Nontraumatic Perforation of the Metacarpal by the Stem of a Flexible Silicone Implant in a Patient with Rheumatoid Arthritis

A 49-year-old woman with rheumatoid arthritis who underwent replacement arthroplasty of second to fifth left metacarpophalangeal joints with silastic implant seven years ago presented with a complaint of mild pain and discomfort on the replaced joint of index finger. Ulnar deviation had relapsed, with severe swan neck deformities. Computed tomography examination demonstrated that the tip of the stem of the silicon implant penetrated the second metacarpal. We confirmed that finding surgically, and we performed a revision surgery successfully with autogenous bone grafting from distal radius. As the patient had undergone finger joint replacement surgery with silastic implant, nontraumatic perforation of the bone cortex by the implant could happen in a long-term process. On long-term follow up of silastic arthroplasty of finger joint, the possibility of nontraumatic perforation of the finger bone by the prosthesis should be considered, especially in the coexistence of severe finger deformities such as swan neck deformity.

Silastic first metatarsophalangeal joint arthroplasty for the treatment of end-stage hallux rigidus

Aims Arthroplasty for end-stage hallux rigidus (HR) is controversial. Arthrodesis remains the gold standard for surgical treatment, although is not without its complications, with rates of up to 10% for nonunion, 14% for reoperation and 10% for metatarsalgia. The aim of this study was to analyze the outcome of a double-stemmed silastic implant (Wright-Medical, Memphis, Tennessee, USA) for patients with end-stage HR. Methods We conducted a retrospective review of 108 consecutive implants in 76 patients, between January 2005 and December 2016, with a minimum follow-up of two years. The mean age of the patients at the time of surgery was 61.6 years (42 to 84). There were 104 females and four males. Clinical, radiological, patient reported outcome measures (PROMS) data, a visual analogue score (VAS) for pain, and satisfaction scores were collected. Results The survivorship at a mean follow-up of 5.3 years (2.1 to 14.1) was 97.2%. The mean Manchester Oxford Foot and Ankle Questionnaire (MOXFQ) scores improved from 78.1 to 11.0, and VAS scores for pain from 7/10 to 1.3/10. The rate of satisfaction was 90.6%. Three implants (2.8%) required revision; one for infection, one-month postoperatively, and two for stem breakage at 10.4 and 13.3 years postoperatively. There was a 1.9% reoperation rate other than revision, 23.1% of patients developed a minor complication, and 21.1% of patients had non-progressive and asymptomatic cysts on radiological review. Conclusion We report a 97.2% survivorship at a mean follow-up of 5.3 years with this implant. We did not find progressive osteolysis, as has been previously reported. These results suggest that this double-stemmed silastic implant provides a predictable and reliable alternative with comparable outcomes to arthrodesis for the treatment of end-stage HR. Cite this article: Bone Joint J 2020;102-B(2):220–226.

Peri-orbital Aesthetic Rejuvenation Surgical Protocol and Clinical Outcomes

The aim was to examine the validity of a peri-orbital rejuvenation protocol with clinical surgical results evaluating patient satisfaction and complications. Retrospective patient data and chart review was performed on 367 patients who underwent a blepharoplasty procedure. Outcome measures were dependent upon direct patient responses on postoperative visits, photographic documentation, and physical examination findings. The other outcome measure was termed a successful surgical outcome. This definition included the procedure goal was met, no postoperative complication was observed, there was no need for a revision, and the patient was satisfied with the outcome. From a cosmetic result standpoint, 99.5% (365 of 367 patients) were satisfied with the outcome. There were a total of 456 blepharoplasty surgeries: 203 upper, 75 lower, and 89 quad blepharoplasties. The patients defined with a successful outcome totaled 94.0% (345 of 367 patients). There was a complication incidence of 2.5%. Revision surgery occurred in 3% of upper blepharoplasties and in 1.8% of lower blepharoplasties. Adjuvant procedures performed either at the same time or as a staged procedure to complete the peri-orbital rejuvenation protocol were as follows: browlift surgery 24, brow or hairline dermal filler placement 4, facial silastic implant surgery 9, mid-facelift 16, lateral canthopexy 7, facelift 41, laser skin resurfacing 53, trichloroacetic acid peels 19, radiofrequency skin treatments 19, lower eyelid fat transposition 10, and facial fat transfer 25. The peri-orbital rejuvenation surgical protocol, surgical blepharoplasty techniques, and adjuvant procedure techniques performed revealed a high benefit to risk profile and high patient satisfaction rate.

Correction of Severely Deformed Hammertoe Attributable to Silastic Implant Failure with Use of Calcaneal Autograft

Few studies exist investigating surgical hammertoe correction salvage procedures regarding poor outcomes secondary to silastic implant failure. We present a case of a patient who presented to our clinic with a grossly deformed digit after undergoing several silastic implant procedures. The patient wanted to salvage the toe and elected for surgical intervention. Surgical planning consisted of a V-Y skin plasty with interposition of calcaneal autograft. This allowed restoration of anatomic dimensions and function of the patient's digit. We present this operative technique as a viable method of salvaging failed hammertoe correction procedures.

Differential Permeability of the Blood-Testis Barrier During Reinitiation of Spermatogenesis in Adult Male Rats

The blood-testis barrier (BTB) sequesters meiotic spermatocytes and differentiating spermatids away from the vascular environment. We aimed to assess whether meiosis and postmeiotic differentiation could occur when the BTB is permeable. Using a model of meiotic suppression and reinitiation, BTB function was assessed using permeability tracers of small, medium, and large (0.6-, 70-, and 150-kDa) sizes to emulate blood- and lymphatic-borne factors that could cross the BTB. Adult rats (n = 9/group) received the GnRH antagonist acyline (10 wk) to suppress gonadotropins, followed by testosterone (24cm Silastic implant), for 2, 4, 7, 10, 15, and 35 days. In acyline-suppressed testes, all tracers permeated the seminiferous epithelium. As spermatocytes up to diplotene stage XIII reappeared, both the 0.6- and 70-kDa tracers, but not 150 kDa, permeated around these cells. Intriguingly, the 0.6- and 70-kDa tracers were excluded from pachytene spermatocytes at stages VII and VIII but not in subsequent stages. The BTB became progressively impermeable to the 0.6- and 70-kDa tracers as stages IV–VII round spermatids reappeared in the epithelium. This coincided with the appearance of the tight junction protein, claudin-12, in Sertoli cells and at the BTB. We conclude that meiosis can occur when the BTB is permeable to factors up to 70 kDa during the reinitiation of spermatogenesis. Moreover, BTB closure corresponds with the presence of particular pachytene spermatocytes and round spermatids. This research has implications for understanding the effects of BTB dynamics in normal spermatogenesis and also potentially in states where spermatogenesis is suppressed, such as male hormonal contraception or infertility.

Pyrocarbon metacarpophalangeal joint replacement in primary osteoarthritis

The purpose of this retrospective cohort study was to evaluate the outcomes of 18 primary pyrocarbon metacarpophalangeal joint replacements in 10 patients, performed for primary osteoarthritis. The mean age at operation was 66 years and mean follow-up was 58.6 months. The arc of motion improved from a mean of 30° to 40° and the mean QuickDASH score improved from 35 to 17. All except one patient were satisfied with their outcomes. Radiographically, there has been no evidence of dislocation or overt loosening, although there has been subsidence of some components up to 5 mm. One index finger implant was revised to a silastic implant for perceived alteration of precision pinch. Other complications included one intra-operative fracture that united and an asymptomatic stem fracture of one proximal phalangeal component. We continue to use the implant and aim to review our experience in a further 5 years.