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Kurosawa A, Higuchi M, Tachiya H, Tada K, Murai A, Nishi T. Effective shape of ball-and-socket prosthesis in restoring range of thumb motion for total thumb carpometacarpal joint arthroplasty: three-dimensional motion analysis. BMC Musculoskelet Disord 2024; 25:607. [PMID: 39085859 PMCID: PMC11292886 DOI: 10.1186/s12891-024-07728-z] [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] [Received: 09/05/2023] [Accepted: 07/23/2024] [Indexed: 08/02/2024] Open
Abstract
PURPOSE Total joint arthroplasty (TJA) has often been used to treat thumb carpometacarpal (CMC) osteoarthritis (OA). However, guidelines for the CMC prosthesis shape remain unclear. This study aimed to identify the effective shape of a ball-and-socket prosthesis in restoring the range of thumb motion after TJA. METHODS The participants were 10 healthy young adult men (22-32 years; 26.8 ± 3.57 [mean ± SD]). CT scans were performed in eight static limb positions during abduction and flexion. We defined three design variables (offset R, height H, and neck rotation angle Φ) as the variables that determine the basic shape of the ball-and-socket prosthesis. The ideal values of these design variables were examined based on the results of a 3D motion analysis, which evaluated the change in the posture of the first metacarpal (r, h, and φ corresponding to R, H, and Φ, respectively) relative to the center of rotation (COR) during abduction and flexion. We also simulated the effect of these design variables on the range of thumb motion after TJA using 3D CAD. RESULTS We found that the values of r and h averaged over all limb positions were 6.92 ± 1.60 mm and 51.02 ± 1.67 mm, respectively, showing that these values remained constant regardless of limb position. In contrast, φ changed significantly. The simulation results indicated that Φ affected the range of thumb motion after TJA, and Φ = 0° relatively reproduced all limb positions compared to other values. CONCLUSION Our results suggested that the desirable values of R and H were the average of r and h over several limb positions and that Φ = 0° was effective in restoring the range of thumb motion after TJA. Our results will provide surgeons with new guidelines for selecting a prosthesis.
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Affiliation(s)
- Akihiro Kurosawa
- Graduate School of Natural Science and Technology, Kanazawa University, Kakuma-machi, Kanazawa-shi, Ishikawa, 920-1192, Japan
| | - Masahiro Higuchi
- Faculty of Frontier Engineering, Institute of Science and Engineering, Kanazawa University, Kakuma-machi, Kanazawa-shi, Ishikawa, 920-1192, Japan.
| | - Hiroshi Tachiya
- Advanced Mobility Research Institute, Kanazawa University, Kakuma-machi, Kanazawa-shi, Ishikawa, 920-1192, Japan
| | - Kaoru Tada
- Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, 13-1, Takara-Machi, Kanazawa-shi, Ishikawa, 920-8641, Japan
| | - Atsuro Murai
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1, Takara-Machi, Kanazawa-Shi, Ishikawa, 920-8641, Japan
| | - Taiki Nishi
- Graduate School of Natural Science and Technology, Kanazawa University, Kakuma-machi, Kanazawa-shi, Ishikawa, 920-1192, Japan
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Toffoli A, Degeorge B, Cloquell Y, Teissier P, Teissier J. MAÏA Trapeziometacarpal Joint Arthroplasty: Clinical and Radiological Outcomes of 76 Patients With More Than 10 Years of Follow-Up. J Hand Surg Am 2024:S0363-5023(24)00174-6. [PMID: 38935000 DOI: 10.1016/j.jhsa.2024.03.019] [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: 09/24/2023] [Revised: 03/04/2024] [Accepted: 03/27/2024] [Indexed: 06/28/2024]
Abstract
PURPOSE Trapeziometacarpal (TMC) joint replacement has become a valid option in the therapeutic arsenal of TMC joint osteoarthritis in Europe. Good mid-term results of the MAÏA TMC joint prosthesis suggested that it is a reliable procedure. This study aimed to assess the long-term results of this modular uncemented ball-and-socket hydroxyapatite-coated implant. METHODS This single-center retrospective study evaluated 92 MAÏA TMC joint prostheses in 76 patients with a minimum of 10 years of follow-up. Indications for the procedure were painful TMC joint osteoarthritis both at rest and during activity, despite nonsurgical treatment for more than six months. Pre- and postoperative clinical and radiographic outcomes were compared. RESULTS Mean follow-up was 134 months (range: 120-158 months). Mean age at the time of surgery was 67 years (range: 53-84 years). The cohort comprised 86.8% of women (n = 66). The mean Quick Disabilities of the Arm, Shoulder, and Hand score improved from 61.3 ± 17.1 to 19.6 ± 16. Range of motion was restored, and postoperative mobility was comparable with that of the contralateral side. Final Kapandji opposition score was almost normal (9.2 ± 0.7). Final key pinch and grip strength improved by 26% and 39%, respectively. Eight implants were surgically revised, six for trapezium cup loosening and two for instability because of polyethylene wear. Three cases of traumatic fracture of the trapezium in older patients were successfully treated with a cast for eight weeks. Five of 26 (20.8%) cases of preoperative-reducible z-deformity were not totally corrected after surgery. The Kaplan-Meier survival over 10 years was 88% (95% confidence interval: 84-93) versus 93% (95% confidence interval: 87-98) over 5 years. CONCLUSIONS MAÏA TMC joint prosthesis is a reliable long-term surgical procedure for TMC joint osteoarthritis, improving overall function beyond 10 years. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Adriano Toffoli
- Division of Hand, Shoulder, and Upper Extremity Surgery, Clinique Saint Jean Sud de France Montpellier Métropole, Saint Jean de Védas, France.
| | - Benjamin Degeorge
- Division of Hand, Shoulder, and Upper Extremity Surgery, Clinique Saint Jean Sud de France Montpellier Métropole, Saint Jean de Védas, France
| | - Yannick Cloquell
- Division of Hand, Shoulder, and Upper Extremity Surgery, Clinique Saint Jean Sud de France Montpellier Métropole, Saint Jean de Védas, France
| | - Philippe Teissier
- Division of Hand, Shoulder, and Upper Extremity Surgery, Clinique Saint Jean Sud de France Montpellier Métropole, Saint Jean de Védas, France
| | - Jacques Teissier
- Division of Hand, Shoulder, and Upper Extremity Surgery, Clinique Saint Jean Sud de France Montpellier Métropole, Saint Jean de Védas, France
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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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Piccirilli E, Primavera M, Salvati C, Oliva F, Tarantino U. Proposed Radiographic Parameters to Optimize Clinical Outcomes in Trapezio-Metacarpal Prosthesis Placement Using CT Imaging, with 1-Year Follow-Up. J Pers Med 2024; 14:585. [PMID: 38929806 PMCID: PMC11204668 DOI: 10.3390/jpm14060585] [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: 04/26/2024] [Revised: 05/19/2024] [Accepted: 05/22/2024] [Indexed: 06/28/2024] Open
Abstract
PURPOSE Addressing trapezio-metacarpal (TMC) osteoarthritis often involves considering TMC joint replacement. Utilizing TMC prostheses offers advantages such as preserving the thumb length and more accurately replicating the thumb's range of motion (ROM). TMC prostheses have an intrinsic risk of dislocation and aseptic loosening. Analyzing pre- and postoperative imaging can mitigate complications and improve prosthetic placement, providing insights into both successes and potential challenges, refining overall clinical outcomes. MATERIALS AND METHODS We conducted a prospective analysis of 30 patients with severe TMC arthritis treated with a Touch© (Kerimedical, Geneva, Switzerland) prosthesis in 2021-2023: X-ray and CT protocols were developed to analyze A) the correct prosthesis placement and B) its correlation with clinical outcomes (VAS, Kapandji and QuickDASH scores) by performing Spearman correlation analysis. RESULTS The average differences in trapezium height and M1-M2 ratio pre- and post-surgery were, respectively, 1.8 mm (SD ± 1.7; p < 0.001) and 0.04 mm (SD ± 0.04; p = 0.017). Pre-to-postoperative M1 axis length increased by an average of 2.98 mm (SD ± 3.84; p = 0.017). Trapezial cup sinking, indicated by the trapezium index, measured 4.6 mm (SD ± 1.2). The metacarpal index averaged at 11.3 mm (SD ± 3.3). The distance between the centers of the trapezium distal surface and the prosthesis cup was 2.23 mm (SD ± 1.4). The Spearman correlation analysis gave the following results: negative correlations were highlighted between postoperative VAS scores and the M1/M2 ratio and residual trapezium height (correlation coefficient: -0.7, p = 0.03 and -0.064, p = 0.03, respectively) at 6 months; a negative correlation was found at the 3-month mark between QuickDASH and the trapezium residual height (correlation coefficient: -0.07, p = 0.01); and a positive correlation was found for the trapezium index at 1 month (correlation coefficient: 0.07, p = 0.03) and 3 months (p = 0.04) using the Kapandji score. Similarly, we found a positive correlation between the distance between the prosthesis and trapezium centers and QuickDASH score at 1 and 3 months (correlation coefficient: 0.066, p = 0.03; correlation coefficient: 0.07, p = 0.05, respectively) and a positive correlation between prosthesis axis and the residual first metacarpal angle with QuickDASH score at 3 months (correlation coefficient: 0.07, p = 0.02). CONCLUSIONS Pre- and postoperative systematic imaging analysis should become a method for predicting complications and guiding recovery in TMC prosthesis: CT imaging could provide us with radiographical landmarks that are intrinsically linked to clinical outcomes. Further research is necessary to fuel a protocol for the correct intraoperative TMC prosthesis implantation.
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Affiliation(s)
- Eleonora Piccirilli
- Department of Orthopaedics and Traumatology Policlinico Tor Vergata, University of Rome “Tor Vergata”, 00133 Rome, Italy; (M.P.); (C.S.); (U.T.)
- Department of Clinical Sciences and Translational Medicine, University of Rome “Tor Vergata”, Via Mont-Pellier 1, 00133 Rome, Italy
| | - Matteo Primavera
- Department of Orthopaedics and Traumatology Policlinico Tor Vergata, University of Rome “Tor Vergata”, 00133 Rome, Italy; (M.P.); (C.S.); (U.T.)
| | - Chiara Salvati
- Department of Orthopaedics and Traumatology Policlinico Tor Vergata, University of Rome “Tor Vergata”, 00133 Rome, Italy; (M.P.); (C.S.); (U.T.)
| | - Francesco Oliva
- Department of Sport Traumatology, Università Telematica San Raffaele, 00166 Rome, Italy;
| | - Umberto Tarantino
- Department of Orthopaedics and Traumatology Policlinico Tor Vergata, University of Rome “Tor Vergata”, 00133 Rome, Italy; (M.P.); (C.S.); (U.T.)
- Department of Clinical Sciences and Translational Medicine, University of Rome “Tor Vergata”, Via Mont-Pellier 1, 00133 Rome, Italy
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Latelise B, Ben Brahim E, Prasil L, Freslon M. Complications of prosthesis versus trapeziectomy in trapeziometacarpal joint arthritis: A systematic review. HAND SURGERY & REHABILITATION 2024; 43:101672. [PMID: 38408727 DOI: 10.1016/j.hansur.2024.101672] [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: 12/12/2023] [Revised: 02/11/2024] [Accepted: 02/12/2024] [Indexed: 02/28/2024]
Abstract
OBJECTIVE Thumb osteoarthritis is a frequent pathology, mainly affecting the elderly. The surgical treatment initially described and having proved its worth is total trapeziectomy. Since the advent of trapeziometacarpal prostheses, several studies showed the non-inferiority of this technique on clinical criteria, with superiority in bone sparing, although neither technique demonstrated overall superiority. We therefore examined the specific complications of each surgical technique by analyzing their nature and prevalence through a review of the literature to compare them on these new parameters. METHODS Seventy-four of the 320 articles reviewed were included, 38 of which concerned trapeziectomy, and 36 concerned prostheses, for a total of 4,865 patients. They were original studies, involving adults undergoing trapeziometacarpal arthroplasty or trapeziectomy, published after 2015, reporting at least one well-described complication. RESULTS 6.13% of trapeziectomies presented severe complications (in particular thumb collapse and metacarpophalangeal hyperextension), 3.31% moderate complications and 1.90% minor complications, leading to a 2.0% revision rate. 23.88% of prostheses had severe complications (loosening, dislocation and wear), 5.06% moderate complications and 1.36% minor complications, leading to a 12.8% revision rate. In addition, we analyzed more recent prosthesis designs separately, and found lower prevalence of severe complications (16.56%) and revision surgery (4.3%). CONCLUSION Revision surgery for trapeziometacarpal prostheses is usually only a standard trapeziectomy with the same follow-up as first-line trapeziectomy, whereas revision surgery for trapeziectomies is much more complex and the results are uncertain. For this reason, we would reserve total trapeziectomy for revision surgeries and patients with low functional demand for whom a second surgery is not desirable. Further studies could confirm this attitude, especially focusing on the latest generation of dual mobility implants. LEVEL OF EVIDENCE: 1
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Affiliation(s)
- Benoît Latelise
- Department of Orthopedic Surgery, Poitiers University Hospital, 2 Rue de la Milétrie, 86000 Poitiers, France.
| | - Estelle Ben Brahim
- Department of Orthopedic Surgery, Poitiers University Hospital, 2 Rue de la Milétrie, 86000 Poitiers, France.
| | - Laure Prasil
- Department of Orthopedic Surgery, Poitiers University Hospital, 2 Rue de la Milétrie, 86000 Poitiers, France.
| | - Morgan Freslon
- Department of Orthopedic Surgery, Polyclinique de Poitiers, 1 Rue de la Providence, 86000 Poitiers, France.
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Hwang JS, Li Q, Kim J. A quantitative measurement of trapeziometacarpal joint pressure using a cadaveric model of lateral pinch. J Orthop Res 2022; 40:1523-1528. [PMID: 34664302 DOI: 10.1002/jor.25188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 09/13/2021] [Accepted: 09/30/2021] [Indexed: 02/04/2023]
Abstract
Trapeziectomy is performed for trapeziometacarpal (TMC) arthritis but decreased lateral pinch strength is a major source of discomfort after the surgery. The magnitude of the decrease is unclear, however, and how the pressure changes in the TMC joint is unknown. To investigate this relationship, we designed a cadaveric study to measure TMC joint pressure using a lateral pinch model, and quantitatively evaluated the effect of trapeziectomy on the pressure measurements. For 10 cadaveric forearms, physiologic forces were applied across the thumb TMC joint by loading five tendons, thereby simulating lateral pinch. Using pressure sensors, we measured the lateral pinch pressure and TMC joint pressure, which averaged 10.1 (range, 4.2-16.2) kg/cm2 and 2.0 (range, 0.8-4.4) kg/cm2 , respectively. A significant correlation between the measurements was found, with an average ratio of 19% (range, 10%-27%). After trapeziectomy and interposition of the tendon ball using flexor carpi radialis, the pressure measurements were repeated under the same conditions. Significant changes were found, which averaged 5.1 (range, 1.7-10.7) kg/cm2 for lateral pinch pressure and 15.0 (range, 5.6-25.6) kg/cm2 for TMC joint pressure. In conclusion, TMC joint pressure could be measured as the ratio relative to lateral pinch pressure using a cadaveric model. After trapeziectomy, the lateral pinch strength decreased, whereas the TMC joint pressure increased.
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Affiliation(s)
- Ji Sup Hwang
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Qingyuan Li
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Hand and Microsurgery, Tianjin Hospital, Tianjin, China
| | - Jihyeung Kim
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Republic of Korea
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Murai A, Kurosawa A, Tada K, Tachiya H, Tamai A, Akahane M, Matsuta M, Nakamura Y, Kawashima H, Tsuchiya H. Optimal Center of Rotation for Ball-And-Socket Thumb Carpometacarpal Arthroplasty Identified Using Three-Dimensional Kinematic Analysis: A Pilot Study. Front Bioeng Biotechnol 2022; 10:868150. [PMID: 35721848 PMCID: PMC9200493 DOI: 10.3389/fbioe.2022.868150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 05/13/2022] [Indexed: 11/18/2022] Open
Abstract
Total joint arthroplasty is one of the surgical option for thumb carpometacarpal (CMC) joint arthritis, however the optimal position the center of rotation (COR) has not been quantified. The purpose of this study is to identify ideal ball-and-socket thumb carpometacarpal joint implants and the optimal position of the COR. We obtained eight right thumb computed tomography images each from ten healthy men, comprising four images each of thumbs at various angles of flexion-extension and abduction-adduction. We reconstructed 3D bone models on 3D CAD, created virtual ball-and-socket implants with three variables (neck offset, implant height, neck rotation), and found the optimal COR where the position change in the COR was smallest across various thumb positions. When the offset was 4.5 mm, neck rotation angle was 130.6° from the radial side to the palmar side of the first metacarpal, and implant height from the distal end of the metacarpal was 43.6 mm, we could restore almost normal kinematics. This study could serve as a reference for implant development and surgical technique guidelines.
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Affiliation(s)
- Atsuro Murai
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
| | - Akihiro Kurosawa
- Institute of Science and Engineering, Faculty of Mechanical Engineering, Kanazawa University, Kanazawa, Japan
| | - Kaoru Tada
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
- *Correspondence: Kaoru Tada,
| | - Hiroshi Tachiya
- Institute of Science and Engineering, Faculty of Mechanical Engineering, Kanazawa University, Kanazawa, Japan
| | - Atsuya Tamai
- Institute of Science and Engineering, Faculty of Mechanical Engineering, Kanazawa University, Kanazawa, Japan
| | - Mika Akahane
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
| | - Masashi Matsuta
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
| | - Yuta Nakamura
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
| | - Hiroki Kawashima
- Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
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Sánchez-Crespo M, de la Red-Gallego M, Ayala-Gutiérrez H, Couceiro-Otero J, Rodríguez-Fernández J, del Canto-Alvarez F. Initial survival of the Isis® total trapeziometacarpal prosthesis with conical trunk threaded cups. Rev Esp Cir Ortop Traumatol (Engl Ed) 2021. [DOI: 10.1016/j.recote.2021.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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9
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Sánchez-Crespo MR, de la Red-Gallego MA, Ayala-Gutiérrez H, Couceiro-Otero J, Rodríguez-Fernández J, Del Canto-Alvarez FJ. Initial survival of the Isis® total trapeziometacarpal prosthesis with conical trunk threaded cups. Rev Esp Cir Ortop Traumatol (Engl Ed) 2021; 65:S1888-4415(21)00081-3. [PMID: 34148810 DOI: 10.1016/j.recot.2021.02.006] [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: 08/17/2020] [Revised: 01/20/2021] [Accepted: 02/10/2021] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The treatment of trapeziometacarpal osteoarthritis through the implantation of total trapeziometacarpal prostheses is in continuous expansion. The Isis® prosthesis is a trunk-conical threaded anchorage prosthesis. Our objective was to assess the functional results and survival of this implant for at least one year of follow-up. MATERIAL AND METHOD Prospective study on 53 Isis® prosthesis, implanted from april 2014 to january 2019. The Van Cappelle functional test, pain, strength, mobility, return to previous activity, radiological variables and placement of the trapezial component were evaluated. The surgical technique was performed with a guide wirefocused on the trapezius and control of the scopia. Observed complications were recorded and statistical analysis was performed. RESULTS Fifty-one implants (49 patients) were reviewed. Mean follow-up was 2.1 years (1-5.7). Van Cappelle's test, pain, mobility, and grip and clamp strength improved significantly, as did the distance between the metacarpal head and the trapezius base; 96% of the patients returned in less than 6 months to their activities. Minor complications, 3 De Quervain's tendinopathy and 2 intra-operative metacarpal and 2 trapezium fractures were recorded, and one carpal tunnel syndrome. There was no dislocation, mobilization, or implant infection. CONCLUSIONS The functional results of the Isis® prosthesis are excellent in the short term, far exceeding the first year of 100% of survival. The complications that arose were minor and few. The anchorage and placement of the trapezial component guided by scopia seem to be crucial for the good result.
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Affiliation(s)
- M R Sánchez-Crespo
- Servicio de Cirugía Ortopédica y Traumatología, Unidad de Mano y Muñeca, Hospital Universitario Marqués de Valdecilla, Santander, España; Universidad de Cantabria, Santander, España.
| | - M A de la Red-Gallego
- Servicio de Cirugía Ortopédica y Traumatología, Unidad de Mano y Muñeca, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - H Ayala-Gutiérrez
- Servicio de Cirugía Ortopédica y Traumatología, Unidad de Mano y Muñeca, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - J Couceiro-Otero
- Servicio de Cirugía Ortopédica y Traumatología, Unidad de Mano y Muñeca, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - J Rodríguez-Fernández
- Servicio de Cirugía Ortopédica y Traumatología, Unidad de Mano y Muñeca, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - F J Del Canto-Alvarez
- Servicio de Cirugía Ortopédica y Traumatología, Unidad de Mano y Muñeca, Hospital Universitario Marqués de Valdecilla, Santander, España; Universidad de Cantabria, Santander, España
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10
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Borgers A, Verstreken A, Vanhees M, Verstreken F. Primary endoprosthetic replacement of the arthritic CMC-1 joint. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2021; 33:228-244. [PMID: 34003322 DOI: 10.1007/s00064-021-00713-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 11/23/2020] [Accepted: 12/10/2020] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Osteoarthritis of the carpometacarpal (CMC)-1 joint is a common condition that can cause significant pain and functional problems. When nonoperative management fails, surgery may be indicated. Resection of the trapezium, often combined with soft tissue stabilization, is still considered the gold standard. But recovery time is often prolonged and a significant number of patients remain unsatisfied in the long term. Knowing that total endoprosthetic joint replacement is one of the most successful achievements of orthopedic surgery, many attempts have been made to produce a replacement for the CMC‑1 joint that provides a better outcome than trapeziectomy. INDICATIONS Eaton-Glickel stage 2-3 CMC‑1 osteoarthritis. CONTRAINDICATIONS Symptomatic pan-trapezial osteoarthritis (Eaton-Glickel stage 4), infection, young manual worker, poor bone quality or insufficient trapezium size. SURGICAL TECHNIQUE A dorsoradial approach to the CMC‑1 joint is used. Minimal resection of the trapezial and metacarpal articular surfaces, including osteophytes and loose bodies. Reaming of the trapezium and broaching of the metacarpal stem with dedicated instruments. Implantation of the endoprosthetic components. Selection of the correct neck length to ensure a stable joint. Closure of the capsule and skin. POSTOPERATIVE MANAGEMENT Immobilization of thumb for 2 weeks in a splint. Followed by a removable thumb CMC brace for 4 weeks, starting with gentle mobilization exercises. No forceful gripping or pinching the first 6 weeks. RESULTS A specific design-the uncemented, ball in socket, metal on polyethylene total joint replacement-has stood the test of time and successful long-term clinical and radiographic outcome results have been published. Recent comparative trials have shown better pinch strength, better pain relief and faster functional recovery, when compared to trapeziectomy with ligament reconstruction and tendon interposition. The incidence of complications such as dislocation, polyethylene wear and cup loosening is acceptable.
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Affiliation(s)
- Anton Borgers
- Orthopedic Department, AZ Turnhout Hospital, Turnhout, Belgium
| | | | - Matthias Vanhees
- Orthopedic Department, Antwerp University Hospital, Edegem, Belgium.,Orthopedic Department, AZ Monica Hospital, Antwerp, Belgium
| | - Frederik Verstreken
- Orthopedic Department, Antwerp University Hospital, Edegem, Belgium. .,Orthopedic Department, AZ Monica Hospital, Antwerp, Belgium.
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Ten Brinke B, Mathijssen NMC, Blom IF, Koster LA, Kraan GA. A radiostereometric and clinical long-term follow-up study of the surface replacement trapeziometacarpal joint prosthesis. BMC Musculoskelet Disord 2021; 22:148. [PMID: 33546653 PMCID: PMC7866696 DOI: 10.1186/s12891-021-03957-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 12/30/2020] [Indexed: 11/16/2022] Open
Abstract
Background The aim of this study was to determine long-term survival and clinical outcomes of the surface replacement trapeziometacarpal joint prosthesis (SR™TMC) and to evaluate implant migration using radiostereometric analysis (RSA). Methods In this clinical long-term follow-up study outcomes of ten patients who received the SR™TMC joint prosthesis were evaluated using DASH and Nelson scores, Visual Analogue Scale (VAS) of pain, and key pinch strength. RSA-radiographs were obtained direct postoperatively and 6 months, 1, 5 and 10 years postoperatively and were analyzed using model-based RSA software. Results During follow-up, two early revisions took place. Mean pre-operative DASH and Nelson scores were 54 (SD 15) and 54 (SD 17), improved significantly after 6 months (DASH 25 (SD 20), Nelson 75 (SD 18)) and remained excellent during long-term follow-up in all patients with a stable implant. At final follow-up, clinical scores deteriorated clearly in two patients with a loose implant in situ. Conclusions Long-term survival of the SR™TMC joint prosthesis is relatively poor. However, clinical outcomes improved significantly in the short-term and remained excellent in the long-term in those patients with a stable implant, but deteriorated clearly in case of loosening. The role of RSA in TMC joint arthroplasty is potentially valuable but needs to be further investigated. Several challenges of RSA in the TMC joint have been addressed by the authors and suggestions to optimize RSA-data are given. Trial registration This study was registered in the Netherlands Trial Register (NL7126).
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Affiliation(s)
- Bart Ten Brinke
- Department of Orthopaedic Surgery, Reinier de Graaf Groep, P.O. Box 5011, 2600, GA, Delft, The Netherlands.
| | - Nina M C Mathijssen
- Department of Orthopaedic Surgery, Reinier de Graaf Groep, P.O. Box 5011, 2600, GA, Delft, The Netherlands
| | - Ian F Blom
- Department of Radiology, Reinier de Graaf Groep, P.O. Box 5011, 2600, GA, Delft, The Netherlands
| | - Lennard A Koster
- Department of Orthopaedic Surgery, Leids Universitair Medisch Centrum, P.O. Box 5011, 2300, RC, Leiden, The Netherlands
| | - Gerald A Kraan
- Department of Orthopaedic Surgery, Reinier de Graaf Groep, P.O. Box 5011, 2600, GA, Delft, The Netherlands
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