Functional and radiographic analysis of a cohort of 48 Tactys® prostheses with an average follow-up of 5 years: A retrospective study.

OBJECTIVES: The Tactys® prosthesis is an anatomical unconstrained sliding implant with 4 modular components, designed for proximal interphalangeal arthroplasty. The main objective of our study was to evaluate medium-term functional outcomes at a minimum follow-up of 1 year. MATERIALS AND METHODS: Forty-eight implants were studied, with a mean follow-up of 4.8 years. The study retrospectively analyzed functional, clinical and radiological results. Complications and re-interventions were also analyzed. RESULTS: Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) and Patient-Rated Wrist Evaluation (PRWE) scores improved from 40.9 to 17.7 and from 47. 1 to 11 .2, respectively (p < 0.001) at last follow-up. Seventy-seven percent of patients rated their results as good or very good, and 83% were willing to undergo the procedure again. Pain on VAS improved significantly from 7.9 to 0.8/10 (p < 0.001). There was no significant difference in range of motion (53° vs 48°), grip strength (14.9 kgF vs 14.6 kgF), or pinch strength (3.4 kgF vs 3.4 kgF). There were no cases of fracture or loosening of implants. Periarticular ossification without functional impairment was observed in 31 patients. Axial deviation was generally corrected. Three surgical re-interventions were required, including 2 implant revisions using a silicone spacer. Five-year implant survival was 94%. CONCLUSION: The Tactys® prosthesis was a reliable and effective option for the management of proximal interphalangeal osteoarthritis. Patient satisfaction was generally good, with improvement in pain and function; however, longer-term follow-up is needed.

Quantification of acromioplasty. Systematic review of the literature.

INTRODUCTION: Acromioplasty is controversial. Technically, it consists in bone resection, but there is no gold-standard technique and resection is often not quantified. The aims of the present study were 1/to assess the methodological quality of studies of acromioplasty; 2/to identify reports in which acromioplasty was quantified; and 3/to assess any correlation between clinical results and resection quantity. MATERIAL AND METHODS: A systematic literature review was performed on PRISMA criteria in the PubMed, Springer and Ovid databases, including all articles in French or English referring to acromioplasty. Articles were analyzed by 2 surgeons and those with complete procedural description were selected. 1/Methodology was assessed on 3 grades according to aim of acromioplasty, intraoperative assessment of resection, and postoperative radiologic assessment. 2/Results were extracted from articles with robust methodology and quantitative data. 3/Correlations were assessed between clinical results and resection quantity. RESULTS: Out of the 250 articles retrieved, 94 were selected. 1/44 of these (47%) specified the aim of the acromioplasty, 53 (56%) included an intraoperative clinical assessment criterion, and 13 (14%) included postoperative radiographic assessment. Methodologic quality was insufficient in 33 articles (35%), poor in 23 (24%) and robust in 38 (40%). 2/Seven articles (7.5%) included quantitative results. 3/Three articles assessed correlation between clinical results and resection quantity, but only 1 used reproducible radiographic assessment by critical shoulder angle (CSA); this study reported a significant positive correlation between clinical results and decreased CSA. CONCLUSION: Methodology in studies of acromioplasty was largely insufficient and resection was usually not quantified. Current data to assess the usefulness of the procedure are sparse. We advocate including a Checklist for Acromioplasty Studies in the methodology of future studies. There is at present no gold-standard for assessing and quantifying acromial resection. CSA seems contributive, but other methods might be worth developing. LEVEL OF EVIDENCE: IV; systematic review of level 1-4 studies.

Learning and optimizing arthroscopic knot-tying by surgery residents using procedural simulation.

INTRODUCTION: Procedural training of orthopedic surgery residents includes learning arthroscopic knot-tying. The models used comprise arthroscopy training modules of increasing complexity, although there is no procedural training guide for the acquisition of arthroscopic knot-tying skills. Few studies have focused on how residents learn arthroscopic knot-tying. The aim of our study was to determine the type of arthroscopic knot that is the easiest to perform and learn and that can be done the most successfully by orthopedic surgery residents. MATERIALS AND METHODS: Each participant had to learn five knots in a random order: Tennessee slider, Duncan loop, Revo knot (Surgeon's knot), Nicky knot, and the SMC (Samsung Medical Center) knot. The FAST Arthroscopy Workstation™ (Sawbones, Vashon Island, WA) was used for this study. Each participant could use a FAST Knot Tester™ (Sawbones®, Vashon Island, WA) to evaluate by themselves the biomechanical properties of the knots to optimize learning. Each participant had to rank how easy it was to learn this knot on a visual scale from 0 to 10. They also had to rank the reliability of the knots done on a visual scale from 0 to 10. Then, an independent rater assessed whether the knots were completed successfully; a knot was considered successful if it stretched by less than 3 mm when 60 N of load was applied. RESULTS: Ten participants were included in the study; 250 knots were done and evaluated. When ranked from simplest to most complicated, the easiest knot to learn was the Surgeon's knot, followed by the Duncan loop, Tennessee slider, Nicky knot and SMC knot (p<0.0001). The overall success rate for the knots was 80%. There was a statistical trend for the Nicky being done better than the other arthroscopic knots (88% success rate). CONCLUSION: For orthopedics surgery residents, the surgeon's knot (Revo knot) was the easiest to learn, while the Nicky knot had the highest success rate. LEVEL OF EVIDENCE: II; prospective, randomized study with low power.

Revision of failed trapeziometacarpal prothesis by CMI pyrocarbon implant: Retrospective study of 28 patients with a mean follow-up of 7.5 years.

INTRODUCTION: There is no consensus on the best salvage option after a failed trapeziometacarpal prothesis. Conserving the trapezium and inserting a pyrocarbon hemiarthroplasty implant will prevent thumb shortening and preserve the thumb's motion. The aim of this study was to evaluate the clinical and radiological outcomes in the medium term of trapeziometacarpal prothesis revisions done using the CMI pyrocarbon implant. PATIENTS AND METHODS: This was a retrospective study of 28 patients with a mean age of 63.5 years. The mean time to revision was 6.1 years after the initial arthroplasty. The dominant side was operated in 70% of patients. The surgery consisted of removing the existing prosthesis, reconstructing the trapezium with a bone graft, and inserting the CMI pyrocarbon implant. The review consisted of a functional assessment (visual analog scale for pain, QuickDASH score, patient satisfaction), physical assessment (Kapandji, grip strength, key pinch strength, tip pinch strength) and radiological assessment (complications, radiolucent lines, scaphometacarpal height, implant centering, bone remodeling). RESULTS: At a mean follow-up of 7.5 years, no further surgical revisions were needed. The mean QuickDASH score was 1.1 and the mean QuickDASH was 13%. Twenty-five patients (89%) were satisfied with the outcome. The Kapandji score improved significantly from 7.5 to 9.5 on average. Grip strength improved significantly from 16.7kg to 21.5kg on average. The mean postoperative key pinch strength was 93% of the contralateral side. The mean postoperative tip pinch strength was 88% of the contralateral side. There were no fractures or dislocations visible on the radiographs. However, there was bone remodeling in the trapezium related to the pyrocarbon implant's indentation that was well tolerated by patients in the medium term. CONCLUSION: For revision of failed trapeziometacarpal prothesis, inserting the CMI pyrocarbon implant combined with trapezium reconstruction appears to be a good alternative to the more commonly used trapeziectomy procedure. Reconstructing the trapezium and inserting this hemiarthroplasty implant preserves the thumb's projection, length, and stability. The functional improvement experienced by patients makes this a relevant treatment option. LEVEL OF EVIDENCE: IV; retrospective study without control group.