Proximal Interphalangeal Joint Arthroplasty Using the Wide-Awake Local Anesthesia No Tourniquet Technique

Sharma, Sidharth; Ong, Jason J.; Putti, Amit

doi:10.1177/15589447211063545

Cited by 5 publications

(3 citation statements)

References 20 publications

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“…Эндопротезирование проксимального межфалангового сустава остается нерешенной биомеханической проблемой, несмотря на достижения в области материалов и новых конструкций имплантатов [21,22]. Целями этой операции являются уменьшение болевого синдрома, увеличение объема движений, восстановление биологической оси пальцев кисти и улучшение их функции [23,24].…”

Section: Discussionunclassified

The long-term results of proximal interphalangeal joint arthroplasty of the hand

Fedotov,

Kovalev,

Rybakov

2024

jour

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Introduction Small joints replacement is a valid treatment for deforming osteoarthritis and traumatic injuries to the phalangeal joints of the hand to restore motor hand functions. Various types of implants differing in shape, biomechanics and material composition have been developed.The purpose of the study was to evaluate long-term results of the proximal interphalangeal joint arthroplasty of the hand using various implants and identify their advantages.Material and methods We retrospectively reviewed 78 cases of proximal interphalangeal joint replacement in 64 patients. Outcomes were assessed at 6 months and at follow-up stages with preoperative and postoperative measurements of the range of motion in the joint evaluating pain, radiographs and outcomes measures using the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire.Results The range of motion in the prosthetic joint increased significantly at different follow-up periods with all types of implants. The pain syndrome decreased. Radiographs revealed 10 cases of aseptic instability in the group of constrained prostheses. The DASH assessment showed high subjective satisfaction with the treatment.Discussion We could not find papers reporting PIP joint arthroplasty using SBI D.G.T. implant system. A retrospective study of RM Finger arthroplasty of the PIP joint indicated restored joint stability with AROM improvement and with low pain, although it had a high rate of complications. We recorded no complications with this implant model. Some authors would not recommend the RM Finger implant (Mathys) for PIP joint replacement. Arthroplasty of small joints of the hand with MOJE kermik-implantate showed satisfactory outcomes for 82 % of patients at a long term.Conclusion Arthroplasty of the PIP joint of the hand using various implant designs resulted in greater mobility of the upper limbs, a lower pain due to subjective improvement in the functionality at a long term. Although the procedures were effective with all implant designs the reliability of changes in the parameters was more evident with nonconstrained implants.

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Section: Discussionunclassified

The long-term results of proximal interphalangeal joint arthroplasty of the hand

Fedotov,

Kovalev,

Rybakov

2024

jour

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“…WALANT may help with intraoperative release of adduction contracture or the stabilization of metacarpophalangeal instability if a swan-neck deformity persists during surgery (67). Reconstruction of interphalangeal joints with WALANT can provide active testing of the implants (68).…”

Section: Joint Reconstructionmentioning

confidence: 99%

WALANT surgery of the hand: state of the art

Degreef,

Lalonde

2024

EFORT Open Reviews

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Wide-awake local anesthesia no tourniquet is named the WALANT technique. WALANT has had a major positive impact on cost, convenience, ecology, patient satisfaction, access to surgical care, and outcomes in hand surgery in the last 20 years. Safe and efficient application of the technique is based on two principles. The first principle is the tumescent injection of a large volume low concentration 0.25–1% lidocaine, with 1:100 000–1:400 000 epinephrine. The second principle of WALANT is that the proper injection should be almost painless, with the patient only feeling the first needle poke of a tiny 30G needle. This wide awake patient approach reduces pain, neuropraxia, and systemic side effects of sedation with preservation of motor control, thereby aiding balanced reconstruction in hand surgery.

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“…Protocols for the use of wide-awake local anaesthesia no tourniquet (WALANT) in upper limb surgery have expanded and gained ground in recent years. Initially described by Lalonde as an anesthetic alternative for repairing flexor tendon injuries of the fingers, nowadays it is used for procedures of increasing complexity in the upper limb [1][2][3][4][5][6][7].…”

Section: Introductionmentioning

confidence: 99%

Wide-Awake Local Anesthesia No Tourniquet for Rhizarthrosis Surgery: Technique and Experience for 16 Consecutive Cases

Castelo,

Santos,

Costa

et al. 2023

Cureus

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Since it was described, wide-awake local anaesthesia no tourniquet (WALANT) has gained popularity. Our department has started using WALANT for hand surgery with increasing complexity. We present our results with WALANT rhizarthrosis surgery, including prosthetic replacement, trapeziectomy with suture button suspensionplasty and revision surgery. A retrospective review of all rhizarthrosis procedures under WALANT was performed from April 2021 to July 2022. We included patients who fulfilled inclusion criteria and had adequate imaging and clinical follow-up. A satisfaction survey was performed by telephone. Surgical time, complications, conversion to conventional anesthesia, pain, anxiety and global satisfaction were recorded. Tumescent anesthesia is performed 20-25 minutes before surgery, and is performed in four or five strategic locations that allow adequate anesthesia and vasoconstriction for the procedure to be comfortably carried out. We observed a series of 16 sequential surgeries involving 14 patients. All were female with a mean age of 65 years. Fourteen cases were performed due to primary rhizarthrosis, eight trapeziectomies with suture button suspensionplasty, six prosthetic replacements, and two revision surgeries. One patient needed to be converted to conventional anaesthesia due to anxiety during the procedure. Mean procedure time was 73 minutes. There were no WALANT-related complications. Mean patient-reported satisfaction with the anesthetic technique was a 9 (on a scale from 1 to 10) and 100% of patients would choose to undergo surgery with WALANT anesthesia for a future procedure. We find it useful to actively engage the patients during surgery to keep them comfortable and also help the surgeons assess stability and functional results. After wound closure, the hand is shown to the patient and he performs various tasks. There is somewhat of a learning curve for rhizarthrosis surgery under WALANT; patient comfort can be achieved through an adequate anesthetic technique and reassurance before and during surgery. We recommend that the first few cases be done in the presence of an anesthesiologist and a fasting patient in case there is a need to convert to conventional anesthesia. Wide awake rhizarthrosis surgery, even revision surgery, is safe and pain-free. Patient-reported satisfaction is also high. The authors find that including patient participation in their own surgery might be promising for post-op rehabilitation. There are limitations in this study such as the absence of a control conventional anesthesia group, the satisfaction questionnaire was not done immediately post-operatively, as such, a memory bias cannot be excluded, and it is not yet validated for the Portuguese population.

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Proximal Interphalangeal Joint Arthroplasty Using the Wide-Awake Local Anesthesia No Tourniquet Technique

Cited by 5 publications

References 20 publications

The long-term results of proximal interphalangeal joint arthroplasty of the hand

The long-term results of proximal interphalangeal joint arthroplasty of the hand

WALANT surgery of the hand: state of the art

Wide-Awake Local Anesthesia No Tourniquet for Rhizarthrosis Surgery: Technique and Experience for 16 Consecutive Cases

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