1
|
Falkner F, Tümkaya AM, Thomas B, Böcker A, Aman M, Bickert B, Harhaus L, Panzram B. Resection arthroplasty versus dual mobility prosthesis in the treatment of trapeziometacarpal joint osteoarthritis: A 3 year non-randomized prospective study. J Orthop 2024; 57:72-78. [PMID: 38988723 PMCID: PMC11231515 DOI: 10.1016/j.jor.2024.06.005] [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: 05/13/2024] [Accepted: 06/09/2024] [Indexed: 07/12/2024] Open
Abstract
Purpose Resection arthroplasty (RA) is still the most common surgical intervention for the treatment of symptomatic trapeziometacarpal (TMC) joint osteoarthritis. The implantation of a dual mobility prosthesis may represent a joint function preserving alternative. The aim of the presented study is to prospectively compare the outcomes of RA with dual mobility prosthesis. Methods In this 2-center non-randomized prospective study, we compared results of RA (n = 22) with implantation of a dual mobility prosthesis (n = 49) (Touch®) at a minimum of 3-year follow-up. The patients underwent preoperative assessments and postoperative follow-up at 6 weeks, 3, 6, 12, 24, and 36 months. Comparisons were conducted, covering pain assessment via the visual analogue scale (VAS), thumb range of motion (ROM), pinch and grip strength, as well as functional scores and radiological examinations. Results The time intervals from surgery until absence of pain on the VAS (3 months: 3 vs 1, p = 0.0001), recovery of ROM in radial (3 months: 33° vs 42°, p = 0.0001), and palmar abduction (3 months: 33° vs 48°, p = 0.0001), were significantly longer for the RA group compared with the prosthesis group. At 3-year follow-up there was no significant difference in absence of pain, ROM and grip strength between both groups. Key pinch strength was significantly weaker in the RA group compared to prosthesis group at 3 months (2.6 kg vs 4.6 kg, p = 0.001), to 3-year follow-up (3.1 kg vs 5.7 kg, p = 0.0001). The final mean DASH (15.5 vs 13.2, p = 0.01) and MHQ scores (78 vs 82, p = 0.01) were significantly better in the prosthesis group. Conclusion Both techniques show high patient satisfaction in mid-term follow-up. Dual mobility TMC joint arthroplasty seems to be associated with a superior pinch strength and shorter time of recovery as compared to patients after RA.
Collapse
Affiliation(s)
- Florian Falkner
- Department of Hand and Plastic Surgery, Peripheral Nerve Surgery and Rehabilitation, BG Trauma Center Ludwigshafen, Ludwig-Guttmann-Strasse 13, 67071, Ludwigshafen, Germany
- Department of Hand and Plastic Surgery, Heidelberg University, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
| | - Arman Mahmut Tümkaya
- Department of Hand and Plastic Surgery, Peripheral Nerve Surgery and Rehabilitation, BG Trauma Center Ludwigshafen, Ludwig-Guttmann-Strasse 13, 67071, Ludwigshafen, Germany
- Department of Hand and Plastic Surgery, Heidelberg University, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
| | - Benjamin Thomas
- Department of Hand and Plastic Surgery, Peripheral Nerve Surgery and Rehabilitation, BG Trauma Center Ludwigshafen, Ludwig-Guttmann-Strasse 13, 67071, Ludwigshafen, Germany
- Department of Hand and Plastic Surgery, Heidelberg University, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
| | - Arne Böcker
- Department of Hand and Plastic Surgery, Peripheral Nerve Surgery and Rehabilitation, BG Trauma Center Ludwigshafen, Ludwig-Guttmann-Strasse 13, 67071, Ludwigshafen, Germany
- Department of Hand and Plastic Surgery, Heidelberg University, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
| | - Martin Aman
- Department of Hand and Plastic Surgery, Peripheral Nerve Surgery and Rehabilitation, BG Trauma Center Ludwigshafen, Ludwig-Guttmann-Strasse 13, 67071, Ludwigshafen, Germany
- Department of Hand and Plastic Surgery, Heidelberg University, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
| | - Berthold Bickert
- Department of Hand and Plastic Surgery, Peripheral Nerve Surgery and Rehabilitation, BG Trauma Center Ludwigshafen, Ludwig-Guttmann-Strasse 13, 67071, Ludwigshafen, Germany
- Department of Hand and Plastic Surgery, Heidelberg University, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
| | - Leila Harhaus
- Department of Hand and Plastic Surgery, Peripheral Nerve Surgery and Rehabilitation, BG Trauma Center Ludwigshafen, Ludwig-Guttmann-Strasse 13, 67071, Ludwigshafen, Germany
- Department of Hand and Plastic Surgery, Heidelberg University, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
| | - Benjamin Panzram
- Department of Orthopaedics, University of Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Germany
| |
Collapse
|
2
|
O'Halloran A, Tiedt L, Flannery O. Functional and patient reported outcomes of Pyrocardan implants for carpometacarpal osteoarthritis. Ir J Med Sci 2024:10.1007/s11845-024-03785-4. [PMID: 39160423 DOI: 10.1007/s11845-024-03785-4] [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: 07/19/2024] [Accepted: 08/08/2024] [Indexed: 08/21/2024]
Abstract
AIMS The primary aim of this study was to assess functional and patient reported outcomes among those with first carpometacarpal joint osteoarthritis treated with the Pyrocardan implant (Stryker-Wright Medical) in Ireland. The secondary aim of this study was to assess implant survival and revision rates. METHODS We conducted a single surgeon retrospective study assessing 40 Pyrocardan arthroplasties among 37 patients, with a minimum of 6 months follow-up. Patient reported outcomes were assessed via quick disability of the arm, shoulder and hand (quick DASH) questionnaire, the visual analog score (VAS) for pain, and patient rated wrist evaluation (PRWE) questionnaire. Functional scores were assessed via lateral key pinch strength and Kapandji scores. Implant survival, complication and revision rates were also recorded. RESULTS Forty Pyrocardan implants among 37 patients were included. Mean follow-up was 2.5 years with a 97.5% implant survival rate. One patient underwent revision to trapeziectomy and Weilby sling. Eighty-eight percent of survey responders admitted that they would undergo the operation again, and 75% declared a 75-100% improvement in symptoms. Post-operative pain scores include a mean VAS of 2.07, quickDASH of 22.82, and PRWE of 26.92. Of those tested, there was an average increase in post-operative lateral key pinch, and 89% obtained a post-operative Kapandji score equal to or better than pre-operative scores. CONCLUSIONS This is the first study assessing the Pyrocardan interpositional arthroplasty in Ireland. The implant appears to produce good functional and patient reported outcomes. There is high satisfaction and low revision rate, producing a reliable and successful surgical technique for treating CMC joint osteoarthritis.
Collapse
Affiliation(s)
- Aoife O'Halloran
- Department of Trauma and Orthopaedics, Connolly Hospital Blanchardstown, Dublin, Ireland.
| | - Lauren Tiedt
- Department of Trauma and Orthopaedics, Connolly Hospital Blanchardstown, Dublin, Ireland
| | - Olivia Flannery
- Department of Trauma and Orthopaedics, Connolly Hospital Blanchardstown, Dublin, Ireland
- Department of Trauma and Orthopaedics, National Orthopaedic Hospital Cappagh, Dublin, Ireland
| |
Collapse
|
3
|
Windhofer CM, Hirnsperger C, Lill M. [Base-of-thumb osteoarthritis: aspects to be considered with the indication of trapeziectomy and CMC I prosthesis]. HANDCHIR MIKROCHIR P 2024; 56:192-200. [PMID: 38861974 DOI: 10.1055/a-2316-8102] [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: 06/13/2024] Open
Abstract
Base-of-thumb osteoarthritis is the most frequent osteoarthritis of the hand requiring surgical treatment, although conservative treatment options should be exhausted before surgery. If the wear process progresses with continuing pain-related loss of thumb function, thus leading to a loss of function of the whole hand, surgical treatment is indicated. In 1947, Gervis published results after trapeziectomy and heralded the development of a multitude of different surgical procedures. The long time needed for rehabilitation is a major problem of trapeziectomy with or without tendon interposition and/or suspension. After the implementation of the first CMC I prosthesis by De la Caffiniere 50 years ago, a rapid development took place, leading to the current modular bipolar implants. Especially in the German-speaking world, there is still some scepticism regarding these prostheses, which is why this review aims to illuminate both surgical procedures with a special focus placed on the aspects of indication.
Collapse
Affiliation(s)
| | | | - Markus Lill
- Traumatologie, Praxisgemeinschaft Unfallchirurgie, Innsbruck, Austria
| |
Collapse
|
4
|
de Sire A, Marotta N, Sconza C, Lippi L, Drago Ferrante V, Respizzi S, Invernizzi M, Ammendolia A. Oxygen-ozone therapy for pain relief in patients with trapeziometacarpal osteoarthritis: a proof-of-concept study. Disabil Rehabil 2024:1-7. [PMID: 38644616 DOI: 10.1080/09638288.2024.2342491] [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: 11/23/2023] [Accepted: 04/05/2024] [Indexed: 04/23/2024]
Abstract
PURPOSE Trapeziometacarpal osteoarthritis (TMC-OA) is a prevalent hand disorder affecting a growing number of people worldwide. While a multidisciplinary approach might provide additional advantages, the analgesic and anti-inflammatory role of intra-articular oxygen-ozone (O2O3) injections combined with physical therapy is still unknown. To assess the impact of a multimodal therapeutic approach combining O2O3 injections with physical therapy in patients with TMC-OA. MATERIALS AND METHODS A prospective open-label study conducted in the Physical and Rehabilitation Medicine Unit of the "Renato Dulbecco" University Hospital of Catanzaro. We assessed patients with TMC-OA who had not responded to standard medical therapy. Participants received O2O3 therapy and targeted physical therapy for 4 weeks. Pain relief, muscle strength, and physical functioning were assessed at baseline and after 4, 12 and 24 weeks (respectively T0, T1, T2, and T3). RESULTS Seventeen patients with a mean age of 67.1 ± 6.1 years were included in the study. Short-term improvements in pain intensity were observed (T0: 6.221 ± 1.514; T1: 3.172 ± 1.1451; p < .001) and were maintained over a 24-week follow-up period (T0: 6.221 ± 1.514; T3: 4.393 ± 1.438; p: 0.006). Significant changes were reported also in terms of muscle strength and physical functioning. O2O3 therapy was well-tolerated with no adverse effects. CONCLUSIONS A combination of O2O3 injections and physical therapy might be considered in patients with TMC-OA. Further investigation is warranted to assess the effectiveness of O2O3 therapy in managing TMC-OA.
Collapse
Affiliation(s)
- Alessandro de Sire
- Physical and Rehabilitative Medicine Unit, Department of Medical and Surgical Sciences, University of Catanzaro "Magna Graecia", Catanzaro, Italy
- Research Center on Musculoskeletal Health, MusculoSkeletalHealth@UMG, University of Catanzaro "Magna Graecia", Catanzaro, Italy
| | - Nicola Marotta
- Research Center on Musculoskeletal Health, MusculoSkeletalHealth@UMG, University of Catanzaro "Magna Graecia", Catanzaro, Italy
- Physical and Rehabilitative Medicine Unit, Department of Experimental and Clinical Medicine, University of Catanzaro "Magna Graecia", Catanzaro, Italy
| | - Cristiano Sconza
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- IRCCS Humanitas Research Hospital, Milan, Italy
| | - Lorenzo Lippi
- Department of Scientific Research, Campus LUdeS Lugano (CH), Off-Campus Semmelweis University of Budapest, Budapest, Hungary
| | - Vera Drago Ferrante
- Physical and Rehabilitative Medicine Unit, Department of Medical and Surgical Sciences, University of Catanzaro "Magna Graecia", Catanzaro, Italy
| | - Stefano Respizzi
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- IRCCS Humanitas Research Hospital, Milan, Italy
| | - Marco Invernizzi
- Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont "A. Avogadro", Novara, Italy
- Dipartimento Attività Integrate Ricerca e Innovazione (DAIRI), Translational Medicine, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Antonio Ammendolia
- Physical and Rehabilitative Medicine Unit, Department of Medical and Surgical Sciences, University of Catanzaro "Magna Graecia", Catanzaro, Italy
- Research Center on Musculoskeletal Health, MusculoSkeletalHealth@UMG, University of Catanzaro "Magna Graecia", Catanzaro, Italy
| |
Collapse
|
5
|
Windhofer CM, Neureiter J, Schauer J, Zimmermann G, Hirnsperger C. Trapeziectomy versus Maïa Prosthesis in Trapeziometacarpal Osteoarthritis. J Wrist Surg 2024; 13:142-150. [PMID: 38505211 PMCID: PMC10948241 DOI: 10.1055/s-0043-1770793] [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: 10/18/2022] [Accepted: 05/29/2023] [Indexed: 03/21/2024]
Abstract
Background Osteoarthritis at the base of the thumb is the most frequent osteoarthritis of the hand. Trapeziectomy in a broad variety of surgical methods have been proposed to achieve pain reduction and improvement of thumb function. A well-known disadvantage is the long recovery time. Arthroplasty of the thumb carpometacarpal joint is a competing new method for this indication with different revision and complication rates reported. Purposes The aim of this study is to assess whether there are significant differences in outcome during the first 12 months and time return to work after either, implant of a Maïa joint prosthesis, or trapeziectomy with tendon interposition after Weilby. Patients and Methods This clinical follow-up study compares the efficacy of total basal joint replacement using the Maïa prosthesis with tendon interposition arthroplasty in 59 thumbs. Clinical, functional, and radiological results at preoperative, 3-, 6-, and 12-month postoperative are presented. Results We found a significant shorter return to work in the prosthesis group with 4.5 compared with 8.6 weeks. In addition to a significant difference in pain reduction with a better Mayo wrist score in the Maïa group after 3 months. The scores are closer after 6 months and nearly match after 12 months. Measurement of the pinch grip showed a parallel course. A radiological loosening of the cup in two patients was detected after 12 months. Conclusion Implantation of Maïa prosthesis enables a significant shorter recovery but is associated with the risk of loosening and higher costs. Level of Evidence Level IV, case-control study.
Collapse
Affiliation(s)
- Christian M. Windhofer
- Department Traumatology, AUVA Trauma Center Salzburg, Salzburg, Austria
- Ludwig-Boltzmann-Institute for Experimental and Clinical Traumatology in AUVA Trauma Research Center, Wien, Austria
| | - Johann Neureiter
- Department Traumatology, AUVA Trauma Center Salzburg, Salzburg, Austria
| | - Josef Schauer
- Department Traumatology, AUVA Trauma Center Salzburg, Salzburg, Austria
| | - Georg Zimmermann
- Team Biostatistics and Big Medical Data, IDA Lab Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria
- Research and Innovation Management, Paracelsus Medical University, Salzburg, Austria
| | | |
Collapse
|
6
|
Lirola-Palmero S, Salva-Coll G, Yáñez-Juan AM, Sánchez-Iriso E. Cost-effectiveness and cost-utility of the ball-and-socket trapeziometacarpal prosthesis compared to trapeziectomy and ligament reconstruction: study protocol for a randomized controlled clinical trial. Trials 2024; 25:220. [PMID: 38532422 PMCID: PMC10967180 DOI: 10.1186/s13063-024-08057-1] [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: 08/25/2023] [Accepted: 03/13/2024] [Indexed: 03/28/2024] Open
Abstract
BACKGROUND Trapeziometacarpal (TMC) osteoarthritis (OA) is a common cause of pain and weakness during thumb pinch leading to disability. There is no consensus about the best surgical treatment in unresponsive cases. The treatment is associated with costs and the recovery may take up to 1 year after surgery depending on the procedure. No randomized controlled trials have been conducted comparing ball and socket TMC prosthesis to trapeziectomy with ligament reconstruction. METHODS A randomized, blinded, parallel-group superiority clinical trial comparing trapeziectomy with abductor pollicis longus (APL) arthroplasty and prosthetic replacement with Maïa® prosthesis. Patients, 18 years old and older, with a clinical diagnosis of unilateral or bilateral TMC OA who fulfill the trial's eligibility criteria will be invited to participate. The diagnosis will be made by experienced hand surgeons based on symptoms, clinical history, physical examination, and complementary imaging tests. A total of 106 patients who provide informed consent will be randomly assigned to treatment with APL arthroplasty and prosthetic replacement with Maïa® prosthesis. The participants will complete different questionnaires including EuroQuol 5D-5L (EQ-5D-5L), the Quick DASH, and the Patient Rated Wrist Evaluation (PRWE) at baseline, at 6 weeks, and 3, 6, 12, 24, 36, 48, and 60 months after surgical treatment. The participants will undergo physical examination, range of motion assessment, and strength measure every appointment. The trial's primary outcome variable is the change in the visual analog scale (VAS) from baseline to 12 months. A long-term follow-up analysis will be performed every year for 5 years to assess chronic changes and prosthesis survival rate. The costs will be calculated from the provider's and society perspective using direct and indirect medical costs. DISCUSSION This is the first randomized study that investigates the effectiveness and cost-utility of trapeziectomy and ligament reconstruction arthroplasty and Maïa prosthesis. We expect the findings from this trial to lead to new insights into the surgical approach to TMC OA. TRIAL REGISTRATION ClinicalTrials.gov NCT04562753. Registered on June 15, 2020.
Collapse
Affiliation(s)
- Serafín Lirola-Palmero
- Departmen of Hand Surgery and Microsurgery, Hospital Universitari Son Espases, Ctra. Valldemosa 79, Palma de Mallorca, 07120, Spain.
| | - Guillem Salva-Coll
- Departmen of Hand Surgery and Microsurgery, Hospital Universitari Son Espases, Ctra. Valldemosa 79, Palma de Mallorca, 07120, Spain
| | | | | |
Collapse
|
7
|
Tovar-Bazaga M, Martínez-Ulloa A, Luengo-Alonso G, Maestro-Carvajal R, Cervera-Irimia J. Clinical Outcomes of Trapeziometacarpal Arthrodesis with a Mean 3-Year Follow-up. J Wrist Surg 2023; 12:522-527. [PMID: 38213562 PMCID: PMC10781569 DOI: 10.1055/s-0043-1764301] [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: 10/19/2022] [Accepted: 01/30/2023] [Indexed: 01/13/2024]
Abstract
Background This paper's purpose was to analyze clinical results obtained with trapeziometacarpal arthrodesis and complications comparing different osteosynthesis systems. Methods Thirty-seven trapeziometacarpal arthrodesis were performed in our center in a 7-year period, with a mean age of 52 years and 34 months of follow-up. The implants were distributed homogenously into three groups, using bone grafts in 12.5% of them. Results A 75% achieved complete consolidation with a mean postsurgical Visual Analog Scale (VAS) of 2.4, Kapandji Opposition Score (KOS) of 8.1, lateral pinch strength of 12.1 kg, tripod pinch strength of 3.6 kg, and tip-to-tip strength of 1.5 kg. Consolidation was not achieved in nine patients, of which five were asymptomatic, three reoperated on trapeziectomy and tenosuspension, and one rearthrodesis. No statistical association was found between the implant used and pseudoarthrosis ( p = 0.17), VAS ( p = 0.06), or KOS ( p = 0.45). Conclusions Trapeziometacarpal arthrodesis reduces pain for well-chosen patients. Nonunion has low clinical significance in most cases and does not seem to depend on the use of allograft or the type of implant but on an appropriate surgical technique.
Collapse
Affiliation(s)
- Miguel Tovar-Bazaga
- Department of Orthopaedic and Traumatology Surgery, Hand Surgery and Microsurgery Unit, IIS-Fundación Jiménez Díaz, Madrid, Spain
| | - Aarón Martínez-Ulloa
- Department of Orthopaedic and Traumatology Surgery, Hand Surgery and Microsurgery Unit, IIS-Fundación Jiménez Díaz, Madrid, Spain
| | - Gonzalo Luengo-Alonso
- Department of Orthopaedic and Traumatology Surgery, Hand Surgery and Microsurgery Unit, IIS-Fundación Jiménez Díaz, Madrid, Spain
| | - Rubén Maestro-Carvajal
- Department of Orthopaedic and Traumatology Surgery, Hand Surgery and Microsurgery Unit, IIS-Fundación Jiménez Díaz, Madrid, Spain
| | - Javier Cervera-Irimia
- Department of Orthopaedic and Traumatology Surgery, Hand Surgery and Microsurgery Unit, IIS-Fundación Jiménez Díaz, Madrid, Spain
| |
Collapse
|
8
|
Dong M, Kerkhof F, Deleu G, Vereecke E, Ladd A. Using a finite element model of the thumb to study Trapeziometacarpal joint contact during lateral pinch. Clin Biomech (Bristol, Avon) 2023; 101:105852. [PMID: 36521409 DOI: 10.1016/j.clinbiomech.2022.105852] [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: 07/28/2022] [Revised: 11/26/2022] [Accepted: 12/01/2022] [Indexed: 12/10/2022]
Abstract
BACKGROUND Finite element (FE) analysis is widely used in different fields of orthopaedic surgery, however, its application to the trapeziometacarpal joint has been limited due to the small size, complex biconcave-convex joint geometry, and complex musculature. The goal of this study was to improve upon existing models by creating a muscle-driven FE thumb model and use the model to simulate the biomechanical effect of hand therapy exercises and ligament reconstructive surgeries. METHODS Bone and cartilage geometry were based on a CT dataset of a subject performing a static lateral pinch task. A previously validated musculoskeletal model was utilized to extract electromyography (EMG)-driven muscle forces. Five ligaments with biomechanical significance were modeled as springs using literature values and attached according to their anatomical landmarks. FINDINGS The biomechanical consequence of various interventions was proxied as a change in the maximum cartilage stress. The result shows tightening the dorsal ligament complex (dorsal radial ligament, dorsal central ligament, posterior oblique ligament) is the most effective, achieving a stress reduction of 4.8%. Five exercises used in hand therapies were modeled, among which thenar eminence strengthening showed the most prominent stress reduction of 4.0%. Four ligament reconstructive surgeries were modeled, with Eaton-Littler reconstruction showed the most significant stress reduction of 25.0%. INTERPRETATION Among the routinely utilized treatment options for early thumb osteoarthritis, we found that three methods: dorsal ligament imbrication, thenar eminence exercise, and the Eaton-Littler method may confer biomechanical advantages cartilage loading. These advantages align with the clinically observed favorable outcomes.
Collapse
Affiliation(s)
- Meilin Dong
- Stanford University School of Medicine, Stanford, CA, USA.
| | - Faes Kerkhof
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Palo Alto, CA, USA
| | - GertJan Deleu
- Muscles & Movement, Biomedical Sciences Group, University of Leuven Campus Kulak, Kortrijk, Belgium
| | - Evie Vereecke
- Muscles & Movement, Biomedical Sciences Group, University of Leuven Campus Kulak, Kortrijk, Belgium
| | - Amy Ladd
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Palo Alto, CA, USA
| |
Collapse
|
9
|
Guerra Bresson H, Desmoineaux P, Maillot C, Delcourt T, Pujol N. Survey of practices in surgical management of trapeziometacarpal osteoarthritis in France in 2020. HAND SURGERY & REHABILITATION 2022; 41:613-623. [PMID: 35781064 DOI: 10.1016/j.hansur.2022.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 06/13/2022] [Accepted: 06/20/2022] [Indexed: 06/15/2023]
Abstract
The purpose of this study was to obtain an overview of French surgical practices for treating trapeziometacarpal osteoarthritis in 2020. An online survey was sent to 64 French hand surgeons: 32 authors of articles on carpometacarpal osteoarthritis of the thumb and 32 other surgeons randomly selected from the membership of the French Society of Hand Surgery (SFCM). The questions concerned demographic data, surgical practice, operative indications, choices for revision surgery, and eight clinical cases. The response rate was 56.2%. The most popular technique was trapeziometacarpal replacement (63.9%). During the previous 5 years, 31.6% of respondents had changed their practices, 69.2% of whom had adopted total joint replacement. Total trapeziectomy with ligamentoplasty and interposition was the second most frequent method. Most surgeons (77.8%) implemented medical treatment for 6 months to 1 year before resorting to surgery. In the clinical cases, agreement between surgeons was very low, with an overall inter-rater concordance coefficient of 0.182. Except for two cases (a young manual worker and a patient with a flattened trapezium) where no technique was significantly preferred, trapeziometacarpal replacement was chosen by a majority of respondents (p < 0.001). It was the most frequently performed surgical technique in France in 2020. However, there is no real consensus on choice of technique, which reflects the absence of guidelines.
Collapse
Affiliation(s)
- H Guerra Bresson
- Service de chirurgie orthopédique et traumatologique, Centre hospitalier de Versailles, 177 Rue de Versailles, 78150 Le Chesnay, France.
| | - P Desmoineaux
- Service de chirurgie orthopédique et traumatologique, Centre hospitalier de Versailles, 177 Rue de Versailles, 78150 Le Chesnay, France.
| | - C Maillot
- Service de chirurgie orthopédique et traumatologique, Hôpital Bichat-Beaujon, 46 Rue Henri Huchard, 75018 Paris, France
| | - T Delcourt
- Service de chirurgie orthopédique et traumatologique, Centre hospitalier de Versailles, 177 Rue de Versailles, 78150 Le Chesnay, France
| | - N Pujol
- Service de chirurgie orthopédique et traumatologique, Centre hospitalier de Versailles, 177 Rue de Versailles, 78150 Le Chesnay, France
| |
Collapse
|
10
|
Arthroscopic Hemitrapezectomy and Suspension with Mini TightRope for the Treatment of Rhizarthrosis: Outcome in patients in stages Eaton-Littler 2 to 3. REVISTA IBEROAMERICANA DE CIRUGÍA DE LA MANO 2022. [DOI: 10.1055/s-0042-1743512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
Abstract
Introduction Rhizarthrosis is a common cause of pain and impaired function of the hand. Most patients present an excellent response to the conservative treatment, although a small percentage requires a surgical procedure due to the persistence of symptoms. Different surgical procedures have been described; however, there is still no consensus in the literature regarding the superiority of one technique over the others.
Objective To evaluate the clinical and radiological results of patients with a diagnosis of rhizarthrosis in stages 2 to 3 of the Eaton-Littler classification, submitted to arthroscopic hemitrapezectomy and suspension with Mini TightRope (Arthrex, Naples, FL, US).
Materials and methods We conducted a retrospective evaluation of the clinical and radiological results of patients operated on through the technique proposed in Clínica INDISA, in Santiago, Chile, between 2017 and 2019. The pre- and postsurgical assessments were performed using the visual analog scale (VAS) for pain, the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, and the Kapandji score. The state of the articular cartilage was also evaluated intraoperatively according to the Badia classification.
Results A total of 12 patients (3 men and 9 women) met the inclusion criteria. Their mean age was 56 years, the mean duration of the follow-up was of 21 months. There were 7 patients in stage 2 and 5 in stage 3 according to the Eaton-Littler classification. Intraoperatively, there were 6 patients in stage II and 6 in stage III of the Badia classification. The mean preoperative score on the Kapandji index was of 3.6, and the mean postoperative score was of 9. The mean preoperative score on the VAS was of 8.8, and the mean postoperative score was of 1.2. The mean preoperative score on the DASH was of 33.3, and the mean postoperative score was of 4.7.
Conclusion Arthroscopic and suspension hemitrapezectomy with Mini TightRope for the treatment of stage 2-3 rhizarthrosis is a minimally-invasive, reproducible technique, effective in reducing pain and improving function, with sustained effects on the short and middle terms (6 to 36 months).
Collapse
|
11
|
Cerlier A, Guinard D, Gay AM, Legré R. Outcomes of secondary trapeziectomy after revision of trapeziometacarpal implants: a retrospective comparative matched study. J Hand Surg Eur Vol 2021; 46:1096-1100. [PMID: 34407692 DOI: 10.1177/17531934211039184] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We evaluated secondary trapeziectomy for revision of trapeziometacarpal implants and compared this to primary trapeziectomy with a matched retrospective single centre study performed between October 2003 and February 2015. Thirty-one patients with trapeziometacarpal prosthesis failure who had a secondary trapeziectomy were matched with a primary trapeziectomy regarding sex, date of the operation and age. We evaluated function, mobility, autonomy, pain, strength, complications and shortening of the thumb on radiographs. The median time until removal of the implant was 37 months. The median age in both groups was similar. Median follow-up was more than 7 years in both groups. There was no statistically significant difference in terms of function, mobility, autonomy, pain, strength, complications and shortening of the thumb. Secondary trapeziectomy after revision of trapeziometacarpal implants provides results comparable with primary trapeziectomy.Level of evidence: III.
Collapse
Affiliation(s)
| | - Didier Guinard
- Department of Hand Surgery, Upper Limb and Limb Reconstruction, Centre Hospitalo Universitaire La Timone, Marseille, France
| | - André M Gay
- Institut de la Main et du Member Superieur, Marseille, France
| | - Régis Legré
- Department of Hand Surgery, Upper Limb and Limb Reconstruction, Centre Hospitalo Universitaire La Timone, Marseille, France
| |
Collapse
|
12
|
Lavignac P, Legallois Y, Meynard P, Lacroix PM, Abi-Chahla ML, Bovet JL. Revision of failed trapeziometacarpal prothesis by CMI pyrocarbon implant: Retrospective study of 28 patients with a mean follow-up of 7.5 years. Orthop Traumatol Surg Res 2021; 107:102984. [PMID: 34116234 DOI: 10.1016/j.otsr.2021.102984] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 05/22/2020] [Accepted: 06/01/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION There is no consensus on the best salvage option after a failed trapeziometacarpal prothesis. Conserving the trapezium and inserting a pyrocarbon hemiarthroplasty implant will prevent thumb shortening and preserve the thumb's motion. The aim of this study was to evaluate the clinical and radiological outcomes in the medium term of trapeziometacarpal prothesis revisions done using the CMI pyrocarbon implant. PATIENTS AND METHODS This was a retrospective study of 28 patients with a mean age of 63.5 years. The mean time to revision was 6.1 years after the initial arthroplasty. The dominant side was operated in 70% of patients. The surgery consisted of removing the existing prosthesis, reconstructing the trapezium with a bone graft, and inserting the CMI pyrocarbon implant. The review consisted of a functional assessment (visual analog scale for pain, QuickDASH score, patient satisfaction), physical assessment (Kapandji, grip strength, key pinch strength, tip pinch strength) and radiological assessment (complications, radiolucent lines, scaphometacarpal height, implant centering, bone remodeling). RESULTS At a mean follow-up of 7.5 years, no further surgical revisions were needed. The mean QuickDASH score was 1.1 and the mean QuickDASH was 13%. Twenty-five patients (89%) were satisfied with the outcome. The Kapandji score improved significantly from 7.5 to 9.5 on average. Grip strength improved significantly from 16.7kg to 21.5kg on average. The mean postoperative key pinch strength was 93% of the contralateral side. The mean postoperative tip pinch strength was 88% of the contralateral side. There were no fractures or dislocations visible on the radiographs. However, there was bone remodeling in the trapezium related to the pyrocarbon implant's indentation that was well tolerated by patients in the medium term. CONCLUSION For revision of failed trapeziometacarpal prothesis, inserting the CMI pyrocarbon implant combined with trapezium reconstruction appears to be a good alternative to the more commonly used trapeziectomy procedure. Reconstructing the trapezium and inserting this hemiarthroplasty implant preserves the thumb's projection, length, and stability. The functional improvement experienced by patients makes this a relevant treatment option. LEVEL OF EVIDENCE IV; retrospective study without control group.
Collapse
Affiliation(s)
- Pierre Lavignac
- Service de chirurgie orthopédique et traumatologique, CHU de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux, France.
| | - Yohan Legallois
- Service de chirurgie orthopédique et traumatologique, CHU de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux, France
| | - Pierre Meynard
- Service de chirurgie orthopédique et traumatologique, CHU de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux, France
| | - Paul-Maxime Lacroix
- Service de chirurgie orthopédique et traumatologique, CHU de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux, France
| | - Marie-Laure Abi-Chahla
- Service de chirurgie orthopédique et traumatologique, CHU de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux, France
| | | |
Collapse
|
13
|
Lee JK, Yoon BH, Lee HI, Kim C, Choi S, Han SH. Prosthetic Replacement Has a Clinical Outcome Superior to That of Trapeziectomy With Ligament Reconstruction and Tendon Interposition: A Meta-Analysis. Orthopedics 2021; 44:e151-e157. [PMID: 33416899 DOI: 10.3928/01477447-20210104-06] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
A meta-analysis was performed to compare trapeziectomy with ligament reconstruction and tendon interposition (LRTI) vs prosthetic replacement for first carpometacarpal joint osteoarthritis. Seven prospective and retrospective comparison trials were retrieved. A total of 459 patients receiving trapeziectomy with LRTI and 374 patients receiving prosthesis replacement with a follow-up of 12 to 69 months were identified. There were no differences in visual analog scale scores or complications. However, the mean Disabilities of the Arm, Shoulder and Hand score was 3.73 points lower and the mean pinch power was 1.16 points higher in the prosthesis replacement group, and this was significant. Prosthetic replacement led to a superior clinical outcome compared with trapeziectomy with LRTI, with no difference in complications. [Orthopedics. 2021;44(2):e151-e157.].
Collapse
|
14
|
Inui S, Yoshizawa S, Shintaku T, Kaneko T, Ikegami H, Okuno Y. Intra-Arterial Infusion of Imipenem/Cilastatin Sodium through a Needle Inserted into the Radial Artery as a New Treatment for Refractory Trapeziometacarpal Osteoarthritis. J Vasc Interv Radiol 2021; 32:1341-1347. [PMID: 34242776 DOI: 10.1016/j.jvir.2021.06.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 06/23/2021] [Accepted: 06/27/2021] [Indexed: 10/20/2022] Open
Abstract
PURPOSE To evaluate the efficacy and safety of intra-arterial infusion of temporary embolic material with/without radiographic monitoring via a needle placed into the radial artery to occlude abnormal neovessels for trapeziometacarpal osteoarthritis. MATERIALS AND METHODS Thirty-one patients having Eaton stage II or III osteoarthritis, with a symptom duration longer than 6 months, resistant to conservative therapy for at least 3 months were prospectively enrolled. All procedures were performed by infusing imipenem/cilastatin sodium through a 24-gauge needle that was percutaneously inserted into the radial artery. Seven patients underwent the procedure with fluoroscopy, and 21 patients underwent the procedure without fluoroscopy. The mean Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score, numerical rating scale (NRS), and Patient Global Impression of Change (PGIC) scale were evaluated before and at 2, 6, and 24 months after the first procedure. RESULTS Technical success was 100%. The mean procedure time (from the beginning of local anesthesia to the removal of needle) was 2.9 minutes ± 1.6. The QuickDASH score improved from the baseline to 2, 6, and 24 months (49.2 ± 11.2 vs 22.1 ± 11.2, 20.9 ± 16.6, and 19.5 ± 16.1, respectively, all P <.001). The NRS improved from the baseline to 2, 6, and 24 months (7.2 ± 1.1 vs 3.1 ± 1.8, 2.8 ± 2, and 2.5 ± 2.1, respectively, all P <.001). Improvement on PGIC was observed in 84%, 81%, and 77% of patients at 2, 6, and 24 months, respectively. No major adverse events were encountered. CONCLUSIONS Intra-arterial infusion of temporary embolic material is a feasible treatment option for trapeziometacarpal osteoarthritis.
Collapse
Affiliation(s)
- Shohei Inui
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Shu Yoshizawa
- Department of Orthopedic Surgery, School of Medicine, Toho University, Tokyo, Japan; Musculoskeletal Intervention Center, Edogawa Hospital, Tokyo, Japan
| | - Takanori Shintaku
- Department of Orthopedic Surgery, School of Medicine, Toho University, Tokyo, Japan
| | - Takao Kaneko
- Department of Orthopedic Surgery, School of Medicine, Toho University, Tokyo, Japan
| | - Hiroyasu Ikegami
- Department of Orthopedic Surgery, School of Medicine, Toho University, Tokyo, Japan
| | - Yuji Okuno
- Musculoskeletal Intervention Center, Edogawa Hospital, Tokyo, Japan; Musculoskeletal Intervention Center, Okuno Clinic, Tokyo, Japan.
| |
Collapse
|
15
|
Ribeiro E, Ribau M, Ribeiro J, Varanda P, Rodrigues LF. Pyrocarbon Implant for Trapeziometacarpal Arthritis: Mid-term Clinical and Radiological Results. REVISTA IBEROAMERICANA DE CIRUGÍA DE LA MANO 2021. [DOI: 10.1055/s-0041-1729998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
AbstractPyrolytic carbon implants for trapeziometacarpal (TMC) arthritis have been extensively studied, but there is still discrepancy in the literature concerning the mid-term functional results. Our group describes the clinical and radiological results after five years of surgical management of TMC arthritis with Pyrodisk (Integra Life Sciences, Plainsboro, NJ, US). A total of 19 patients (2 males and 17 females) aged 56.45 ± 5.95 (range: 44 to 67) years were reviewed with a mean follow-up of 74.05 ± 14.43 (range: 60.00 to 105.83) months. At the final follow-up, the score on the Visual Analogue Scale (VAS) for pain was of 1.76 ± 2.05, the average score on the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire was of 22.73 ± 22.33, and all functional parameters were above the 90% barrier of the contralateral side. The progression of radiolucency was 89% at 1 year and 11% at 5 years of follow-up respectively, but it was not related to the clinical outcomes. The prevalence of subluxation (around one-fourth of the center of the implant) was of 24% in asymptomatic patients, and dislocation was not observed. The overall survival of the implant was of 89%. Revision took place in 11% of the cases due to persistent pain and implant breakage after direct impact. More than 75% of the patients were very or highly satisfied with the treatment. In conclusion, Pyrodisk enabled us to obtain good functional mid-term results, with an acceptable survival of the implant and low risk of dislocation. Radiological findings do not necessarily translate into clinical symptoms.
Collapse
Affiliation(s)
- Elisabete Ribeiro
- Departament of Orthopedics and Traumatology, Hospital de Braga, Braga, Portugal
| | - Melanie Ribau
- Departament of Orthopedics and Traumatology, Hospital de Braga, Braga, Portugal
| | - Juvenália Ribeiro
- Departament of Orthopedics and Traumatology, Hospital de Braga, Braga, Portugal
| | - Pedro Varanda
- Departament of Orthopedics and Traumatology, Hospital de Braga, Braga, Portugal
| | | |
Collapse
|
16
|
Tchurukdichian A, Gerenton B, Moris V, See LA, Stivala A, Guillier D. Outcomes of Double-Mobility Prosthesis in Trapeziometacarpal Joint Arthritis With a Minimal 3 Years of Follow-Up: An Advantage for Implant Stability. Hand (N Y) 2021; 16:368-374. [PMID: 31272202 PMCID: PMC8120594 DOI: 10.1177/1558944719855690] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: New generation of total trapeziometacarpal joint prosthesis using double mobility concept has been used for several years. The aim of this study was to evaluate the dislocation rate with this implant after a minimal 3 years of follow-up. Methods: From September 2013 to August 2015, 200 trapeziometacarpal prostheses were implanted in 179 patients. Clinico-radiological follow-up was performed with an average of 48.2 months (36-60 months). Survival rate and dislocation rate were analyzed. Loosening of the implants and other intercurrent events were noticed. Results: Visual analog scale, Quick-DASH, strengths and range of motion improved significantly. We report a survival rate of 97% with only 0.5% of dislocation of prosthesis at 48 months of follow-up. Intercurrent events rate were similar to the ones found in literature or other studies. Conclusions: After a minimal of 3 years of follow-up, prosthesis with double mobility seemed to bring better stability in implant for thumb prosthetic replacement.
Collapse
Affiliation(s)
- Alain Tchurukdichian
- Dijon University Hospital, France,Cliniques de Valmy et de Drevon, Dijon, France
| | | | | | | | | | - David Guillier
- Dijon University Hospital, France,David Guillier, Department of Plastic Reconstructive and Hand Surgery and Department of Oral and Maxillofacial Surgery, Dijon University Hospital, Boulevard de Lattre de Tassigny, F-21000 Dijon, France.
| |
Collapse
|
17
|
Rouveyrol M, de Villeneuve Bargemon JB, Levet P, Mattéi JC, Legré R, Jaloux C. Revision of trapeziectomy failures in thumb base osteoarthritis: retrospective analysis of ten cases and review of the literature. HAND SURGERY & REHABILITATION 2021; 40:464-471. [PMID: 33836280 DOI: 10.1016/j.hansur.2021.03.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 03/22/2021] [Accepted: 03/31/2021] [Indexed: 10/21/2022]
Abstract
Controversy persists around trapeziectomy as standard of care in thumb base osteoarthritis. The difficulty of management of failure requires the utmost caution in choice of the initial technique. We here report a retrospective series of 10 revision procedures following trapeziectomy, supported by a review of literature. The main cause of revision was collapse of the thumb column resulting in arthrogenic contact of the first metacarpal with the scaphoid. At a mean 73.3 months' follow-up, 5 patients had to undergo additional surgery. Mean VAS pain score was 2.9; 5 patients were pain-free. Strength was more severely impaired than joint motion, resulting in disappointing functional results. The present outcomes are consistent with the literature, which mostly comprises heterogeneous series, making it impossible draw conclusions to guide practice. The most common option seems to be to perform a new ligament procedure, with or without tendon or pyrocarbon interposition, and was the one that provided the only good result in the present series. Other techniques (composite graft, non-autogenic interposition, scaphometacarpal prosthesis) seem promising, and deserve large-scale evaluation. Thus, the gold-standard status of trapeziectomy should be weighed against the observation of these multi-operated patients in situations of therapeutic impasse. Should indications for first-line trapeziectomy be restricted, especially in patients with a revision risk factor? LEVEL OF EVIDENCE: 4.
Collapse
Affiliation(s)
- M Rouveyrol
- Chirurgie de la Main - Chirurgie Plastique Réparatrice des Membres, Hôpital de la Timone, 264 Rue Saint-Pierre, 13005 Marseille, France.
| | - J-B de Villeneuve Bargemon
- Chirurgie de la Main - Chirurgie Plastique Réparatrice des Membres, Hôpital de la Timone, 264 Rue Saint-Pierre, 13005 Marseille, France
| | - P Levet
- Chirurgie de la Main - Chirurgie Plastique Réparatrice des Membres, Hôpital de la Timone, 264 Rue Saint-Pierre, 13005 Marseille, France
| | - J-C Mattéi
- Chirurgie de la Main - Chirurgie Plastique Réparatrice des Membres, Hôpital de la Timone, 264 Rue Saint-Pierre, 13005 Marseille, France
| | - R Legré
- Chirurgie de la Main - Chirurgie Plastique Réparatrice des Membres, Hôpital de la Timone, 264 Rue Saint-Pierre, 13005 Marseille, France
| | - C Jaloux
- Chirurgie de la Main - Chirurgie Plastique Réparatrice des Membres, Hôpital de la Timone, 264 Rue Saint-Pierre, 13005 Marseille, France
| |
Collapse
|
18
|
Tchurukdichian A, Guillier D, Moris V, See LA, Macheboeuf Y. Results of 110 IVORY® prostheses for trapeziometacarpal osteoarthritis with a minimum follow-up of 10 years. J Hand Surg Eur Vol 2020; 45:458-464. [PMID: 31992116 DOI: 10.1177/1753193419899843] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The IVORY® prosthesis is a total trapeziometacarpal joint prosthesis used for the treatment of symptomatic trapeziometacarpal osteoarthritis. The aim of this prospective study was to evaluate its long-term outcomes with a minimum follow-up of 10 years. From 2004 to 2007, 110 trapeziometacarpal prostheses (95 patients) were implanted. The implant survival curve was constructed using the Kaplan-Meier method. Five patients were lost from follow-up and two died. Six prosthesis (5.5%) were removed after dislocation or fracture of the trapezium. The survival rate of the prosthesis was 95%. After 10 years, the mean visual analogue pain score was 0.24/10 and the key-pinch force was similar to the other hand. Dislocations occurred for eight implants (7.3%). No radiological loosening was noted. In conclusion, the long-term results with the IVORY® prosthesis are very satisfactory in terms of pain relief, function and survival. Level of evidence: II.
Collapse
Affiliation(s)
- Alain Tchurukdichian
- Service de Chirurgie Plastique, Reconstructrice et Esthétique et Chirugie de la Main, CHRU de Dijon, Dijon, France.,Chirurgie de la main, Cliniques de Valmy et de Drevon, Dijon, France
| | - David Guillier
- Service de Chirurgie Plastique, Reconstructrice et Esthétique et Chirugie de la Main, CHRU de Dijon, Dijon, France
| | - Vivien Moris
- Service de Chirurgie Plastique, Reconstructrice et Esthétique et Chirugie de la Main, CHRU de Dijon, Dijon, France
| | - Leslie-Ann See
- Service de Chirurgie Plastique, Reconstructrice et Esthétique et Chirugie de la Main, CHRU de Dijon, Dijon, France
| | - Yvan Macheboeuf
- Service de Chirurgie Plastique, Reconstructrice et Esthétique et Chirugie de la Main, CHRU de Dijon, Dijon, France
| |
Collapse
|
19
|
Lallemand B, Cheval D, Camps C, Merle M, Jager T. Outcome of Silicone Implant for Treatment After Failure of Primary Trapeziometacarpal Surgery. J Hand Surg Am 2020; 45:451.e1-451.e5. [PMID: 31818540 DOI: 10.1016/j.jhsa.2019.09.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Revised: 06/29/2019] [Accepted: 09/25/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the outcome of a silicone implant used after failure of primary trapeziometacarpal (TMC) surgery. METHODS We retrospectively reviewed 22 Tie-in silicone implants performed between January 2005 and December 2015. All silicone implants were used for revision after failure of TMC surgery. We determined the time between implantation and the date of diagnosis of the failed revision procedure (rupture, major wear, dislocation, or poor clinical tolerance). RESULTS Median survival was 2.15 years. Only 3 patients did not show wear, but one was lost after 1 year of follow-up. We found 10 cases with rupture of the implant, 5 with implant instability (subluxation or dislocation), 3 implants with abnormal wear, and 1 patient who reported residual pain. A total of 42% of failures were associated with silicone synovitis CONCLUSIONS: Survival of the Tie-in silicone implant in TMC revision surgery is poor; nearly half of implants failed at 2 years. The rate of silicone synovitis is also important because future revision might be more complex owing to bone loss. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
Collapse
Affiliation(s)
- Bernard Lallemand
- European Hand Institute, Kirchberg Hospital, Luxembourg, Luxembourg; Department of Orthopedics, Aspetar, Doha, Qatar.
| | - Damien Cheval
- Department of Orthopedics, Cornouaille Hospital, Quimper, France
| | - Christophe Camps
- European Hand Institute, Kirchberg Hospital, Luxembourg, Luxembourg
| | - Michel Merle
- European Hand Institute, Kirchberg Hospital, Luxembourg, Luxembourg
| | - Thomas Jager
- European Hand Institute, Kirchberg Hospital, Luxembourg, Luxembourg
| |
Collapse
|
20
|
Vissers G, Goorens CK, Vanmierlo B, Bonte F, Mermuys K, Fils JF, Goubau JF. Ivory arthroplasty for trapeziometacarpal osteoarthritis: 10-year follow-up. J Hand Surg Eur Vol 2019; 44:138-145. [PMID: 30227766 DOI: 10.1177/1753193418797890] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This prospective study investigates long-term functional outcome after total trapeziometacarpal joint replacement with the Ivory arthroplasty for trapeziometacarpal joint osteoarthritis. Clinical outcome, overall function, pain, and radiologic outcome after a minimum of 10 years were evaluated for 26 Ivory arthroplasty in 24 patients. Two patients had bilateral arthroplasties. The female to male ratio was 22:2, and the mean age was 71 years (range 57-83). The mean follow-up period was 130 months (range 120-142). Overall functioning as defined by the QuickDASH score and visual analogue pain score improved by 50% and 81%, respectively, when compared with the preoperative status. However, these outcomes deteriorated beyond 5 years after surgery. Long-term results suggest the Ivory arthroplasty to be a reliable treatment for trapeziometacarpal osteoarthritis since it improves overall function and reduces pain up to 10 years postoperatively. However, revision within 10 years after surgery was needed in four of 26 cases. Level of evidence: II.
Collapse
Affiliation(s)
- Gino Vissers
- 1 Department of Orthopaedics and Traumatology, Upper Limb Unit, Orthoclinic, AZ Sint-Jan Hospital, Bruges, Belgium
| | - Chul Ki Goorens
- 2 Department of Orthopaedics and Traumatology, Vrije Universiteit Brussel, Brussels, Belgium
| | - Bert Vanmierlo
- 1 Department of Orthopaedics and Traumatology, Upper Limb Unit, Orthoclinic, AZ Sint-Jan Hospital, Bruges, Belgium
| | - Francis Bonte
- 1 Department of Orthopaedics and Traumatology, Upper Limb Unit, Orthoclinic, AZ Sint-Jan Hospital, Bruges, Belgium
| | - Koen Mermuys
- 3 Department of Radiology, AZ Sint-Jan Hospital, Bruges, Belgium
| | | | - Jean F Goubau
- 1 Department of Orthopaedics and Traumatology, Upper Limb Unit, Orthoclinic, AZ Sint-Jan Hospital, Bruges, Belgium.,2 Department of Orthopaedics and Traumatology, Vrije Universiteit Brussel, Brussels, Belgium
| |
Collapse
|
21
|
Dauvissat J, Rizzo C, Lellouche H, Porterie J, Melac-Ducamp S, Locquet V, Travers V, Maillet B, Conrozier T. Safety and Predictive Factors of Short-Term Efficacy of a Single Injection of Mannitol-Modified Cross-Linked Hyaluronic Acid in Patients with Trapeziometacarpal Osteoarthritis. Results of a Multicentre Prospective Open-Label Pilot Study (INSTINCT Trial). CLINICAL MEDICINE INSIGHTS-ARTHRITIS AND MUSCULOSKELETAL DISORDERS 2018; 11:1179544118782901. [PMID: 29977118 PMCID: PMC6024274 DOI: 10.1177/1179544118782901] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 05/20/2018] [Indexed: 12/18/2022]
Abstract
Purpose: To assess safety and search predictive factors of efficacy of a single intra-articular injection of a mannitol-modified hyaluronic acid (HA) viscosupplement, in patients having trapeziometacarpal (TMC) osteoarthritis (OA). Methods: Patients with symptomatic TMC OA, not adequately relieved by analgesic therapy and/or by the use of a thumb splint, were included in a 3-month prospective multicentre open-label trial. All underwent plain radiographs with the Kapandji incidences allowing the Dell radiological grade assessment (1-4). Primary end point was the variation between injection (D0) and day 90 (D90) of the thumb pain (11-point Likert scale). Treatment consisted in a single injection of 0.6 to 1 mL of a viscosupplement made of a cross-linked HA combined with mannitol. All injections were performed under imaging guidance. Predictive factors of pain decrease were studied in univariate and multivariate analysis. Results: A total of 122 patients (76% women, mean age 60, mean disease duration 36 months) were included and 120 (98%) were assessed at 3 months. The TMC OA was of Dell’s grade 1, 2, 3, and 4 in 23%, 36.8%, 36.8%, and 3.5% of cases, respectively. At D0, the average (SD) pain level was 6.5 ± 1.6 without significant difference between Dell groups (P = .21). At day 90, pain decreased from 6.5 ± 1.6 to 3.9 ± 2.5 (difference −2.7 ± 2.5; −42%; P < .0001) without significant difference between Dell grade (P = .055), despite a seemingly smaller number of responders in stage 2 patients. The average analgesic consumption decreased in more than 1 out of 2 patients. In multivariate analysis, no predictor of response was identified. There was no safety issue. All adverse events (11%) were transient increase in pain during or following HA administration and resolved without sequel within 1 to 7 days. Conclusions: This study suggests that a single course of HANOX-M-XL injection is effective in relieving pain in patients with TMC OA, without safety concern. Patients with advanced stage of OA benefit the treatment as much as those with mild or moderate OA.
Collapse
Affiliation(s)
- Jérémy Dauvissat
- Service de Rhumatologie, Hôpital Nord Franche-Comté, Belfort, France
| | | | | | - Jérôme Porterie
- Service d'Orthopédie du membre supérieur, Cabinet de Rhumatologie, Auch, France
| | | | - Vincent Locquet
- Institut Chirurgical de la Main et du Membre Supérieur, Villeurbanne, France
| | | | - Bernard Maillet
- Service de Rhumatologie, Polyclinique Saint-Odilon, Moulins, France
| | - Thierry Conrozier
- Service de Rhumatologie, Hôpital Nord Franche-Comté, Belfort, France
| |
Collapse
|
22
|
Eltorai AEM, Han A. Current trends in the management of trapeziometacarpal arthritis. Orthop Rev (Pavia) 2017; 9:7195. [PMID: 29564072 PMCID: PMC5850058 DOI: 10.4081/or.2017.7195] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Revised: 07/25/2017] [Accepted: 08/08/2017] [Indexed: 11/30/2022] Open
Abstract
The purpose of this update is to report on a variety of topics related to trapeziometacarpal arthritis that have been recently investigated. The keyword trapeziometacarpal arthritis was utilized to query the PubMed database of the U.S. National Library of Medicine. From the resulting list, papers published from the beginning of April 2014 through the beginning of April 2017 were reviewed. The forty-five studies identified are reviewed here and referenced.
Collapse
Affiliation(s)
- Adam E M Eltorai
- Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Alex Han
- Warren Alpert Medical School of Brown University, Providence, RI, USA
| |
Collapse
|
23
|
Toffoli A, Teissier J. MAÏA Trapeziometacarpal Joint Arthroplasty: Clinical and Radiological Outcomes of 80 Patients With More than 6 Years of Follow-Up. J Hand Surg Am 2017; 42:838.e1-838.e8. [PMID: 28711157 DOI: 10.1016/j.jhsa.2017.06.008] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Revised: 05/15/2017] [Accepted: 06/07/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE Trapeziometacarpal (TMC) total joint replacement is increasingly being performed in Europe. MAÏA TMC total joint arthroplasty is a modular uncemented ball-and-socket hydroxyapatite-coated implant. This study assessed the midterm clinical and radiological results of the MAÏA TMC prosthesis. METHODS This single-center retrospective study involved 80 patients who underwent 96 MAÏA TMC prosthesis implantations from February 2006 to April 2009, and who had a minimum of 5 years' follow-up. Indications for the procedure were painful TMC joint osteoarthritis affecting activities of daily living and a failure of at least 6 months of nonsurgical treatment. Pre- and postoperative clinical and radiographic data were reviewed. RESULTS The mean age at surgery was 68 years (range, 53-84 years) and the median follow-up was 76 months (range, 60-102 months). The mean Quick Disabilities of the Arm, Shoulder, and Hand score improved from 61.3 ± 17.1 to 17.5 ± 16. The mobility of the thumb was restored to a range of motion comparable with that of the contralateral thumb. Opposition, defined by the Kapandji score, was almost normal (9.2 of 10; range, 6-10), as was the final mean key pinch and grip strength, which improved by 26% and 43%, respectively. Among the 96 implants, 4 (4.2%) were surgically revised for trapezium loosening. One dislocation was treated with closed reduction; 3 (3.1%) posttraumatic trapezium fractures were immobilized for 8 weeks. Among the 26 preoperative reducible z-deformities, only 5 (19.2%) were not totally corrected after surgery. The procedure success, by survival analysis over 6 years, was 93% (95% confidence interval, 87-98). CONCLUSIONS MAÏA TMC total joint arthroplasty may be a reliable treatment option for TMC joint osteoarthritis, with very good results for pain relief, strength, mobility, and restoration of the thumb length, providing correction of most thumb z-deformities. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
Collapse
Affiliation(s)
- Adriano Toffoli
- Division of Hand and Upper Extremity Surgery, Department of Orthopaedics, Lapeyronie University Hospital, Montpellier, France.
| | - Jacques Teissier
- Division of Shoulder, Hand and Upper Extremity Surgery, Clinique Beau Soleil, Polyclinique Saint Jean, Montpellier, France
| |
Collapse
|