Outcome of the Cementless Zweymüller BICON-PLUS Cup and SL-PLUS Stem in the Very Elderly Individuals.

INTRODUCTION: There is current debate about which type of total hip prosthesis implants are best for the elderly patient. Implanting uncemented total hip arthroplasty (THA) in elderly people remains contested. The aim of present study was to evaluate the outcome of the uncemented Zweymüller BICON-PLUS THA in those with a minimum of 80 years of age. MATERIALS AND METHODS: A retrospective data collection was performed in a regional teaching hospital in the Netherlands. The primary outcome of interest was the operation-free period. Secondary outcomes included the revision rates of the femoral and acetabular components and postoperative complications of the procedure. After a follow-up of at least 7 years, the surviving patients were reviewed on functionality using validated scores (Hip Disability and Osteoarthritis Outcome Score, Timed Up and Go, and Harris Hip Score) and radiographic analysis. RESULTS: Between January 1999 and September 2004, 124 patients (128 THAs), aged 80 years and older, received an uncemented THA with a BICON-PLUS cup and SL-PLUS stem. The overall operation-free period was 6.5 years. One case of loosening of the cup was found among participants, with a survival rate of 99.2% of the BICON-PLUS cup in the analyzed group. In all, 28.8% of this group could be followed for a postoperative period of at least 7 years. The remainder of the patients died prior to the end of the 7-year period. Of these, 16.0% were eligible for clinical review. This group showed good function without evident signs of prosthetic loosening. CONCLUSION: The uncemented Zweymüller THA system, with threaded BICON-PLUS cup and SL-PLUS stem, showed good results, compared to outcome of other THA systems in elderly individuals. Therefore, it is a reliable option in older patients requiring THA.

Is it too early to move to full electronic PROM data collection?: A randomized controlled trial comparing PROM's after hallux valgus captured by e-mail, traditional mail and telephone.

BACKGROUND: Patient reported outcome measures (PROM's) after hallux valgus surgery are used to rate the effectiveness as perceived by the patient. The interpretability of these PROM's is highly dependent on participation rate. Data capture method may be an important factor contributing to the response rate. We investigated the effect on response rate of traditional paper mail, telephone and e-mail PROM's after hallux valgus surgery. METHODS: All consecutive patients operated between January and September 2013, were identified. Included patients were randomized by envelope in three groups: traditional pen and paper mail, e-mail and telephone. They were asked to fill in a FFI and EQ-5D. Two weeks later non-responders were sent a reminder. RESULTS: Of the 73 included patients, 25 were approached by mail, 24 by e-mail and 24 patients by telephone. The response rate on traditional mail was highest (88%), while response on e-mail was lowest (33%). Response rate on telephone was also high (79%). Response rate on traditional mail and telephone was significantly higher (p<0.001) than response on e-mail. CONCLUSIONS: Though electronic data collection has enormous potential, this study shows that e-mail yields unacceptable low response rates. It is too early to replace traditional pen-and-paper PROM's by electronic questionnaires.

Patient-reported outcome measures in hallux valgus surgery. A review of literature.

BACKGROUND: Up to a third of patients may be dissatisfied with the outcome of hallux valgus surgery. This stresses the importance of uniform and relevant outcome measures. The purpose of the current systematic review is to identify and rate available patient-reported outcome measures (PROMs) in hallux valgus surgery. METHODS: We performed a systematic literature search for outcome measures directed at hallux valgus. We searched electronic databases for relevant content according to the PRISMA standard. Eligible articles were used to give an overview of available PROMs, with qualitative evaluation of their properties. RESULTS: Twenty-eight eligible studies were included. Most adapted general health assessment tools, in studies on hallux valgus surgery, were the EQ5D and the SF-36 score. The visual analogue scale (VAS) was most cited as pain score. Three disease-specific outcome scores were identified: the Manchester-Oxford foot questionnaire (MOXFQ), the foot and ankle outcome score (FAOS) and the self-reported foot and ankle score (SEFAS). The MOXFQ showed the best psychometric properties. CONCLUSIONS: The MOXFQ scores best on positively rated qualities based on our criteria. The SEFAS may be a good alternative, however it contains less items which are regarded as important by patients with foot/ankle complaints. A relative drawback of the MOXFQ consists of the copyright licence. The VAS is the best pain score and the SF36 the best general health assessment tool. Availability in native languages and future research should lead to uniformity in application of these tools.

Rheumatoid forefoot deformity: pathophysiology, evaluation and operative treatment options.

Despite recent advances in pharmacological management of rheumatoid arthritis, forefoot deformity, with its symptoms, remains a common problem, often requiring operative treatment. Typical deformities in these patients comprise hallux valgus and deformity of the lesser metatarsophalangeal (MTP) joints and toes. With regard to the lesser rays the standard operative procedure, advocated for the disabling forefoot pain in these patients, remains metatarsal head resection. It should be considered that with increasing success of pharmacological treatment the degree of forefoot deformity in these patients is becoming less and that resection of the lesser MTP joints is becoming more and more superfluous. This supports a trend towards metatarsal head-preserving surgery. The optimal treatment of the hallux deformity remains unclear. Fusion of the first MTP joint is, generally, recommended. This article will discuss the current surgical options in rheumatoid forefoot pathology.

Definitions of hammer toe and claw toe: an evaluation of the literature.

BACKGROUND: Lesser toe surgery is among the most conducted interventions in general orthopedic practice. However, the definitions of hammer toe and claw toe are not uniform. The objective of this literature study is to propose clear definitions for these deformities to establish unambiguous communication. METHODS: A literature search was performed in the PubMed database (May 2006). Of 81 eligible articles, 42 that stated a clear definition of hammer toe or claw toe were selected. RESULTS: In all 35 articles in which hammer toe was clearly defined, flexion in the proximal interphalangeal joint was part of the definition. Seventeen articles (49%) defined hammer toe as a combination of metatarsophalangeal extension and proximal interphalangeal flexion. Thirteen articles showed flexion of the proximal interphalangeal joint as the single criterion. Twenty-three articles with a clear definition of claw toe were selected. Twenty-one articles (91%) showed metatarsophalangeal extension as part of the claw toe deformity. Twelve articles (52%) regarded metatarsophalangeal extension and flexion of the proximal interphalangeal and distal interphalangeal joints as the essential characteristics. Seven articles described a claw toe as metatarsophalangeal extension with flexion in the proximal interphalangeal joint. CONCLUSIONS: There are variations in the definitions of lesser toe deformities in the literature. We propose that extension of the metatarsophalangeal joint is the discriminating factor and essential characteristic for claw toe. Claw toe and hammer toe should be characterized by flexion in the proximal interphalangeal joint, which is the single criterion for a hammer toe. The flexibility of these joints could be a basic factor in discriminating between these deformities. The development of these deformities should be regarded as a continuum in the same pathophysiologic process.

Opinions on lesser toe deformities among Dutch orthopaedic departments.

BACKGROUND: Wide variations in definitions of lesser toe deformities exist. In addition, a general consensus regarding treatment of lesser toe deformities is lacking. The objective of this study was to evaluate of the definitions, current concepts, and treatment protocols for lesser toe deformities among orthopaedic departments in The Netherlands. METHODS: A questionnaire with statements regarding lesser toe deformities was sent to all 101 Dutch departments of orthopaedic surgery. RESULTS: In total 76 (75%) completed forms were analyzed. A wide variation regarding definitions, concepts, and treatment strategies of lesser toe deformities was reported among the Dutch orthopaedic departments. Only half of all responding departments had a protocol or consensus in the treatment. CONCLUSIONS: The definitions of lesser toe deformities used in Dutch orthopaedic departments do not coincide. This might explain the variations in indications and the various performed interventions for different deformities. The differences of opinion among the Dutch orthopaedic departments may have important clinical consequences because an indication for surgery depends on the correct diagnosis. To correctly interpret and improve treatment results, a consensus on this topic should be introduced.