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Adams AJ, Kasper A, Tosti R. Arthroscopic Total Trapeziectomy for Thumb Carpometacarpal Arthrosis. Hand (N Y) 2024:15589447241262055. [PMID: 39045649 DOI: 10.1177/15589447241262055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/25/2024]
Abstract
BACKGROUND The purpose of this individual cohort study is to demonstrate safety and efficacy in removing the trapezium through minimally invasive arthroscopy. METHODS A prospective case series was performed on all arthroscopic total trapeziectomy procedures for thumb basal joint arthrosis between 2018 and 2022. Patients were followed for up to 1 year. All patients received an examination at each visit to include pain, range of motion, strength, and metacarpal height. Complications, concomitant procedures, and revision procedures were recorded as well. RESULTS A total of 49 arthroscopic trapeziectomy procedures were recorded for 46 patients. The average preoperative visual analog pain scale score was 8.8 out of 10, and the postoperative score was 1 out of 10. All patients had a resolution of the carpometacarpal grind test postoperatively. The average preoperative key pinch, 3-point chuck, and grip strength were 9.8 lbs/in2, 7.8 lbs/in2, and 45 lbs/in2, respectively. Final 6-month postoperative key pinch, 3-point chuck, and grip strength were 11.0 lbs/in2, 9.8 lbs/in2, and 49.2 lbs/in2, respectively. Metacarpal height subsided on average 50%. We report one revision and no cases of radial sensory neuritis or flexor tendon rupture. CONCLUSIONS Arthroscopic total trapeziectomy appears to be a safe and effective treatment for end-stage arthrosis of the thumb basal joint. LEVEL OF EVIDENCE 2b Therapeutic; Individual Cohort Study.
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Affiliation(s)
| | | | - Rick Tosti
- Thomas Jefferson University, Philadelphia, PA, USA
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2
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Hidajat NN, Aditya R, Arsa W, Malik R. Outcome Comparison between Carpometacarpal Arthroplasty and Trapeziectomy in Patients with Carpometacarpal Osteoarthritis: A Systematic review. Orthop Rev (Pavia) 2024; 16:117651. [PMID: 38947179 PMCID: PMC11213695 DOI: 10.52965/001c.117651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 03/24/2024] [Indexed: 07/02/2024] Open
Abstract
Background Osteoarthritis of the carpometacarpal (CMC) is considered a common musculoskeletal disorder. The treatment of carpometacarpal osteoarthritis could be either by conservative or surgical methods. surgical treatment, there are various alternatives, including trapeziectomy and arthroplasty. This study aims to perform a systematic review of the literature to determine the functional outcomes associated with trapeziectomy and arthroplasty in CMC arthritis. Objectives To determine the functional outcomes associated with trapeziectomy and arthroplasty in CMC arthritis patients. Methods A systematic review was conducted according to PRISMA guidelines and performed on August 2022 by one independent reviewer (author) using PubMed database, EBSCO Host, EMBASE, and ScienceDirect. The literature search will be based on Patients, Intervention, Control, and Outcome (PICO) criteria, as mentioned in the following: Patients with any carpometacarpal arthritis; with the intervention of using carpometacarpal arthroplasty as their method of surgery; control with trapeziectomy and primary outcome of functional outcome. Clinical outcomes using patient-reported outcome measures and complications were included. The quality of the included studies was evaluated with Cochrane risk-of-bias assessment tools. Quantitative analysis was performed by Review Manager 5.4. Results Three studies met the inclusion criteria for the systematic review. Both treatments resulted in significant improvements in functional scores. When matching patients according to preoperative function, patients receiving arthroplasty had better postoperative function (Quick DASH: trapeziectomy = 25.1, ARPE = 16.8). Conclusion This study showed that variable results of clinical outcomes improved after trapezeictomy and arthroplasty in patients with CMC arthritis. Evidence showed that arthroplasty allows for a better improvement in functional outcome.
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Affiliation(s)
- Nucki Nursjamsi Hidajat
- Hand, upper Limb and microsurgery department, Hasan Sadikin Hospital, Padjadjaran University, Bandung, Indonesia
| | - Rio Aditya
- Orthopaedic & Traumatology department, Hasan Sadikin Hospital, Padjadjaran University, Bandung,Indonesia
| | - Widya Arsa
- Hand, upper Limb and microsurgery department, Hasan Sadikin Hospital, Padjadjaran University, Bandung, Indonesia
| | - Realita Malik
- Hand, upper Limb and microsurgery department, Hasan Sadikin Hospital, Padjadjaran University, Bandung, Indonesia
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3
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Liukkonen R, Karjalainen VL, Kvist R, Vaajala M, Ponkilainen V, Karjalainen T. Total joint arthroplasty for thumb carpometacarpal joint osteoarthritis: a systematic review and meta-analysis of randomized controlled trials. Acta Orthop 2024; 95:325-332. [PMID: 38887076 PMCID: PMC11184324 DOI: 10.2340/17453674.2024.40816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 04/13/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND AND PURPOSE Thumb carpometacarpal (CMC) joint osteoarthritis (OA) is increasingly treated with total joint arthroplasty (TJA). We aimed to perform a systematic review and meta-analysis of the benefits and harms of the TJA for thumb CMC OA compared with other treatment strategies. PATIENTS AND METHODS We performed a systematic search on MEDLINE and CENTRAL databases on August 2, 2023. We included randomized controlled trials investigating the effect of TJA in people with thumb CMC joint OA regardless of the stage or etiology of the disease or comparator. The outcomes were pooled with a random effect meta-analysis. RESULTS We identified 4 studies randomizing 420 participants to TJA or trapeziectomy. At 3 months, TJA's benefits for pain may exceed the clinically important difference. However, after 1-year follow-up TJA does not improve pain compared with trapeziectomy (mean difference 0.53 points on a 0 to 10 scale; 95% confidence interval [CI] 0.26-0.81). Furthermore, it provides a transient benefit in hand function at 3 months (measured with Disabilities of Arm, Shoulder, and Hand questionnaire, scale 0-100, lower is better) compared with trapeziectomy with or without ligament reconstruction tendon interposition. The benefit in function diminished to a clinically unimportant level at 1-year follow-up (4.4 points better; CI 0.42-8.4). CONCLUSION Transient benefit in hand function for TJA implies that it could be a preferable option over trapeziectomy for people who consider fast postoperative recovery important. However, current evidence fails to inform us if TJA carries long-term higher risks of revisions compared with trapeziectomy.
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Affiliation(s)
- Rasmus Liukkonen
- Faculty of Medicine and Health Technology, Tampere University, Tampere
| | | | - Reetta Kvist
- Central Finland Central Hospital Nova, Jyväskylä
| | - Matias Vaajala
- Faculty of Medicine and Health Technology, Tampere University, Tampere
| | | | - Teemu Karjalainen
- Central Finland Central Hospital Nova, Jyväskylä; Department of Hand and Microsurgery, Tampere University Hospital Tampere, Finland.
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Tosun SC, Pietzsch LB, Held M, Daigeler A, Eisler W. [Rhizarthrosis: Resection Arthroplasty versus Resection Suspension Arthroplasty - Still the Gold Standard?]. HANDCHIR MIKROCHIR P 2024; 56:219-226. [PMID: 38508223 DOI: 10.1055/a-2231-2279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024] Open
Abstract
Rhizarthrosis is one of the most common arthritic changes in the hand, which has led to the development of a large number of surgical methods in recent years. In addition to the traditional resection arthroplasty with tendon suspension or interposition, if needed, thumb saddle joint prostheses are being used more and more frequently. However, these are not an option for all patients such as those with severe osteoporosis, severe nickel allergy, insufficient height of the trapezium or STT osteoarthritis. This study examined whether the traditional surgical methods continue to have their "right to exist" or whether they will be replaced by prostheses. In a retrospective study with prospective data collection, 48 hands of 45 patients diagnosed with rhizarthrosis in stages II and III according to Eaton and Littler were clinically examined 2.5 years after resection arthroplasty/resection-suspension-interposition arthroplasty using flexor carpi radialis (FCR) or abductor pollicis longus (APL) tendon strips in the years 2015-2018. The postoperative outcome was assessed using mobility, grip strength, two-point discrimination, postoperative satisfaction with regard to pain and resilience, as well as the DASH and MHQ questionnaires. There were no significant differences in surgery duration, inability to work, time to full weight-bearing, pain, satisfaction, grip strength and mobility. Regardless of the surgical method used, patients achieved an almost free range of motion in the thumb and wrist as well as age-appropriate hand strength. Pain at rest was rare; 48% were pain-free during exercise. The DASH questionnaire scored 20.2, 13.9 and 22.1 points and the MHQ scored 76.3, 79.3 and 79.4 points. Hence, the traditional surgical techniques showed good postoperative results with high patient satisfaction. "Newer procedures" such as endoprosthesis offer promising results in terms of faster regeneration times. However, this is offset by a longer surgery time and higher material costs, which means that resection arthroplasty represents a long-established procedure with a low potential for complications and a lower revision rate and should continue to be used, especially if there are relative contraindications to an endoprosthesis.
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Affiliation(s)
- Saskia Carolin Tosun
- Klinik für Hand-, Plastische, Rekonstruktive und Verbrennungschirurgie, BG Klinik Tübingen, Tübingen, Germany
| | - Leonie Barbara Pietzsch
- Klinik für Hand-, Plastische, Rekonstruktive und Verbrennungschirurgie, BG Klinik Tübingen, Tübingen, Germany
| | - Manuel Held
- Klinik für Hand-, Plastische, Rekonstruktive und Verbrennungschirurgie, BG Klinik Tübingen, Tübingen, Germany
| | - Adrien Daigeler
- Klinik für Hand-, Plastische, Rekonstruktive und Verbrennungschirurgie, BG Klinik Tübingen, Tübingen, Germany
| | - Wiebke Eisler
- Klinik für Hand-, Plastische, Rekonstruktive und Verbrennungschirurgie, BG Klinik Tübingen, Tübingen, Germany
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5
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Herren DB, Beaulieu JY, Calcagni M, Erling C, Jung M, Kaulich A, Mühldorfer-Fodor M, Papaloïzos M, Rosenkranz A, Vögelin E, Marks M. [Current Trends in the Implantation of the Touch Prosthesis at the Thumb Carpometacarpal Joint: Results of the 1st German-Speaking User Meeting]. HANDCHIR MIKROCHIR P 2024; 56:201-211. [PMID: 38861975 PMCID: PMC11166473 DOI: 10.1055/a-2321-9426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 04/09/2024] [Indexed: 06/13/2024] Open
Abstract
The introduction of the new generation of thumb carpometacarpal (CMC I) joint implants for the treatment of CMC I osteoarthritis has significantly broadened the scope of hand surgery in recent years. However, the technical demands of the procedure and the many details that need to be considered require appropriate training and a learning curve. To share experiences with the Touch CMC I prosthesis, we held the first German-speaking CMC I joint prosthetics user meeting in Zurich. After some basic introductory lectures on biomechanics and the principles of prosthetic fitting of the CMC I joint, the various challenges associated with CMC I joint prosthetics were discussed in interactive expert panels. Subsequently, cases were discussed in small groups under expert guidance and the respective conclusions were discussed in plenary. The main results of this symposium are summarised in this manuscript.
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Affiliation(s)
| | - Jean-Yves Beaulieu
- Unité Chirurgie de la main, Hôpitaux universitaires de Genève, Genf,
Switzerland
| | - Maurizio Calcagni
- Klinik für Plastische Chirurgie und Handchirurgie, Universitätsspital
Zürich, Zürich, Switzerland
| | | | - Martin Jung
- Handchirurgie, OCM Orthopädische Chirurgie München, München,
Germany
| | - Axel Kaulich
- Handchirurgie, Hanusch Krankenhaus, Orthopädie und Traumatologie, Wien,
Austria
| | | | | | - Anton Rosenkranz
- Abteilung Orthopädie und Traumatologie, Krankenhaus St. Josef Braunau,
Braunau am Inn, Austria
| | - Esther Vögelin
- Universitätsklinik für Plastische- und Handchirurgie, Inselspital,
Bern, Switzerland
| | - Miriam Marks
- Lehre, Forschung und Entwicklung, Schulthess Klinik, Zürich,
Switzerland
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6
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Moradi A, Daliri M, Rezaeian A, Hafiz H, Hajiaghajani G, Hedjazi A, Akbarzadeh A. A new magnetic internal distractor: cadaveric study of changes in trapeziometacarpal joint forces. J Hand Surg Eur Vol 2024; 49:436-443. [PMID: 37882683 DOI: 10.1177/17531934231203301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
Distraction is a new treatment for trapeziometacarpal joint osteoarthritis. The purpose of this study was to test the efficiency of magnetic distraction using a new internal distractor in cadavers. The distractor consists of two magnets embedded inside titanium capsules that are implanted on either side of the trapeziometacarpal joint with the same poles facing each other, so that the force between the magnets distracts the joint. Intra-articular forces were recorded pre-implantation, immediately after implantation and again 10 minutes later. We also studied the changes in the forces before and after the procedure in different thumb positions. Our findings show that the trapeziometacarpal joint could be offloaded in all the studied trapeziometacarpal positions.
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Affiliation(s)
- Ali Moradi
- Orthopedics Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahla Daliri
- Orthopedics Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amin Rezaeian
- Orthopedics Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hamed Hafiz
- Mechanical Engineering Department, Ferdowsi University of Mashhad, Mashhad, Iran
| | | | - Arya Hedjazi
- Legal Medicine Research Center, Tehran, Iran, Legal Medicine Organization, Tehran, Iran
| | - Alireza Akbarzadeh
- Mechanical Engineering Department, Ferdowsi University of Mashhad, Mashhad, Iran
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7
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Van Geel P, Decramer A, Top A, Muermans S, Ryckaert T, Vanmierlo B. Thumb Arthroplasty as Reliable Long-term Solution for Trapeziometacarpal Osteoarthritis: A Minimum of 15 Years of Follow-up. Hand (N Y) 2024:15589447241233367. [PMID: 38389259 DOI: 10.1177/15589447241233367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
BACKGROUND In patients with symptomatic trapeziometacarpal (TMC) joint arthritis resistant to conservative treatment, surgical treatment can be advised. One of the many surgical treatment options is TMC arthroplasty. The Arpe prosthesis is one example of these TMC arthroplasties. METHODS This retrospective study evaluated patients who underwent TMC arthroplasty with the Arpe prosthesis after a minimum of 15 years of follow-up. Clinical, radiologic, and qualitative outcomes were assessed for 43 Arpe arthroplasties in 41 patients, of whom 2 had bilateral arthroplasties. The female to male ratio was 39:4. The mean follow-up time was 197 months (range = 180-225). RESULTS The cumulative survival rate after a mean of 16.5 years was 84%. Seven failures (16%) were registered, of which 5 during the first 3 years after primary surgery. All patients were successfully converted to a trapeziectomy. Quick Disabilities of the Arm, Shoulder and Hand score improved with 44.9 points and visual analogue pain score with 97% and 91% at rest and during exercise, respectively. CONCLUSIONS This series demonstrates that thumb arthroplasty is a reliable long-term solution for thumb base arthritis, with significant pain reduction and functional improvement, even after 15 years of follow-up.
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Affiliation(s)
- Pieter Van Geel
- Department of Orthopaedic Surgery, AZ Delta, Roeselare, Belgium
| | - Arne Decramer
- Department of Orthopaedic Surgery, AZ Delta, Roeselare, Belgium
| | - Alexander Top
- Department of Orthopaedic Surgery, AZ Delta, Roeselare, Belgium
| | - Stijn Muermans
- Department of Orthopaedic Surgery, AZ Delta, Roeselare, Belgium
| | | | - Bert Vanmierlo
- Department of Orthopaedic Surgery, AZ Delta, Roeselare, Belgium
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8
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Herren DB. Basal thumb arthritis surgery: complications and its management. J Hand Surg Eur Vol 2024; 49:188-200. [PMID: 38315137 DOI: 10.1177/17531934231197787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
The management of complications after surgery for basal thumb arthritis is sometimes challenging, and there are no clear recommendations on how to evaluate and manage patients with residual symptoms. The aim of the present article was to review the most common complications after surgery for basal thumb arthritis, with an emphasis on resection arthroplasty, joint replacement and joint fusion. In addition, possible management strategies for the different types of complications will be highlighted.
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Affiliation(s)
- Daniel B Herren
- Schulthess Klinik, Department of Hand Surgery, Zurich, Switzerland
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9
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Ghayyad K, Golovachev N, Sarli N, Hirsch D, Shojaie B, Kachooei AR. Effectiveness of Arthroscopic Debridement, Trapeziectomy, and Joint Replacement for Trapeziometacarpal Joint Osteoarthritis: A Meta-Analysis of Pre and Postoperative Pain Scores. Cureus 2024; 16:e54409. [PMID: 38510875 PMCID: PMC10954316 DOI: 10.7759/cureus.54409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2024] [Indexed: 03/22/2024] Open
Abstract
Trapeziometacarpal joint osteoarthritis (TMJO) affects up to 33% of postmenopausal women, leading to pain, reduced mobility, and grip strength, with initial treatments focusing on non-surgical options like injections, orthoses, and exercises before considering surgery. A major challenge in managing TMJO involves selecting the optimal surgical strategy that is customized to individual clinical conditions. This study aimed to compare the effectiveness of three common surgical interventions for TMJO in relieving pain, including arthroscopic debridement (AD), trapeziectomy (TRAP), and joint replacement (JR). PubMed, Cochrane, Embase, and MEDLINE databases were queried according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for studies that presented pain outcomes following intervention for TMJO. Pain scores were reported preoperatively and postoperatively using the visual analog scale (VAS). Inclusion criteria included studies published in Q1 and Q2 journals and those with a follow-up of > six months. The final selection comprised 18 studies with 763 patients treated with AD (n = 102, 13%), TRAP (n = 428, 56%), and JR (n = 233, 31%) between 2010 and 2023, with a mean follow-up period of 38 ± 28 months. The studies included a total of 24 groups, five of which received AD, 13 of which received TRAP, and six of which received JR. The mean preoperative VAS was 6.7 ± 1.7, and the mean postoperative VAS was 1.7 ± 1.3 for all groups (P < 0.001). The meta-analysis demonstrated a mean preoperative pain score of 5.8 (95% CI, 4.1-7.5) for AD, 6.6 (95% CI, 5.7-7.5) for TRAP, and 7.8 (95% CI, 7.0-8.7) for JR. Postoperatively, there was a mean pain score of 2.2 (95% CI, 0.1-4.2) for AD, 1.4 (95% CI, 1.1-1.7) for TRAP, and 0.9 (95% CI, 0.6-1.2) for JR. This study showed that, if appropriately indicated, joint preservation with AD may be as effective as TRAP and JR for reducing pain associated with TMJO in the short term. However, the rate of conversion or revision should be assessed in future studies.
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Affiliation(s)
- Kassem Ghayyad
- Orthopedic Surgery, Rothman Orthopaedics Florida at AdventHealth, Orlando, USA
| | - Nikita Golovachev
- Orthopedic Surgery, Rothman Orthopaedics Florida at AdventHealth, Orlando, USA
| | - Nathan Sarli
- Orthopedic Surgery, Rothman Orthopaedics Florida at AdventHealth, Orlando, USA
| | - David Hirsch
- Orthopedic Surgery, Rothman Orthopaedics Florida at AdventHealth, Orlando, USA
| | - Babak Shojaie
- Plastic and Reconstructive Surgery, Klinikum Bremen-Mitte, Gottingen University of Medical Science, Bremen, DEU
| | - Amir R Kachooei
- Orthopedic Surgery, Rothman Orthopaedics Florida at AdventHealth, Orlando, USA
- Orthopedics, University of Central Florida, Orlando, USA
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10
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Farkash U, Sakhnini M, Dreyfuss D, Tordjman D, Rotem G, Luria S. Failure Rate and Early Complications of Thumb Carpometacarpal Joint Replacement-A Multicenter Retrospective Study of Two Modern Implant Designs. J Clin Med 2023; 13:121. [PMID: 38202128 PMCID: PMC10779986 DOI: 10.3390/jcm13010121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 12/08/2023] [Accepted: 12/21/2023] [Indexed: 01/12/2024] Open
Abstract
Joint replacement arthroplasty for the treatment of thumb osteoarthritis is gaining popularity as recent studies have demonstrated better pinch and grip strength and faster rehabilitation. Our aim was to identify early complications in modern implant designs using a multicenter study. A total of 381 patients who underwent thumb carpometacarpal replacement surgery in six participating hospitals were enrolled. The complications included were fractures, dislocations, infections, tendon and nerve injuries, and complex regional pain syndrome. Major complications were defined as a failure to implant the prosthesis, revision surgery to remove the implant, and any other need for further surgical intervention. The secondary outcomes were any other complications treated non-surgically and the timing of the complications. Eleven procedures failed, and these patients were treated with trapeziectomies. Twelve other patients required repeat surgical interventions. Minor adverse events occurred in 25.4% of the cases, and transient irritation of the superficial radial nerve and De Quervain tendinopathy were the most prevalent complications. Although this cohort depicted the learning curves of multiple surgeons, our study demonstrated low short-term failure rates. An inability to achieve primary stability of the cup in the trapezium was the leading cause of failure. Dislocations and other major complications with modern implants were very few.
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Affiliation(s)
- Uri Farkash
- Hand Surgery Unit, Department of Orthopedic Surgery, Assuta-Ashdod University Hospital, Ashdod 7747629, Israel
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva 8499000, Israel
| | - Mojahed Sakhnini
- Department of Orthopedic Surgery, Rivka Ziv Medical Center, Safed 1304435, Israel;
| | - Daniel Dreyfuss
- Hand and Microsurgery Unit, Rambam Health Care Campus, Haifa 3525408, Israel;
- Rappaport Faculty of Medicine, Technion, Haifa 3525408, Israel
| | - Daniel Tordjman
- Hand Surgery Unit, Orthopedic Division, Tel-Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel;
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv 6139001, Israel;
| | - Gilad Rotem
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv 6139001, Israel;
- Department of Hand Surgery, Sheba Medical Center, Tel Hashomer 5262000, Israel
| | - Shai Luria
- Department of Orthopedic Surgery, Hadassah Medical Center, Jerusalem 9371125, Israel;
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112102, Israel
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11
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Herren DB, Marks M, Neumeister S, Schindele S. Short-term recovery after implant versus resection arthroplasty in trapeziometacarpal joint osteoarthritis. J Hand Surg Eur Vol 2023; 48:1048-1055. [PMID: 37477211 DOI: 10.1177/17531934231188407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
We compared the short-term recovery of patients treated with trapeziometacarpal joint (TMJ) implant arthroplasty versus resection-suspension-interposition (RSI) arthroplasty. Implant patients (n = 147) had a better 3-month postoperative brief Michigan Hand Outcomes Questionnaire (MHQ) score (mean 82) compared to RSI patients (n = 127), who had a mean score of 69. Key pinch strength at 3 months was also higher in the implant group compared to the RSI group (6.8 kg vs. 3.1 kg). At 1 year, both groups had similar brief MHQ scores, but key pinch remained higher in the implant group (7.0 kg vs. 3.9 kg [RSI]). After implant arthroplasty, employed patients returned to work after a mean of 44 days, which was significantly faster than the 84 days for RSI patients. Patients after TMJ implant arthroplasty recover significantly faster in the first 3 postoperative months compared to RSI patients. However, 1-year postoperative outcomes are similar for both cohorts, with key pinch strength remaining higher for patients with TMJ implant arthroplasty.Level of evidence: II.
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Affiliation(s)
- Daniel B Herren
- Department of Hand Surgery, Schulthess Klinik, Zurich, Switzerland
| | - Miriam Marks
- Department of Teaching, Research and Development, Schulthess Klinik, Zurich, Switzerland
| | - Sara Neumeister
- Department of Teaching, Research and Development, Schulthess Klinik, Zurich, Switzerland
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12
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Herren DB, Marks M, Neumeister S, Schindele S. Low complication rate and high implant survival at 2 years after Touch® trapeziometacarpal joint arthroplasty. J Hand Surg Eur Vol 2023; 48:877-883. [PMID: 37310049 DOI: 10.1177/17531934231179581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
We analysed complications, revision surgeries, and patient-reported and clinical outcomes 2 years after trapeziometacarpal joint implant arthroplasty using the Touch® prosthesis. Of 130 operated patients with trapeziometacarpal joint osteoarthritis, four had to be revised owing to implant dislocation, loosening or impingement, leading to an estimated 2-year survival rate of 96% (95% confidence interval: 90 to 99). Of 101 patients available for the 2-year follow-up, complications occurred in 17, with the most frequent being de Quervain stenosing vaginosis (n = 6) and trigger thumb (n = 5). Pain at rest decreased significantly from a median value of 5 (interquartile range [IQR]: 4 to 7) before surgery to 0 (IQR: 0 to 1) at 2 years. Key pinch strength increased significantly from 4.5 kg (IQR: 3.0 to 6.5) to 7.0 kg (IQR: 6.0 to 8.0). We recommend surgery with the Touch® prosthesis as the standard procedure for patients with isolated trapeziometacarpal joint osteoarthritis because of the high survival rate and promising outcomes at 2 years.Level of evidence: IV.
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Affiliation(s)
- Daniel B Herren
- Department of Hand Surgery, Schulthess Klinik, Zurich, Switzerland
| | - Miriam Marks
- Department of Teaching, Research and Development, Schulthess Klinik, Zurich, Switzerland
| | - Sara Neumeister
- Department of Teaching, Research and Development, Schulthess Klinik, Zurich, Switzerland
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13
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Frost CM, Suresh V, Padovano W, Luck JD, Quan A, Aravind P, Ingari JV, Laporte DM, Shores JT, Lifchez SD. Selective Thumb Carpometacarpal Joint Denervation Versus Trapeziectomy and Ligament Reconstruction With Tendon Interposition for Painful Arthritis: A Prospective Study With 2 Years of Follow-Up. J Hand Surg Am 2023; 48:853-860. [PMID: 37452814 DOI: 10.1016/j.jhsa.2023.05.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 04/27/2023] [Accepted: 05/17/2023] [Indexed: 07/18/2023]
Abstract
PURPOSE Thumb carpometacarpal (CMC) joint denervation is a relatively novel method for the management of osteoarthritis-associated pain by selective transection of articular nerve branches of the CMC joint. This study compared functional/patient-reported outcomes after CMC denervation with those after trapeziectomy and ligament reconstruction with tendon interposition (T + LRTI) over a 2-year follow-up period. We hypothesized that the outcomes of denervation and T + LRTI would be similar over the course of the study and at the final 2-year follow-up. METHODS Adults with Eaton stage 2-4 disease, no evidence of CMC subluxation, and no history of thumb injury/surgery were included. Pain scores, brief Michigan Hand Questionnaire (bMHQ), Kapandji score, 2-point discrimination, and grip/key/3-point pinch strength were measured at 3-, 6-, 12-, and 24-months after surgery. On average, T + LRTI patients underwent 7 weeks of splinting, with release to full activity at 3 months; denervation patients were placed in a soft postoperative dressing for 2 weeks, with release to full activity as tolerated at 3 weeks. RESULTS Thirty-three denervation and 20 T + LRTI patients were included. Preoperative characteristics were similar between both groups. Two denervation patients underwent secondary T + LRTI during the study period; one denervation patient underwent fat grafting to the CMC joint at an outside institution. Data prior to secondary surgeries were included in the analysis. The average tourniquet times (minutes) for denervation and T + LRTI were 43.5 ± 11.8 and 82.7 ± 14.2 minutes, respectively. For denervation and T + LRTI, the postoperative bMHQ scores were significantly higher than those at baseline at all time points. No significant differences were found between both groups for bMHQ, sensation, or strength measures. CONCLUSIONS Carpometacarpal denervation is well tolerated, with shorter tourniquet times and faster return to full activity than T + LRTI. For the study cohort, the conversion rate to T + LRTI at 2 years was 9%. Both procedures demonstrated durable improvement in bMHQ compared with the preoperative state with similar long-term outcomes over 2 years of follow-up. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic II.
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Affiliation(s)
- Chris M Frost
- Department of Plastic and Reconstructive Surgery, Johns Hopkins School of Medicine, Baltimore, MD
| | - Visakha Suresh
- Department of Plastic and Reconstructive Surgery, Johns Hopkins School of Medicine, Baltimore, MD
| | - William Padovano
- Department of Plastic and Reconstructive Surgery, Johns Hopkins School of Medicine, Baltimore, MD
| | - John D Luck
- Department of Plastic and Reconstructive Surgery, Johns Hopkins School of Medicine, Baltimore, MD
| | - Amy Quan
- Department of Plastic and Reconstructive Surgery, Johns Hopkins School of Medicine, Baltimore, MD
| | - Pathik Aravind
- Department of Plastic and Reconstructive Surgery, Johns Hopkins School of Medicine, Baltimore, MD
| | - John V Ingari
- Department of Orthopedic Surgery, Johns Hopkins School of Medicine, Baltimore, MD
| | - Dawn M Laporte
- Department of Orthopedic Surgery, Johns Hopkins School of Medicine, Baltimore, MD
| | - Jaimie T Shores
- Department of Plastic and Reconstructive Surgery, Johns Hopkins School of Medicine, Baltimore, MD
| | - Scott D Lifchez
- Department of Plastic and Reconstructive Surgery, Johns Hopkins School of Medicine, Baltimore, MD.
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Ling K, Fassler R, Burgan J, Komatsu DE, Wang ED. Readmission and Reoperation Following Carpometacarpal Arthroplasty. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2023; 5:661-666. [PMID: 37790819 PMCID: PMC10543817 DOI: 10.1016/j.jhsg.2023.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 06/21/2023] [Indexed: 10/05/2023] Open
Abstract
Purpose Carpometacarpal (CMC) arthroplasty is an effective surgical treatment for osteoarthritis of the CMC joint. Risk factors for readmission and reoperation have been studied for other joint arthroplasty procedures but have not yet been studied for CMC arthroplasty. The purpose of this study was to identify patient demographics and comorbidities associated with 30-day readmission and 30-day reoperation after CMC arthroplasty. Methods The American College of Surgeons National Surgical Quality Improvement Program database was queried for all records of patients who underwent CMC arthroplasty between 2015 and 2020. Variables collected in this study included patient demographics, comorbidities, surgical characteristics, and 30-day postsurgical complication data. Multivariate logistic regression was used to identify independent associations between patient characteristics and readmission and reoperation after CMC arthroplasty. Results In total, 6,432 records were included in this study: 34 (0.5%) were readmitted within 30 days, and 27 (0.4%) underwent reoperation within 30 days. Compared with the non-readmission cohort, the readmission cohort was significantly associated with higher rates of age ≥ 75 years (P = .003), body mass index (BMI) ≥ 40 kg/m2 (P = .005), American Society of Anesthesiologists classification (ASA) ≥ 3; P < .001), insulin-dependent diabetes (P = .016), and chronic obstructive pulmonary disease (COPD; P = .009). Compared with the non-reoperation cohort, the reoperation cohort was significantly associated with higher rates of age ≥ 75 years (P = .003), BMI ≥ 40 kg/m2 (P = .005), ASA ≥ 3 (P < .001), insulin-dependent diabetes (p = .016), and COPD (P = .009). Conclusion The clinically significant predictors for 30-day readmission and 30-reoperation after CMC arthroplasty were age ≥ 75 years, BMI ≥ 40 kg/m2, ASA ≥ 3, insulin-dependent diabetes, and COPD. Of these risk factors, age and BMI were identified as independent predictors for 30-day readmission. A better understanding of presurgical risk factors for postsurgical complications may help surgeons with risk stratification and optimization of outcomes. Type of study/level of evidence Prognostic III.
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Affiliation(s)
- Kenny Ling
- Department of Orthopaedics, Stony Brook University, Stony Brook, NY
| | - Richelle Fassler
- Renaissance School of Medicine at Stony Brook University, Stony Brook, NY
| | - Jane Burgan
- Renaissance School of Medicine at Stony Brook University, Stony Brook, NY
| | - David E. Komatsu
- Department of Orthopaedics, Stony Brook University, Stony Brook, NY
| | - Edward D. Wang
- Renaissance School of Medicine at Stony Brook University, Stony Brook, NY
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15
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Rath R, Haerle M, Stollberg C, Herrmann S, Lampert F. Denervation of the thumb carpometacarpal joint for symptomatic osteoarthritis in 46 patients. HAND SURGERY & REHABILITATION 2023; 42:51-55. [PMID: 36436810 DOI: 10.1016/j.hansur.2022.11.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 10/30/2022] [Accepted: 11/19/2022] [Indexed: 11/25/2022]
Abstract
We investigated the effect of an extended denervation procedure in the thumb carpometacarpal (CMC) joint in patients suffering from CMC osteoarthritis. Between 2006 and 2018, 46 patients underwent the procedure in our clinic and were included in this retrospective study. Pain, strength, range of motion, DASH score, complications and overall satisfaction were determined. Assessment showed a significant decrease in pain and excellent physical function at a median 5 years' follow-up. Twelve patients needed secondary surgery due to persistent pain. Overall, 28 of the 46 patients were satisfied with the results of the denervation. Even though the results of CMC denervation are poorer than with simple trapeziectomy, considerable pain relief can be achieved in selected young, physically active patients by exclusively soft-tissue surgery, conserving the biomechanical properties of the joint. In case of failure of the procedure, all other options remain available.
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Affiliation(s)
- R Rath
- Clinic for Hand Surgery and Plastic Surgery, Orthopädische Klinik Markgröningen, Kurt-Lindemann-Weg 10, 71706 Markgröningen, Germany; Clinic for Hand, Plastic and Aesthetic Surgery, Klinikum Bad Cannstatt, Prießnitzweg 24, 70374 Stuttgart, Germany.
| | - M Haerle
- Clinic for Hand Surgery and Plastic Surgery, Orthopädische Klinik Markgröningen, Kurt-Lindemann-Weg 10, 71706 Markgröningen, Germany.
| | - C Stollberg
- Clinic for Hand Surgery and Plastic Surgery, Orthopädische Klinik Markgröningen, Kurt-Lindemann-Weg 10, 71706 Markgröningen, Germany; Clinic for Plastic and Aesthetic Surgery, Pflugfelder Straße 22, 71636 Ludwigsburg, Germany.
| | - S Herrmann
- Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Strasse 55, 79106 Freiburg, Germany.
| | - F Lampert
- Clinic for Hand Surgery and Plastic Surgery, Orthopädische Klinik Markgröningen, Kurt-Lindemann-Weg 10, 71706 Markgröningen, Germany; Department of Plastic and Hand Surgery, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Strasse 55, 79106 Freiburg, Germany.
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16
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Abstract
Importance Carpal tunnel syndrome, trigger finger, de Quervain tenosynovitis, and basilar (carpometacarpal) joint arthritis of the thumb can be associated with significant disability. Observations Carpal tunnel syndrome is characterized by numbness and tingling in the thumb and the index, middle, and radial ring fingers and by weakness of thumb opposition when severe. It is more common in women and people who are obese, have diabetes, and work in occupations involving use of keyboards, computer mouse, heavy machinery, or vibrating manual tools. The Durkan physical examination maneuver, consisting of firm digital pressure across the carpal tunnel to reproduce symptoms, is 64% sensitive and 83% specific for carpal tunnel syndrome. People with suspected proximal compression or other compressive neuropathies should undergo electrodiagnostic testing, which is approximately more than 80% sensitive and 95% specific for carpal tunnel syndrome. Splinting or steroid injection may temporarily relieve symptoms. Patients who do not respond to conservative therapies may undergo open or endoscopic carpal tunnel release for definitive treatment. Trigger finger, which involves abnormal resistance to smooth flexion and extension ("triggering") of the affected finger, affects up to 20% of adults with diabetes and approximately 2% of the general population. Steroid injection is the first-line therapy but is less efficacious in people with insulin-dependent diabetes. People with diabetes and those with recurrent symptoms may benefit from early surgical release. de Quervain tenosynovitis, consisting of swelling of the extensor tendons at the wrist, is more common in women than in men. People with frequent mobile phone use are at increased risk. The median age of onset is 40 to 59 years. Steroid injections relieve symptoms in approximately 72% of patients, particularly when combined with immobilization. People with recurrent symptoms may be considered for surgical release of the first dorsal extensor compartment. Thumb carpometacarpal joint arthritis affects approximately 33% of postmenopausal women, according to radiographic evidence of carpometacarpal arthritis. Approximately 20% of patients require treatment for pain and disability. Nonsurgical interventions (immobilization, steroid injection, and pain medication) relieve pain but do not alter disease progression. Surgery may be appropriate for patients unresponsive to conservative treatments. Conclusions and Relevance Carpal tunnel syndrome, trigger finger, de Quervain tenosynovitis, and thumb carpometacarpal joint arthritis can be associated with significant disability. First-line treatment for each condition consists of steroid injection, immobilization, or both. For patients who do not respond to noninvasive therapy or for progressive disease despite conservative therapy, surgical treatment is safe and effective.
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Affiliation(s)
- Kelly Bettina Currie
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University in St Louis School of Medicine, St Louis, Missouri
| | - Kashyap Komarraju Tadisina
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University in St Louis School of Medicine, St Louis, Missouri
| | - Susan E Mackinnon
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University in St Louis School of Medicine, St Louis, Missouri
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