Outcome Measures Following Metacarpophalangeal Joint Replacement

2000 ◽  
Vol 25 (6) ◽  
pp. 601-603 ◽  
Author(s):  
K. SYNNOTT ◽  
H. MULLETT ◽  
H. FAULL ◽  
E. P. KELLY
Keyword(s):  
Patient Satisfaction ◽  
Pain Relief ◽  
Outcome Measures ◽  
Joint Replacement ◽  
Hand Function ◽  
Metacarpophalangeal Joint ◽  
Assessment System ◽  
High Rate ◽  
Modest Improvement ◽  
Objective Outcome

We used the Jebsen–Taylor hand function assessment system to prospectively study the effect of metacarpophalangeal joint replacement on overall hand function in 29 hands. In addition pain relief, subjective improvement in hand function, appearance and overall patient satisfaction were assessed. There was modest improvement in the number of Jebsen–Taylor tasks performed (1.8 to 3.1), and pain relief was good or excellent in 18 of 24 patients. Eleven patients felt their hand function had improved by more than 50%, and the majority of patients (22 of 24) were very satisfied with the procedure. This study demonstrates that despite limited improvements in objective outcome measures, this procedure is reliable in producing a very high rate of patient satisfaction.

Low-profile plate fixation in arthrodesis of the first metacarpophalangeal joint

2011 ◽  
Vol 36 (6) ◽  
pp. 509-513 ◽  
Author(s):  
C. Rasmussen ◽  
S. Roos ◽  
M. Boeckstyns
Keyword(s):  
Patient Satisfaction ◽  
Plate Fixation ◽  
Metacarpophalangeal Joint ◽  
High Rate ◽  
Bone Union ◽  
Titanium Plate ◽  
Low Profile ◽  
Short Period ◽  
Primary Bone

Fifty-one consecutive arthrodeses (46 patients) of the first metacarpophalangeal joint were retrospectively reviewed, after fixation with a Leibinger low-profile titanium plate, using a cup-and-cone technique. Primary bone union was achieved in 98%. Three cases required removal of the plate and one case a tenolysis. Follow-up time was 13–92 months (mean 52). There was no correlation between patient satisfaction and position of fusion. We conclude that this technique gives a high rate of union, a short period of immobilization and rehabilitation, and a reliable position at the site of fusion.

BIOMECHANICS OF THE NORMAL AND DISEASED METACARPOPHALANGEAL JOINT: IMPLICATIONS ON THE DESIGN OF JOINT REPLACEMENT IMPLANTS

2007 ◽  
Vol 07 (02) ◽  
pp. 163-174 ◽  
Author(s):  
T. PYLIOS ◽  
DUNCAN E. T. SHEPHERD
Keyword(s):  
Range Of Motion ◽  
Grip Strength ◽  
Joint Replacement ◽  
Large Range ◽  
Hand Function ◽  
Metacarpophalangeal Joint ◽  
Careful Consideration ◽  
Hand Strength ◽  
Flexion Extension

The metacarpophalangeal (MCP) joint is crucial for hand function, but is frequently affected by arthritis, leading to pain and disability. This paper reviews the biomechanics of the normal and diseased joint in order to help consider the design of improved MCP joint replacement implants. The normal MCP joint enables a large range of motion in flexion/extension and abduction/adduction as well as a few degrees of rotation. A normal joint typically allows 90° flexion, with a grip strength of up to 672 N. The diseased joint has a reduced range of motion (typically 30° flexion) and reduced hand strength compared to the normal joint. Current MCP joint replacement implants generally try to recreate the range of motion of the normal joint; however, many designs are prone to fracture, as they are unable to withstand the conditions of the diseased joint. It may be beneficial for future implant designs to provide just a functional range of motion. Future designs of MCP joint replacement implants need to be more durable and last longer. Careful consideration of the diseased joint, rather than the normal joint, may help to better define the requirements for such implants.

Hand Function, Biomechanics and Disability

1980 ◽  
Vol 9 (4) ◽  
pp. 215-220
Author(s):  
W K Purves ◽  
N Berme ◽  
J P Paul
Keyword(s):  
Rheumatoid Arthritis ◽  
Functional Assessment ◽  
Joint Replacement ◽  
Index Finger ◽  
Hand Function ◽  
Three Dimensional ◽  
Normal Subjects ◽  
Metacarpophalangeal Joint ◽  
Biomechanical Analysis ◽  
Biomechanical Tests

A functional assessment and biomechanical analysis of certain joints of the fingers are presented. The functional assessment has been carried out on rheumatoid arthritis patients who were assessed pre- and post-surgically after metacarpophalangeal joint replacement. Twenty normal subjects have been assessed in the biomechanical tests as they carried out two activities, tap turning and jar closing. The load actions applied by the index finger were measured by a six component transducer and the three-dimensional coordinates of the joint centres were derived from external markers attached to the skin of the index finger. From this information the forces and components of moment to be transmitted at the proximal interphalangeal and metacarpophalangeal joints have been calculated.

Pain and Function: Occupational Therapists' Use of Orthotics in Rheumatoid Arthritis

2002 ◽  
Vol 65 (4) ◽  
pp. 165-171 ◽  
Author(s):  
Sarah Elizabeth Henderson ◽  
Ian R McMillan
Keyword(s):  
Rheumatoid Arthritis ◽  
Outcome Measures ◽  
Hand Function ◽  
Occupational Therapists ◽  
Postal Questionnaire ◽  
Easy Answer ◽  
Subjective Evidence ◽  
And Function ◽  
Intervening Variables ◽  
Objective Outcome

The use of orthotics in the management of rheumatoid arthritis appears to be relatively commonplace within occupational therapy departments. The aim of this study was to identify the frequency of orthotic use by occupational therapists, their beliefs about the efficacy of orthotic use, what they aimed to achieve by orthotic provision and any outcome measures used. The total membership of the British Association of Hand Therapists who were both occupational therapists and self-identified as working and/or having an interest in rheumatology (n = 132) were surveyed through a postal questionnaire. Of the responses received (n = 89, 67%), all the respondents (100%) were regular users of orthotics in the management of rheumatoid arthritis. The results showed that the most highly rated reasons for orthotic provision were to decrease hand and wrist pain and to improve hand function. Subjective comments from the respondents provided evidence of positive beliefs about the efficacy of orthotic use, despite a lack of objective outcome measures to support such comment. Given the complexity of the intervening variables that occur with orthotic use, perhaps there is no easy answer; however, with the expectation of evidence-based practice and intervention, it is suggested that an increased use of standardised outcome measures may provide additional strength in presenting, often subjective, evidence.

SHORT TO MEDIUM RESULTS USING THE REMOTION TOTAL WRIST REPLACEMENT FOR RHEUMATOID ARTHRITIS

Hand Surgery ◽  
2013 ◽  
Vol 18 (02) ◽  
pp. 175-178 ◽  
Author(s):  
A. S. C. Bidwai ◽  
F. Cashin ◽  
A. Richards ◽  
D. J. Brown
Keyword(s):  
Rheumatoid Arthritis ◽  
Pain Relief ◽  
Surgical Intervention ◽  
Case Series ◽  
High Rate ◽  
Wound Breakdown ◽  
Radial Forearm ◽  
Skin Coverage

We present the clinical outcome of patients who underwent RE-MOTION Total Wrist Replacement (TWR) for the treatment of Rheumatoid arthritis involving the wrist. Ten patients were available for follow-up, ranging from one to five years after index surgery. Two patients required surgical intervention for wound breakdown, including one patient who required a radial forearm flap for skin coverage. No patients required revision surgery or conversion to fusion. Patients who did not have complications gained statistically significant pain relief and improvement in mean overall flexion. In this small case series with short to medium results patients reported an improvement in terms of flexion and pain. Despite this, the question of efficacy of TWR compared to fusion in the long term remains unanswered due to the high rate of complications.

Evaluation of the Effect of Cannabidiol on Naturally Occurring Osteoarthritis-Associated Pain: A Pilot Study in Dogs

2021 ◽  
Vol 57 (2) ◽  
pp. 81-90
Author(s):  
Sebastian Mejia ◽  
Felix Michael Duerr ◽  
Gregg Griffenhagen ◽  
Stephanie McGrath
Keyword(s):  
Outcome Measures ◽  
Liver Enzymes ◽  
Symptom Relief ◽  
Controlled Study ◽  
Random Allocation ◽  
Naturally Occurring ◽  
Double Blinded ◽  
Objective Outcome ◽  
Canine Osteoarthritis ◽  
Time Point

ABSTRACT The objective of this study was to provide preliminary data describing the safety and effect of cannabidiol (CBD) for symptom relief of canine osteoarthritis-associated pain in a clinical setting using objective outcome measures. Twenty-three client-owned dogs with naturally occurring osteoarthritis of appendicular joints completed this prospective, double-blinded, crossover, placebo-controlled study. Baseline data were acquired for 4 wk, followed by random allocation to either placebo or CBD treatment for 6 wk, followed by 6 wk with the opposite treatment. Outcome measures included objective gait analysis, activity counts (via accelerometry) and clinical metrology instruments. There were no differences noted between groups at any time point for any of the recorded outcome measures. Adverse events associated with CBD administration included elevation in liver enzymes (n = 14) and vomiting (n = 2).

scholarly journals Reduction in resource utilization and increase in patient satisfaction two years after implementation of Perioperative Surgical Home

2017 ◽  
Vol 3 (2) ◽  
pp. 18
Author(s):  
Devanand Mangar ◽  
Prachiti H. Dalvi ◽  
Thomas Bernasek ◽  
Enrico Camporesi
Keyword(s):  
Patient Satisfaction ◽  
Joint Replacement ◽  
Average Length ◽  
Preoperative Evaluation ◽  
Preoperative Imaging ◽  
Utilization Review ◽  
Single Shot ◽  
Patient Centered ◽  
Perioperative Surgical Home ◽  
Institutional Review

Introduction: Perioperative Surgical Home (PSH) provides coordinated, team-based care that is patient-centered, designed to guide patients efficiently through the surgical experience. We applied several changes to our anesthesia practice during 2014 and evaluated outcomes for all orthopedic major joint replacement surgeries completed in 2015. Since this was a quality improvement/utilization study, we were granted approval from our institutional review board to retrospectively review these data.Methods: We conducted a utilization review of all 1,356 patients who received total knee, hip, or shoulder joint replacement from 4 major surgical providers in 2015. Preoperative evaluation was limited and focused to each patient’s unique medical conditions. Additionally, we reduced intraoperative fluid use, reduced continuous femoro-sciatic nerve or brachial plexus blocks by increasing the administration of single-shot regional blocks, limited transfusion, and minimized urinary catheter use. We improved pain consult response time and provided timely discharges.Results: We noted 9% reduction in preoperative imaging per case, 22% decrease in average number of tests per case, 87% fewer average units of red blood cell used per case, and a 0.4 day reduction in average length of stay (LOS). Patient satisfaction data showed constant improvement in pain management, and doctor communication.Conclusions: Numerous small modifications to patient care collectively contributed to these progressive observed changes in patient outcomes from quarter to quarter.

Pelvic Radiation Improves Local Control After Hysterectomy for Uterine Leiomyosarcoma: A 20-Year Experience

2009 ◽  
Vol 19 (6) ◽  
pp. 1080-1084 ◽  
Author(s):  
Ali Mahdavi ◽  
Bradley J. Monk ◽  
Jennifer Ragazzo ◽  
Mark I. Hunter ◽  
Scot E. Lentz ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
High Rate ◽  
Entire Group ◽  
Adjuvant Radiation ◽  
Uterine Leiomyosarcoma ◽  
Modest Improvement ◽  
Adjuvant Radiation Therapy

Background:Uterine leiomyosarcoma (LMS) is associated with high rate of recurrence after surgical resection. The role of adjuvant radiation therapy in improving survival in women with uterine LMS is unclear.Methods:All cases of LMS treated from 1985 to 2005 at 11 regional medical centers were identified. Kaplan-Meier survival curves were constructed and compared with log-rank testing. Multivariate analysis was performed to account for the potential influence of confounding factors.Results:One hundred forty-seven patients with LMS were identified. The median age of diagnosis was 51 years with the stage distribution of stage I (n = 87), II (n = 9), III (n = 25), IV (n = 25), and unknown (n = 1). One hundred forty-three underwent total abdominal hysterectomy and bilateral salpingoophorectomy. Twenty-four (17%) of these patients received adjuvant pelvic irradiation, and 63 (44%) received adjuvant and/or palliative chemotherapy. With a median follow-up of 24 months (range, 1-249 months), the median survival for the entire group was 37 months. Cox proportional hazards modeling demonstrated the presence of high tumor grade and advanced stage adversely affected survival. Although the 5-year survival for patients who received adjuvant radiotherapy was significantly higher than those who did not (70% vs 35%), this survival advantage was not sustained as the curves crossed at 90-month follow-up. Pelvic recurrence rate was lower in the radiation group (18% vs 49%; P = 0.02).Conclusions:Adjuvant radiation therapy was associated with decreased pelvic failure and a modest improvement in 5-year survival, but did not impact overall survival with extended follow-up.

scholarly journals Comparison of 3 Approaches to Percutaneous Epidural Adhesiolysis and Neuroplasty in Post Lumbar Surgery Syndrome

2018 ◽  
Vol 1 (21;1) ◽  
pp. E501-E508
Author(s):  
Haitham Hamdy Salem
Keyword(s):  
Patient Satisfaction ◽  
Pain Relief ◽  
Group Analysis ◽  
Pain Severity ◽  
University Hospital ◽  
Pain Clinic ◽  
Complication Rates ◽  
Lumbar Surgery ◽  
Time Intervals ◽  
Number Of Patients

Background: Percutaneous epidural adhesiolysis and neuroplasty (PEAN) has been proven to be safe and effective in treating different spine pathologies, in particular post lumbar surgery syndrome (PLSS). Objectives: The purpose of this study was to compare the efficacy and complication rates of the 3 different PEAN anatomical approaches (caudal, S1 foraminal, and L5-S1 transforaminal) used to treat PLSS. Study Design: This study used a case control, blind study. Setting: The research took place at the pain clinic and interventional pain practice room at Asyut University Hospital, Assiut, Egypt. Methods: Sixty consecutive PLSS patients were recruited and randomized into 3 groups (caudal, S1 foraminal, and L5-S1 transforaminal) before receiving adhesiolysis and neuroplasty. All patients underwent nerve conduction studies and magnetic resonance imaging (MRI). Pain severity levels were assessed and measured using the Oswestry Disability Questionnaire (OSW) and the Visual Analog Scale (VAS). Patient satisfaction was evaluated using a Likert scale. The first assessment was performed prior to the procedure to determine the patients’ baseline levels of pain severity. Followup assessments were performed 1-, 3-, and 6-months after the procedure. Results: Results of the group pairwise analysis indicated that, relative to baseline, there were significant decreases in pain relief scores (VAS and OWS) and functional assessment expressed by patients’ satisfaction across all time intervals and in all 3 groups (P < 0.01). Conversely, a between group analysis revealed that VAS, OWS, and patient satisfaction scores were comparable across the 3 groups at all time intervals (P > 0.05). There were no differences in rates of complications between the 3 different groups. Limitations: Our study was limited by the low number of patients and the short duration (6 months) of follow-up. Conclusion: The 3 anatomical approaches (caudal, S1 foraminal, and L5-S1 transforaminal) result in the same outcome with regard to pain relief and complication rate. Key words: Post lumber surgery syndrome, post laminectomy back pain, percutaneous adhesiolysis, Racz catheter, percutaneous neuroplasty

scholarly journals Patient-controlled epidural analgesia for labor – a step forward in Ukrainian obstetrics

Pain medicine ◽  
2019 ◽  
Vol 4 (3) ◽  
pp. 67-70
Author(s):  
Yevhenii Grizhimalsky ◽  
Andrii Harha
Keyword(s):  
Patient Satisfaction ◽  
Pain Relief ◽  
Epidural Analgesia ◽  
Local Anesthetics ◽  
Gold Standard ◽  
Severe Pain ◽  
Labour Pain ◽  
Randomized Controlled ◽  
Randomized Controlled Studies

Labour pain is recognized by some women as the most severe pain that they have ever felt in their life. Epidural analgesia is an effective method of pain relief in labour and is considered as the gold standard of analgesia for delivery. Traditionally, epidural analgesia in Ukraine is performed without the ability for the patient to control the process of anesthesia. The authors became interested in the delivery of local anesthetics by patient­controlled epidural analgesia instead of the traditional physician methods. In randomized controlled studies there is an evidence that the PCEA method tends to improve the quality of pain relief and increase the patient satisfaction.

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