We performed a systematic review of the current literature regarding
the outcomes of unconstrained metacarpophalangeal joint (MCPJ) arthroplasty. We initially identified 1305 studies, and 406 were found to be
duplicates. After exclusion criteria were applied, seven studies
were included. Outcomes extracted included pre- and post-operative
pain visual analogue scores, range of movement (ROM), strength of
pinch and grip, satisfaction and patient reported outcome measures
(PROMs). Clinical and radiological complications were recorded.
The results are presented in three groups based on the design of
the arthroplasty and the aetiology (pyrocarbon-osteoarthritis (pyro-OA),
pyrocarbon-inflammatory arthritis (pyro-IA), metal-on-polyethylene
(MoP)).Aims
Materials and Methods
The dual mobility (DM) bearing concept was introduced to reduce the risk of dislocation in total hip arthroplasty (THA). Our aim was to evaluate the early outcomes following the utilisation of DM in primary and revision THA in our unit. Prospectively collected data on all patients undergoing a DM bearing at was reviewed between July 2012and December 2015. The primary outcome assessed was dislocation, with a secondary outcome revision for any reasons. All data was gathered from patient clinical records and the digital picture archiving and communication system (PACS) 30 primary THA were undertaken and 54 revision THAin the time period described. 11 of the procedures involved a proximal femoral endoprosthesis. The mean age in the primary setting was 65 and 73 in the revision population. The main indications for using DM bearing in the primary setting were; trauma (40%), residual dysplasia (40%) and malignancy (17%). There were no dislocations in the primary THA category. Indications in the revision THA cohort included 33% for aseptic loosening, 11% for instability, 18% for ALVAL reactions, 20% for infection, 18% for fracture. 1 out of the 54 revision THA had one large bearing dislocation requiring closed reduction. Subsequent analysis confirmed that implant alignment was satisfactory and this was a patient compliance issue due to mental health concerns. To date no patient in either cohort required revision surgery. Overall dislocation rate was 1.2%. Our early experience with DM bearings has been positive with no evidence of early failure or loosening. The dislocation rate overall has been low and matches the current large series in the literature.
Regional nerve block for upper limb surgery is an established procedure. Our study was undertaken to look at the patient experience of this. We prospectively studied 59 consecutive patients undergoing shoulder arthroscopic surgery under regional anaesthesia in our department. They completed a questionnaire which they brought back at their first follow up appointment. The questionnaire gathered information of their experience of anaesthesia and surgery, adequate postoperative information. We reviewed if intra-operative pain occurred and if the patients would undergo such a procedure again. All surgeons were upper limb specialists.3 out of 59 patients required conversion to general anaesthetic (5%) due to failure of the block. The introduction of the block was mainly painless;with patients giving a mean scoring of 0.59 on the visual analog pain score (VAS, range 0–5). 26 patients (44%) expressed interest and watched their operation. Of those, 7 patients felt anxious after having the proceedings explained.1 patient discontinued to watch due to this. 10 patients experienced intraoperative pain, 2 requiring local anaesthetic, 8 receiving sedation, giving a mean score of 3.2 on the VAS. 81.4% of patients would have surgery with regional anaesthetic again, 85% would recommend to others. 83% of patients received adequate information. Overall satisfaction of the experience was rated out of 10, with a mean score of 8.7 (median 9). Regional blocks are an established technique. Since patients are awake and can watch their surgery, it is important to consider the patients perception of this experience. The majority of viewing patients were reassured by explanations of their pathology. Most patients would undergo another procedure with regional anaesthesia and would recommend it, suggesting that this is an effective and popular choice. The overall experience is positive. This supports our intention of offering regional blocks for all upper limb surgery, facilitating increasing use of day case facilities, reducing inpatient stays
