Joint Survival Analysis and Clinical Outcome of Total Joint Arthroplasties With the ARPE Implant in the Treatment of Trapeziometacarpal Osteoarthritis With a Minimal Follow-Up of 5 Years.

PURPOSE: The ARPE joint arthroplasty was introduced in 1991 for the treatment of symptomatic trapeziometacarpal (TMC) osteoarthritis. The primary outcome of this prospective study is to report the medium- to long-term joint survival of this prosthesis. Our secondary outcomes are the clinical and functional results. METHODS: A prospective, consecutive case series study was done at our hand unit. Patients included in the study had at least 5 years follow-up after a total joint arthroplasty for osteoarthritis of the TMC joint using the ARPE implant. The Kaplan-Meier method was used to estimate implant survival over time. Clinical and radiological assessment was recorded prospectively: before surgery and at 1 year and 5 years or more after surgery. We compared the means of the Kapandji index (assessing the thumb range of motion and opposition), the grip strength, and the pinch strength before surgery and at the latest follow-up. RESULTS: We included all 166 prostheses in the survival analysis with a mean follow-up of 80 months. Five prostheses (3%) required revision surgery and 1 implant (0.6%) failed. Therefore, Kaplan-Meier survival probability was 96% with a mean follow-up of 80 months (95% confidence interval, 91-98). A total of 120 arthroplasties from 115 patients were included in the clinical analysis. At 5 years' follow-up, the median Disabilities of the Arm, Shoulder, and Hand (DASH) score was 4.6 (range, 0-86.6). There was a significant improvement of the mean opposition and grip strength of the affected thumb at final follow-up in comparison with the preoperative values. There was also a significant improvement in the mean pinch strength at 1 year and 5 years after surgery compared with preoperative measurements. CONCLUSIONS: In our series, the ARPE prosthesis of the thumb TMC joint has proven to be a reliable and effective implant. Mean motion and strength increased whereas pain decreased after surgery and these results remained constant within the follow-up period. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Extensor tendon and fascia sectioning of extensors at the musculotendinous unit in lateral epicondylitis.

Different surgical techniques exist to treat lateral epicondylitis. In most techniques, release of the common extensor origin is performed adjacent to the humeral epicondyle. The purpose of the present study was to assess the outcome of transverse sectioning of the intermuscular septum and the aponeuroses of the extensor carpi radialis brevis and extensor digitorum communis, 3 to 5 cm distally to the radial epicondyle. Forty-nine elbows were operated on in 44 patients. Subjective results were obtained after a mean followup of 33 months. Mean age of patients was 44 years. Mean disabilities of arm, shoulder and hand score was 6, mean visual analogue scale score for pain was 1 and for satisfaction 9. The result was excellent in 26, good in 15 and poor in 8 elbows following Spencer and Herndon. Mean absence from work was 40 days. We conclude that tendon release in the musculotendinous unit can be used to treat lateral epicondylitis.

Diagnostic performance of combined specific urinary proteins and urinary flow cytometry in urinary tract pathology.

BACKGROUND: Urinalysis comprises three techniques: urinary flow cytometry, test strip analysis and determination of specific urinary proteins. We investigated the diagnostic possibilities of combining these methods for a cohort of patients with a variety of well-documented urological and nephrological pathology. METHODS: Urinary samples from 407 in- and out-patients with nephrological or urological pathology were retrospectively included in our study. Test strip analysis (URISYS 2400), urinary flow cytometry (UF-100) and urinary protein analysis [albumin, total protein, alpha1-microglobulin (A1M), alpha2-macroglobulin (A2M)] were performed. RESULTS: In discriminating upper and lower urinary tract infections, A1M and A1M/log(white blood cells) can be used, whereas pathological casts only give poor discrimination. The ratio A2M/log(red blood cells; RBC) allows differentiation between cystitis and pyelonephritis, while glomerular diseases can be recognised by the log(RBCxurinary total protein). Combining A2M and urinary albumin allows the determination of acute prostatitis. CONCLUSIONS: Using combined parameters provided by various urinalysis techniques, ratios can be proposed with diagnostic value for classifying renal and urological conditions. Possible integration in computer-based knowledge systems may offer valuable information for clinicians dealing with these pathologies.