Long-term clinical outcome of collagenase clostridium histolyticum treatment is independent of Dupuytren Diathesis Score.

Collagenase clostridium histolyticum (CCH) is a pharmaceutical, non-surgical treatment option for Dupuytren Disease. However, recurrence is common, and predictors of treatment outcome of CCH treatment are largely unknown. In this retrospective study, we analysed the possible correlation between Abe's Dupuytren Diathesis Score (DDS) and recurrence after treatment with CCH. In a total of 74 patients, with an average follow-up of 5 years, we found an overall recurrence rate of 67% after 5y but no correlation with DDS. Sub-scale analysis indicated that the presence of knuckle pads was associated with a reduced recurrence risk. Patient satisfaction after CCH was high. Deriving from our data, there is no correlation between DDS and recurrence following CCH treatment. Therefore, at this moment, we do not advocate the use of the DDS when informing patients about recurrence rates after CCH treatment. Level of evidence: IV: therapeutic cohort study.

Salvage revision arthroplasty after failed TMC joint prosthesis.

The purpose of this retrospective study was to describe our experience with failed TMC joint prostheses and to report the results of 7 cases that were treated by a salvage revision arthroplasty. We only performed this salvage arthroplasty when partial (cup replacement) or total replacement of TMC prosthesis was not possible. We performed a resection arthroplasty with (partial) trapezial excision and spacer insertion to prevent scaphometacarpal collaps. We used the proximal part of the Ascencion® MCP implant (Integra) as spacer. Among our 7 patients, 3 were satisfied with a VAS satisfaction of 8 or more. Four patients had pain levels less than or equal to 3. Our mean DASH score was 32.7. Our patients had good opposition and retropulsion scores and the mean TMC joint flexion and abduction values were both 40°. But tip and key pinch ipsilateral was insufficient (mean tip pinch of 2kg and key pinch of 1kg). We believe that the salvage revision arthroplasty with (partial) trapezial excision and spacer insertion is a valuable treatment option for failed TMC joint replacement. But further research needs to compare all the different revision options after TMC joint replacement in a multicenter randomized controlled trial.

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.

A surgical algorithm for the treatment of recurrent patellar dislocation. Results at 5 year follow-up.

Several options exist for the treatment of recurrent patellar dislocation. In our institution a specific treatment algorithm for patellofemoral maltracking, depending on skeletal maturity and the recognition of local risk factors has been in use for several years. The aim of our study was to evaluate the overall results of using this algorithm and to compare the outcome of the different subgroups. A total of 110 patients were studied with an average follow-up of 53 years. The patients were classified into 6 groups depending on the surgical treatment they had received. Eighty-seven percent of patients remained free of dislocation at final follow-up, and 66% of patients no longer experienced any patellar instability or subluxation. There was no statistically significant difference between skeletally mature and immature patients in the incidence of redislocation or recurrent instability, nor in functional or clinical outcome scores. Skeletally immature patients who underwent isolated medial retinacular imbrication experienced the highest redislocation rate (29%), whereas skeletally mature patients who were treated with combined proximal and distal realignment procedures demonstrated the lowest redislocation rate (6%). Skeletally mature patients with combined proximal and distal procedures reached lower clinical and functional outcome scores. Based upon the results from this study we believe that our surgical algorithm can serve as a model for the treatment of recurrent patellofemoral dislocation.