Cartiva interpositional arthroplasty versus arthrodesis in the treatment of Hallux rigidus: A retrospective comparative study with mean 2 year follow up

BACKGROUND

Hallux rigidus is a common condition characterised by first metatarsophalangeal joint (MTPJ) degeneration, pain and limited range of motion (ROM). The gold standard surgical treatment is arthrodesis, providing good pain relief, but sacrifices ROM. The Cartiva synthetic cartilage implant (SCI) has been utilised as an interpositional arthroplasty, aiming to reduce pain whilst preserving range of motion. Current evidence for Cartiva SCI is limited. The aim was to evaluate the clinical outcomes of Cartiva SCI compared to arthrodesis undertaken in our centre.

METHODS

A retrospective cohort study was conducted, enrolling all adult patients who underwent primary first MTPJ SCI arthroplasty or arthrodesis for the treatment hallux rigidus. The primary outcome was a validated patient-reported outcome measure (PROM), the Manchester-Oxford Foot Questionnaire (MOXFQ). Secondary outcomes included EQ-5D, complication rates, VAS Pain and FAAM (ADL).

RESULTS

Between 2017 and 2020 there were 33 cases divided into two groups (17 Cartiva SCI, 16 arthrodesis, mean age 59.0 ± 9.9 years) with a mean follow up of 2.3 years. There was no statistically significant difference in any of the MOXFQ, EQ-5D, VAS Pain or FAAM (ADL) outcome scores between the Arthrodesis and SCI groups (p > 0.05). The mean MOXFQ Index score was 7.2 ± 6.4 for the SCI group and 3.9 ± 5.8 for the Arthrodesis group at final follow up (p = 0.15). Although complications were high in both groups, the overall hallux reoperation rate was 29.4 % in the SCI cohort and 0.0 % for arthrodesis.

CONCLUSION

This retrospective comparative study found no significant superiority of Cartiva SCI over arthrodesis in terms of PROMs. Due to the higher rate of further surgical intervention in the SCI cohort, we recommend arthrodesis as the preferred surgical option for hallux rigidus.

LEVEL OF EVIDENCE

III.

Tourniquet use in ankle arthroscopy: A systematic review

BACKGROUND

Ankle arthroscopy is commonly performed using a thigh tourniquet and is thought to improve visibility and reduce operative time. However, the current evidence is unclear as to whether the use of a tourniquet provides these benefits. The aim of this study was to investigate whether there is any clinical benefit of using a tourniquet in ankle arthroscopy.

METHODS

A systematic review following PRISMA guidelines was undertaken. All clinical studies published in Medline, Embase, PubMed and the Cochrane Library Database from inception until January 2023 reporting on the use of a tourniquet in ankle arthroscopy were included.

RESULTS

180 studies were identified of which 3 (164 patients) met the inclusion criteria. All studies showed no statistically significant difference in mean surgical time and complication rate between the tourniquet and non-tourniquet groups. Overall, the quality of the evidence was moderate to poor without data in favour or against the routine use of tourniquets in ankle arthroscopy.

CONCLUSION

The current literature suggests that there are no significant differences in mean surgical time and complication rate between the tourniquet and non-tourniquet groups.

The intra-muscular course and distribution of the anterior interosseous nerve within pronator quadratus: An anatomical study

BACKGROUND

The anterior interosseous nerve (AIN) is a terminal motor branch of the median nerve innervating the following three muscles from proximal to distal: Flexor pollicis longus (FPL), the radial half of flexor digitorum profundus (FDP), and the pronator quadratus (PQ). The aim of this study was to define the course of the AIN within the PQ to aid surgeons performing distal radial procedures.

METHODS

Ten embalmed cadaveric forearms were dissected to identify the path of the AIN within PQ. An en-bloc excision of the PQ with its supplying AIN and vasculature was performed to identify a safe zone where PQ can be elevated without damaging AIN. A scoping literature search was performed to identify other studies reporting the path of AIN through PQ.

RESULTS

The mean distance from the radial border of the radius perpendicular to the point at which the AIN enters the PQ was 22.3 mm (range 21-24 mm). The mean distance from the distal wrist crease to the AIN entering PQ was 74.3 mm (range 59-84 mm). The mean number of nerve branches to PQ was 5.2 (range 3-8). In all specimens, the AIN was found to lie on the radial side of the anterior interosseous artery (AIA).

CONCLUSIONS

The AIN courses on the deep surface of the PQ in a longitudinal proximal to distal direction. A 'safe zone' was identified within 20 mm of the radial border of the distal radius, which may be utilised by surgeons in a muscle-splitting approach to the distal radius.

Aseptic lymphocytic vasculitis-associated lesion in a well-fixed total knee arthroplasty: a case report

Adverse reactions to metal debris in relation to metal-on-metal hip arthroplasty has been heavily discussed in the literature. In contrast, few cases have been reported in the context of total knee arthroplasty. A 77-year-old woman presented with a painful total knee arthroplasty. At the time of revision surgery, intra-articular cream-coloured fluid and material was found in association with a well-fixed prosthesis. Synovial and capsular samples were obtained for histological assessment and a diagnosis of aseptic lymphocytic vasculitis associated lesion was confirmed. The patient went on to have an uncomplicated recovery following a two-stage revision to a constrained knee prosthesis.