De la Caffinière thumb carpometacarpal replacements. 93 cases at 6 to 16 years follow-up

Surface replacement trapeziometacarpal joint arthroplasty--early results

This study reviews the results of Surface Replacement Trapeziometacarpal (SR TMC, Avanta, San Diego, CA) total joint arthroplasty. Fifty patients (62 joints) were included in the study. Forty-three patients (54 joints) were seen at final follow up. Seven patients (eight joints) were interviewed over the phone. Seven patients were revised to trapeziectomy and ligament reconstruction with tendon interposition, five for aseptic loosening and two for dislocation. At final follow up, the mean Quick DASH score was 30.4 and the Sollerman Score was 77.3. Radiological review of the surviving 55 joints showed subsidence of four trapezial components in asymptomatic patients. Cumulative survival rate was 91% at 3 years. Eighty-five percent of the patients were satisfied with the outcome of their treatment.

Surgery for thumb (trapeziometacarpal joint) osteoarthritis

BACKGROUND

This is an update of a Cochrane Review first published in 2005. Surgery has been used to treat persistent pain and dysfunction at the base of the thumb. However, there is no evidence to suggest that any one surgical procedure is superior to another.

OBJECTIVES

To compare the effect of different surgical techniques in reducing pain and improving physical function, patient global assessment, range of motion and strength in people with trapeziometacarpal osteoarthritis at 12 months. Additionally, to investigate whether there was any improvement or deterioration in outcomes between the 12-month review and five year follow up.

SEARCH STRATEGY

We searched:(CENTRAL) (The Cochrane Library 2008, issue 1), MEDLINE (1950 to Dec 2008), CINAHL (1982 to Dec 2008), AMED (1985 to Dec 2008) and EMBASE (1974 to Dec 2008), and performed handsearching of conference proceedings and reference lists from reviews and papers.

SELECTION CRITERIA

Randomised or quasi-randomised trials where the intervention was surgery and pain, physical function, patient global assessment, range of motion or strength was measured as an outcome.

DATA COLLECTION AND ANALYSIS

Two review authors independently selected studies according to the inclusion criteria, assessed the risk of bias and extracted data, including adverse effects. We contacted trial authors for missing information.

MAIN RESULTS

We included nine studies involving 477 participants. Seven surgical procedures were identified (trapeziectomy with ligament reconstruction and tendon interposition (LRTI), trapeziectomy, trapeziectomy with ligament reconstruction, trapeziectomy with interpositional arthroplasty, Artelon joint resurfacing, arthrodesis and joint replacement). Studies reported results of a mixed group of participants with Stage II-IV osteoarthritis, with a range of improvement for pain and physical function. The majority of studies included in this review had an unclear risk of bias which raises some doubt about the results. No procedure demonstrated any superiority over another in terms of pain, physical function, patient global assessment or range of motion. Of participants who underwent trapeziectomy with ligament reconstruction and tendon interposition, 22% had adverse effects (including scar tenderness, tendon adhesion or rupture, sensory change, or Complex Regional Pain Syndrome (Type 1)) compared to 10% who underwent trapeziectomy. Trapeziectomy with ligament reconstruction and tendon interposition is therefore associated with 12% more adverse effects (RR = 2.21, 95% CI 1.18 to 4.15).

AUTHORS' CONCLUSIONS

Although it appears that no one procedure produces greater benefit in terms of pain and physical function, there was insufficient evidence to be conclusive. Trapeziectomy has fewer complications than trapeziectomy with LRTI.

Second generation GUEPAR total arthroplasty of the thumb basal joint: 50 months follow-up in 84 cases

BACKGROUND

Osteoarthritis of the thumb basal joint is the most common location for hand degenerative joint disease. First, carpometacarpal (CMC) joint arthroplasty is one treatment option. The purpose of this article is to present the outcome of the GUEPAR II prosthesis, a total trapeziometacarpal cemented implant of the retaining ball-and-socket design type. Numerous other advantageous features of this implant, second generation of an earlier version are explored.

HYPOTHESIS

Clinical and radiological results confirm the GUEPAR II trapeziometacarpal arthroplasty as a reliable and efficient evolution of earlier prosthetic designs.

MATERIALS AND METHODS

Eighty-four GUEPAR II prostheses were implanted to treat advanced and severely incapacitating first CMC osteoarthritis. The average follow-up time in this collaborative series (from 2 centers) was 50 months.

RESULTS

There were no intraoperative complications and no dislocations at the final follow-up evaluation, 92% of patients were satisfied or very satisfied with their results with objective improvement of their Kapandji score. Strength was closely comparable to the nonaffected side. Radiographic studies at the final follow-up evaluations did not show (except in one socket revision instance) signs of implant loosening. On occasion, non-progressive radiolucent lines were observed. More than 80% of the patients remained pain free.

CONCLUSIONS

In our series, GUEPAR II total joint arthroplasty of the thumb CMC joint has proven to be efficacious, improving motion, strength, and achieving a high degree of pain relief. Successful outcome appears in our experience contingent upon strict compliance with numerous surgical technique details. Current research focuses on improving bipolar fixation by developing press-fit cementless implants.

Prospective 1-year follow-up study comparing joint prosthesis with tendon interposition arthroplasty in treatment of trapeziometacarpal osteoarthritis

PURPOSE

Osteoarthritis of the thumb basal joint is a common and disabling condition. This clinical follow-up study compares the efficacy of total basal joint replacement surgery with that of tendon interposition arthroplasty.

METHODS

Ninety-eight patients (mean age, 60 years +/- 1) with severe trapeziometacarpal joint osteoarthritis (Eaton-Littler stage 2.4 +/- 0.1) were included in this prospective follow-up study. Based on written and verbal information, the patients could choose either a cementless, unconstrained, hydroxyapatite-coated trapeziometacarpal joint prosthesis or abductor pollicis longus tendon interposition arthroplasty. Clinical outcome parameters were determined preoperatively and at 3, 6, and 12 months postoperatively. Furthermore, osteo-integration and osteo-fixation of the implants were radiologically analyzed after 12 months.

RESULTS

Joint replacement surgery resulted in faster and better pain relief, stronger grip functions, improved range of motion, and faster convalescence than did tendon interposition arthroplasty. After 12 months, patients with joint prostheses had regained the same strength and range of motion as in the asymptomatic contralateral thumb. After 12 months, osteolysis had developed in the vicinity of 2 cups, but there were no signs of implant loosening. The prosthesis surgery was not associated with more complications than occurred with tendon interposition arthroplasty.

CONCLUSIONS

This study demonstrates that patients with joint prostheses achieve faster convalescence with better patient comfort and improved strength and range of motion without any increased risk of complications than do patients treated with tendon interposition arthroplasty at 1-year follow up. However, a randomized clinical trial with long-term follow-up is required.

Treatment of advanced CMC joint disease: trapeziectomy and implant arthroplasty (silastic-metal-synthetic allograft)

Osteoarthritis of the basal joint of the thumb is a common and frequently debilitating condition, most often affecting middle-aged women. Nonoperative treatment with activity modification, splinting, oral anti-inflammatory medication, and intraarticular steroid injection frequently leads to acceptable control of symptoms. If nonoperative treatment fails, many surgical techniques have been described for management of symptomatic advanced degenerative joint changes. This article reviews the literature related to various arthroplasty options for advanced disease. Treatment decisions must clearly be tempered by the surgeon's experience, the patient's goals and expectations, and the extent of degenerative disease.

Microstructural adaptation in trapezial bone due to subluxation of the thumb

Although the thumb saddle is one of the most common sites of degenerative osteoarthritis in the hand, little is known about the altered microstructure in osteoarthritic trapezial bones. External forces resulting from subluxation of the carpometacarpal joint of the thumb (CMC I) should provoke microstructural changes in the trapezium. The purpose of this study was to compare the regional differences of the microstructure between osteoarthritic and healthy trapezial bones. Fifteen trapezia harvested from female patients with radiologically and clinically diagnosed saddle joint osteoarthritis (OA) were compared with 15 unaffected controls. Microstructural parameters, such as bone volume ratio (BV/TV), three-dimensional connectivity (Conn.D), trabecular number (Tb.N), and trabecular thickness (Tb.Th) were studied using a microcomputed tomography (microCT) system. While the trapezial height in OA was 22% less, the sclerotic subchondral bone layer thickness was 50% higher in OA compared with the control group (p < 0.001). In the OA group there was a 42% higher bone volume ratio (p <or= 0.001), an 18% increase in Tb.Th (p = 0.006), and a 10% greater Tb.N (p = 0.034) compared with the control group. Although in both groups BV/TV was significantly lower in the radial region, the radial column showed the highest relative increase in bone volume and structure compared with the control group (+67% BV/TV, +20% Tb.Th, +23% Tb.N). The reinforcement of the bony microstructure in CMC I OA, especially at the radial side, is a sign for bone adaptation reacting to radially shifted joint forces. This has to be considered during the development of new prosthetic alternatives.

CMC arthroplasty of the thumb: a review

Arthritis of the first carpometacarpal (CMC) joint of the hand is a common and often debilitating disease. Diagnosis can be readily made with history, physical exam, and radiographic evaluation. Patients with advanced disease who have failed conservative treatment modalities have multiple surgical options including ligament reconstruction, resection arthroplasty, silicone implantation, tendon interposition, or total joint arthroplasty. This article will describe the variety of approaches to treatment as well as the author's preferred method.

Biomechanic analysis of trapeziectomy, ligament reconstruction with tendon interposition, and tie-in trapezium implant arthroplasty for thumb carpometacarpal arthritis: a cadaver study

PURPOSE

Thumb carpometacarpal joint arthritis has been commonly treated with some combination of resection of the trapezium and interposition of a spacer using either a biologic or artificial material plus tenodesis to reconstruct the volar oblique ligament. The purpose of this study was to evaluate the biomechanic stability of the classic ligament reconstruction with tendon interposition (LRTI) or without tendon interposition compared with a newly developed 1-piece silicone trapezium implant.

METHODS

Twelve cadaver arm specimens had the following procedures: resection of the trapezium, tendon interposition, ligament reconstruction, LRTI, and the silicone implant. Biomechanic testing of joint stability was performed with a physiologic loading protocol before and after each procedure.

RESULTS

The implant significantly corrected the axial displacement after trapeziectomy and resulted in less radial displacement than LRTI. It significantly reduced angulation of the thumb metacarpal base but resulted in more rotation of the thumb during simulated pinch. There was no significant difference in stability measures between trapeziectomy and LRTI or ligament reconstruction without tendon interposition.

CONCLUSIONS

We found several biomechanic advantages to the implant compared with LRTI. Advantages include reduction in axial and radial displacement and maintenance of the trapezial space. We attribute these advantages to the effect of the implant as a spacer. The significant rotation with the implant, however, raises questions concerning implant design and fixation. We found no biomechanic advantage to LRTI or ligament reconstruction without tendon interposition over trapeziectomy alone.

[Results of a 5 years follow-up of Arpe prosthesis for the basal thumb osteoarthritis]

INTRODUCTION

The surgical gold standart treatment of the thumb osteoarthritis is the trapeziectomy with tendon interposition with ligament reconstruction. The trapeziometacarpal prosthesis is insufficiently assessed in literature.

METHODS

Between 1994 and 2001, 43 trapeziometacarpal prosthesis Arpe were implanted by the same surgeon for isolated trapeziometacarpal degenerative osteoarthritis. The minimum follow-up is 5 years. 33 women and 2 men , average age 59,4-years, were operated after failure of conservative treatment. 7 patients were lost sight of (9 prosthesis) and 2 deaths (2 prosthesis). 26 other patients (32 prostheses) were examined by the author with an original revision questionnaire associated to the score of DASH.

RESULTS

7 revisions were necessary: 5 for loosening, 1 for premature dismemberment and 1 for recurrent partial dislocation. The survival of the prosthesis is 85% in 5 years. In the group of 25 prosthesis still implanted, there is no radiological sign of loosening, but in some cases a development of medial ossification. The average DASH score is 27,4/100. All the patients of this group are satisfied or very satisfied.

CONCLUSION

The prosthesis Arpe is an effective option in this series for the treatment of the degenerative trapeziometacarpal arthritis but its radioclinical control is necessary for the first year.

Total joint arthroplasty in the treatment of advanced stages of thumb carpometacarpal joint osteoarthritis

PURPOSE

Osteoarthritis of the thumb basal joint is a very common and disabling condition that frequently affects middle-aged women. Many different surgical techniques have been proposed for extensive degenerative arthritis of the first carpometacarpal (CMC) joint. Joint replacement has been an effective treatment of this condition. The purpose of this article is to present the outcome of a total cemented trapeziometacarpal implant in the treatment of more advanced stages of this disease.

METHODS

Total joint arthroplasty of the trapeziometacarpal joint was performed on 26 thumbs in 25 patients to treat advanced osteoarthritis (Eaton and Littler stages III and IV) between 1998 and 2003. Indications for surgery after failure of conservative treatment were severe pain, loss of pinch strength, and diminished thumb motion that limited activities of daily living. A trapeziometacarpal joint prosthesis was the implant used in this series. The average follow-up time was 59 months.

RESULTS

At the final follow-up evaluation, thumb abduction averaged 60 degrees and thumb opposition to the base of the small finger was present. The average pinch strength was 5.5 kg (85% of nonaffected side). One patient had posttraumatic loosening, which was revised with satisfactory results. Radiographic studies at the final follow-up evaluations did not show signs of atraumatic implant loosening. One patient complained of minimal pain, and the remaining 24 patients were pain free.

CONCLUSIONS

In our series, total joint arthroplasty of the thumb CMC joint has proven to be efficacious with improved motion, strength, and pain relief. We currently recommend this technique for the treatment of stage III and early stage IV osteoarthritis of the CMC joint in older patients with low activity demands.

TYPE OF STUDY/LEVEL OF EVIDENCE

Therapeutic IV.

Analysis of methodological deficiencies of studies reporting surgical outcome following cemented total-joint arthroplasty of trapezio-metacarpal joint of the thumb

Cemented total-joint arthroplasty has been increasingly used in the treatment of end stage arthritis of the thumb trapeziometacarpal joint. Evidence supporting its use in the treatment of trapeziometacarpal disorders in the literature is very limited. Most hand surgeons agree that there are concerns about the methodological quality of the limited literature available. In this study, we analysed the methodological quality of the outcome studies on cemented total-joint arthroplasty of the thumb. We included all the outcome studies published in the English literature on cemented total-joint arthroplasty of the trapeziometacarpal joint of thumb. We analysed these studies for methodological deficiencies and quality of outcome reporting based on the recommendations given by Coleman et al. Our study revealed that there were no uniform standards of outcome reporting. The mean Coleman score for the studies dealing with cemented total-joint arthroplasty of the thumb was 42.9. Major deficiencies were identified in areas like subject selection criteria (0/15), type of study (5.7/15), description of surgical procedure (3.7/5), description of the rehabilitation protocol (2/10), outcome measures (4.4/10) and outcome assessment (3.9/15). The methodological quality of the studies published within the last 10 years (49.9+/-9.7) was found to be slightly better than the studies published over 10 years ago (39.7+/-7.8). Our study highlights the need for more evidence in the form of randomised controlled prospective studies conducted with good methodological quality, comparing the cemented total-joint arthroplasty of the thumb to other procedures available for the treatment of disorders of the thumb. Further, to improve the standards of reporting, journal editors should try to standardise the outcome of the reporting by following the surgical procedures on the thumb.

Electra trapezio metacarpal prosthesis: results of the first 100 cases

The Elektra trapeziometacarpal prosthesis is a cementless, unconstrained prosthesis made by Fixano with titanium and chrome-cobalt steel. This paper examines the results of the first 100 prostheses used by the author for one indication only, viz. painful trapeziometacarpal osteoarthritis. The average follow-up period was 54 (range 36-78) months. Studies of pain, mobility and grip and pinch strength were carried out, the results of which were good in 83 cases. Seven dislocations occurred. Five of these were following severe trauma. The commonest complication was a lack of osteointegration of the trapezial part of the prosthesis, which occurred in 15 cases. Sinking into the metacarpal of the distal stem occurred early in the series in two cases. Some others complications were observed: allergy to the metal (one case), fracture after direct trauma of the thumb (one case) and very painful osteoarthritis of the scaphotrapeziotrapezoid joint (one case).

Tendon suspension sling arthroplasty for degenerative arthritis of the thumb trapeziometacarpal joint: long-term follow-up

Twenty-two tendon suspension sling arthroplasties for thumb trapeziometacarpal osteoarthritis were reviewed. Age at operation ranged from 53 to 74 years (average, 65 years); 20 of the 22 patients were women. The average follow-up period was 101 months (range, 63-139 months). At the final follow-up, 18 of 22 thumbs were painless. Grip and side pinch measurements averaged 98% and 79% of unaffected opposite sides, respectively. Range of motion at the trapeziometacarpal joint improved, and the average shortening of the trapezial space was 6.4 mm. Function was improved in all cases. The long-term results show that tendon suspension sling arthroplasty is a useful surgical procedure and an attractive alternative to existing tendon interposition arthroplasty with ligament reconstruction.

Surgery for thumb (trapeziometacarpal joint) osteoarthritis

BACKGROUND

Surgery has been used to treat persistent pain and dysfunction at the base of the thumb. However, there is no evidence to suggest that any one surgical procedure is superior to another.

OBJECTIVES

To investigate the effect of surgery in reducing pain and improving physical function, patient global assessment, range of motion, and strength in people with trapeziometacarpal osteoarthritis at 12 months. Additionally, it was the reviewers intention to investigate whether there was any improvement or deterioration in outcomes between the 12 months review and a 5 year follow-up.

SEARCH STRATEGY

We searched the the following databases in the Cochrane Library 2004, Issue 4: Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Database of Systematic Reviews, and the Database of Abstracts of Reviews of Effects (DARE) as well as MEDLINE (1966-Dec 2004), CINAHL (1982-Dec 2004), AMED (1985-Dec 2004), and EMBASE (1974-Dec 2004). Database searches were supplemented by hand searching conference proceedings and reference lists from reviews and papers.

SELECTION CRITERIA

Studies were included if they were: randomised, quasi-randomised or controlled trials; intervention was surgery; and pain, physical function, patient global assessment, range of motion, or strength was measured as an outcome.

DATA COLLECTION AND ANALYSIS

Two independent reviewers examined the identified studies according to the inclusion criteria. Included studies were assessed for methodological quality and then data, including adverse effects, was extracted and cross-checked. Authors were contacted to provide missing information.

MAIN RESULTS

Seven studies involving 384 participants were included. Studies of five surgical procedures were identified (trapeziectomy, trapeziectomy with interpositional arthroplasty, trapeziectomy with ligament reconstruction, trapeziectomy with ligament reconstruction and tendon interposition (LRTI), and joint replacement). All studies reported results of a mixed group of participants with Stage II-IV osteoarthritis, with a range of improvement across all stages of 27 to 57 mm on a 0-100 VAS scale for pain and 18-24 mm on a 0-100 VAS scale for physical function. No procedure demonstrated any superiority over another in terms of pain, physical function, patient global assessment, range of motion or strength. However, participants who underwent trapeziectomy had 16% fewer adverse effects (p=0<.001) than the other commonly-used procedures studied in this review; conversely, those who underwent trapeziectomy with ligament reconstruction and tendon interposition had 11% more (p=0.03) (including scar tenderness, tendon adhesion or rupture, sensory change, or Complex Regional Pain Syndrome (Type 1).

AUTHORS' CONCLUSIONS

No one procedure produced greater strength than any other. Although this also appears to be the case for pain and physical function, there was insufficient evidence to be conclusive. Trapeziectomy is safer and has fewer complications than the other procedures studied in this review, and conversely trapeziectomy with LRTI has more.

[Differential therapy for the rheumatoid thumb]

The thumb frequently is involved in rheumatoid arthritis and often is a source of significant functional loss, pain, and deformity. Surgical intervention in patients with rheumatoid arthritis of the thumb should be based on the degree of radiological destruction according to Larsen, the natural course of the rheumatoid hand, the nature and stage of deformity as well as the status of tendons, ligaments, and adjacent joints. The goals of surgery are to relieve pain, increase motion, and restore thumb function. The timing for shoulder surgery should be early in the course of the disease, since it determines the long-term prognosis and the remaining surgical options. Treatment options, alone or in combination, include synovectomy, arthrodesis, arthroplasty, and tendon repair or transfer. Joint-preserving surgery is indicated in the early stages of radiological destruction according to Larsen classification O-III, whereas the late stages of destruction (Larsen IV-V) require reconstructive surgery. Especially in hand and finger arthritis, the "wait and see" strategy should no longer be followed. Close interdisciplinary cooperation between surgeon and rheumatologist is necessary for early therapeutic strategy, taking into account the functional unit of the whole upper extremity. The ultimate aim is to provide pain relief, improve function, enhance appearance, and slow the progression of disease. When the pathogenesis and pathoanatomy of the impaired rheumatoid thumb are appreciated, and appropriate treatment is selected, surgical intervention is likely to provide a favorable outcome for the patient.

Results of the cemented SR trapeziometacarpal prosthesis in the treatment of thumb carpometacarpal osteoarthritis

PURPOSE

The purpose of this study was to analyze our experience in the treatment of trapeziometacarpal (TMC) osteoarthritis with a cemented surface replacement arthroplasty.

METHODS

We did a retrospective study of 19 patients with 20 hands operated on with this technique, with a follow-up evaluation of 33 months. We analyzed the preoperative stage, the postoperative clinical results, measured the radiographic changes found at the end of the study, and correlated all these data with a statistical study. For statistical analysis chi(2) test and Student t-test were used. The level of significance was set at a p value of.05 or less.

RESULTS

With an average follow-up period of 33 months (range, 24-45 mo) the following rates were obtained: 55% loosenings and 15% ankylosis owing to periprosthetic calcifications (70% of failures of the technique). Four patients (20%) needed a revision surgery (a salvage procedure with a dynamic ligament reconstruction arthroplasty). In the subjective functional evaluation only 8 cases of 19 patients (40%) maintained an excellent/good result at the end of the study.

CONCLUSIONS

In our group of patients the cemented surface replacement TMC prosthesis was not an adequate surgical option for the treatment of TMC osteoarthritis. Further studies are necessary to clarify the role of this surgical technique in this pathology.

[Guepar anatomical trapeziometacarpal prosthesis]

INTRODUCTION

A choice of surgical techniques of treatment for trapeziometacarpal (TMC) Osteo-Arthritis (OA) have been described. Total arthroplasty is often used, especially in France. Many papers have been published, presenting various prostheses. In English literature, this device is not thoroughly used.

MATERIALS AND METHODS

[corrected] Guepar total arthroplasty is a cemented ball-in-socket prosthesis in metal-polyethylene. It includes an anatomical stem available in 4 sizes. After failure of the conservative treatment, total arthroplasty must be reserved to elderly patients, painful, with OA Dell stage III or IV aligned or not. The trapezial height must be sufficient. The authors reports the preliminary results of 64 Guepar prostheses, anatomical new design, implanted since 1995.

RESULTS

Results of 63 prostheses are presented. One removal had been necessary at 9 months for metacarpal loosening (failure). Mean follow-up was 29 months. Clinical results were judged excellent or good in all cases. Regarding the radiological results, no modifications has been observed in 56 cases. Six radiolucent lines without displacement of the implants has been noted, with no incidence on clinical results. In one case, a metacarpal stem penetrated into the medullary canal in the bone axis but without any clinical modifications.

DISCUSSION AND CONCLUSION

Clinically, in addition to pain relief, trapeziometacarpal prosthesis allows to preserve the first column length and to obtain a better opposition of the thumb as well of a better thumb-digits pinch, compared after trapeziectomy. Radiologically, as for total hip arthroplasty, the exact adaptation of an anatomical stem (new design) to the canal has probably a better prognosis at long term follow-up.

[Total trapezometacarpal prostheses: concepts and classification study]

This paper is an attempt to classify the different types of trapezio-metacarpal total prostheses according to their bio-mechanical principle and to compare the bio-mechanics of these prostheses to that of the normal trapeziometacarpal joint. The trapeziometacarpal joint has two approximate centres of rotation (one in the proximal metacarpal, one in the trapezium), two degrees of freedom and two arc of mobility about 70 degrees. The mechanical model of the trapeziometacarpal joint is a universal-joint called "cardan" with three constraint forces (one axial compression force, and two shear forces, radial and posterior) and one constraint moment around the longitudinal axis. The trapeziometacarpal prostheses may be classified in two main categories: the most frequently used are the "ball and socket" prostheses. Several prostheses, including the surface replacement prostheses have the mechanical characteristics of an universal joint (cardan). Ball and socket prostheses have one centre of rotation, 3 degrees of freedom, three constraint forces in three directions and no constraint moment when "cardan" or surface prostheses have two centres of rotation and 2 degrees of freedom; three constraint forces and one constraint moment. Trapeziometacarpal prostheses may also be classified according to their arc of mobility, or according to their mode of primary fixation (cemented, non-cemented), "press-fit", expansion and to their secondary fixation (hydroxyapatite).

Long-term results and loosening analysis of de la Caffinière replacements of the trapeziometacarpal joint

The results of 77 de la Caffinière arthroplasties for osteoarthritis of the thumb carpometacarpal joint were reviewed. The mean follow-up period was 8.5 years (range, 2-16 years). The survival rate at 16 years was 72%. Clinical and subjective scores were good in primary implants, reasonable in revisions, and poor in salvage procedures. The total loosening rate was 44%. Half of the loosening cases led to revision; the other half had good results. Loosening occurred significantly more often in men and younger women. The use of this prosthesis is only advised for women, preferably those older than 60 years.