14 years follow-up.

Osteolytic lesions were identified adjacent to 17% of acetabular components at follow-up and all were confined to zone two. Eighty-nine percent of femoral radiographs showed evidence of stress shielding however there were no grade four changes.

Osteolytic lesions were identified adjacent to 17% of femoral components at follow-up and were predominantly seen distally in zones three, four and five.

This study demonstrates satisfactory results for the Harris-Galante 1 total hip joint replacement at fourteen years follow-up. Cases should be kept under annual review to assess for progressive osteolysis, liner dissociation and the need for revision surgery.


Orthopaedic Proceedings
Vol. 85-B, Issue SUPP_III | Pages 205 - 205
1 Mar 2003
Foster M Hanlon M Stott S Walt S
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The purpose of the study was to evaluate the functional outcome of different limb salvage procedures for osteosarcoma about the knee.

A selection of patients who have undergone limb salvage procedures for osteosarcoma about the knee were invited to join the study. Medical and operation notes were reviewed along with recent radiographs of the involved limb. Patients completed the Musculoskeletal Tumour Society functional questionnaire and underwent a gait analysis assessing walking and running. Most patients had stage 2B osteosarcoma involving either the proximal tibia or distal femur. Limb salvage procedures included arthrodesis, allograft reconstruction, endoprosthesis and rotationplasty.

All patients scored highly (> 70 %) on the MSTS questionnaire except the arthrodesis that scored 57 %. The gait analysis revealed some subtle changes with a quadriceps-sparing gait in the endoprosthesis, mild foot drop in the proximal tibial allograft and a lateral lean of the trunk over the ipsilateral limb in the rotationplasty. The arthrodesis had an obvious straight leg gait with subtle pelvic hiking to assist foot clearance. While analysis of walking was close to normal most patients were unable to obtain a double float and run.

This study shows that limb salvage procedures tailored to each individual case can result in an excellent functional outcome with close to normal gait and high MSTS scores.