Outcomes of Multiple Digit Proximal Interphalangeal Joint Swanson Arthroplasty Done at a Single Operation.

Background: Proximal interphalangeal joint (PIPJ) arthroplasty using a Swanson implant is commonly used for the treatment of PIPJ arthritis despite newer implants being available. Many patients develop arthritis in more than one digit and some tend to have multiple digits operated on in their lifetime. There is paucity of literature on the outcomes of multiple PIPJ arthroplasty in one sitting. The aim of this study is to determine the outcomes of PIPJ arthroplasty using a Swanson implant done for multiple digits at one sitting. Methods: We retrospectively reviewed the outcomes of multiple Swanson PIPJ arthroplasty during a single operation from 2008 to 2018 in 13 patients (43 arthroplasties). We compared pre- and post-operative results of flexion/extension arcs, grip and pinch strength and questionnaires subsequently compared QuickDASH (Disabilities of Arm, Shoulder and Hand), Patient Evaluation Measure (PEM) and Visual Analogue Score (VAS) scores. Data were analysed with a Mann-Whitney U test. Results: Patients on average attended 5.6 hand therapy sessions over 5.1 months post-operatively. Average flexion/extension arc improved from 31.9° pre-operatively to 37.2° post-operatively. Average grip strength increased from 7.2 kg to 10.2 kg. The QuickDASH, PEM and VAS scores improved in keeping with the reported literature. There were no implant failures. Conclusion: We demonstrate similar outcomes for multi-digit Swanson PIPJ arthroplasty compared to the literature for single digit Swanson PIPJ arthroplasty. We conclude that multi-digit arthroplasty in a single operation is safe and effective. Level of Evidence: Level IV (Therapeutic).

Is it safe to restart elective day-case surgery? Lessons learned from upper limb ambulatory trauma during the COVID-19 pandemic.

BACKGROUND: The COVID-19 pandemic has impacted on the provision of elective and trauma orthopaedic surgery worldwide with millions of operations cancelled. The risk of patients developing COVID-19 after undergoing ambulatory procedures in hospitals is unknown. This paper aims to investigate the risk of developing COVID-19 from day-case and overnight stay upper limb procedures during the peak of the pandemic in London, and to discuss the implications for the safe management of elective hand and upper limb patients in the coming months. METHODS: 56 patients underwent emergency trauma upper limb procedures as a day case or with a single overnight stay from 1st March to May 31, 2020 at two central London hospitals that were also key players in the pan-London COVID response. Data was collected retrospectively from clinical and theatre records. Patients were contacted post-operatively and answered a structured questionnaire, including whether patients had experienced any of the symptoms suggestive of COVID-19 in the 14 days prior or 30 days following surgery. RESULTS: Of 56 patients, one patient reported COVID-19 symptoms, which were minor and did not require hospitalisation. Five patients experienced minor post-operative complications such as stiffness and scar hypersensitivity; one patient had a superficial wound infection. The mean age was 46 years (20-90) with 68% patients ASA I, 25% ASA II and 4% ASA III. 9% had LA, 30% a regional block and 61% had a GA. The most common operation was a distal radius open reduction and internal fixation. The average time spent in hospital was 11 h (3-34 h) and 12 patients required an overnight stay. The median length of face-to-face follow up was 38.5 days. CONCLUSION: Our study suggests that, with appropriate precautions, elective upper limb ambulatory surgery can be safely restarted with a low risk of contracting COVID-19 or its complications.