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Stilling M, Dremstrup L, Hansen TB, Thillemann JK. Superior bone fixation of conical compared with hemispherical trapezial cup design: an experimental radiostereometry study. J Exp Orthop 2023; 10:127. [PMID: 38032446 PMCID: PMC10689311 DOI: 10.1186/s40634-023-00692-y] [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: 06/06/2023] [Accepted: 11/14/2023] [Indexed: 12/01/2023] Open
Abstract
PURPOSE The most used cup designs for trapeziometacarpal (TMC) arthroplasty are of hemispherical and conical geometrical shape. Using a validated pig bone model, we compared the bone fixation using radiostereometry (RSA). METHODS Twenty saddle-shaped pig forefoot bones were prepared with insertion of bone markers and reaming. Hemispherical Type T cups (Beznoska, Kladno, Czech Republic) (N = 10) and conical Moovis cups (Stryker, Pusignan, France) (N = 10) of 9-mm diameter were inserted press-fit. The bones were fixed in cement blocks for stability, and the cups were loaded in a motorized test stand. First, a low-pressure cyclic load test (0-150N) with 130 compression cycles was performed. Next, a push-in test of progressive loads with 50N increments (range: 150-900N) was applied until a visual change in cup position appeared. Cup migration was evaluated with RSA after every new load application. Cup failure was defined as total translation > 0.5 mm between two load applications. RESULTS Both cup types tolerated a compression load of 450 N without failure. Beyond this load level, the total translation cup migration of mean 0.20 mm (95% CI 0.11; 0.30) for the Type T group was higher than mean 0.10 mm (95% CI 0.06; 0.15) of the Moovis group (p = 0.046). The Hazard ratio for failure was 0.52 (95% CI 0.12; 2.17) (p = 0.37), indicating that the risk of failure was two-fold higher in the Type T group. CONCLUSION We conclude that conical TMC cups have superior fixation as compared to hemispherical cups above a loading level of 450 N, which correspond to a 3.8 kg tip-pinch. In a clinical perspective, based on the fixation strength of both cup types, it seems safe to allow light-load activities of daily living such as buttoning a shirt and using a key shortly after surgery and until sufficient osseointegration is achieved.
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Affiliation(s)
- Maiken Stilling
- Department of Orthopaedic Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 165 J801, DK- 8200, Aarhus N, Denmark.
- Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark.
- AutoRSA Research Group, Orthopaedic Research Unit, Aarhus University Hospital, Aarhus N, Denmark.
- Department of Orthopaedics, University Clinic for Hand, Hip and Knee Surgery, Gødstrup Hospital, Herning, Denmark.
| | - Lene Dremstrup
- Department of Orthopaedics, University Clinic for Hand, Hip and Knee Surgery, Gødstrup Hospital, Herning, Denmark
| | - Torben Bæk Hansen
- Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
- Department of Orthopaedics, University Clinic for Hand, Hip and Knee Surgery, Gødstrup Hospital, Herning, Denmark
| | - Janni Kjærgaard Thillemann
- Department of Orthopaedic Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 165 J801, DK- 8200, Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
- AutoRSA Research Group, Orthopaedic Research Unit, Aarhus University Hospital, Aarhus N, Denmark
- Department of Orthopaedics, University Clinic for Hand, Hip and Knee Surgery, Gødstrup Hospital, Herning, Denmark
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Balesar VV, Koster LA, Kaptein BL, Keizer SB. Five-Year Prospective Roentgen Stereophotogrammetric and Clinical Outcomes of the BioPro MTP-1 Hemiarthroplasty. Foot Ankle Int 2022; 43:637-645. [PMID: 34962173 DOI: 10.1177/10711007211061366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Mixed results for functional outcomes and long-term fixation have been reported for first metatarsophalangeal arthroplasty. This prospective study was designed to evaluate the migration of the BioPro metatarsophalangeal-1 (MTP-1) joint hemiprosthesis with Roentgen stereophotogrammetric analysis (RSA). Migration patterns of the prosthesis, prosthesis-induced erosion of the metatarsal bone, and clinical outcomes were evaluated sequentially to 5 years postoperation (PO). METHODS Eleven female patients received the BioPro-1 hemiprosthesis. Prosthesis translation and metatarsal erosion were measured with RSA at immediately PO, 6 weeks, and 3, 6, 12, 36, and 60 months postoperatively. Clinical assessment was done by patient questionnaires. RESULTS RSA data of 9 patients were available for analysis. Median (range) number of markers used in RSA analysis, condition number, and mean error of markers around the prosthesis were 4 (3-7), 320 (208-862), and 0.13 (0.02-0.28), respectively. Progressive subsidence was seen up to 3 years PO (mean 2.1 mm, SE 0.32). Progressive metatarsal erosion was found from 1 year PO (mean 0.49 mm, SE 0.15). Pain, function, and quality scores improved after surgery and did not deteriorate at later follow-up moments. CONCLUSION Model-based RSA of the BioPro-1 prosthesis shows nonstabilizing medial and distal translation and metatarsal erosion. Despite the measured migration and erosion, clinical outcomes improved and remained similar up to 5 years postoperation. LEVEL OF EVIDENCE Level II, prospective analysis of MTP-1 hemiprosthesis.
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Affiliation(s)
| | | | - Bart L Kaptein
- Leiden Universitair Medisch Centrum, Leiden, the Netherlands
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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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Thillemann JK, Dremstrup L, Hansen TB, Stilling M. The mechanical fixation of a cementless conical cup in cortical versus cancellous trapezial bone: an experimental study. J Hand Surg Eur Vol 2021; 46:146-153. [PMID: 33079604 DOI: 10.1177/1753193420963255] [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
In a pig bone model mimicking the human trapezium, we assessed the cementless fixation of trapezial cups in cancellous and cortical bone. Thirty-two saddle-shaped pig forefoot bones were prepared for cup fixation. Conical Konos cups (Beznoska, Kladno, Czech Republic) size 9 mm or 10 mm diameter were impacted. Cup migration was evaluated with repeated radiostereometry after intervals of cyclic-load tests. Migration increased for every load-interval up to 750 N and was higher with cancellous bone fixation than with cortical bone fixation. In cancellous bone, 9 mm cups migrated more than 10 mm cups. At the highest load (1050 N), the cumulative implant survival was 88% for 10 mm cups with cortical bone fixation and 13% for 9 mm cups with cancellous bone fixation. We conclude that mechanical fixation of conical Konos cups was better in cortical than in cancellous bone. Our results further suggest that the largest possible cup diameter should be used.
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Affiliation(s)
- Janni K Thillemann
- Department of Orthopeadics, University Clinic for Hand, Hip and Knee Surgery, Hospital Unit West, Holstebro, Denmark.,Department of Clinical Medicine, Aarhus University, Skejby, Denmark
| | - Lene Dremstrup
- Department of Orthopeadics, University Clinic for Hand, Hip and Knee Surgery, Hospital Unit West, Holstebro, Denmark
| | - Torben B Hansen
- Department of Orthopeadics, University Clinic for Hand, Hip and Knee Surgery, Hospital Unit West, Holstebro, Denmark.,Department of Clinical Medicine, Aarhus University, Skejby, Denmark
| | - Maiken Stilling
- Department of Clinical Medicine, Aarhus University, Skejby, Denmark.,Department of Orthopaedics, Aarhus University Hospital, Skejby, Denmark
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van Hooff ML, Heesterbeek PJC, Spruit M. Mechanical Stability of the Prodisc-C Vivo Cervical Disc Arthroplasty: A Preliminary, Observational Study Using Radiostereometric Analysis. Global Spine J 2020; 10:294-302. [PMID: 32313795 PMCID: PMC7160805 DOI: 10.1177/2192568219850763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Prospective cohort study. OBJECTIVE To investigate the primary stability of the Prodisc-C Vivo cervical disc arthroplasty with regard to the adjacent cervical vertebrae using radiostereometric analysis (RSA), and to monitor its clinical performance. METHODS Sixteen patients with degenerative cervical disc disease were included. RSA radiographs were obtained at the first postoperative day, at 6 weeks, 3 months, and 6 months postoperatively. Migration (translation [mm]) of the superior and inferior implant components were measured with model-based RSA, expressed along the 3 orthogonal axes, and calculated as total translation. Clinical outcomes were Neck Disability Index, numeric rating scales for neck and arm pain, Likert-type scales for satisfaction, and adverse events. Range of motion was reported as C2-C7 flexion-extension mobility (ROM). RESULTS At final follow-up, no significant increase over time in median total translation was found. One inferior and 3 superior components subsided but were asymptomatic. ROM remained stable and clinical outcomes improved over time. Although 3 patients were unsatisfied and 3 adverse events occurred, this was not related to translation of the components. CONCLUSIONS On a group level, both components of the Prodisc-C Vivo cervical disc arthroplasty remained stable over time and below the clinical threshold of 1 mm. Individual outliers for translation were not clinically relevant and probably related to settling of the components into the vertebral endplates. RSA allowed us to perform a preliminary but accurate study on the micromotion of a new cervical disc replacement in a small sample size, without putting large numbers of patients at risk.
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Affiliation(s)
- Miranda L. van Hooff
- Sint Maartenskliniek, Nijmegen, the Netherlands,Radboud University Medical Center, Nijmegen, the Netherlands,Miranda L. van Hooff, Department of Research, Sint
Maartenskliniek, P.O. Box 9011, 6500 GM Nijmegen, the Netherlands.
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Holm-Glad T, Reigstad O, Tsukanaka M, Røkkum M, Röhrl SM. High precision and accuracy of model-based RSA for analysis of wrist arthroplasty. J Orthop Res 2018; 36:3053-3063. [PMID: 29873422 DOI: 10.1002/jor.24063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 06/03/2018] [Indexed: 02/04/2023]
Abstract
Radiostereometric analysis (RSA) is a method for measuring micromotion in joint arthroplasties. RSA has never been used in total wrist arthroplasties. We evaluated: (i) the precision of model-based RSA in total wrist arthroplasties measured in a phantom model and in patients; (ii) the number of bone markers necessary to ensure the precision; and (iii) the accuracy of model-based RSA in a phantom model. Reverse engineered models of radial and carpal/metacarpal components of two wrist arthroplasties (ReMotion® and Motec®) were obtained by laser scanning. Precision and accuracy of each arthroplasty were analyzed with regards to translation and rotation along the three coordinate axes. Precision was analyzed in 10 phantom and 30 clinical double examinations for each arthroplasty, and was expressed by a repeatability coefficient. The precision of different numbers and configurations of bone markers in the phantom model were compared. Accuracy was tested in a phantom model where the implants were attached to a micrometer, and was defined as the mean difference between measured and true migration. In the phantom model the precision for translations ranged from 0.03 to 0.14 mm and for rotations from 0.18 to 1.52°. In patients the precision for translations ranged from 0.06 to 0.18 mm, and for rotations from 0.32 to 2.18°. Less than four bone markers resulted in inferior precision. Accuracy ranged from -0.06 to 0.04 mm, and from -0.38 to -0.01°. Y-rotations could not be obtained from the Motec® due to rotational symmetry about the longitudinal axis. We conclude that model-based RSA in total wrist arthroplasties is precise, accurate, and feasible to use for clinical evaluation of micromotion in wrist arthroplasties. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:3053-3063, 2018.
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Affiliation(s)
- Trygve Holm-Glad
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ole Reigstad
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Masako Tsukanaka
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Magne Røkkum
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Stephan M Röhrl
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Ten Brinke B, Beumer A, Koenraadt KLM, Eygendaal D, Kraan GA, Mathijssen NMC. The accuracy and precision of radiostereometric analysis in upper limb arthroplasty. Acta Orthop 2017; 88:320-325. [PMID: 28464752 PMCID: PMC5434603 DOI: 10.1080/17453674.2017.1291872] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Radiostereometric analysis (RSA) is an accurate method for measurement of early migration of implants. Since a relation has been shown between early migration and future loosening of total knee and hip prostheses, RSA plays an important role in the development and evaluation of prostheses. However, there have been few RSA studies of the upper limb, and the value of RSA of the upper limb is not yet clear. We therefore performed a systematic review to investigate the accuracy and precision of RSA of the upper limb. Patients and methods - PRISMA guidelines were followed and the protocol for this review was published online at PROSPERO under registration number CRD42016042014. A systematic search of the literature was performed in the databases Embase, Medline, Cochrane, Web of Science, Scopus, Cinahl, and Google Scholar on April 25, 2015 based on the keywords radiostereometric analysis, shoulder prosthesis, elbow prosthesis, wrist prosthesis, trapeziometacarpal joint prosthesis, humerus, ulna, radius, carpus. Articles concerning RSA for the analysis of early migration of prostheses of the upper limb were included. Quality assessment was performed using the MINORS score, Downs and Black checklist, and the ISO RSA Results - 23 studies were included. Precision values were in the 0.06-0.88 mm and 0.05-10.7° range for the shoulder, the 0.05-0.34 mm and 0.16-0.76° range for the elbow, and the 0.16-1.83 mm and 11-124° range for the TMC joint. Accuracy data from marker- and model-based RSA were not reported in the studies included. Interpretation - RSA is a highly precise method for measurement of early migration of orthopedic implants in the upper limb. However, the precision of rotation measurement is poor in some components. Challenges with RSA in the upper limb include the symmetrical shape of prostheses and the limited size of surrounding bone, leading to over-projection of the markers by the prosthesis. We recommend higher adherence to RSA guidelines and encourage investigators to publish long-term follow-up RSA studies.
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Affiliation(s)
- Bart Ten Brinke
- Department of Orthopaedic Surgery, Amphia Ziekenhuis, Breda;,Department of Orthopaedic Surgery, Reinier de Graaf Hospital, Delft;,Correspondence:
| | | | - Koen L M Koenraadt
- FORCE Foundation, Department of Orthopaedic Surgery, Amphia Ziekenhuis, Breda
| | - Denise Eygendaal
- Department of Orthopaedic Surgery, Amphia Ziekenhuis, Breda;,Department of Orthopaedic Surgery, Academic Medical Center, Amsterdam, the Netherlands
| | - Gerald A Kraan
- Department of Orthopaedic Surgery, Reinier de Graaf Hospital, Delft
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Ten Brinke B, Mathijssen NMC, Blom I, Deijkers RLM, Ooms EM, Kraan GA. Model-based roentgen stereophotogrammetric analysis of the surface replacement trapeziometacarpal total joint arthroplasty. J Hand Surg Eur Vol 2016; 41:925-929. [PMID: 26852245 DOI: 10.1177/1753193416629070] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
UNLABELLED The primary aim of this clinical and radiostereometric study was to study the migration pattern of the surface replacement trapeziometacarpal joint prosthesis (SRTMTMC, Avanta®, San Diego, CA). The secondary aims were to assess patient-related outcomes and prosthesis survival 5 years after surgery. Ten patients received the prosthesis. Radiostereometric radiographs were obtained 6 weeks, 6 months, 1 year and 5 years post-operatively and were analysed using model-based software. All patients completed DASH and Nelson Hospital scores at these follow-ups. Mean translations varied between 0.0 and 0.5 mm after 5 years. Rotation values could be calculated in six patients and mean rotations varied between -0.3 and 2.3°, although the precision of rotation values seems to be poor. The 5-year survival rate was 80%. Mean pre-operative DASH and Nelson Hospital scores were 53 (SD 14) and 51 (SD 13), respectively. Six months post-operatively, the DASH and Nelson Hospital scores had both significantly improved to 25 (SD 20) and 74 (SD 18) and remained high after 5 years. Implant stability was good 5 years post-operatively, and early migration did not predict implant failure in this study. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- B Ten Brinke
- 1 Department of Orthopaedic Surgery, Reinier de Graaf Groep, Delft, The Netherlands
| | - N M C Mathijssen
- 1 Department of Orthopaedic Surgery, Reinier de Graaf Groep, Delft, The Netherlands
| | - I Blom
- 2 Department of Radiology, Reinier de Graaf Groep, Delft, The Netherlands
| | - R L M Deijkers
- 3 Department of Orthopaedic Surgery, Haga Ziekenhuis, Den Haag, The Netherlands
| | - E M Ooms
- 4 Centre for Orthopaedic Surgery, OCON, Hand and Wrist unit, Hengelo, The Netherlands
| | - G A Kraan
- 1 Department of Orthopaedic Surgery, Reinier de Graaf Groep, Delft, The Netherlands
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Ooms EM, ten Brinke B, Mathijssen NMC, Blom IF, Deijkers RLM, Kraan GA. Feasibility of model-based Roentgen Stereophotogrammetric Analysis to evaluate early migration of the trapeziometacarpal joint prosthesis. BMC Musculoskelet Disord 2015; 16:295. [PMID: 26466802 PMCID: PMC4607147 DOI: 10.1186/s12891-015-0747-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 10/02/2015] [Indexed: 11/15/2022] Open
Abstract
Background The purpose of this study was to determine the feasibility of Roentgen Stereophotogrammetric Analysis (RSA) in total joint arthroplasty of the trapeziometacarpal (TMC) joint of the thumb. Methods In five cadaveric hands the TMC-joint was replaced by the Surface Replacement Trapeziometacarpal prosthesis (SR™ TMC prosthesis; Avanta, San Diego, CA) and tantalum beads of 0.8 mm were implanted for RSA. RSA radiographs in two directions were made in ten positions to calculate the measurement error. Migration values from zero are indicative for the measurement error. The number of detected markers was recorded. Results The accuracy analysis showed that for the translations the mean measurement error varied between 0.003 mm (SD 0.057) and 0.055 mm (SD 0.133). For the rotations values ranged from 0.034° (SD 1.759) to 0.502° (SD 1.617). Conclusions RSA analysis of the SR™ TMC prosthesis is feasible. The measurement error is good for the translations but high for the rotations. The latter is due to the close position of the markers relative to each other. Level of evidence III.
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Affiliation(s)
- E M Ooms
- Centre for Orthopaedic Surgery, OCON, Hand and Wrist unit, Hengelo, The Netherlands.
| | - B ten Brinke
- Department of Orthopaedic Surgery, Reinier de Graaf Groep, Delft, The Netherlands.
| | - N M C Mathijssen
- Department of Orthopaedic Surgery, Reinier de Graaf Groep, Delft, The Netherlands.
| | - I F Blom
- Departments of Radiology and Orthopaedic Surgery, Reinier de Graaf Groep, P.O. Box 5011, 2600 GA, Delft, The Netherlands.
| | - R L M Deijkers
- Department of Orthopaedic Surgery, Haga Ziekenhuis, Den Haag, The Netherlands.
| | - G A Kraan
- Department of Orthopaedic Surgery, Reinier de Graaf Groep, Delft, The Netherlands.
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Chug M, Williams N, Benn D, Brindley S. Outcome of uncemented trapeziometacarpal prosthesis for treatment of thumb carpometacarpal joint arthritis. Indian J Orthop 2014; 48:394-8. [PMID: 25143644 PMCID: PMC4137518 DOI: 10.4103/0019-5413.136270] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Osteoarthritis of the trapeziometacarpal joint of thumb occurs frequently and can be very disabling. Numerous surgical techniques including trapeziectomy with or without tendon interposition arthrodesis and partial or total joint arthroplasty with cemented and noncemented prosthesis have been described for the treatment of trapeziometacarpal joint osteoarthritis. Initial problems of osteolysis and implant loosening have been substantially reduced with improvement in implant design. The aim of this study is to demonstrate that trapeziometacarpal osteoarthritis of the thumb can be effectively treated with uncemented total joint replacement prosthesis. MATERIALS AND METHODS We retrospectively collected data for 16 trapeziometacarpal joint replacements in 14 patients. One patient was excluded as they required revision with trapeziectomy and ligament reconstruction following fracture of Trapezium. The trapeziometacarpal joint prosthesis was used in all cases and all operations were carried out by one surgeon. Clinical outcome was determined by a pre and postoperative patient rated wrist evaluation (PRWE) and Michigan Hand Questionnaire Score. Range of motion, grip, tip pinch and key pinch strength were measured and compared with the unoperated hand. Radiological assessment was carried out by plain radiographs for preoperative staging of arthritis and postoperative radiographs at latest followup for evaluation of osteolysis and implant loosening. Average followup period was 26 months. RESULTS There was an improvement in hand function and pain level based on PRWE and Mischigan Hand outcome Questionnaire Score. One patient had intraoperative fracture of Trapezium and subsequent radiographs at 14 months followup showed loosening of the trapezial component due to nonunion of the fracture and complete disintegration of the trapezium. There were no cases of dislocation or implant loosening for the remaining 15 CMC joints at the latest followup. CONCLUSION The use of uncemented prosthesis in treatment of Questionnaire Score. Range of motion joint osteoarthritis gives excellent short term results in improving hand function in terms of strength and stability and achieving pain relief.
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Affiliation(s)
- Manish Chug
- Department of Hand Surgery, John Hunter Hospital, Hunter New England Area Health Services, Lookout Road, New Lambton, Newcastle, NSW 2290, Australia,Address for correspondence: Dr. Manish Chug, 506/18-20, Smart Street, Sky Central Apartments, Charlestown, Newcastle, NSW 2290, Australia. E-mail:
| | - Nicole Williams
- Department of Hand Surgery, John Hunter Hospital, Hunter New England Area Health Services, Lookout Road, New Lambton, Newcastle, NSW 2290, Australia
| | - David Benn
- Department of Hand Surgery, John Hunter Hospital, Hunter New England Area Health Services, Lookout Road, New Lambton, Newcastle, NSW 2290, Australia
| | - Stephen Brindley
- Department of Hand Surgery, John Hunter Hospital, Hunter New England Area Health Services, Lookout Road, New Lambton, Newcastle, NSW 2290, Australia
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Hansen TB, Stilling M. Equally good fixation of cemented and uncemented cups in total trapeziometacarpal joint prostheses. A randomized clinical RSA study with 2-year follow-up. Acta Orthop 2013; 84:98-105. [PMID: 23343372 PMCID: PMC3584612 DOI: 10.3109/17453674.2013.765625] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2012] [Accepted: 10/15/2012] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE Cup failure is a recognized problem in total trapeziometacarpal (TM) joint prostheses; it may be related to poor fixation, which can be revealed by radiostereometric analysis (RSA). We compared the early implant migration of cemented trapezium cups to that of uncemented screw cups. PATIENTS AND METHODS In a prospective, parallel-group, randomized patient-blinded clinical trial, we included 32 hands in 28 patients (5 males) with a mean age of 58 (40-77) years and with Eaton stage-2 or -3 osteoarthritis of the trapeziometacarpal joint. Patients were randomized to surgery with a cemented DLC all-polyethylene cup (C) (n = 16) or an uncemented hydroxyapatite-coated chrome-cobalt Elektra screw cup (UC) (n = 16). Uncemented cups were inserted without threading of the bone. Stereoradiographs for evaluation of cup migration (primary effect size) and DASH and pain scores were obtained during 2 years of follow-up. RESULTS The 2-year total translation (TT) was similar (p = 0.2): 0.24 mm (SD 0.10) for the C (n = 11) and 0.19 mm (SD 0.16) for the UC (n = 11). Variances were similar (p = 0.4). Judged by RSA, 2 UC cups and 1 C cup became loose (TT > 1 mm). Both UC cups were found to be loose at revision. Grip strength, pain, and DASH scores were similar between groups at all measurement points. INTERPRETATION Early implant fixation and clinical outcome were equally good with both cup designs. This is the first clinical RSA study on trapezium cups, and the method appears to be clinically useful for detection of loose implants.
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Affiliation(s)
- Torben Baek Hansen
- Department of Orthopaedics, Section of Hand Surgery, and Orthopaedic Research Unit, Holstebro Regional Hospital, Holstebro, Denmark.
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Hansen TB, Hengst D, Mortensen J, Amstrup AL. Fixation of trapezial implants in a trapeziometacarpal total joint prosthesis tested in a model of porcine bone. J Plast Surg Hand Surg 2012; 45:263-6. [PMID: 22250717 DOI: 10.3109/2000656x.2011.634564] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
High aseptic loosening rates have been reported in total joint prostheses of the carpometacarpal joint of the thumb, particularly in the trapezial component. The primary fixation of new implants may be tested in cadaver bones, but the anatomy of the pig is in many ways similar to that of the human, so we compared the central carpal bone from the forefoot of 6-month-old pigs, which has a saddle joint surface similar to the trapezium, to the trapezium in patients with carpometacarpal osteoarthritis. The mean (SD) bone mineral density of the 13 pig forefoot bones was 0.88 (0.12) g/cm(2) compared with 0.63 (0.16) g/cm(2) in the 31 human trapeziums. The measured size of the porcine bones was slightly larger than that of the human trapeziums. The similarity in form, size, and bone mineral density means that the central bone of the forefoot of 6-month-old pigs may be used for fixation tests in trapezial implants.
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Affiliation(s)
- Torben Bæk Hansen
- The Orthopaedic Research Unit, Regional Hospital Holstebro, Holstebro, Denmark.
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Hansen TB, Meier M, Møller MCM, Larsen K, Stilling M. Primary cup fixation with different designs of trapeziometacarpal total joint trapezium components: a radiostereometric analysis in a pig bone model. J Hand Surg Eur Vol 2011; 36:285-90. [PMID: 21282215 DOI: 10.1177/1753193410394526] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
High loosening rates of the trapezium components of trapeziometacarpal total joint prostheses have been reported. The purpose of this study was to compare the primary press fit fixation of two different, uncemented cup designs (MOTEC and Elektra) with the primary fixation of a cemented polyethylene cup (DLC) in a pig bone model. We did a push out test to measure the maximal load strength of the implants and a low-pressure cyclic loading test combined with radiostereometric analysis to measure the micromotion of the implants. There was no significant difference in fixation strength between the two uncemented screw cup designs or between the two uncemented screw cups and the cemented polyethylene cup. However, we found that threading of the bone before insertion of the Electra screw cup weakens the primary fixation strength of the implant. The results indicate that focus should be on the insertion technique as well as on the cup design of uncemented trapezium cup implants. Further studies of trapezium implant migration in a clinical setting are needed.
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Affiliation(s)
- T B Hansen
- Department of Orthopaedics, Section of Hand Surgery, and Orthopaedic Research Unit, Regional Hospital Holstebro, Denmark.
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Stilling M, Krøner K, Rømer L, Van De Giessen M, Munk B. Scaphoid kinematics before and after scaphotrapeziotrapezoidal ligament section. Assessment by radiostereometric analysis and computed tomography in a cadaver study. J Hand Surg Eur Vol 2010; 35:637-45. [PMID: 20427407 DOI: 10.1177/1753193410368615] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The purpose of this study was to measure changes in scaphoid kinematics after division of scaphotrapeziotrapezoidal ligaments, with the intention of determining a clinical measure that could be detected by computed tomography. Twelve freshly frozen cadaver upper extremities were marked with tantalum beads and fixed in positions of neutral, 30° extension, and 40° ulnar deviation. Stereoradiographs for bone migration analysis by radiostereometric analysis and computed tomography scans for visible assessment were obtained before and after scaphotrapeziotrapezoidal ligament section. After ligament resection there was a scaphoid supination of 5° and a small (less than 1 mm) radial, distal, and dorsal translation of the distal pole in 30° of wrist extension. In computed tomography reconstructions, the ligament section appeared as a 1 to 2 mm gap in the scaphotrapeziotrapezoidal corner, with loss of articulation between the distal scaphoid pole and the trapezoid bone and increased scaphoid flexion.
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Affiliation(s)
- M Stilling
- Orthopaedic Research Unit, Aarhus University Hospital, Aarhus, Denmark.
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