De Quervain Tenosynovitis Following Trapeziometacarpal Ball-and-Socket Joint Replacement

TOUCH® duo-mobile prosthesis in TMC osteoarthritis: two-year results and practical insights regarding key surgical steps and complication management

INTRODUCTION

The Touch® dual-mobility prosthesis is a well-established treatment for advanced trapeziometacarpal (TMC) joint osteoarthritis, offering an alternative to resection arthroplasty. Short-term studies suggest dual-mobility designs reduce dislocation and loosening compared to single-mobility prostheses. This retrospective study presents clinical outcomes after a mean follow-up of 24 months, focusing on revision surgery and providing insights about key surgical steps and the management of adverse events.

MATERIALS AND METHODS

A total of 78 patients (88 prostheses) with TMC osteoarthritis underwent surgery between August 2019 and December 2023, performed by a single surgeon in a monocentric setting. Preoperative assessments and follow-ups were conducted at 6 weeks, 6 months, 12 months, and annually. Outcome measures included radiographic analysis, range of motion, grip/pinch strength, pain (NRS 1-10), and functional scores (qDASH, briefMHQ). Complications and revisions were recorded.

RESULTS

At a mean follow-up of 24 months (range 6-61 months), significant improvements in hand function, pain, and mobility were observed. Preoperative thumb MCP hyperextension (> 15° in 23 thumbs) was corrected to 6° on average, and thumb length was restored. Four patients (4.5%) required implant revision: two due to secondary cup dislocation after misplacement, two due to impingement. Seven secondary surgeries addressed wound healing disorders (n = 2) and secondary De Quervain tenosynovitis (n = 5). Kaplan-Meier analysis showed a 96% prosthesis survival rate at two years.

CONCLUSIONS

The Touch® dual-mobility prosthesis demonstrates high effectiveness in improving pain, function, and thumb stability, with low revision rates. Restoration of thumb length and correction of hyperextension support its use as a reliable surgical option. These findings are consistent with existing literature suggesting superior long-term stability compared to single mobility implants. Identified surgical challenges highlight factors contributing to complications and emphasize intraoperative strategies to prevent revision.

Dual mobility trapeziometacarpal prosthesis: A review of the current literature

Osteoarthritis of the first carpometacarpal joint is a common condition affecting up to 70% of the general population, with symptomatic disease occurring in 6% of cases, predominantly in postmenopausal women. Among the therapeutic options, total prosthetic replacement of the trapeziometacarpal joint is gaining prominence. The aim of this review is to provide a comprehensive update on dual mobility total arthroplasty of the trapeziometacarpal joint. PubMed, Google Scholar, and MEDLINE were searched for relevant publications that addressed the outcomes of dual mobility trapeziometacarpal prostheses. The Methodological Index for Non-Randomized Studies (MINORS) was used to assess the risk of bias. The effect model (EM) was calculated using the Cohen's d index. Ten studies with a total of 931 patients were included. Two prosthetic models were implanted (Moovis and Touch). Of the 931 implants, 25 failed (2.7%) and required surgical revision. The pooled random EM was 34.15 (95% CI, 23.53;44.77, I2 = 99%) for QuickDASH, -2.36 (95% CI, -4.24; -0.47, I2 = 99%) for Kapandji score, -7.49 (95% CI, -8.94; -6.04, I2 = 82%) for grip strenght, and -2.43 (95% CI, -2.92; -1.94, I2 = 91%) for key-pinch strenght. Dual mobility provides a good functional outcome in terms of range of motion and early recovery of pinch and grip strength, with a lower rate of dislocation compared to standard surgical procedures, and should be considered in patients with advanced trapeziometacarpal osteoarthritis with moderate functional demands.

Total joint arthroplasty of the thumb CMC joint

PURPOSE OF THE STUDY

Rhizarthrosis-osteoarthritis of the thumb carpometacarpal (CMC) joint is usually a primary idiopathic disease. Total joint arthroplasty (TJA) is one of the surgical treatment options for symptomatic advanced thumb CMC arthritis. This retrospective study aims to evaluate the mid-term functional and radiological results of TJA with the minimum follow-up period of 3 years after the surgery.

MATERIAL AND METHODS

Presented are the results of 136 total trapeziometacarpal joint replacements in the group of 105 patients consisted of 96 women and 9 men. Used prostheses were ELiS® implant (27 cases), Ivory® implant (42 cases), Touch® Dual mobility (67 cases). The follow-up period was minimally 3 years postoperatively. In all the patients, along with range of motion and radiologic evaluation of implant position, the function and pain of operated joint were evaluated using DASH and VAS score at regular intervals pre- and postoperatively.

RESULTS

At a mean of 85 months (range 38-126 months) post-operatively, patients in 116 cases (85%) reported full satisfaction and absence of symptoms and difficulties. In 12 cases (9%) some slight residual post-exercise pain was reported. In eight cases (6%) patients suffered from episodic rest-pain, but with a lower intensity than in the preoperative period. Postoperatively, the patients declared subjective improvement in hand function. The total DASH score and VAS score decreased in all patients, while ROM increased. The course of all of TJA surgeries was complication-free. Five patients needed revision surgery. In two patients a dislocation has occurred and in three cases a loosening of the cup's implant was reported. The most frequent postoperative complication was the occurrence of transient paraesthesias of the thumb in eight cases (6%).

CONCLUSIONS

TJA is the method of choice in management of advanced symptomatic osteoarthritis of the thumb CMC joint. Mastering surgical technique, TJA represents safe and effective treatment method in advanced degenerative changes of the thumb CMC joint and it's benefits exceed possible perioperative and postoperative risks.

Immobilization, rehabilitation and complications classification after thumb trapeziometacarpal total joint arthroplasty. A scoping review

The best way of immobilization as well as effectiveness of rehabilitation for trapeziometacarpal total joint arthroplasty is unknown. We aimed to identify and describe the available evidence, practice variation and knowledge gaps. The literature was searched without restrictions. 123 studies were included, reporting 21 types of prosthesis. Reported immobilization types were cast (23%), splint (18%), compression bandage (10%), or combinations (26%). In 19%, immobilization time and type was not reported. Supervised rehabilitation (22%), self-rehabilitation (11%), functional use (11%), or customized rehabilitation (16%) were the rehabilitation forms reported. In 28% rehabilitation type was not described. Two (2%) studies used complication classifications, but time to complication was not described in 53 (43%). Multiple evidence gaps exist; lacking studies comparing types of immobilization protocols as well as rehabilitation regimens after trapeziometacarpal total joint arthroplasty. Currently there is no scientific evidence for any postoperative regime. This means that decision-making is based on clinical experience rather than evidence, explaining the wide practice variation.

De Quervain's Tendinitis Following Trapeziectomy for the Management of Trapeziometacarpal Arthritis: A Case Report

De Quervain's tendonitis develops when multiple factors coincide, causing the entrapment of two valuable tendons responsible for the normal range of motion of the thumb. Consequently, symptoms such as pain in the radial side of the wrist and difficulty in grasping and pinching manifest. This case report aims to discuss the presentation of De Quervain's tendinitis following trapeziectomy with suspensionplasty using the Mini TightRope implant (Arthrex, Inc., Naples, USA) for the management of trapeziometacarpal arthritis.

De Quervain's tendinitis after trapeziometacarpal arthroplasty

OBJECTIVES

De Quervain's tendinitis is frequently observed after placement of a trapeziometacarpal prosthesis. The aim of this study was to investigate the relationship between De Quervain's tendinitis, osteoarthritis of the thumb and placement of a trapeziometacarpal prosthesis. The second aim was a critical analysis of the literature in search of a cause for this postoperative event after arthroplasty or trapeziectomy.

METHODS

We reviewed a series of 331 trapeziometacarpal prostheses.

RESULTS

There were no differences in thumb column length, gender, type of neck (straight or angled), or surgical approach between patients who developed De Quervain's tendinitis and those who did not. However, the frequency of De Quervain's tendinitis was much higher after arthroplasty than trapeziectomy.

CONCLUSIONS

We believe that the preoperative frequency of De Quervain's tendinitis in trapeziometacarpal osteoarthritis is underestimated, being part of a more general pain symptomatology. More precise and specific examination is needed for a better preoperative diagnosis. Trapeziometacarpal osteoarthritis should be considered within a more global framework of peri-trapeziometacarpal pathology, including the trapeziometacarpal and triscaphoid levels, the articular ligaments and the abductor pollicis longus, extensor pollicis brevis, flexor pollicis longus, and flexor carpi radialis tendons.

Comparative Analysis of Prosthetic (Touch) and Arthroplastic Surgeries for Trapeziometacarpal Arthrosis: Functional Outcomes and Patient Satisfaction With a 2-Year Follow-Up

Purpose

Trapeziometacarpal (TMC) joint prosthesis poses its own challenges for the treatment of TMC arthrosis, especially when compared with the present gold standard, arthroplasty. The aim of this study was to highlight possible outcome differences and patients' satisfaction regarding the treatment of TMC arthrosis.

Methods

We evaluated 100 patients with TMC arthrosis treated in two centers and divided into two groups: group A received TMC prosthesis (Touch), whereas group B was treated with arthroplasty, with a 2-year follow-up period.

Results

In a comparative analysis, findings revealed group A's superiority in the shortened disabilities of the arm, shoulder and hand questionnaire scores at 1 and 6 months, with significant differences: 34.6% vs 67.1% and 2% vs 9.1%, respectively (P < .0001). Although group A also showed lower the shortened disabilities of the arm, shoulder and hand questionnaire scores at 3 months, this was not statistically significant. Notably, at 1 and 2 years, group A demonstrated better scores without statistical significance. The Kapandji score differed significantly at 6 months: 9.8 vs 9.1 (P = .029). Although the visual analog scale showed generally lower values for the prosthesis group, no statistical differences emerged. Additionally, the M1/M2 ratio became significant postoperatively, favoring group A (P < .05).

Conclusions

Trapeziometacarpal prosthesis shows promise for TMC arthrosis, enhancing function, thumb length, and patient recovery, warranting further research and x-ray guidance.

Type of study/level of evidence

Therapeutic III.

De Quervain tendinitis after total trapeziometacarpal joint arthroplasty: Biomechanical evaluation of tendon excursion in the first extensor tendon compartment

De Quervain's tenosynovitis is the most common complication after total trapeziometacarpal joint replacement. Etiology is unclear. Implantation of a ball-in-socket implant changes the biomechanics of the normal trapeziometacarpal saddle joint and increases its range of motion. The present study demonstrates that this procedure also significantly increases excursion of the abductor pollicis longus and extensor pollicis brevis tendons during thumb flexion-extension, and not during thumb abduction-adduction. Increased tendon gliding under the retinaculum of the first extensor tendon compartment could predispose to the development frictional tenosynovitis and play a role in the development of de Quervain's syndrome after total trapeziometacarpal joint replacement. LEVEL OF EVIDENCE: Not applicable (laboratory study).

Computer-simulated TOUCH prosthesis cup malposition and solutions

INTRODUCTION

Total joint replacement has become significantly more common as a treatment for advanced trapeziometacarpal joint osteoarthritis in recent years. The latest generation of prostheses with dual-mobility designs leads to very good functional results and low rates of loosening and dislocation in the short and medium term. Biomechanical studies showed that central placement and parallel alignment of the cup with respect to the proximal articular surface of the trapezium are crucial for both cup stability and prevention of dislocation. Despite correct positioning of the guidewire, incorrect placement or tilting of the inserted cup may occur, requiring immediate intraoperative revision.

METHODS

The existing spherical and conical cup models in sizes 9 mm and 10 mm were transferred to a computer-aided design dataset. Depending on the intraoperative complication (tilting or incorrect placement), the revision options resulting from the various combinations of cup type and size were simulated and analyzed according to the resulting defect area and bony contact area.

RESULTS

In well centered cups, a size 9 conical cup could be replaced by a size 9 spherical cup and still be fixed by press-fit. Conversely, a size 9 spherical cup could not be replaced by a size 9 conical cup, but only by a size 10 cup, of whatever shape. When a size 9 conical cup was tilted up to 20°, the best revision option was to resect the sclerotic margin and insert a size 10 conical cup deeper into the cancellous bone, to achieve the largest contact area with the surrounding bone. When a size 9 cup of whatever shape was poorly centered (misplaced with respect to the dorsopalmar or radioulnar line of the trapezium), placement should be corrected using a size 10 cup, combined with autologous bone grafting of the defect. Again, the size 10 conical cup showed the largest bony contact area.

CONCLUSION

Our computer-based measurements suggested options for intraoperative cup revision depending on cup shape and size and on type of misalignment with resulting bone defects. These suggestions, however, need to be confirmed in anatomic specimens before introducing them into clinical practice.

[Current Trends in the Implantation of the Touch Prosthesis at the Thumb Carpometacarpal Joint: Results of the 1st German-Speaking User Meeting]

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.

Proposed Radiographic Parameters to Optimize Clinical Outcomes in Trapezio-Metacarpal Prosthesis Placement Using CT Imaging, with 1-Year Follow-Up

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.

Dislocation in Single-Mobility Versus Dual-Mobility Trapezometacarpal Joint Prostheses

BACKGROUND

The purpose of this study was to analyze postoperative dislocation rates in single-mobility (Ivory) versus dual-mobility (Moovis) trapezometacarpal (TMC) joint prostheses. Second, we report complications requiring additional surgery in these 2 types of prostheses.

METHODS

We retrospectively obtained data of all patients receiving a TMC joint prothesis at our hospital between January 2015 and December 2020. We recorded the type of implant used (ie, single vs dual mobility; Ivory vs Moovis), and recorded dislocations and complications requiring additional surgery.

RESULTS

We recorded significantly more prosthetic dislocations in the single-mobility (Ivory) group (n = 6, 9.7%), compared with the dual-mobility (Moovis) group (n = 1, 1.4%). The most frequent complication requiring additional surgery was De Quervain tendinitis (n = 13, 9.6%).

CONCLUSIONS

This study shows that a dual-mobility TMC prosthesis has significantly less postoperative dislocations compared with its single-mobility counterpart. We identity De Quervain tendinitis as the most frequent complication requiring additional surgery.

Mid- and long-term clinical results of the Elektra and Moovis prosthesis for trapeziometacarpal joint replacement

BACKGROUND

Total joint arthroplasty as a surgical treatment option for trapeziometacarpal joint arthritis is recently revived. The aim of this study is to report on mid- and long-term results of the Elektra (single-mobility) and Moovis (dual-mobility) prosthesis for treatment of primary thumb carpometacarpal joint arthritis.

METHODS

In this retrospective, monocentric, descriptive cohort study, 31 prostheses were evaluated that were implanted by a single surgeon in 26 patients between 2009 and 2019. Indication for surgery was trapeziometacarpal joint osteoarthritis (Eaton/Littler Stage II and III). Clinical and radiological follow-up was performed at a minimum of 24 months. The postoperative assessment included range of motion, pain, strength as well as functional scores (DASH, MHQ). Implant survival and complications were the primary endpoints.

RESULTS

10 Elektra and 21 Moovis prostheses were implanted between 2009 and 2019 with a mean follow-up of 74.2 months in the Elektra and 41.4 months in the Moovis group. The average patients' age at surgery was 64 years. Postoperative pain levels (VAS 0-10) were below 2 at rest and under stress in both groups. Grip/pinch strength and range of motion showed results comparable to the contralateral hand. Opposition was excellent with an average Kapandji index of 9.6 in both groups. Elektra achieved slightly better functional scores in the DASH and MHQ score. Satisfaction was high in both groups, and 96% of the patients would recommend the procedure. Metacarpophalangeal hyperextension > 15° was seen in 3 patients per group preoperatively and was corrected to < 5° post-surgery. 3 Elektra prostheses were revised due to cup loosening and dislocation for cup and/or neck replacement or secondary trapeziectomy. 1 Moovis prosthesis was revised with an exchange of the neck to a larger size due to restricted movement. After the mean follow-up of 7.9 years in Elektra and 3.5 years in MOOVIS, cumulative survival was 68.6% vs. 95.2%, respectively.

CONCLUSIONS

In this mid- to long-term retrospective analysis, total joint arthroplasty in primary trapeziometacarpal joint arthritis results in low pain levels, excellent mobility and clinical function. Patient satisfaction is overall high. While revision due to cup loosening occurred more often in patients with single-mobility implants, no cases of dislocation or loosening of components were observed in the dual-mobility group.

TRIAL REGISTRATION

The study was conducted in accordance with the Declaration of Helsinki, and approved by the Ethics Committee of the Medical Faculty of Heidelberg University, reference number S-150/2020.

Basal thumb arthritis surgery: complications and its management

The management of complications after surgery for basal thumb arthritis is sometimes challenging, and there are no clear recommendations on how to evaluate and manage patients with residual symptoms. The aim of the present article was to review the most common complications after surgery for basal thumb arthritis, with an emphasis on resection arthroplasty, joint replacement and joint fusion. In addition, possible management strategies for the different types of complications will be highlighted.

Total joint replacement for osteoarthritis of the carpometacarpal joint of the thumb: why and how?

Total joint replacement has certain advantages over other surgical treatment methods for osteoarthritis of the thumb carpometacarpal joint, including restoration of thumb length and alignment, good cosmetical result, fast recovery of hand function and prevention of iatrogenic complications at neighbouring joints. Disadvantages include the technical difficulty to perform this surgery and a possible higher complication rate. A meticulous surgical technique is mandatory. Combined with a cementless and modular ball-in-socket implant with a metal-on-polyethylene friction couple, a 10-year survival rate higher than 90% can be expected. Revision surgery is possible with implant exchange or conversion to trapeziectomy.

Touch® double mobility arthroplasty for trapeziometacarpal osteoarthritis: outcomes for 92 prostheses

Trapeziometacarpal prostheses have been used in the treatment of first carpometacarpal joint osteoarthritis for many years. No studies have demonstrated statistical superiority over gold-standard trapeziectomy, but they have been proved to enable shorter convalescence, better pain relief and faster functional recovery. The aims of the present study were to report functional results in a large cohort treated with the Touch® new-generation dual mobility trapeziometacarpal prosthesis, with comparison to results in the literature. A retrospective study included 92 Touch® prostheses. Assessment comprised pre- and post-operative pain, QuickDASH score and satisfaction rate. Mean follow-up was 1.33 ± 0.4 years. Pain significantly improved after surgery. Functional QuickDASH scores did not significantly differ from those reported in the age-matched general population. Return to work was fast, at 2.6 months. Satisfaction scores were high. There were no major complications such as dislocation, fracture or loosening, but the rate of De Quervain's tenosynovitis was higher than in other studies. The Touch® prosthesis appeared to be a safe and stable implant, providing good satisfaction and very good functional scores and fast return to work and leisure activity. Considering the high rate of postoperative De Quervain's tenosynovitis, we suggest opening the first sheath of the extensors tendons while positioning the prosthesis.

Primary endoprosthetic replacement of the arthritic CMC-1 joint

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.

Outcomes of Double-Mobility Prosthesis in Trapeziometacarpal Joint Arthritis With a Minimal 3 Years of Follow-Up: An Advantage for Implant Stability

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.

Trapeziectomy and Abductor Pollicis Longus Suspensionplasty Combined with Extensor Pollicis Brevis Tenodesis for Management of Thumb Basal Joint Osteoarthritis and Metacarpophalangeal Hyperextension

Metacarpal joint hyperextension is common cause of postoperative dissatisfaction after trapeziectomy in the management of basal thumb osteoarthritis. The senior author uses this technique to address this biomechanical problem at the time of trapeziectomy.

Reporting Outcomes and Outcome Measures in Thumb Carpometacarpal Joint Osteoarthritis: A Systematic Review

PURPOSE

In the thumb carpometacarpal (CMC) joint osteoarthritis (OA) literature, there is substantial heterogeneity in outcome and outcome measure reporting. This could be rectified by a standardized core outcome set (COS). This study aimed to identify a comprehensive list of outcomes and outcome measures for thumb CMC joint OA, which represents the first step in developing a COS.

METHODS

A computerized search of MEDLINE, EMBASE, Cochrane, and CINAHL was performed to identify randomized controlled trials, as well as observational studies involving at least 50 participants aged greater than 18 years undergoing surgery for thumb CMC joint OA. Reported outcomes and outcome measures were extracted from these trials and summarized.

RESULTS

This search yielded 3,498 unique articles, 97 of which were used for analysis. A total of 33 unique outcomes and 25 unique outcome measures were identified. The most frequently used outcomes were complications (78), postoperative pain (73), radiologic outcomes (64), and grip strength (63). Within each reported outcome, there was substantial variation in how the outcome was measured. Of the 25 unique outcome measures, 10 were validated. Of the remaining 15, 12 were created ad hoc by the author. The Disabilities of the Arm, Shoulder, and Hand questionnaire was the most commonly reported outcome measure (34%).

CONCLUSIONS

There is a lack of consensus on critical outcomes after surgery for thumb CMC joint OA. A standardized COS created by stakeholder consensus would improve the consistency and therefore the quality of future research.

CLINICAL RELEVANCE

This systematic review of outcomes represents the first step in developing a core outcome set for thumb CMC joint OA.

Trapeziometacarpal total joint arthroplasty: The effect of capsular release on range of motion

It has been suggested that trapeziometacarpal total joint arthroplasty be combined with complete release of the joint capsule to prevent ligament tethering and implant dislocation. Our goal was to evaluate the consequences of capsular release on range of motion. Trapeziometacarpal joint motion was measured with a 3D motion tracking system in seven fresh frozen human cadaver hands before and after capsular release and total joint arthroplasty with subsequently longer neck lengths. Relative to the native trapeziometacarpal joint with intact joint capsule, mean flexion-extension was significantly increased after the arthroplasty with released capsule and lengthening up to 6 mm. Mean abduction-adduction did not increase significantly. Total joint replacement combined with capsular release increases the trapeziometacarpal joint's range of motion, but not beyond the limits of most trapeziometacarpal implant designs. Lengthening of the implant neck progressively decreases the excess motion.

Five year long term results of total joint arthroplasties in the treatment of trapeziometacarpal osteoarthritis

INTRODUCTION

Trapeziometacarpal (TMC) osteoarthritis is a common disease. Patients with advanced disease who have failed conservative treatment have different surgical options, including total joint prosthesis. The aim of this study was to investigate the long-term outcome and complications of trapeziometacarpal (TMC) total arthroplasty.

MATERIALS AND METHODS

One hundred and forty-seven patients with TMC osteoarthritis were surgically treated with TMC arthroplasty, and one hundred and thirty-seven patients were seen for follow-up (102 women and 35 men). At follow -up patients were asked to complete a visual linearanalogue scale (VAS) for satisfaction with the result of the operation and persisting pain from the thumb, the Spanish validated Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire was used to evaluate function of the affected hand.(9) The radiological examination consisted of posterior-anterior and oblique radiographs. In preoperative radiographs Eaton-Little was used, and in postoperative radiographs were assessed with regard to implant loosening and alignment.

RESULTS

The subjective outcome was satisfactory in 126 cases (92 %), 14 (12 %) patients would undergo the same procedure in the other hand. The DASH questionnaireswere 19.55 (range 5.6-33,5) on average, and EVA was 1 on average. The mean key pinch strength was 5.8 Kg at 5 years follow-up. The most frequent postoperative complication was De Quervain tenosynovitis (21%), other complications were: Cup loosening (3.6%), traumatic dislocation (3,6%). The prosthesis was removed in nine cases (7%). There were four intraoperative complications. The survival rate for ARPE prosthesis was 92,7% at 60,5 months. TMC total arthroplasty offers a reliable treatment alternative in patients with thumb carpometacarpal joint osteoarthrosis which conservatives' treatment had failed.

CONCLUSIONS

The TMC joint prosthesis is an option for patients with TCM osteoarthritis, provides satisfactory outcomes and has a low failure rate.(www.actabiomedica.it).

Maïa® trapeziometacarpal joint arthroplasty: Survival and clinical outcomes at 5 years' follow-up

We sought to report the clinical and radiological outcomes and the survival of Maïa^® trapeziometacarpal joint arthroplasty retrospectively at a mean 5 years' follow-up. We evaluated the implant survival and the clinical outcomes of 93 patients (113 prostheses). Patients were examined during a consultation and their mobility, key pinch strength and satisfaction were recorded. Patients also completed a QuickDASH evaluation. The 5-year survival rate was 92.2%. The mean QuickDASH Score was 26.7. The complication rate was 31% and the revision rate was 12.4%. The most common complication was dislocation and the most frequent cause of surgical revision was periprosthetic ossification. We identified two cases of aseptic loosening. This study shows the Maïa^® prosthesis provides satisfactory medium-term results and has an excellent 5-year survival. However, the high complication and revision rates are still a major concern.

Outcomes of cementless joint prosthesis versus tendon interposition for trapeziometacarpal osteoarthritis: a prospective study

We compared 84 patients with the Ivory trapeziometacarpal prosthesis versus 62 with ligament reconstruction and tendon interposition arthroplasty performed for osteoarthritis. There were 134 women and 12 men with a mean age of 60 years. Prospective clinical assessment was made using the Quick Disability of the Arm, Shoulder and Hand (DASH) questionnaire, visual analogue scale for pain, range of motion, and grip and pinch strength. The mean follow-up was 4 years (range 2-5). Prosthetic replacement provided significantly better thumb abduction, adduction, pinch strength, QuickDASH, pain relief, satisfaction and a faster return to daily activities and previous work. Revision surgery was required for two patients in the prosthesis group, two for dislocation and one cup loosening, while in the ligament reconstruction group there were no revisions. We conclude that trapeziometacarpal prosthesis provides better mid-term results in terms of function compared with ligament reconstruction and tendon interposition for patients with Stages 2 and 3 osteoarthritis of the trapeziometacarpal joint. Level of evidence: II.

Arthroscopic Synovectomy Combined with Autologous Fat Grafting in Early Stages of CMC Osteoarthritis of the Thumb

Background  Minimal invasive treatments such as arthroscopic techniques may be adequate to restore the anatomy and functional integrity of the thumb CMC (carpometacarpal) joint. In this paper, we reported the interposition of autologous fat tissue in combination with arthroscopic synovectomy/debridement for early stage of the thumb CMC joint osteoarthritis. Patients and Methods  Twelve patients with a mean age of 46 years with early radiological stages of thumb CMC joint osteoarthritis were included. Evaluation of outcome was measured prior and 3, 12, and 24 months after surgery including, Visual Analog Scale (VAS), QuickDASH, grip and pinch strength, range of motion (ROM), and patient satisfaction. Results  Pain at rest (or with load) was reduced from preoperative 4,7 (8,7) to 2 (5,9) at 3 to 6 months; 1,4 (4,3) at 12 months; and 0,75 (2,7) at 2 years after the surgery. Initial preoperative QuickDASH value of 52 points reduced to 33 (17-65) at 6 months, 23 (2-70) at 12 months, and 20 (11-29) at 24 months after the surgery. Grip strength and thumb pinch with respect to the contralateral untreated thumb was reduced in the first 12 months but recovered subsequently. ROM was equal to the contralateral thumb. Three patients suffered from tendinitis and required surgical treatment. One patient indicated prolonged pain symptoms. No infections were noted and no donor-site morbidity or side effects were detected. Conclusion  Arthroscopic synovectomy combined with autologous fat graft is a reliable surgical option for early thumb CMC joint osteoarthritis and that effect continues for more than 24 months.

Current trends in the management of trapeziometacarpal arthritis

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.

Complications and failures of the trapeziometacarpal Maia® prosthesis: A series of 156 cases

When implanting the Maia^® trapeziometacarpal prosthesis, surgeons will be faced with a variety of complications they must be able to recognize and anticipate. Their ability to deal with these complications and possibly even failures is governed by their knowledge of the right steps to take. The aim of this retrospective study was to assess the incidence of complications reported during implantation of the Maia^® prosthesis, to describe their nature and potential predisposing factors, and to study failures and their outcomes. Between January 2008 and December 2012, 156 Maia^® prosthetic joints were implanted in 139 patients at one center by one surgeon. Clinical and radiological parameters were analyzed before, during and after surgery. The implant characteristics were documented and the surgical technique used was analyzed. The overall postoperative complication rate was 35.9%. The most common complication (16%) was tendinopathy. Prosthesis dislocation (4.5%) and trapezoid loosening (2.6%) were the primary causes of failure. Eighteen patients required secondary surgical revision (11.5%) and the implant was removed in 12 cases (failure rate of 7.7%). Two factors were significantly correlated with the onset of complications, independent of their nature and irrespective of whether secondary surgical revision was required: a deformed thumb prior to surgery and the position of the trapezial cup. Mediocre trapezium bone quality was a statistically significant factor for secondary surgical revision. The survival rate of the Maia^® prosthesis was 90.8% at 62months. These factors influence the onset of complications and must be taken into account in the pre-surgical workup in order to identify the best candidates for successful Maia^® joint replacement. For the most part, the failure rate in our series was due to inappropriate surgical technique rather than an inherent defect in the prosthesis. A meticulous, precise surgical technique is therefore essential.