The Utility of the Carpal Tunnel Syndrome-6 for Predicting the Outcomes of Carpal Tunnel Release.

PURPOSE: Considering the cost of, discomfort with, and time required for nerve conduction testing, the Carpal Tunnel Syndrome-6 (CTS-6) is often used to determine the likelihood of the presence of carpal tunnel syndrome. We sought to determine whether the CTS-6, designed as a diagnostic instrument, could serve a dual purpose and predict the outcome of carpal tunnel release (CTR) based on postoperative changes in the Boston Carpal Tunnel Questionnaire (BCTQ) score. METHODS: This prospective observational study enrolled 118 adults before they underwent open CTR at a tertiary center. A primary regression analysis was used to determine the association between preoperative CTS-6 scores and changes in the BCTQ score at ≥6 months after surgery. Additional demographic, social, electrodiagnostic, and mental health variables were assessed for associations with changes in the BCTQ score. The secondary outcomes included single questions rating satisfaction with the result of CTR as well as symptom changes and the Decision Regret Scale. Noneffective CTR was defined as a BCTQ score change of <1.0 point or reported dissatisfaction. RESULTS: Postoperatively, the BCTQ score improvement averaged 1.38 ± 0.77. Although 102 of 109 patients (94%) noted symptom improvement, 94 of 109 (86%) were satisfied with the result of CTR, and 78 of 109 patients (72%) demonstrated a meaningful change in the BCTQ score. Preoperative CTS-6 scores were not correlated with changes in BCTQ scores. CTS-6 scores were not associated with Decision Regret Scale scores, reported satisfaction, or the single-question assessment of symptom changes. Satisfaction, decision regret, and the single symptom change question were correlated with changes in the BCTQ score and each other. Dissatisfied patients were distinguished by a differential improvement in the BCTQ score (1.5 vs 0.7), but no preoperative variable consistently predicted noneffective CTR. CONCLUSIONS: The CTS-6 score does not predict changes in BCTQ scores after CTR. Patient satisfaction with surgical results is associated with postoperative changes in carpal tunnel symptoms but is not predictable using preoperative information. A single question of symptom change may offer an efficient assessment of CTR outcomes. TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic II.

Pediatric Lyme Arthritis of the Hip: The Great Imitator?

BACKGROUND: Lyme arthritis (LA) of the hip can present similarly to septic arthritis (SA) and transient synovitis (TS). The primary purpose of this study was to determine clinical and laboratory parameters differentiating LA of the hip from SA or TS among children who had undergone hip aspiration during the evaluation of hip pain. METHODS: This was a retrospective review of all patients who underwent hip aspiration for the evaluation of hip pain at a tertiary care children's hospital in a Lyme endemic area. Clinical and laboratory data were reviewed and comparative analyses were performed between those diagnosed with LA, SA, and TS. Independent samples t test, ANOVA, and χ test were used to compare clinical and laboratory variables as appropriate. Multivariable logistic regression was used to elucidate independent predictors of LA. Statistical significance was set at P<0.05. RESULTS: Ninety-three hip aspirations (93 patients) were included in the final analysis. Seventeen patients were diagnosed with LA, 40 with SA, and 36 with TS. Multivariable logistic regression revealed febrile history (OR=16.3; 95% CI, 2.35-113.0) and increased peripheral white blood cell (WBC) count (OR=1.26; 95% CI, 1.01-1.58) to be significantly associated with increased odds of being diagnosed with SA versus LA. Increased erythrocyte sedimentation rate (ESR) was significantly associated with increased odds of being diagnosed with LA versus TS (OR=1.06; 95% CI, 1.02-1.10), whereas febrile history (OR=0.06; 95% CI, 0.01-0.49) and increased peripheral WBC count (OR=0.8; 95% CI, 0.65-0.98) were associated with decreased odds of LA. CONCLUSIONS: Children presenting in a Lyme endemic area with an isolated hip effusion are more likely to have LA versus SA if they have no history of fever and a decreased peripheral WBC count. Compared with TS, patients with LA are more likely to have an elevated ESR. This study adds to existing knowledge because there are few investigations examining isolated LA of the hip. LEVEL OF EVIDENCE: Level III-retrospective case-control study.

Salvaging a Failed Proximal Interphalangeal Joint Implant.

Salvaging a failed proximal interphalangeal (PIP) joint implant arthroplasty remains a considerable technical and rehabilitation challenge. Experienced arthroplasty surgeons have reported 70% survival of revision PIP implants at 10 years with 25% of patients requiring subsequent revision surgery. At this time, there is no consensus surgical approach or implant proven superior for revision implant arthroplasty of the PIP joint. Secondary arthrodesis or amputation may be required to salvage the failed PIP implant arthroplasty with compromised bone stock or soft tissue envelopes that are inadequate for implant arthroplasty.

Ceramic-Ceramic Hip Arthroplasty for Osteonecrosis: Average 5-year Follow-up in Patients Less Than 50 Years of Age.

INTRODUCTION: The optimal bearing surface for the young, active patient undergoing total hip arthroplasty (THA) is unknown. We sought to examine the clinical results of ceramic-on-ceramic (CoC) THA in patients under 50 years of age with a diagnosis of osteonecrosis. MATERIALS AND METHODS: Fifty-three hips underwent cementless THA with a CoC articulation. Clinical and functional outcomes, including preoperative and postoperative WOMAC and UCLA scores, were recorded. Serial radiographs were studied for component loosening or evidence of osteolysis. Revision surgery for any reason was the primary clinical endpoint. RESULTS: The average age at time of THA was 31.03 years (range: 15 to 50 years). Average follow-up was 64 months (range: 24 to 112 months). Average preoperative BMI was 25.3 (range: 20.1 to 39.4). WOMAC scores increased from a preoperative average of 37.1 (range: 3.9 to 70.2) to 89 (range: 11.7 to 100) at latest follow-up (p less than 0.05). UCLA scores improved from a preoperative average of 2.39 (range: 1 to 4) to 6.72 (range: 1 to 10) postoperatively (p less than 0.05). Forty-five percent of patients were highly active with UCLA scores between 8 and 10. There were no dislocations, deep infections, or ceramic component failures. One patient was revised for chronic pain at another institution, and one patient underwent revision for femoral component loosening. Three patients experienced squeaking, which did not affect quality of life. CONCLUSION: At mid-term follow-up, THA with CoC bearings affords high activity level with excellent clinical outcomes and component longevity in young, active patients with osteonecrosis.