Failure of an uncemented thumb carpometacarpal joint ceramic prosthesis

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

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

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.

[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.

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.

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

Trapeziometacarpal joint arthritis: a personal approach to its treatment

Many hand surgeons have fixed beliefs on how trapeziometcarapl (TMC) osteoarthritis should be treated. However, not all hand surgeons share the same fixed beliefs, so different factions of hand surgeons can hold contradictory beliefs. Many retain their fixed beliefs, rather than reconsidering them, when the best available evidence challenges them. The problem causing this heterogeneity of fixed beliefs is the lack of high-quality evidence that can withstand critical appraisal and cannot be ignored or simply dismissed by those with rigid contradictory beliefs. This article examines some of the dogmas surrounding the treatment of TMC osteoarthritis.

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.

Results of 110 IVORY® prostheses for trapeziometacarpal osteoarthritis with a minimum follow-up of 10 years

The IVORY® prosthesis is a total trapeziometacarpal joint prosthesis used for the treatment of symptomatic trapeziometacarpal osteoarthritis. The aim of this prospective study was to evaluate its long-term outcomes with a minimum follow-up of 10 years. From 2004 to 2007, 110 trapeziometacarpal prostheses (95 patients) were implanted. The implant survival curve was constructed using the Kaplan-Meier method. Five patients were lost from follow-up and two died. Six prosthesis (5.5%) were removed after dislocation or fracture of the trapezium. The survival rate of the prosthesis was 95%. After 10 years, the mean visual analogue pain score was 0.24/10 and the key-pinch force was similar to the other hand. Dislocations occurred for eight implants (7.3%). No radiological loosening was noted. In conclusion, the long-term results with the IVORY® prosthesis are very satisfactory in terms of pain relief, function and survival. Level of evidence: II.

Elektra prosthesis versus resection-suspension arthroplasty for thumb carpometacarpal osteoarthritis: a long-term cohort study

The present study compares 34 patients with thumb carpometacarpal osteoarthritis (37 thumbs) treated with the Elektra® prosthesis, with 18 patients (18 thumbs) treated with resection-suspension arthroplasty, with an overall mean follow-up period of 13.3 years. Evaluation with disability of arm and shoulder scores, pain via visual analogue scale and range of motion (radial and palmar abduction, and opposition) indicated no significant difference. However, the cohort with a surviving prosthesis showed significantly better subjective grip strength (p  =  0.04). Complications occurred in 23 of the 37 thumbs in the prosthesis group compared with two in the resection-suspension arthroplasty patients. Seventeen prostheses required revision. At revision operations, we observed local signs of metallosis in 15 of 17 cases. The patients receiving resection-suspension arthroplasty were more satisfied with their treatment (p  =  0.003). Therefore, we cannot recommend the implantation of Elektra® prosthesis and we speculate that the key problem of aseptic cup loosening is a result of the metal-on-metal bearing. Level of evidence: III.

Total arthroplasty with Ivory® prosthesis versus resection-suspension arthroplasty: a retrospective cohort study on 82 carpometacarpal-I osteoarthritis patients over 4 years

Background

To elucidate the performance of carpometacarpal-I joint prostheses in comparison with the current gold standard treatment, resection–suspension arthroplasty (RA), we conducted a study comparing outcomes of the Ivory prosthesis to those of a cohort of patients receiving RA.

Methods

Initially, we had enrolled 34 prosthesis patients and 48 RA patients, of which 5 and 11 were lost to follow-up. We defined Eaton/Littler stage 3 osteoarthritis, no previous surgery, no concomitant arthrosis, no rheumatic arthritis, no history of trauma and a minimum follow-up period of 2 years as inclusion criteria. We assessed patient demographics, disability of the arm, shoulder, and hand score, pain via visual analogue scale, subjective strength of the thumb, range of motion (radial and palmar abduction and opposition), and patient satisfaction. All occurring complications were recorded.

Results

Follow-up included a mean period of 4.5 years (2–7.4) in the prosthesis cohort and 4.1 years (2–6.8) in the RA group. Disability of the arm, shoulder, and hand scores, pain scores, palmar abduction and opposition, and subjective satisfaction showed no significant differences between the two cohorts. Postoperative loss of strength was significantly less in the prosthesis group (p = 0.01). Moreover, we were able to demonstrate better range of motion in terms of radial abduction in the prosthesis group (p = 0.001). The overall complication rate was significantly higher in the prosthesis cohort (41.4% vs. 10.8%) (p = 0.008). Nevertheless, the Ivory prosthesis group showed a survival rate of 93.1%.

Conclusion

As the high complication rate is compensated by a better functional outcome (enhanced range of motion and strength), we believe that prosthesis implantation can be a reasonable treatment option for carpometacarpal-I osteoarthritis in a particular patient group.

Level of Evidence IIIl: Retrospective cohort study.

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.

Total Endoprosthesis Versus Lundborg´s Resection Arthroplasty for the Treatment of Trapeziometacarpal Joint Osteoarthritis

Background:

There exist various operative approaches for the treatment of trapeziometacarpal joint osteoarthritis. The aim of this study was to compare the results of Lundsborg’s resection arthroplasty (RA) with implantation of a total endoprosthesis.

Patients and Methods:

In this 2-center study, we retrospectively analyzed 71 patients with symptomatic osteoarthritis of the carpometacarpal I joint stage III according to the Eaton-Littler classification. Thirty-two patients underwent a Lundsborg’s RA group, and 39 patients received a total endoprosthesis of the carpometacarpal I joint (TEP group). We evaluated operative time, DASH score, postoperative time until resolution of symptoms, pain level, pinch force, and satisfaction with the treatment.

Results:

Both groups had a similar mean length of follow-up of 42 months (TEP group) and 36 months (RA group). The final DASH score was significantly better in the TEP-group (10.1 versus 21.5 in the RA group; P ≤ 0.05). Also, the time interval from surgery till absence of any pain (1.5 versus 5.9 months) and the time of inability to work (6 versus 21 weeks) were significantly shorter for the TEP group compared with the RA group (P ≤ 0.05). The pinch force, pain intensity, and the satisfaction with the treatment were comparable (P > 0.05). The duration of the operation was significantly shorter in the RA group (31 min versus 65 min in the TEP group; P ≤ 0.05).

Conclusion:

Both techniques resulted in improved function of the operated hand and a clear reduction of symptoms. However, the implantation of a total endoprosthesis seems to have advantages, given a significantly better DASH score and a significantly shorter time until resolution of symptoms.

[Replacement of the thumb carpometacarpal joint : Current importance of endoprosthetics for operative treatment of rhizarthrosis]

The role of joint replacement in the treatment of osteoarthritis of the thumb carpometacarpal joint is a subject of considerable controversy in the current literature. In German-speaking countries this technique is used much less frequently than resection procedures. Aseptic loosening of the prosthesis is believed to be the major cause of the high failure rates reported for cemented and uncemented types of implants. In this study the different implant designs were evaluated on the basis of the results reported in the international literature. There are only a few studies that cover relatively long follow-up periods and provide convincing results for thumb carpometacarpal joint prostheses in terms of implant survival and function. Aseptic loosening is reported to be the major cause with failure rates of 50 % or more. Although a Norwegian study reported high 5 and 10-year survival rates for various thumb carpometacarpal joint prostheses according to the Norwegian arthroplasty registry, it did not recommend the widespread use of thumb carpometacarpal joint replacement at the present time. In our opinion, joint replacement may be considered as a possible treatment option for advanced osteoarthritis of the thumb carpometacarpal joint but it should not always be recommended because long-term results are inconsistent and similar functional outcomes have been reported for alternative surgical techniques, such as resection arthroplasty.