Carpal tunnel release surgery is a commonly performed procedure for alleviating symptoms of median nerve compression and restoring hand function. With pressure on theatre time these procedures are now commonly performed in a step-down out-patient facility under local anaesthetic. The choice of suture for skin closure in this procedure can impact the quality of wound healing, patient outcomes and the follow-up required however the question of the best type of suture remains unanswered. The purpose of this study was to compare the outcomes of absorbable and non-absorbable sutures using a randomised control trial design. Eighty patients diagnosed with bilateral carpal tunnel syndrome were enrolled and underwent outpatient carpal tunnel release surgery under local anaesthetic in a staged fashion. Random number generation was used to assign each hand to receive interrupted nylon or Vicryl Rapide sutures. Pre-operative data collection included patient demographics, ASA, inflammatory conditions, smoking status as well as a Boston Carpal Tunnel Questionnaire (BCTQ) for each hand. Patients were followed up at 2 and 6 weeks after each operation and the BCTQ was repeated along with the Patient and Observer Scar Assessment Scale and the VAS score for wound discomfort. This study has approval from the DHB ethics committee, Local Iwi, HDC and ANZ Clinical Trials:ACTRN12623000100695.Objective
Methods
Proximal tibial bone mineral density (BMD) has been shown to decrease following Total Knee Arthroplasty (TKA) by both dual-energy x-ray absorbtiometry (DEXA) and quantitative computed tomography (qCT)-assisted osteodensitometry. Little is known about changes in BMD following unicompartmental knee arthroplasty (UKA). Additionally, there are proposed differences in stress transmission between cemented metal and polyethylene (PE) components. We proposed two hypotheses. First, that proximal tibial BMD decreases following UKA. Second, that BMD loss would be greater below metal tibial components. We performed a prospective clinical trial of 50 consecutive UKAs in 49 patients performed by two surgeons at one institution. There were 25 mobile bearing Oxford and 25 fixed bearing Accuris arthroplasties, all were medial. BMD was assessed with qCT-assisted osteodensitometry scans prior to discharge and then at 1 and 2 years post surgery. Each CT slice was divided into medial and lateral halves and cortical and cancellous bone was analysed separately. The six 2mm slices immediately beneath the tibial implant were analysed using previously validated software to create a three-dimensional assessment of BMD. The lateral half was used as a control. There were a total of 30 females (60%), with an average age of 70 (49–84). One patient was lost to follow-up and another was unable to be analysed due to failure requiring revision before follow-up was complete. Preliminary results showed no significant change in BMD at either 1 or 2 years follow-up. There was no difference in BMD change between the mobile and fixed bearing prostheses, between the medial and lateral halves nor between cortical and cancellous bone. Final results will be presented at the AONZOA conference. This trial shows that UKA does not result in significant change to BMD at 2 years. The preservation of BMD may indicate that UKA is better at maintaining physiologic stress transfer than a TKA, which has been shown to be associated with a reduction in BMD.
