High revision rates with the metal-on-metal Motec carpometacarpal joint prosthesis

Long-term results of 292 CarpoFit®-joint replacements for trapeziometacarpal osteoarthritis: a prospective cohort study with a 10-year follow-up

We report a prospective consecutive series of CarpoFit® (Implantcast, Buxtehude, Germany) trapeziometacarpal prostheses used between 2006 and 2014 for 292 patients with stage I-III trapeziometacarpal arthritis who remained symptomatic after conservative treatment. Patients were assessed at 3 months, 6 months and 1 year postoperatively for thumb movement, pinch strength and by validated patient-derived outcome scores and radiographs. Follow-up at 5 and 10 years was by outcome scores alone. Complications and revisions were recorded. Of the patients, 91% were either satisfied or very satisfied with their treatment at 10 years. Pain relief and functional outcomes were significantly improved within 3 months. Results were sustained during the entire observation period. The implant survival was 95% after 10 years. Prosthetic arthroplasty is a reliable treatment option for trapeziometacarpal osteoarthritis and the CarpoFit® prosthesis has excellent long-term results for patient satisfaction, functional scores and implant survivorship.Level of evidence: III.

[Base-of-thumb osteoarthritis: aspects to be considered with the indication of trapeziectomy and CMC I prosthesis]

Base-of-thumb osteoarthritis is the most frequent osteoarthritis of the hand requiring surgical treatment, although conservative treatment options should be exhausted before surgery. If the wear process progresses with continuing pain-related loss of thumb function, thus leading to a loss of function of the whole hand, surgical treatment is indicated. In 1947, Gervis published results after trapeziectomy and heralded the development of a multitude of different surgical procedures. The long time needed for rehabilitation is a major problem of trapeziectomy with or without tendon interposition and/or suspension. After the implementation of the first CMC I prosthesis by De la Caffiniere 50 years ago, a rapid development took place, leading to the current modular bipolar implants. Especially in the German-speaking world, there is still some scepticism regarding these prostheses, which is why this review aims to illuminate both surgical procedures with a special focus placed on the aspects of indication.

[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.

A review of wear debris in thumb base joint implants

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.

Superior bone fixation of conical compared with hemispherical trapezial cup design: an experimental radiostereometry study

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.

Outcomes of Revision of Interposition Implant Trapeziometacarpal Arthroplasty

BACKGROUND

Implant arthroplasties for trapeziometacarpal osteoarthritis are often associated with high complication and revision surgery rates. There are no previous studies reporting revision outcomes of failed interposition implant arthroplasty.

METHODS

A patient register search was done for all implant arthroplasties performed for trapeziometacarpal osteoarthritis during a 10-year period in a single hand surgical unit. Altogether, 32 patients had primary interposition implant arthroplasty (Artelon 22, Pyrosphere 6, Ortosphere 2, and Pyrodisk 2), and 19 of these patients had revision surgery with 23 revision procedures performed. In all, 15 of the revised 19 patients were reexamined clinically (Connolly-Rath score, Quick Disabilities of the Arm Shoulder and Hand, patient evaluation measure, the visual analog score for pain, thumb range of motion and strength measurements) and radiographically.

RESULTS

The indication for revision surgery was pain alone or implant dislocation accompanied by pain in all cases. Thirteen of the revised 15 patients reported functional deficit and pain after revision. There was no statistically significant difference in the revision outcomes between patients operated on primarily with the Artelon implant versus pyrocarbon/ceramic implants. Compared to previous studies on revision surgery and primary trapeziometacarpal arthroplasty, our results showed slightly higher pain and poorer functional scores.

CONCLUSIONS

Interposition implant arthroplasty may yield high revision rates. The results after revision surgery may be worse than previously described, and there may also be a tendency for worse results than those of primary arthroplasty. Interposition implant arthroplasty should always be thoroughly contemplated.

Safety and efficacy of a novel three-dimensional printed microporous titanium prosthesis for total wrist arthroplasty in the treatment of end-stage wrist arthritis

Background: Total wrist arthroplasty is an effective treatment for end-stage wrist arthritis from all causes. However, wrist prostheses are still prone to complications such as prosthesis loosening and periprosthetic fractures after total wrist arthroplasty. This may be due to the wrist prosthesis imprecise matching with patient's bone. In this study, we designed and developed a personalized three-dimensional printed microporous titanium artificial wrist prosthesis (3DMT-Wrist) for the treatment of end-stage wrist joint, and investigated its safety and effectiveness. Methods: Total wrist arthroplasty was performed using 3DMT-Wrist in 14 cases of arthritis between February 2019 and December 2021. Preoperative and postoperative visual analog scale scores, QuickDASH scores, wrist range of motion, and wrist grip strength were evaluated. Data were statistically analyzed using the paired samples t-test. Results: After 19.7 ± 10.7 months of follow-up, visual analog scale decreased from 66.3 ± 8.9 to 6.7 ± 4.4, QuickDASH scores decreased from 47.4 ± 7.3 to 28.2 ± 7.6, grip strength increased from 5.6 ± 1.4 to 17.0 ± 3.3 kg. The range of motion improved significantly in palmar flexion (30.1° ± 4.9° to 44.9° ± 6.5°), dorsal extension (15.7° ± 3.9° to 25.8° ± 3.3°), ulnar deviation (12.2° ± 3.9° to 20.2° ± 4.3°) and radial deviation (8.2° ± 2.3° to 16.2 ± 3.1). No dislocation or loosening of the prosthetic wrist joint was observed. Conclusion: Total wrist arthroplasty using 3DMT-Wrist is a safe and effective new treatment for various types of end-stage wrist arthritis; it offers excellent pain relief and maintains the range of motion.

Arthroplasty in thumb trapeziometacarpal (CMC joint) osteoarthritis: An alternative to excision arthroplasty

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.

Thumb Carpometacarpal Implant Arthroplasty

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.

Revision rates of trapeziometacarpal total joint arthroplasty in relation to occupational hand force requirements

The purpose was to determine revision rates after trapeziometacarpal total joint arthroplasty in working age patients, hypothesizing that higher occupational hand force requirements lead to higher revision rates. We conducted a follow-up study of patients operated 2003-2015. Self-reported job titles at the time of primary surgery were linked with a job exposure matrix to estimate occupational hand force requirements. Time until revision was analysed using Cox regression. The study comprised 222 patients aged 39-65 years (mean 55, SD 6), including 133 patients in the labour market. The median follow-up period was 5 years (interquartile range 4-7) and the overall revision rate was 5/100 person-years. For high versus low occupational hand force requirements, the hazard ratio was 1.5 (95% confidence interval 0.5-4.4). For patients outside the labour market, the hazard ratio was 2.3 (0.9-5.6). Our results did not indicate large effects of high occupational hand force requirements on revision rates.Level of evidence: IV.

Update on Thumb Basal Joint Arthritis Surgery

LEARNING OBJECTIVES

After studying this article, the participant should be able to: 1. Comprehend anatomy and biomechanics of the normal and arthritic trapeziometacarpal joint. 2. Evaluate best evidence for diagnosis and for operative and nonoperative treatment of thumb osteoarthritis. 3. Understand treatment pitfalls of basilar joint arthritis and complication avoidance.

SUMMARY

Articular and ligamentous anatomy of the trapeziometacarpal joint enables complex motions. Disability from arthritis, common at the trapeziometacarpal joint, is debilitating. Furthering the understanding of how trapeziometacarpal arthritis develops can improve treatment. The authors provide current best evidence for diagnosis and treatment of basilar joint arthritis. Pitfalls in treatment are discussed.

Dual mobility trapeziometacarpal prosthesis: a prospective study of 107 cases with a follow-up of more than 3 years

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.

Influence of Occupational Hand Force Requirements on Return to Work, Pain, and Disability After Trapeziometacarpal Total Joint Arthroplasty: A 12-Month Follow-Up Study

PURPOSE

We aimed to determine the prognosis after trapeziometacarpal total joint arthroplasty for basal thumb osteoarthritis with respect to sustainable return to work (RTW), pain, and disability. Our main hypothesis was that high occupational hand force requirements are related to slower RTW.

METHODS

We conducted a 12-month follow-up study of patients who were treated with a trapeziometacarpal total joint arthroplasty in 2003 to 2015 and were active in the labor market at the time of surgery. We used registry information about RTW. Before surgery and at the 12-month follow-up, we obtained data on pain and disability. To obtain estimates of occupational hand force requirements for individual patients, we linked the patients' self-reported job title to a job exposure matrix based on experts' ratings. We used Cox regression models to analyze the time until sustainable RTW and logistic regression models to analyze pain and disability.

RESULTS

A total of 133 patients were included. Most patients returned to work within 12 months after surgery (86%). For those who returned to work within 12 months (n = 114), mean time until sustainable RTW was 14 weeks (SD, 9 weeks). Higher hand force requirements were associated with slower RTW (for medium- and high-force requirements, adjusted hazard ratios were 0.48 [95% confidence interval, 0.30-0.78] and 0.41 [95% confidence interval, 0.25-0.69]). Occupational hand force requirements were not associated with pain and disability at follow-up.

CONCLUSIONS

High occupational hand force requirements were associated with slower RTW, but not with pain and disability 12 months after surgery.

TYPE OF STUDY/LEVEL OF EVIDENCE

Prognostic I.

Thumb CMCJ prosthetic total joint replacement: a systematic review

Thumb carpometacarpal joint (CMCJ) arthritis is a common and painful condition. Thumb CMCJ prosthetic replacement aims to restore thumb biomechanics and improve pain and function. Early reviews demonstrated a lack of high-quality studies, but more recently a significant number of higher-quality studies have been published. This review provides a concise and systematic overview of the evidence to date.

A systematic review of several databases was conducted according to PRISMA guidelines. Studies evaluating the outcomes of thumb CMCJ prosthetic total joint replacement were included. Data extracted included patient-reported outcome measures (PROMs), pain scores, range of motion, strength, survival rates and complications.

A total of 56 studies met all inclusion criteria and were analysed. There was one randomized controlled trial, three prospective comparative cohort studies, five retrospective comparative cohort studies, and 47 descriptive cohort studies. The reported studies included 2731 patients with 3048 thumb total CMCJ prosthetic joint replacements. Follow up ranged from 12 months to 13.1 years.

In general, good results were demonstrated, with improvements in PROMs, pain scores and strength. Failure rates ranged from 2.6% to 19.9% depending upon implant studied. Comparative studies demonstrated promising results for replacement when compared to resection arthroplasty, with modest improvements in PROMs but at a cost of increased rates of complications.

Studies reporting outcomes in thumb CMCJ prosthetic total joint replacement are increasing in both number and quality. Failure, in terms of loosening and dislocation, remains a concern, although in the medium-term follow up for modern implants this issue appears to be lower when compared to their predecessors.

Functional outcomes also look promising compared to resection arthroplasty, but further high-quality studies utilizing a standardized resection arthroplasty technique and modern implants, together with standardized core outcome sets, will be of value.

Cite this article: EFORT Open Rev 2021;6:316-330. DOI: 10.1302/2058-5241.6.200152

Joint replacement for trapeziometacarpal osteoarthritis: implants and outcomes

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.

Two-year results of the Moovis trapeziometacarpal joint arthroplasty with focus on early complications

In this prospective study, we aimed to analyse the early results of 200 consecutive total trapeziometacarpal joint arthroplasties using the Moovis cup, a new generation, dual-mobility, uncemented conical cup, with special focus on early complications. At the 24-month follow-up, we found clinically relevant improvement of function and comfort. Among intraoperative complications were nine intraoperative trapezial fractures, which were treated by screw osteosynthesis; prolonged immobilization; and conversion to cemented cup fixation or primary or secondary trapeziectomy. One was left untreated as the loose cup did not cause notable symptoms. There were three implants with polyethylene wear and two with liner dislocation. We conclude that early outcomes of this new-generation implant are favourable, but its surgery is challenging and associated with important intraoperative and early postoperative complications related to the learning curve. Attentive reaming of the trapezium and careful cup impaction are crucial steps to avoid trapezial fracture and early cup failure. Level of evidence: II.

Geographical differences in carpometacarpal joint osteoarthritis treatment of the thumb: A survey of 1138 hand surgeons from the USA and Europe

BACKGROUND

Carpometacarpal osteoarthritis of the thumb (CMC OA) is treated with various therapeutic approaches. However, the literature remains inconclusive regarding the ideal procedure for each disease stage. In this study, we assessed the international application of surgical treatment options including CMC I implants and non-surgical treatment options for CMC OA depending on the disease stage, with a strong focus on the detection of geographical disparities.

METHODS

We conducted a large international online survey with members of hand surgical societies of the International Federation of Societies for Surgery of the Hand (IFSSH). The first part of the survey asked about general therapy options of CMC OA depending on the severity of the disease, whereas the second part specifically dealt with the use of prostheses.

RESULTS

We could include 10 of 56 IFSSH member societies (6807 surgeons) and received answers from 1138 members (16.7%). Significant differences were detected in an increased use of corticosteroid injections in the USA, and a growing frequency of fat injections in Europe. Regarding use and frequency of the resection arthroplasty, we found similar results in all participating countries. Prosthetic implantation showed a significant difference between the USA and Europe, with far larger numbers stated by European hand surgeons.

CONCLUSION

CMC OA is treated differently in the participating countries depending on the stage of the disease. We give an insight into geographical differences in treatment paradigms, with corticosteroid injections being more prevalent in the USA, and prosthesis implantation being more frequently chosen in the selected European countries.

Early to Mid-Term Results in Trapezio-metacarpal Joint Replacement using the ARPE Implant

Background:

Trapezio-Metacarpal Joint (TMJ) arthritis is a common cause of radial sided wrist pain. After conservative measures have been exhausted, the current mainstay of surgical treatment is trapeziectomy. Some surgeons combine this with additional ligament reconstruction and tendon or capsular interposition techniques to provide a more stable base for the thumb metacarpal.

Purpose:

In modern Orthopaedic practice, arthroplasty is the procedure of choice for many end-stage arthritic joints. However, due to the reliable and reproducible outcomes of trapeziectomy, this has yet to be widely adopted by hand surgeons in the management of TMJ arthritis. Recent series of arthroplasty implants have consistently shown good outcomes and trapezio-metacarpal joint replacement has been observed to provide excellent long-term function in the fit and active patient.

Methods:

We have performed a total of 52 TMJ arthroplasties in 46 patients in our institution for over 5 years (2011 to 2016). After excluding 3 cases, 43 available patients (49 implants) were subsequently asked to submit QuickDASH scores and a patient satisfaction survey.

Results:

Average QuickDASH score was 16.6, with high patient satisfaction postoperatively at 1 year. Complications included one intraoperative fracture, and five cases of post-operative instability/ dislocation. Dislocations were treated successfully with open reduction and revision.

Conclusion:

TMJ arthroplasty has shown good outcomes and patient satisfaction with a low revision rate and we recommend its use in active patients with well-preserved scapho-trapezio-trapezoid (STT) joints.

Trapeziometacarpal prosthesis: an updated systematic review

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.

Trends in Trapeziometacarpal Implant Design: A Systematic Survey Based on Patents and Administrative Databases

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.

Functional outcomes after surgery for thumb carpometacarpal joint arthritis

There are a number of possible assessments of functional outcomes for thumb carpometacarpal joint arthritis. The most important and easiest to measure is pain, but it is not the only material outcome. Functional scores for measuring the outcome of the treatment of thumb carpometacarpal joint arthritis have been recommended for some time, but are still not widely used even in published studies. It is also unclear which functional scores are the most valuable. Easily used scores, such as the Disabilities of the Arm Shoulder and Hand questionnaire, are freely available, but may not be sensitive enough to assess outcomes especially of thumb carpometacarpal joint arthroplasty. The optimal functional outcome measurement would be weighted for the individual patient. A minimum dataset needs to be defined in order to compare studies and derive meaningful data.

Failure Rates of Base of Thumb Arthritis Surgery: A Systematic Review

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.

Effectiveness of splinting for pain and function in people with thumb carpometacarpal osteoarthritis: a systematic review with meta-analysis

OBJECTIVE

To examine the effectiveness of splinting for reducing pain and improving function and health-related quality of life (HR-QoL) in people with thumb carpometacarpal osteoarthritis (CMC OA).

DESIGN

The Cochrane Library, MEDLINE, Embase, CINAHL, ISI Web of Science, Scopus and Google Scholar, 3 trial registries and 4 conference proceedings were systematically searched for randomised and non-randomised controlled trials up to March 17th, 2018. Two reviewers independently applied the inclusion criteria to select potential studies and assess risk of methodologic bias using the Cochrane Collaboration's Risk of Bias Tool. Studies were pooled using the inverse variance method to calculate standardised mean difference (SMD). Sensitivity analyses were conducted and the quality of evidence for each outcome was judged following the Grades of Recommendation Assessment, Development and Evaluation (GRADE) approach.

RESULTS

Twelve studies were retrieved (n = 1353), 4 comparing a splint to control and 8 to another splint. In the medium-term (3-12 months), low quality evidence showed that splints cause a moderate to large reduction in pain (SMD 0.7 [95% confidence interval (CI) 1.04, 0.35], P < 0.0001) and small to moderate improvement in function (SMD 0.42 [95% CI 0.77, 0.08], P = 0.02). No significant effect was found at short-term or for different types of splints. No studies reported HR-QoL.

CONCLUSIONS

Splinting demonstrated a moderate to large effect for pain and small to moderate effect for function in the medium-term but not in the short term. Quality of the evidence is low. Major challenges are the lack of diagnostic criteria and of a gold-standard outcome measure for thumb CMC OA.

[Advances in small joint reconstruction and arthroplasty of the hand]

Since Swanson designed the silicone small joint prosthesis, the material and design of the small joint prosthesis have been constantly innovating. The number of small joint reconstruction and arthroplasty has gradually increased in the past decade. The numerous studies have focused on design and application of new material prosthesis and its long-term effectiveness analysis, in order to overcome prosthesis loosening, shift, dislocation, and poor function problem, at the same time to challenge the difficulty of the small joints revision procedures. Although the small joint prosthesis which has got the overall performance of the Swanson joints and been mature and stable like a knee joints prosthesis has not been obtained, but the small joint development has made revolutionary changes in the treatment of joint diseases, and the prosthesis selection criterion and surgical technique tendency solution have been established. In the future, digital three-dimensional printing, regenerative medicine, and translational medicine will contribute to the development of small joint reconstruction and replacement.

Can surgical guidelines minimize complications after Maïa® trapeziometacarpal joint arthroplasty with unconstrained cups?

The most important complications of trapeziometacarpal arthroplasty are dislocation and component loosening. Incorrect cup position is often a contributing factor. Intra-operative guidelines to optimize cup orientation have recently been described. We evaluated the functional and radiological outcome of 50 Maïa® trapeziometacarpal prostheses that were implanted according to these guidelines. The minimum follow-up was 56 months. No constrained cups were used. Functional outcome was good to excellent. No spontaneous dislocations occurred. No radiological signs of loosening were observed. There was one case of premature wear. The survival rate was 96% (95% confidence interval 85 to 99%) at a mean of 65 months, with two prosthesie removed for posttraumatic trapezial fractures. This study shows that correct implant position can lead to reliable medium-term results after trapeziometacarpal joint arthroplasty.

LEVEL OF EVIDENCE

IV.

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.

Joint Survival Analysis and Clinical Outcome of Total Joint Arthroplasties With the ARPE Implant in the Treatment of Trapeziometacarpal Osteoarthritis With a Minimal Follow-Up of 5 Years

PURPOSE

The ARPE joint arthroplasty was introduced in 1991 for the treatment of symptomatic trapeziometacarpal (TMC) osteoarthritis. The primary outcome of this prospective study is to report the medium- to long-term joint survival of this prosthesis. Our secondary outcomes are the clinical and functional results.

METHODS

A prospective, consecutive case series study was done at our hand unit. Patients included in the study had at least 5 years follow-up after a total joint arthroplasty for osteoarthritis of the TMC joint using the ARPE implant. The Kaplan-Meier method was used to estimate implant survival over time. Clinical and radiological assessment was recorded prospectively: before surgery and at 1 year and 5 years or more after surgery. We compared the means of the Kapandji index (assessing the thumb range of motion and opposition), the grip strength, and the pinch strength before surgery and at the latest follow-up.

RESULTS

We included all 166 prostheses in the survival analysis with a mean follow-up of 80 months. Five prostheses (3%) required revision surgery and 1 implant (0.6%) failed. Therefore, Kaplan-Meier survival probability was 96% with a mean follow-up of 80 months (95% confidence interval, 91-98). A total of 120 arthroplasties from 115 patients were included in the clinical analysis. At 5 years' follow-up, the median Disabilities of the Arm, Shoulder, and Hand (DASH) score was 4.6 (range, 0-86.6). There was a significant improvement of the mean opposition and grip strength of the affected thumb at final follow-up in comparison with the preoperative values. There was also a significant improvement in the mean pinch strength at 1 year and 5 years after surgery compared with preoperative measurements.

CONCLUSIONS

In our series, the ARPE prosthesis of the thumb TMC joint has proven to be a reliable and effective implant. Mean motion and strength increased whereas pain decreased after surgery and these results remained constant within the follow-up period.

TYPE OF STUDY/LEVEL OF EVIDENCE

Therapeutic IV.

Failure of an uncemented thumb carpometacarpal joint ceramic prosthesis

Thumb carpometacarpal joint replacement is associated with high rates of loosening and failure. We present our results for an uncemented ceramic-ceramic total joint prosthesis with a reverse ball-and-socket design and bioactive coating. Between 2008 and 2012, 29 prostheses were inserted into 28 patients (mean age 63 years) with advanced osteoarthritis. After a mean period of 33 months (range 9-62), 26 patients (27 implants) were available for follow-up. Six months postoperatively, 50% of the patients had radiological evidence of early loosening. Fifteen implants had been removed in 14 patients for aseptic loosening (13) or trapezium fracture (2). The 12 patients whose prosthesis was still in place had a mean visual analogue scale pain score of 1.9 (range 0-6) and a mean Disabilities of the Arm, Shoulder and Hand score of 23 (range 0-73.3). Eleven patients were satisfied with the procedure. The rate of early aseptic failure was unacceptably high.

LEVEL OF EVIDENCE

IV.

Chrome nitride coating reduces wear of small, spherical CrCoMo metal-on-metal articulations in a joint simulator

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.

Total arthroplasty of basal thumb joint with Elektra prothesis: an in vitro analysis

The reported outcomes of the Elektra thumb carpo-metacarpal joint implant have been very variable. This study evaluates the influence of daily cyclic loads and the type of the screw-fit cup insertion technique in the trapezium, with and without prior threading, on the structural bone behaviour. The study was performed experimentally to predict initial implant stability and cortical bone strains. Computational models were developed to assess the structural cancellous bone behaviour. The use of Elektra implant considerably changed the bone strain behaviour compared with the intact joint. This may be associated with risks of cancellous bone fatigue failure due to overload, particularly in the trapezium. The joint load magnitude has a more important structural role than that of the screw-fit cup insertion technique. Limiting the magnitude of thumb loads after arthroplasty may contribute positively to the longevity of this procedure.

LEVEL OF EVIDENCE

V.

Trapezium anatomy as a radiographic reference for optimal cup orientation in total trapeziometacarpal joint arthroplasty

In trapeziometacarpal arthroplasty, correct implant position may be necessary to prevent complications such as dislocation, component loosening and premature wear. The metacarpal stem more easily fits anatomically. However, the cup in the trapezium is not anatomical and guidelines for its orientation are not uniformly defined. We determined the centre of the range of motion of the trapeziometacarpal joint in 30 healthy patients on postero-anterior and lateral radiographs and its relationship to the proximal articular surface of the trapezium. Our study suggests that in thumb carpo-metacarpal total joint arthroplasty, the prosthetic cup in the trapezium should be placed parallel to the proximal articular surface of the trapezium and combined with a metacarpal neck with 7° palmar offset. This should optimize arthroplasty ranges of motion and may minimize the risk of postoperative complications. Our study provides a reference for the surgeon to check correct cup alignment intra-operatively with fluoroscopy.

Unfavourable short-term outcomes of a poly-L/D-lactide scaffold for thumb trapeziometacarpal arthroplasty

The bioabsorbable poly-L-D-lactide joint scaffold arthroplasty is a recent attempt in the reconstruction of small joints in rheumatoid patients. In this study, we analysed the 1-year clinical, functional and radiologic results of partial trapeziectomy with the poly-L-D-lactide (96/4) joint scaffold in 23 patients with isolated trapeziometacarpal osteoarthritis. The results showed that the procedure provided pain relief and improvement in overall function according to the Quick Disabilities of the Arm, Shoulder and Hand score in most patients. However, radiographs demonstrated a high frequency of osteolysis around the implant. Seven patients developed clinically manifested foreign-body reactions 6 months to 1 year after surgery. The reason for the unexpected tissue reactions may relate to excessive mechanical cyclic loading of the implant. The outcomes of this implant in our patients have not been sufficiently beneficial and we have discontinued use of this implant in isolated trapeziometacarpal osteoarthritis.