Long-term follow-up of open and endoscopic Hohmann procedures for lateral epicondylitis.

PURPOSE: The long-term outcome of this new endoscopic technique was compared with that of the classical open Hohmann procedure. TYPE OF STUDY: Retrospective cohort study. METHODS: During 1992 and 1995, 37 patients were surgically treated with the Hohmann procedure after failed intensive conservative treatment. At an average of 92 months after the operation, 30 patients (81%) could be clinically re-examined and were evaluated with a standard questionnaire including the scores of Roles and Maudsley and Morrey et al. RESULTS: Twenty of these patients were treated endoscopically and 10 with the open technique. There were no differences in demographic data between the 2 groups. At follow-up in both groups, similar results were seen for the function of the elbow, the scores of Roles and Maudsley and Morrey et al., the subjective rating of pain and function of the elbow, and complication rate. The results in the score of Morrey showed an average scoring of 93.2 for the endoscopic group and 87.5 for the open group (P > .05). CONCLUSIONS: The endoscopic technique showed results comparable to the open technique and can therefore be recommended for wider surgical use so as to learn more details concerning possible complications and results of the new technique. LEVEL OF EVIDENCE: Level III, retrospective cohort study.

Comparison of conventional versus computer-navigated acetabular component insertion.

This retrospective study compared the efficacy of computer navigation and conventional freehand techniques to place acetabular component orientation in the target position of acetabular cup inclination of 45 degrees and anteversion of 20 degrees . We selected 69 patients who had undergone total hip arthroplasty with freehand cup insertion who had computed tomography (CT) to plan for acetabular cup placement of the contralateral side. This group was compared with 98 patients who underwent CT-based cup insertion, and all had postoperative CT. After CT-based cup placement, average cup position was 43 degrees inclination (95% confidence interval [CI], 0.97; range, 30 degrees -58 degrees ) and 22.2 degrees anteversion (95% CI, 1.72; range, 5 degrees -38 degrees ). For freehand, average cup position was 45.7 degrees inclination (95% CI, 2.63 degrees ; range, 26 degrees -64 degrees ) and 28.5 degrees anteversion (95% CI, 3.80 degrees ; range, 9 degrees -53 degrees ). F ratio was 5.56 for inclination and 3.67 for anteversion (P < .0001). This study demonstrated substantial statistical improvement in accuracy of cup placement using CT-based navigation compared with freehand methods.

Prospective randomized surgical treatments for calcifying tendinopathy.

Thirty-eight patients with chronic calcifying tendinopathy of the shoulder were randomized prospectively into two groups: 19 patients had endoscopic decompression and 19 had open decompression. Thirty-three patients (19 with open and 14 with endoscopic decompression) were available for followup. Clinical and ultrasonographic investigations were done at followup. The purpose of the current study was to evaluate prospectively the clinical and sonographic results after open decompression and after endoscopic decompression. Apportionment of age and gender was similar in both groups. The followup was 15.7 months for patients after open decompression and 17.1 months for patients after endoscopic decompression. The average Patte score was 84.5 points (84.4 for patients who had endoscopic decompression and 84.6 for patients who had open decompression). Corresponding results were found with a Constant and Murley score of 96.6 points (97.6 for patients who had endoscopic decompression and 95.8 for patients who had open decompression). In the endoscopic group physiotherapy was recommended for 5 weeks more than in the open surgery group. Similar results were seen for the incapacity to work in both groups with 4.6 weeks for the patients who had endoscopic surgery and 5 weeks for the patients who had open surgery. No nerve injuries, wound infections, or other postoperative complications were found. Comparison of both surgical methods showed good clinical and score results. Endoscopic and open surgery are equally effective in the treatment of chronic calcifying tendinopathy.

Early results of endoscopic trochanter bursectomy.

Between 1995 and 2000, we performed 45 endoscopic bursectomies in 42 patients (average age 51, range 17-61 years). All patients had at least 6 months of failed conservative treatment, and all responded positively to a sonographic-guided injection with Mepivacaine 0.5%. The bursa was removed using a synovial resector. An additional tractopexie was performed in four cases. We followed 37 patients for 12-48 months. Pre-operatively, the mean modified Japanese Orthopaedic Association (JOA) disability hip score was 40.5 points. It improved to 72.6 points after a mean of 25 months. Severe complications did not occur. The minimally invasive technique requires only stab incisions, and immobilisation and hospitalisation are minimal.