scholarly journals Different collagenase delivery for Dupuytren disease in public hospitals

2020 ◽  
Vol 3 (2) ◽  
pp. 22-31
Author(s):  
Jessca A Paynter ◽  
Vicky Tobin ◽  
James CS Leong ◽  
Warren Matthew Rozen ◽  
David J Hunter-Smith
Keyword(s):  
Clinical Success ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Public Hospitals ◽  
Dupuytren’S Disease ◽  
Patient Specific ◽  
Extension Deficit ◽  
Dupuytren's Disease ◽  
Number Of Patients ◽  
Patient Reported

Background: The delivery protocol of collagenase Clostridium histolyticum (collagenase) injection for Dupuytren’s disease is variable, due to limited evidence for any one approach and widespread ‘off-label’ delivery occurring in Australia. As such, this preliminary study aimed to assess whether different collagenase delivery protocols for treating Dupuytren’s disease have an impact on effectiveness and safety. It was hypothesised that different collagenase delivery would affect outcomes. Methods: This preliminary, prospective study included a consecutive cohort of adult patients with Dupuytren’s disease being treated with collagenase within two Australian public hospitals to determine whether different collagenase delivery protocols impact on effectiveness and safety. The therapeutic effect was measured objectively using the total passive extension deficit (TPED), clinical success and clinical improvement. Three patient-reported outcome measures (PROMs) were used: Unité Rhumatologique des Affections de la Main (URAM), the Southampton Dupuytren’s Scoring Scheme and the Canadian Occupational Patient-Specific Functional Scale (PSFS). Results: The delivery of collagenase was variable at both clinics. The number of patients treated with collagenase at Institute I and Institute II was 49 and 18, respectively. Clinical success was achieved in 42 per cent of the Institute I and 35 per cent of the Institute II cohort. A statistically significant reduction in all three PROMs was observed for both cohorts. No significant differences between effectiveness or safety was found when comparing the two cohorts. Conclusion: The delivery of collagenase was variable at Institutes I and II, but these differences did not appear to impact the effectiveness or safety of collagenase delivery.

The effectiveness of manipulation of fingers with Dupuytren's contracture 7 days after collagenase clostridial histolyticum injection

2019 ◽  
Vol 45 (3) ◽  
pp. 286-291 ◽  
Author(s):  
Bethany Reynolds ◽  
Vicky Tobin ◽  
Julian A Smith ◽  
Warren M Rozen ◽  
David J. Hunter-Smith
Keyword(s):  
Outcome Measures ◽  
Clinical Success ◽  
Demographic Data ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Extension Deficit ◽  
Level Of Evidence ◽  
Patient Reported ◽  
Collagenase Injection ◽  
Tendon Ruptures

Timing of manipulation of digits after collagenase injection for Dupuytren’s disease varies and often takes place within the first few days post-injection. We prospectively investigated the effectiveness of performing manipulation under local anaesthesia 7 days after injection in 100 patients. Demographic data, passive extension deficit, and patient-reported outcome measures were recorded before collagenase injection. Four to 7 weeks after manipulation, passive extension deficit and patient-reported outcome measures improved significantly without the development of any tendon ruptures. Clinical success was achieved in 41% and clinical improvement in 76% of the patients. Adverse events were reported by 85%. The outcomes were comparable with studies with early manipulation, and demonstrate a safe and effective variation to current protocols. We conclude that delaying manipulation to 7 days after collagenase injection is safe and efficient, which allows for flexibility in clinical appointments without negatively affecting outcome. Level of evidence: III

scholarly journals P18: CONVENTIONAL DUPUYTREN'S DIATHESIS FACTORS ARE NOT ASSOCIATED WITH POOR OUTCOME FOLLOWING SURGERY: A SYSTEMATIC REVIEW

2021 ◽  
Vol 108 (Supplement_1) ◽  
Author(s):  
L Geoghegan ◽  
J Man ◽  
A Jain ◽  
JN Rodrigues
Keyword(s):  
Systematic Review ◽  
Data Extraction ◽  
Disease Recurrence ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Dupuytren’S Disease ◽  
Dupuytren's Disease ◽  
Factors Associated ◽  
Poor Outcome ◽  
Patient Reported

Abstract Introduction Dupuytren's diathesis describes an aggressive disease course with tendency for recurrence or extension following intervention. Conventional factors associated with Dupuytren's diathesis are ethnicity, family history, bilateral and ectopic disease. Disease recurrence is not the only cause of poor outcome following intervention. This systematic review aimed to identify all factors that have been investigated for a potential association with the development, progression, recurrence and outcome of treatment in Dupuytren's diathesis. Method A systematic review of MEDLINE, EMBASE and CINAHL using a PRISMA-compliant methodology up to February 2019 was conducted. Abstract screening and data extraction were performed in duplicate. Included prognostic cohort studies were quality assessed using the Quality in Prognosis Study tool. Result The search revealed 2,661 records from which 11 full text articles reported both conventional diathesis factors and outcomes (in addition to recurrence) following intervention for Dupuytren's in 938 patients. Collectively 67% underwent fasciectomy and seven outcomes were reported: three patient reported outcome measures (DASH, quick-DASH and EQ-5D), three functional measures (grip strength, joint angle correction and range of motion) and treatment complications. Two studies used multiple univariate statistical techniques and found no significant association between diathesis factors and disease outcome. Conclusion This systematic review challenges conventional notions of Diathesis factors and provides a comprehensive appraisal of factors associated with poor outcome following intervention for Dupuytren's disease. Take-home message Conventional factors associated with recurrence in Dupuytren's disease are not associated with poor outcome following intervention.

The influence of skin tears following collagenase treatment of Dupuytren’s disease on treatment outcomes

2020 ◽  
pp. 175319342094132
Author(s):  
Robert Phan ◽  
Warren M. Rozen ◽  
Giselle Dela Cruz ◽  
Vicky Tobin ◽  
David J. Hunter-Smith
Keyword(s):  
Patient Reported Outcomes ◽  
Dupuytren’S Disease ◽  
Extension Deficit ◽  
Level Of Evidence ◽  
Dupuytren's Disease ◽  
Finger Extension ◽  
Patient Reported ◽  
Collagenase Injection ◽  
Skin Tears ◽  
Pre Treatment

This study investigated influence of skin tears on patient-reported outcomes of injection of collagenase clostridium histolyticum for Dupuytren’s disease and association between extension deficit of digits before injection and skin tear after the injection. From 2016 to 2018, 391 Dupuytren’s cords were treated in 184 patients in a prospective cohort study and the patients were evaluated before injection and six months after injection. Skin tears occurred in 50% of these patients. We found no significant differences in the patient-reported outcomes between patients with or without skin tears. A higher extension deficit before treatment was associated with significantly increased frequency of skin tears. We conclude that the incidence of skin tears after injection does not affect patient reported outcomes six months after collagenase injection, but the incidence of skin tears is significantly associated with the severity of pre-treatment finger extension deficits. Level of evidence: II

scholarly journals 3D printing and unicompartmental knee arthroplasty

2018 ◽  
Vol 3 (5) ◽  
pp. 248-253 ◽  
Author(s):  
Gareth G. Jones ◽  
Susannah Clarke ◽  
Martin Jaere ◽  
Justin Cobb
Keyword(s):  
3D Printing ◽  
Knee Arthroplasty ◽  
Unicompartmental Knee Arthroplasty ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Patient Specific ◽  
Unicompartmental Knee ◽  
Patient Specific Instrumentation ◽  
Patient Reported ◽  
Total Knee

In suitable patients, unicompartmental knee arthroplasty (UKA) offers a number of advantages compared with total knee arthroplasty. However, the procedure is technically demanding, with a small tolerance for error. Assistive technology has the potential to improve the accuracy of implant positioning. This review paper describes the concept of detailed UKA planning in 3D, and the 3D printing technology that enables a plan to be delivered intraoperatively using patient-specific instrumentation (PSI). The varying guide designs that enable accurate registration are discussed and described. The system accuracy is reported. Future studies need to ascertain whether accuracy for low-volume surgeons can be delivered in the operating theatre using PSI, and reflected in improved patient reported outcome measures, and lower revision rates.Cite this article: EFORT Open Rev 2018;3 DOI: 10.1302/2058-5241.3.180001

scholarly journals Better patients’ treatment experiences are associated with better postoperative results in Dupuytren’s disease

2018 ◽  
Vol 43 (8) ◽  
pp. 848-854 ◽  
Author(s):  
Ralph Poelstra ◽  
Ruud W. Selles ◽  
Harm P. Slijper ◽  
Mark J.W. van der Oest ◽  
Reinier Feitz ◽  
...  
Keyword(s):  
Treatment Outcomes ◽  
Healthcare Delivery ◽  
Dupuytren’S Disease ◽  
Postoperative Treatment ◽  
Extension Deficit ◽  
Level Of Evidence ◽  
Dupuytren's Disease ◽  
Patient Reported ◽  
Treatment Context ◽  
Limited Fasciectomy

This prospective study investigates the extent to which a better experience with healthcare delivery is associated with better postoperative treatment outcomes after surgery for Dupuytren’s contracture. Patients undergoing limited fasciectomy or percutaneous needle fasciotomy for Dupuytren’s contractures completed the Michigan Hand Outcomes Questionnaire before and 3 months after surgery, together with a patient reported experience measure, while hand therapists assessed the straightness of the finger with a goniometer. Regression analyses were used to examine associations. We found that a better experience with healthcare delivery was associated with better patient-reported outcomes, while association with residual extension deficit was minimal. Strongest associations were seen with communication of the physician, postoperative care and information about the treatment. Experience with the treatment explained up to 12% of the variance in treatment outcome. These findings suggest that patient reported treatment outcomes in Dupuytren’s disease can be improved by improving the treatment context. Level of evidence: II

scholarly journals Total knee arthroplasty using patient-specific instrumentation for osteoarthritis of the knee: a meta-analysis

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Kazuha Kizaki ◽  
Ajaykumar Shanmugaraj ◽  
Fumiharu Yamashita ◽  
Nicole Simunovic ◽  
Andrew Duong ◽  
...  
Keyword(s):  
Blood Loss ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Mean Difference ◽  
Patient Specific ◽  
Osteoarthritis Of The Knee ◽  
Transfusion Rate ◽  
Complication Rates ◽  
Patient Specific Instrumentation ◽  
Patient Reported

Abstract Background Total knee arthroplasty using patient-specific instrumentation (TKA-PSI), which are disposable cutting block guides generated to fit each patient’s 3-dimensional knee anatomy, has been developed to treat patients with end-stage osteoarthritis of the knee. Surrogate markers such as radiographic malalignment have been well investigated, however, patient-important outcomes are not well examined to elucidate the efficacy of TKA-PSI. The aim of this review is to determine if TKA-PSI improves patient-reported outcome measures (PROM), surgery time, blood loss, transfusion and complications (e.g. surgical site infection, deep venous thrombosis, and revision TKA). Methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, and ongoing clinical trials. For PROMs, surgery time, blood loss, and transfusion rate, we included randomized controlled trials (RCT) comparing TKA-PSI and standard TKA to treat osteoarthritis of the knee. For complications, we also included non-randomized comparative studies (non-RCT). Results This review includes 38 studies, 24 of which were RCT and 14 of which were non-RCT. These included a total of 3487 patients. The predominant population in the included studies highly reflected the general population, with 62% being female, aged over 60 and having end-stage osteoarthritis of the knee. TKA-PSI did not improve PROMs as compared to standard TKA for less than 1-year (mean difference 0.48, 95% confidence interval (CI) -1.92–0.97 in the Oxford knee score, mean 3-month follow-up) and for 1-year or more (mean difference 0.25, 95%CI − 4.39–4.89 in the WOMAC score, mean 29-month follow-up). TKA-PSI did not reduce surgery time (mean difference − 3.09 min, 95%CI -6.73–0.55). TKA-PSI decreased blood loss with a small effect size corresponding to a 0.4 g/dl hemoglobin decrease (95%CI 0.18–0.88), but did not decrease transfusion rate (risk difference − 0.04, 95%CI -0.09–0.01). TKA-PSI did not reduce complication rates (risk difference 0.00, 95%CI − 0.01–0.01 in the composite outcome). Conclusions TKA-PSI does not improve patient-reported outcome measures, surgery time, and complication rates as compared to standard TKA. TKA-PSI decreases blood loss with a small effect, which is not enough to reduce transfusion rate.

scholarly journals Midterm osteolysis-induced aseptic failure of the M6-C™ cervical total disc replacement secondary to polyethylene wear debris

2022 ◽  
Author(s):  
Matthew Scott-Young ◽  
Evelyne Rathbone ◽  
Lauren Grierson
Keyword(s):  
Polyethylene Wear ◽  
Clinical Success ◽  
Total Disc Replacement ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
The Other ◽  
Disc Replacement ◽  
Cervical Disc ◽  
Cervical Total Disc Replacement ◽  
Patient Reported

Abstract Background According to published meta-analyses, cervical total disc replacement (CTDR) seems to be superior to anterior cervical decompression and fusion (ACDF) in most clinical parameters. Despite short-term clinical success of CTDR, there are concerns regarding long-term durability of these prostheses. Methods This prospective study involved 382 patients who received standalone CTDR or a hybrid procedure (ACDF/CTDR). A retrospective comparison between different CTDR devices was conducted regarding patient-reported outcome measures (PROMs), failure scenarios, and revision surgeries. The M6-C™ Artificial Cervical Disc (Orthofix, Lewisville, Texas) cohort was compared to the other CTDR devices clinically. Etiological reasons for revision, and the surgical technique of the revision was investigated. Results Fifty-three patients received M6-C CTDR. Eighteen patients (34%) were revised at an average of 67 months postoperatively for wear-induced osteolysis. There were three additional cases of pending revision. The PROMs of the two groups were similar, indicating that the failure mode (wear-induced osteolysis) is often asymptomatic. The demographics of the two groups were also similar, with more women undergoing revision surgery than men. There were three one-level CTDR, four two-level hybrids, seven three-level hybrids, and three four-level hybrids revised anteriorly. Sixteen patients underwent removal of the prosthesis and were treated according to the extent of osteolysis. There were four vertebrectomies, six revisions to ACDF, and six revisions to another CTDR. One patient underwent supplemental fixation using a posterior approach. The other CTDR cohort had an incidence of 3.3% at the equivalent time, and none of these were due to osteolysis or wear-related events. Conclusions There is a concerning midterm failure rate related to ultra-high-molecular-weight-polyethylene wear-induced osteolysis in the M6-C. Patients implanted with the M6-C prosthesis should be contacted, informed, and clinically and radiologically assessed.

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