We present a prospective follow-up of 39 Elektra prostheses in 37 patients (32 women and five men), with a mean age of 56.5 (range 46-71) years; 34 patients had osteoarthritis and three had rheumatoid arthritis. Patients were followed using clinical examination, including measurement of pain on a visual analogue scale, mobility, and strength, after 6, 12, 26, and 52 weeks, and annually thereafter. Radiological examination was done preoperatively and after 6, 26, and 52 weeks, and annually thereafter. The mean follow-up time was 48 (range 3-91) months. Although we observed a fast recovery, including maintenance of mobility and a gradual increase in grip strength, there was a revision rate of 7/38 (24%) after 36 months, increasing to 17/38 (44%) after 72 months. The main reason for revision was loosening of the trapezial component, and biomechanical properties of the trapezial fixation may be the key problem in treating trapeziometacarpal osteoarthritis using a total prosthesis.
Purpose Minimally invasive techniques have been recommended in the treatment of painful but stable scaphoid nonunions. The purpose of this study was to determine if arthroscopically assisted bone grafting provided superior results in healing as compared to percutaneous screw fixation. Materials and Methods One hundred sixty-four consecutive patients with scaphoid nonunions were retrospectively analyzed. One hundred forty-eight patients were treated with the open grafting techniques either with iliac or distal radius bone, leaving 16 patients treated with minimally invasive surgery. In the group treated percutaneously (n = 8), the time from injury to surgery was 2.5 months (range: 2–4 months) and it was 27.3 months (range: 3–180 months) in the arthroscopic group (n = 8). The mean age was 39 years (range: 20–66) in the percutaneous group and 22 years (range: 16–32) in the arthroscopic group. In all cases, the Mini Acutrak headless fully threaded compression screw was used. Healing was assessed clinically and radiographically at a minimum follow-up of 12 weeks, mean 7 months (range: 3–12 months). Data were calculated with two-tailed Mann–Whitney U test based on p-value of < 0.05 that was considered statistically significant. Results We recorded no complications in any of the groups. Patients treated arthroscopically received cancellous bone grafting from the distal radius and all patients but one healed at a median of 7.8 weeks (range: 5–18 weeks). Seven patients in the percutaneous group healed at a mean of 10.5 weeks (range: 7–24 weeks), thus leaving one patient from each group without achieving union. Mann–Whitney U test showed the U value of 11, the critical value of U to be 13 (p < 0.05), thus significantly faster healing was observed in the arthroscopically treated group. Conclusions Arthroscopically treated patients achieved faster healing despite shorter time to surgery in the percutaneous group. Local bone grafting is considered as the main reason for this outcome. Younger population in the arthroscopically treated group may have influenced the result. Level of Evidence This is a Level III comparative study.
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