Carpal tunnel decompression in primary care: what is the infection risk and is it safe and effective?

INTRODUCTION

The demand for elective hand surgery in England is predicted to double by 2030 compared with 2011. With such increase in demand, the UK must seek strategies to reduce costs of treatment while still maintaining standards of care. Carpal tunnel decompression performed in a treatment room rather than in theatre may provide a safe alternative setting. As yet, there are no UK-based studies that identify the risk of infection following surgery performed in a treatment room and there are no studies whatsoever assessing the qualitative outcomes of patients undergoing hand surgery outside a theatre environment. Our aim was to assess whether carpal tunnel decompression performed in the community is safe, in terms of infection risk, and effective.

MATERIALS AND METHODS

Patient outcome measures were prospectively recorded following carpal tunnel decompression in one single primary care centre performed by one surgeon from 2012 to 2017. Infection following surgery was evaluated for retrospectively.

RESULTS

A total of 460 patients underwent carpal tunnel decompression within the study time period. There were three superficial infections identified, giving an infection rate of 0.65%. There were no deep infections identified. There was a statistically significant improvement in both symptom and functional outcomes following surgery, with results comparable to other studies where surgery was performed in theatre.

DISCUSSION

We believe that carpal tunnel decompressions performed in a treatment room is both safe, in terms of infection risk, and effective. Surgeons should consider this location as an alternative setting to the main operating theatre.

Low incidence of complications in computer assisted total knee arthroplasty--A retrospective review of 1596 cases

BACKGROUND

Computer assisted total knee arthroplasty (CATKA) has its own unique complications. The aim of this study was to present our experience of early complications in a large consecutive series of CATKA.

METHOD

We investigated retrospective data on the complications specific to computer navigation that were encountered with a consecutive series of 1596 CATKA.

RESULTS

Intraoperatively, eight episodes of software failure occurred, two requiring conversion to conventional jig based TKA. There were four broken drill bits when positioning the pins for data entry. Repeat cuts of bone due to malalignment were required on two occasions. There were 17 episodes of superficial pin site infections at the tibial pin-site managed conservatively with antibiotics. One tibial fracture occurred through an old tibial tracker pin site hole.

CONCLUSION

This large study shows a low complication rate related to CATKA which is reassuring to the orthopaedic community.

CLINICAL RELEVANCE

Level of evidence: III.

Five-year follow-up of minimally invasive computer assisted total knee arthroplasty (MICATKA) versus conventional computer assisted total knee arthroplasty (CATKA) - A population matched study

BACKGROUND

Minimally invasive surgery (MIS) has perceived advantages in the early post-operative stage such as reduced blood loss, decreased pain, earlier return to function and earlier discharge. The aim of our study was to confirm that longer term clinical outcome of TKA is not compromised when MIS is combined with computer assisted surgery.

METHODS

Eighty patients matched for age, gender, pre-operative Knee Society Score (KSS) and mechanical axis were prospectively studied. Forty patients underwent minimally invasive computer assisted total knee arthroplasty (MICATKA) and 40 patients underwent conventional computer assisted TKA (CATKA). Functional scores were determined at 6 weeks, 6, 12, 18, and 24 months and 5 years post-surgery. Long-leg alignment views were obtained 3 months post-operatively.

RESULTS

KSSs in the short term were significantly better in the MICATKA group than in the CATKA group (p<000.1). Tourniquet-time was 58 min in the MICTKA group and 60 min in the CATKA group (p=0.3). Straight leg raise was achieved by day one in 93% of the MICATKA group compared to 30% of the CATKA group (p<0.001). Length of stay for the MICATKA group has a mean of 3.25 days and a mean of 6 days for the CATKA group (p<0.001). KSSs up to 2-years were significantly better in the MICTKA group (p<0.001). At 5-years there was no significant difference in KSSs (p=0.46) in the MICATKA and CATKA groups.

CONCLUSION

We confirm that the use of navigation in minimally invasive TKA permits a number of early post-operative advantages and that longer-term functional outcome is not compromised with its usage.

LEVEL OF EVIDENCE

Level II.