Various systematic reviews have recently shown that intra-articular platelet-rich plasma (IA-PRP) can lead to symptomatic relief of knee osteoarthritis for up to 12 months. There exist limited data on its use in small joints, such as the trapeziometacarpal joint (TMJ) or carpometacarpal joint (CMCJ) of the thumb. A prospective, randomized, blind, controlled, clinical trial of 33 patients with clinical and radiographic osteoarthritis of the TMJ (grades: I-III according to the Eaton and Littler classification) was conducted. Group A patients (16 patients) received 2 ultrasound-guided IA-PRP injections, while group B patients (17 patients) received 2 ultrasound-guided intra-articular methylprednisolone and lidocaine injections at a 2-week interval. Patients were evaluated prior to and at 3 and 12 months after the second injection using the visual analogue scale (VAS) 100/100, shortened Disabilities of the Arm, Shoulder, and Hand Questionnaire (Q-DASH), and patient’s subjective satisfaction. No significant differences between the baseline clinical and demographic characteristics of the 2 groups were identified. After 12 months’ follow-up, the IA-PRP treatment has yielded significantly better results in comparison with the corticosteroids, in terms of VAS score ( P = 0.015), Q-DASH score ( P = 0.025), and patients’ satisfaction ( P = 0.002). Corticosteroids offer short-term relief of symptoms, but IA-PRP might achieve a lasting effect of up to 12 months in the treatment of early to moderate symptomatic TMJ arthritis.

Background: Analysis of hospital mortality helps to assess the standards of health-care delivery.

Objective: The number of hip and knee replacement performed is rising, causing increased pressure for the timely management of these patients. A dry incision is considered a prerequisite for discharge. This is a retrospective cohort study comparing two treatments for skin closure during elective hip and knee arthroplasty. Methods: A barbed monofilament absorbable 3.0 subcuticular suture (Quill), with the additional surface application of n-butyl-2-cyanoacrylate glue, was used for the study group and metal clips or a smooth monofilament absorbable 3.0 subcuticular suture (Monocryl) for the control group. Each group comprised 46 hip and 27 knee replacement patients and data on predisposing risk factors for prolonged wound exudate were collected. We have calculated the proportion of patients who have exceeded their expected length of stay due to a wound exudate, the additional days required for the wound to dry and the derived cost. Results: No significant differences were identified with regards to risk factors. The study group demonstrated a significantly lower incidence of exudating wounds of excessive duration (1% versus 14%, p=0.005, relative risk: 10; 95% confidence interval: 1.31–76.13). The combined additional stay was 22 days more for the control group, producing an average financial benefit of £80 per patient for the study group. There were seven knee replacement and two hip replacement patients treated with a nozzled glue applicator who presented with delayed (> 2 weeks) wound healing issues. Conclusion: Barbed subcuticular suture with surface glue application is a viable option for skin closure after elective lower limb joint arthroplasty and can reduce the incidence of prolonged wound discharge. A brushed glue applicator should be preferred over the nozzled one.

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Background: Plantar fasciitis is a common cause of musculoskeletal discomfort. Minimally invasive interventions are preferred as second-line treatments following failure of conservative management. We report on a novel technique of ultrasound-guided percutaneous release of the medial third of the plantar fascia with the use of a fine cutting device for the treatment of persistent plantar fasciitis. Methods: This is a retrospective case series of all patients treated with the technique between 2013 and 2015. Patients had failed conservative management for a minimum of 6 months. The procedure was performed in an outpatient setting under local anesthesia. Under continuous ultrasound guidance, release of the medial third of the plantar fascia from the calcaneus was performed using an ophthalmic V-Lance knife through a medial stab wound entry point. Results: Fifteen patients (six men and nine women) with an average age of 54.7 years were included. The mean (standard deviation [SD]) visual analogue scale score for pain improved significantly, from 66.0 (SD, 18.8) preoperatively to each consecutive follow-up point: 29.3 (SD, 25.2) at 2 weeks, 30.0 (SD, 27.8) at 4 weeks, and 34.0 (SD, 26.1) at 12 weeks (P < .001). The mild increase in visual analogue scale score between 4 and 12 weeks was statistically significant (P = .018). Average duration of required analgesia was 5.5 days and average time required to return to usual activities was 5.7 days. Two patients suffered with refractory neuropathic pain over the lateral border of the foot without any obvious abnormality. Conclusions: Ultrasound-guided percutaneous release with the use of a fine cutting device could be an alternative option for the treatment of persistent plantar fasciitis. The technique is not without complications, and a mild but statistically significant decline in pain levels from early to short term has been detected. Therefore, the long-term outcomes of this technique need to be investigated before we can advocate its routine use.