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Mangan F, Spece H, Weiss APC, Ladd AL, Stockmans F, Kurtz SM. A review of wear debris in thumb base joint implants. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:251-269. [PMID: 37439887 DOI: 10.1007/s00590-023-03622-x] [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: 03/08/2023] [Accepted: 06/17/2023] [Indexed: 07/14/2023]
Abstract
AIM Polymers and metals, such as polyethylene (PE) and cobalt chrome (CoCr), are common materials used in thumb-based joint implants, also known as CMC (Carpometacarpal) arthroplasty. The purpose of this review was to investigate the reported failure modes related to wear debris from these type of materials in CMC implants. The impact of wear debris on clinical outcomes of CMC implants was also examined. Potential adverse wear conditions and inflammatory particle characteristics were also considered. METHOD A literature search was performed using PRISMA guidelines and 55 studies were reviewed including 49 cohort studies and 6 case studies. Of the 55 studies, 38/55 (69%) focused on metal-on-polyethylene devices, followed by metal-on-metal (35%), and metal-on-bone (4%). RESULTS The summarized data was used to determine the frequency of failure modes potentially related to wear debris from metals and/or polymers. The most commonly reported incidents potentially relating to debris were implant loosening (7.1%), osteolysis (1.2%) and metallosis (0.6%). Interestingly the reported mechanisms behind osteolysis and loosening greatly varied. Inflammatory reactions, while rare, were generally attributed to metallic debris from metal-on-metal devices. Mechanisms of adverse wear conditions included implant malpositioning, over-tensioning, high loading for active patients, third-body debris, and polyethylene wear-through. No specific examination of debris particle characterization was found, pointing to a gap in the literature. CONCLUSION This review underscores the types of failure modes associated with wear debris in CMC implants. It was found that failure rates and adverse wear conditions of CMC implants of any design are low and the exact relationship between wear debris and implant incidences, such as osteolysis and loosening remains uncertain. The authors note that further research and specific characterization is required to understand the relationship between debris and implant failure.
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Affiliation(s)
| | - Hannah Spece
- Drexel University, Philadelphia, PA, USA
- Gyroid, LLC, Haddonfield, NJ, USA
| | | | | | | | - Steven M Kurtz
- Drexel University, Philadelphia, PA, USA
- Gyroid, LLC, Haddonfield, NJ, USA
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Zhang L, Tan Z, Wu T, Zhang L, Hao B. Investigation on the Corrosion Resistance Properties of Cobalt-Chromium-Molybdenum Alloy Artificial Human Body Components with Robust Biomimetic Superhydrophobic and Slippery Surfaces Based on Laser Texturing. LANGMUIR : THE ACS JOURNAL OF SURFACES AND COLLOIDS 2023; 39:14996-15013. [PMID: 37782749 DOI: 10.1021/acs.langmuir.3c01861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
Cobalt-chromium-molybdenum alloy is used as a material for artificial human body components such as artificial hip joint and artificial denture and is often affected by electrochemical corrosion in human body fluids and saliva, which leads to inflammatory reactions and damage to the surrounding tissues as well as loosening and failure of the body components themselves. Few studies have been conducted to prepare corrosion-resistant coatings on the surface of Co28Cr6Mo. In this study, we used laser texturing to process a bionic 3D micronanocomposite structure on the surface of Co28Cr6Mo and quickly prepared a superhydrophobic and slippery surface coating with excellent corrosion resistance using polydimethylsiloxane solution and silicone oil modification. This surface had ultralow surface adhesion and good robustness of durability and abrasion resistance, reducing bacterial colonization or tissue adhesion and solving the problem of the lack of stability of the superhydrophobic surface. Microgrid grooves and layered nanoparticles were structurally responsible for the variation in wettability. The formation mechanism and composition of the prepared coatings were further analyzed. Electrochemical corrosion experiments were conducted on the surface in simulating body fluid and saliva environments, which showed the enhanced corrosion resistance of the prepared surface in the human body. These findings can further develop the surface functional modification of Co28Cr6Mo, accelerating basic and applied research studies on artificial human components.
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Affiliation(s)
- Li Zhang
- School of Control Engineering, Northeastern University at Qinhuangdao, Qinhuangdao 066004, China
- Key Laboratory of Vibration and Control of Aero-Propulsion System Ministry of Education, Northeastern University, Shenyang 110819, China
| | - Zheng Tan
- School of Control Engineering, Northeastern University at Qinhuangdao, Qinhuangdao 066004, China
| | - Tianci Wu
- School of Control Engineering, Northeastern University at Qinhuangdao, Qinhuangdao 066004, China
| | - Lulin Zhang
- School of Control Engineering, Northeastern University at Qinhuangdao, Qinhuangdao 066004, China
| | - Bo Hao
- School of Control Engineering, Northeastern University at Qinhuangdao, Qinhuangdao 066004, China
- Key Laboratory of Vibration and Control of Aero-Propulsion System Ministry of Education, Northeastern University, Shenyang 110819, China
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Falkner F, Tümkaya AM, Thomas B, Panzram B, Bickert B, Harhaus L. Dual mobility prosthesis for trapeziometacarpal osteoarthritis: results from a prospective study of 55 prostheses. J Hand Surg Eur Vol 2023; 48:566-574. [PMID: 36855785 DOI: 10.1177/17531934231156280] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
This prospective study evaluated outcomes after trapeziometacarpal joint replacement with a dual mobility prosthesis (Touch®) in 55 thumbs (52 patients) with a mean follow-up of 25 months (range 12-36). Pre- and postoperative assessments included pain, range of motion, the Kapandji index, pinch- and grip strength, as well as functional scores and radiological parameters. Mean preoperative metacarpophalangeal joint hyperextension of 19° (range 15°-28°) showed a significant correction after 1 year with a mean value of 2° (range 0°-5°). Mean Quick Disabilities of the Hand, Shoulder and Arm score was 14 (range 6-28), and Michigan Hand Questionnaire 82 (range 67-92). No revisions due to infection, loosening, dislocation or material failure occurred during follow-up. The dual mobility trapeziometacarpal joint prosthesis was a reliable treatment option to decrease pain, improve motion, strength and pre-existing metacarpophalangeal joint hyperextension at short-term follow-up.Level of evidence: IV.
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Affiliation(s)
- Florian Falkner
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Ludwigshafen, Germany
- Department of Hand and Plastic Surgery, University of Heidelberg, Heidelberg, Germany
| | - Arman Mahmut Tümkaya
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Ludwigshafen, Germany
- Department of Hand and Plastic Surgery, University of Heidelberg, Heidelberg, Germany
| | - Benjamin Thomas
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Ludwigshafen, Germany
- Department of Hand and Plastic Surgery, University of Heidelberg, Heidelberg, Germany
| | - Benjamin Panzram
- Center of Orthopaedics, Trauma Surgery and Paraplegiology, University of Heidelberg, Heidelberg, Germany
| | - Berthold Bickert
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Ludwigshafen, Germany
- Department of Hand and Plastic Surgery, University of Heidelberg, Heidelberg, Germany
| | - Leila Harhaus
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Ludwigshafen, Germany
- Department of Hand and Plastic Surgery, University of Heidelberg, Heidelberg, Germany
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Newton A, Talwalkar S. Arthroplasty in thumb trapeziometacarpal (CMC joint) osteoarthritis: An alternative to excision arthroplasty. J Orthop 2023; 35:134-139. [PMID: 36471695 PMCID: PMC9719001 DOI: 10.1016/j.jor.2022.11.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 11/15/2022] [Accepted: 11/18/2022] [Indexed: 11/27/2022] Open
Abstract
Trapeziectomy for base of thumb arthritis is well established, but base of thumb arthroplasty offers potential advantages. The review covers the development of arthroplasty for the thumb from interposition arthroplasty to total joint replacement. It discusses contemporary prosthesis designs and results, including trapezial component geometry, bearing surfaces, and dual mobility.
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5
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Abstract
Thumb carpometacarpal implant arthroplasty aims to preserve thumb length and motion and to provide pain relief and functional recovery after a short postoperative time. For several decades, implant arthroplasty has been performed with total trapeziometacarpal joint prosthesis using the concept of "ball-and-socket" joint. More recently, pyrocarbon implants used as hemiarthroplasty or interposition arthroplasty have been proposed. Whatever the type of arthroplasty used, the surgical technique must be precise and may require a learning curve. Implant arthroplasty has proven that in the medium and long-term, it may be considered as a valid and reliable alternative to trapeziectomy.
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Affiliation(s)
- Philippe Bellemère
- Institut de la Main Nantes-Atlantique, Santé Atlantique, avenue Claude Bernard, Saint-Herblain, 44800 France.
| | - Bruno Lussiez
- IM2S, Clinique de Chirurgie orthopédique et traumatologique de Monaco, 11 avenue d'Ostende 98000, Monaco
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Lussiez B, Falaise C, Ledoux P. Dual mobility trapeziometacarpal prosthesis: a prospective study of 107 cases with a follow-up of more than 3 years. J Hand Surg Eur Vol 2021; 46:961-967. [PMID: 34162273 DOI: 10.1177/17531934211024500] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We report the results of a prospective study using a dual mobility trapeziometacarpal prosthesis (Touch®) in 107 patients with a minimum follow-up of 3 years. One-hundred and two patients (95%) were very satisfied or satisfied with the functional outcomes and the mean pain intensity in visual analogue scale decreased from 7.4 to 0.8 (p < 0.001). Thumb opposition (Kapandji score) index increased from an average of 8.0 to 9.4, while the mean QuickDASH score improved from 38 preoperatively to 20 at follow-up (p < 0.01). Key-pinch strength improved from 3.5 kg (range 0.5-9.5) to 5.5 kg (range 3.0-11.5). There was a 4.6% rate of complications, including cup loosening and wear of polyethylene, which required revision, but no cases of prosthetic dislocation were seen. Applying the dual mobility principle to trapeziometacarpal arthroplasty may significatively improve the stability of these prostheses. Radiolucent zones around the components of the prostheses are not systematic predictors of future loosening.Level of evidence: IV.
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TOUCH ® Prosthesis for Thumb Carpometacarpal Joint Osteoarthritis: A Prospective Case Series. J Clin Med 2021; 10:jcm10184090. [PMID: 34575201 PMCID: PMC8470025 DOI: 10.3390/jcm10184090] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 09/08/2021] [Accepted: 09/09/2021] [Indexed: 11/17/2022] Open
Abstract
The dual mobility concept currently represents the newest generation of thumb carpometacarpal prostheses. The aim of this study was to evaluate the short-term outcomes of TOUCH® prosthesis. From September 2019 to July 2020, 40 prosthesis were implanted in 37 patients suffering from symptomatic stage III osteoarthritis. All included patients with a median age of 57.7 (IQR: 13.6) finished the systematic follow-up regimen (4, 8, 16 weeks, 6, and 12 months postoperatively). All parameters significantly improved (p < 0.0001) compared to the preoperative status. At 1 year follow-up, median DASH Scores decreased from 54 (IQR 22) to 12 (IQR 28) and pain levels improved from 8 (IQR 2) to 1 (IQR 2). Moreover, key-pinch strength increased from 3.8 (2.0) to 5.8 (2.5), while palmar abduction, radial abduction, and opposition also significantly improved. 35/37 patients were satisfied with the functional outcomes. We observed 10 complications, of which 6 were tendon-related issues, and 2 were due to an inappropriate choice of neck size. We could detect one dislocation but no evidence of cup loosening, tilting or subsidence in any patient. Despite the occurrence of some complications, we recommend implantation of this prosthesis type due to favorable clinical and radiological performance.
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Abstract
For thumb carpometacarpal osteoarthritis, trapeziectomy provides generally good results with reduction of pain and restoration of thumb mobility, but shortening of the thumb may at least in theory lead to reduction in grip and pinch strength. Furthermore, instability of the base of the first metacarpal and contact with the scaphoid may occur regardless of the several described techniques with ligament reconstruction and tendon interposition. Thus, for years alternatives to trapeziectomy have been explored and reported with disputable success. Often the road from idea to implantation in patients seems to have been short, and high complication rates and failure of new implant designs have been fairly common. This has led to the general impression that the implants do not provide sufficient benefits compared with simple trapeziectomy. More recent uncemented total joint replacement designs have shown rapid rehabilitation, reduction of pain, restoration of grip strength and movement, and much improved long-term implant survival. These factors may make total joint replacement a realistic alternative to trapeziectomy. Still, patient selection has to be improved, as the benefits may be small in the low activity elderly patient.
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Affiliation(s)
- Torben Bæk Hansen
- University Clinic for Hand, Hip and Knee Surgery, Holstebro Hospital, Holstebro, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
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9
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Copeland A, Gallo L, Weber C, Moltaji S, Gallo M, Murphy J, Axelrod D, Thoma A. Reporting Outcomes and Outcome Measures in Thumb Carpometacarpal Joint Osteoarthritis: A Systematic Review. J Hand Surg Am 2021; 46:65.e1-65.e11. [PMID: 32819777 DOI: 10.1016/j.jhsa.2020.05.024] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 04/20/2020] [Accepted: 05/27/2020] [Indexed: 02/02/2023]
Abstract
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.
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Affiliation(s)
- Andrea Copeland
- Division of Plastic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Lucas Gallo
- Division of Plastic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Christina Weber
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Syena Moltaji
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Matteo Gallo
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Jessica Murphy
- Division of Plastic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Daniel Axelrod
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Achilleas Thoma
- Division of Plastic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.
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Remy S, Detrembleur C, Libouton X, Bonnelance M, Barbier O. Trapeziometacarpal prosthesis: an updated systematic review. HAND SURGERY & REHABILITATION 2020; 39:492-501. [PMID: 32860986 DOI: 10.1016/j.hansur.2020.08.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 07/29/2020] [Accepted: 08/04/2020] [Indexed: 12/23/2022]
Abstract
The trapeziometacarpal prosthesis is mostly used in Europe to treat osteoarthritis of the basal joint of the thumb. Its supposed benefits are that it restores the length of the thumb, improves strength, function and mobility while reducing recovery time compared to other surgical treatments. However, previous reviews of the literature could not confirm these assumptions. This article provides an updated systematic review to help answer to these questions through a methodical statistical analysis and to quantify the two main complications, namely failure and deep infection. To achieve these aims, a selection of articles including implant case series was done in the Medline database based on specific criteria. Data about pain, function, strength, infection, and failure were compiled and a statistical analysis was performed. Results show a fast recovery in terms of pain and function but the positive effect on strength seems limited. The failure rate represented by the revision rate is high and the deep infection rate is fairly low. Randomized controlled studies are needed to obtain reliable data to compare the prosthesis to other surgical treatments.
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Affiliation(s)
- S Remy
- Cliniques Universitaires Saint-Luc, Service d'Orthopédie et de Traumatologie de l'Appareil Locomoteur, Avenue Hippocrate 10, 1200 Brussels, Belgium.
| | - C Detrembleur
- Université Catholique de Louvain, Secteur des Sciences de la Santé, Institut de Recherche Expérimentale et Clinique, Neuro Musculo Skeletal Lab (NMSK), Avenue Mounier 53, 1200 Brussels, Belgium
| | - X Libouton
- Cliniques Universitaires Saint-Luc, Service d'Orthopédie et de Traumatologie de l'Appareil Locomoteur, Avenue Hippocrate 10, 1200 Brussels, Belgium; Université Catholique de Louvain, Secteur des Sciences de la Santé, Institut de Recherche Expérimentale et Clinique, Neuro Musculo Skeletal Lab (NMSK), Avenue Mounier 53, 1200 Brussels, Belgium
| | - M Bonnelance
- Cliniques Universitaires Saint-Luc, Service d'Orthopédie et de Traumatologie de l'Appareil Locomoteur, Avenue Hippocrate 10, 1200 Brussels, Belgium
| | - Olivier Barbier
- Cliniques Universitaires Saint-Luc, Service d'Orthopédie et de Traumatologie de l'Appareil Locomoteur, Avenue Hippocrate 10, 1200 Brussels, Belgium; Université Catholique de Louvain, Secteur des Sciences de la Santé, Institut de Recherche Expérimentale et Clinique, Neuro Musculo Skeletal Lab (NMSK), Avenue Mounier 53, 1200 Brussels, Belgium
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11
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Lerebours A, Marin F, Bouvier S, Egles C, Rassineux A, Masquelet AC. Trends in Trapeziometacarpal Implant Design: A Systematic Survey Based on Patents and Administrative Databases. J Hand Surg Am 2020; 45:223-238. [PMID: 31987639 DOI: 10.1016/j.jhsa.2019.11.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 07/09/2019] [Accepted: 11/15/2019] [Indexed: 02/02/2023]
Abstract
Hand function is inseparably linked to the condition of the thumb. The trapeziometacarpal (TMC) joint that provides the different movements of opposition is one of the joints most affected by osteoarthritis, which causes an irreversible deformation of the bone. The ideal thumb carpometacarpal implant must restore range of movement, prevent complications, be biocompatible, and have good mechanical properties (ie, low wear, high corrosion resistance, and osteointegration properties where it is anchored in a bone). The integrity of the implant and the surrounding biological structures must be long-lasting and withstand constant stresses induced by the prosthesis. Three main types of implant systems for the thumb are currently clinically available; others are under investigation in human subjects. This systematic review is based on administrative databases, patents, the literature, and information from orthopedic companies. It provides a summary of strategies and design changes and an overview of the biomechanical characteristics of currently available carpometacarpal implants for treating osteoarthritis of the thumb.
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Affiliation(s)
- Augustin Lerebours
- CNRS, FRE2012 Laboratory Roberval, Sorbonne Universities Alliance, University of Technology of Compiègne, Compiègne, France.
| | - Frederic Marin
- CNRS, UMR7338 Laboratory, Biomechanics and Bioengineering, Sorbonne Universities Alliance, University of Technology of Compiègne, Compiègne, France
| | - Salima Bouvier
- CNRS, FRE2012 Laboratory Roberval, Sorbonne Universities Alliance, University of Technology of Compiègne, Compiègne, France
| | - Christophe Egles
- Department of Orthopedics, Trauma, and Hand Surgery, Saint Antoine Hospital, Paris, France
| | - Alain Rassineux
- CNRS, FRE2012 Laboratory Roberval, Sorbonne Universities Alliance, University of Technology of Compiègne, Compiègne, France
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Ganhewa AD, Wu R, Chae MP, Tobin V, Miller GS, Smith JA, Rozen WM, Hunter-Smith DJ. Failure Rates of Base of Thumb Arthritis Surgery: A Systematic Review. J Hand Surg Am 2019; 44:728-741.e10. [PMID: 31262534 DOI: 10.1016/j.jhsa.2019.05.003] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 02/27/2019] [Accepted: 05/01/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of the current review was to estimate failure rates of trapeziometacarpal (TMC) implants and compare against failure rates of nonimplant techniques for surgical treatment of TMC joint (basal thumb joint) arthritis. METHODS A systematic review was conducted to identify articles reporting on thumb implant arthroplasty and on nonimplant arthroplasty techniques for treatment of base of thumb arthritis in the English literature. The collected data were combined to calculate failure rates per 100 procedure-years. Failure was defined by the requirement for a secondary salvage procedure. The failure rates between different implant and nonimplant arthroplasty groups were compared directly and implants with higher than anticipated failure rates were identified. RESULTS One hundred twenty-five articles on implant arthroplasty and 33 articles on the outcome of nonimplant surgical arthroplasty of the TMC joint were included. The implant arthroplasty failure rates per 100 procedure-years were total joint replacement (2.4), hemiarthroplasty (2.5), interposition with partial trapezial resection (4.5), interposition with complete trapezial resection (1.7), and interposition with no trapezial resection (4.5). The nonimplant arthroplasty failure rates per 100 procedure-years were: trapeziectomy (0.49), joint fusion (0.52), and trapeziectomy with ligament reconstruction ± tendon interposition (0.23). CONCLUSIONS Several implant designs (arthroplasties) had high rates of failure due to aseptic loosening, dislocation, and persisting pain. Furthermore, some implants had higher than anticipated failure rates than other implants within each class. Overall, the failure rates of nonimplant techniques were lower than those of implant arthroplasty. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Aparna D Ganhewa
- Department of Plastic, Reconstructive and Hand Surgery, Peninsula Health, Frankston
| | - Rui Wu
- Department of Plastic, Reconstructive and Hand Surgery, Peninsula Health, Frankston
| | - Michael P Chae
- Department of Plastic, Reconstructive and Hand Surgery, Peninsula Health, Frankston; Peninsula Clinical School, Central Clinical School, Monash University, The Alfred Centre, Melbourne; Department of Surgery, School of Clinical Sciences, Monash Medical Centre, Clayton, Victoria, Australia
| | - Vicky Tobin
- Department of Plastic, Reconstructive and Hand Surgery, Peninsula Health, Frankston
| | - George S Miller
- Department of Plastic, Reconstructive and Hand Surgery, Peninsula Health, Frankston
| | - Julian A Smith
- Department of Surgery, School of Clinical Sciences, Monash Medical Centre, Clayton, Victoria, Australia
| | - Warren M Rozen
- Department of Plastic, Reconstructive and Hand Surgery, Peninsula Health, Frankston; Peninsula Clinical School, Central Clinical School, Monash University, The Alfred Centre, Melbourne; Department of Surgery, School of Clinical Sciences, Monash Medical Centre, Clayton, Victoria, Australia
| | - David J Hunter-Smith
- Department of Plastic, Reconstructive and Hand Surgery, Peninsula Health, Frankston; Peninsula Clinical School, Central Clinical School, Monash University, The Alfred Centre, Melbourne; Department of Surgery, School of Clinical Sciences, Monash Medical Centre, Clayton, Victoria, Australia.
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Thorkildsen RD, Røkkum M. Trapeziectomy with LRTI or joint replacement for CMC1 arthritis, a randomised controlled trial. J Plast Surg Hand Surg 2019; 53:361-369. [PMID: 31271330 DOI: 10.1080/2000656x.2019.1635490] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
We compared an uncemented joint replacement (Elektra) with trapeziectomy (with ligament reconstruction and tendon interposition, LRTI) for the treatment of primary osteoarthritis in the first carpometacarpal joint (CMC1) in a randomised controlled trial. Forty patients were included (20 in each group) and followed for 2 years. The median age in the groups was 64 and 61, respectively, with 14 females in each. At final follow-up, there was no difference in the primary outcome measure (the quick disabilities of the arm, shoulder and hand score, QDASH), but the joint replacement group had significantly better motion and strength during the early rehabilitation period and significantly better range of thumb abduction and extension at the last follow-up. There were more complications in the joint replacement group with revision of prosthetic components in five cases, two of them due to cup loosening. Radiologically, lucency zones were seen around either cup or stem in 15 patients. Most were small, but two cases with major osteolysis resulted in revision. Shortening of the thumb ray was observed after trapeziectomy.
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Affiliation(s)
- Rasmus D Thorkildsen
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway.,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
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14
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Thorkildsen R, Reigstad O, Røkkum M. Chrome nitride coating reduces wear of small, spherical CrCoMo metal-on-metal articulations in a joint simulator. J Hand Surg Eur Vol 2017; 42:310-315. [PMID: 28196445 DOI: 10.1177/1753193416674161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Metal-on-metal articulations have fallen out of favour in larger joint replacements, but are still used in smaller joints. Coating the articulation has been suggested as one way of reducing wear. We compared a standard 6 mm CrCoMo articulation designed for the carpometacarpal joint of the thumb with a chromium nitride-coated version after 512,000 cycles in a joint simulator. A total of 6 articulations in each group were tested with a unidirectional load of 5 kg in Ringer's solution. We found a statistically significant reduction in weight loss, amount of metallic wear produced and volumetric wear for the chromium nitride-coated articulation. Our findings support the use of chromium nitride coating in order to minimize the amount of metallic wear produced.
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Affiliation(s)
- R Thorkildsen
- 1 Orthopaedic Department, University Hospital of Oslo, Oslo, Norway
| | - O Reigstad
- 1 Orthopaedic Department, University Hospital of Oslo, Oslo, Norway
| | - M Røkkum
- 1 Orthopaedic Department, University Hospital of Oslo, Oslo, Norway.,2 University of Oslo, Oslo, Norway
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Thillemann JK, Thillemann TM, Munk B, Krøner K. High revision rates with the metal-on-metal Motec carpometacarpal joint prosthesis. J Hand Surg Eur Vol 2016; 41:322-7. [PMID: 26170338 DOI: 10.1177/1753193415595527] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Accepted: 06/19/2015] [Indexed: 02/03/2023]
Abstract
UNLABELLED We retrospectively evaluated a consecutive series of 42 Motec thumb carpometacarpal total joint arthroplasties. The primary endpoint was revision with implant removal and trapeziectomy. At follow-up the disability of the arm shoulder and hand (DASH) score, pain on numerical rating scale at rest and with activity and serum chrome and cobalt concentrations were assessed for both unrevised and revised patients. At a mean follow-up of 26 months, 17 patients had been revised. The 2 year cumulative revision rate was 42% (95% CI, 28-60%). The DASH score and pain scores at rest and with activity were comparable between the patients whose thumbs remained unrevised and those revised. Patients with elevated serum chrome and cobalt levels had significantly higher DASH and pain scores, but elevated levels were not associated with revision. The revision rate in this study is unacceptably high. However, pain and DASH scores after revision are acceptable and comparable with patients with non-revised implants. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- J K Thillemann
- Department of Hand Surgery, Aarhus University Hospital, Aarhus C, Denmark
| | - T M Thillemann
- Department of Hand Surgery, Aarhus University Hospital, Aarhus C, Denmark
| | - B Munk
- Department of Hand Surgery, Aarhus University Hospital, Aarhus C, Denmark
| | - K Krøner
- Department of Hand Surgery, Aarhus University Hospital, Aarhus C, Denmark
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Schmidt I. Metal allergy after first metatarsophalangeal total joint replacement--Case report. Foot Ankle Surg 2015; 21:211-3. [PMID: 26235863 DOI: 10.1016/j.fas.2015.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Revised: 03/23/2015] [Accepted: 05/07/2015] [Indexed: 02/04/2023]
Abstract
A 62-year-old female patient presented with a symptomatic metal allergy six weeks after first metatarsophalangeal total joint replacement using ROTOGLIDE implant. Preoperatively, there was no history of hypersensitivity. The symptomatic dermatitis was evaluated using dermal patch testing. The implant had to be removed. The possible agents for the allergic reaction are discussed.
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Affiliation(s)
- I Schmidt
- Hospital Schleiz GmbH/Department of Hand Surgery, Berthold-Schmidt-Str. 7-9, 07907 Schleiz Germany.
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17
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Complications Related to Metal-on-Metal Articulation in Trapeziometacarpal Joint Total Joint Arthroplasty. J Funct Biomater 2015; 6:318-27. [PMID: 26020592 PMCID: PMC4493514 DOI: 10.3390/jfb6020318] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 05/18/2015] [Indexed: 02/08/2023] Open
Abstract
Adverse reactions to metal-on-metal (MoM) prostheses are well known from total hip joint resurfacing arthroplasty with elevated serum chrome or cobalt, pain and pseudo tumor formation. It may, however, also be seen after total joint replacement of the trapeziometacarpal joint using MoM articulation, and we present two cases of failure of MoM prostheses due to elevated metal-serum levels in one case and pseudo tumor formation in another case. Furthermore, we suggest a diagnostic algorithm for joint pain after MoM trapeziometacarpal joint replacement based on published experiences from MoM hip prostheses and adverse reactions to metal.
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