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Druel T, Cievet-Bonfils M, Comtet JJ, Gazarian A. 31 years survival rate of ARPE® single-mobility prosthesis in trapeziometacarpal osteoarthritis. J Hand Surg Eur Vol 2024; 49:914-916. [PMID: 38114074 DOI: 10.1177/17531934231221692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
A retrospective study of 41 trapeziometacarpal prostheses showed that the implant survival rate decreased linearly over time with a critical period in the first years; ranging from 83% after 5 years to 50% after 30 years.Level of evidence: IV.
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Affiliation(s)
- Thibault Druel
- Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | | | - Jean-Jacques Comtet
- Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
- Clinique du Parc, Lyon, France
| | - Aram Gazarian
- Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
- Clinique du Parc, Lyon, France
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Hidajat NN, Aditya R, Arsa W, Malik R. Outcome Comparison between Carpometacarpal Arthroplasty and Trapeziectomy in Patients with Carpometacarpal Osteoarthritis: A Systematic review. Orthop Rev (Pavia) 2024; 16:117651. [PMID: 38947179 PMCID: PMC11213695 DOI: 10.52965/001c.117651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 03/24/2024] [Indexed: 07/02/2024] Open
Abstract
Background Osteoarthritis of the carpometacarpal (CMC) is considered a common musculoskeletal disorder. The treatment of carpometacarpal osteoarthritis could be either by conservative or surgical methods. surgical treatment, there are various alternatives, including trapeziectomy and arthroplasty. This study aims to perform a systematic review of the literature to determine the functional outcomes associated with trapeziectomy and arthroplasty in CMC arthritis. Objectives To determine the functional outcomes associated with trapeziectomy and arthroplasty in CMC arthritis patients. Methods A systematic review was conducted according to PRISMA guidelines and performed on August 2022 by one independent reviewer (author) using PubMed database, EBSCO Host, EMBASE, and ScienceDirect. The literature search will be based on Patients, Intervention, Control, and Outcome (PICO) criteria, as mentioned in the following: Patients with any carpometacarpal arthritis; with the intervention of using carpometacarpal arthroplasty as their method of surgery; control with trapeziectomy and primary outcome of functional outcome. Clinical outcomes using patient-reported outcome measures and complications were included. The quality of the included studies was evaluated with Cochrane risk-of-bias assessment tools. Quantitative analysis was performed by Review Manager 5.4. Results Three studies met the inclusion criteria for the systematic review. Both treatments resulted in significant improvements in functional scores. When matching patients according to preoperative function, patients receiving arthroplasty had better postoperative function (Quick DASH: trapeziectomy = 25.1, ARPE = 16.8). Conclusion This study showed that variable results of clinical outcomes improved after trapezeictomy and arthroplasty in patients with CMC arthritis. Evidence showed that arthroplasty allows for a better improvement in functional outcome.
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Affiliation(s)
- Nucki Nursjamsi Hidajat
- Hand, upper Limb and microsurgery department, Hasan Sadikin Hospital, Padjadjaran University, Bandung, Indonesia
| | - Rio Aditya
- Orthopaedic & Traumatology department, Hasan Sadikin Hospital, Padjadjaran University, Bandung,Indonesia
| | - Widya Arsa
- Hand, upper Limb and microsurgery department, Hasan Sadikin Hospital, Padjadjaran University, Bandung, Indonesia
| | - Realita Malik
- Hand, upper Limb and microsurgery department, Hasan Sadikin Hospital, Padjadjaran University, Bandung, Indonesia
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Herren DB, Beaulieu JY, Calcagni M, Erling C, Jung M, Kaulich A, Mühldorfer-Fodor M, Papaloïzos M, Rosenkranz A, Vögelin E, Marks M. [Current Trends in the Implantation of the Touch Prosthesis at the Thumb Carpometacarpal Joint: Results of the 1st German-Speaking User Meeting]. HANDCHIR MIKROCHIR P 2024; 56:201-211. [PMID: 38861975 PMCID: PMC11166473 DOI: 10.1055/a-2321-9426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 04/09/2024] [Indexed: 06/13/2024] Open
Abstract
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.
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Affiliation(s)
| | - Jean-Yves Beaulieu
- Unité Chirurgie de la main, Hôpitaux universitaires de Genève, Genf,
Switzerland
| | - Maurizio Calcagni
- Klinik für Plastische Chirurgie und Handchirurgie, Universitätsspital
Zürich, Zürich, Switzerland
| | | | - Martin Jung
- Handchirurgie, OCM Orthopädische Chirurgie München, München,
Germany
| | - Axel Kaulich
- Handchirurgie, Hanusch Krankenhaus, Orthopädie und Traumatologie, Wien,
Austria
| | | | | | - Anton Rosenkranz
- Abteilung Orthopädie und Traumatologie, Krankenhaus St. Josef Braunau,
Braunau am Inn, Austria
| | - Esther Vögelin
- Universitätsklinik für Plastische- und Handchirurgie, Inselspital,
Bern, Switzerland
| | - Miriam Marks
- Lehre, Forschung und Entwicklung, Schulthess Klinik, Zürich,
Switzerland
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Frey PE, Bühner C, Falkner F, Harhaus L, Panzram B. Mid- and long-term clinical results of the Elektra and Moovis prosthesis for trapeziometacarpal joint replacement. BMC Musculoskelet Disord 2024; 25:332. [PMID: 38664698 PMCID: PMC11044538 DOI: 10.1186/s12891-024-07439-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 04/12/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND Total joint arthroplasty as a surgical treatment option for trapeziometacarpal joint arthritis is recently revived. The aim of this study is to report on mid- and long-term results of the Elektra (single-mobility) and Moovis (dual-mobility) prosthesis for treatment of primary thumb carpometacarpal joint arthritis. METHODS In this retrospective, monocentric, descriptive cohort study, 31 prostheses were evaluated that were implanted by a single surgeon in 26 patients between 2009 and 2019. Indication for surgery was trapeziometacarpal joint osteoarthritis (Eaton/Littler Stage II and III). Clinical and radiological follow-up was performed at a minimum of 24 months. The postoperative assessment included range of motion, pain, strength as well as functional scores (DASH, MHQ). Implant survival and complications were the primary endpoints. RESULTS 10 Elektra and 21 Moovis prostheses were implanted between 2009 and 2019 with a mean follow-up of 74.2 months in the Elektra and 41.4 months in the Moovis group. The average patients' age at surgery was 64 years. Postoperative pain levels (VAS 0-10) were below 2 at rest and under stress in both groups. Grip/pinch strength and range of motion showed results comparable to the contralateral hand. Opposition was excellent with an average Kapandji index of 9.6 in both groups. Elektra achieved slightly better functional scores in the DASH and MHQ score. Satisfaction was high in both groups, and 96% of the patients would recommend the procedure. Metacarpophalangeal hyperextension > 15° was seen in 3 patients per group preoperatively and was corrected to < 5° post-surgery. 3 Elektra prostheses were revised due to cup loosening and dislocation for cup and/or neck replacement or secondary trapeziectomy. 1 Moovis prosthesis was revised with an exchange of the neck to a larger size due to restricted movement. After the mean follow-up of 7.9 years in Elektra and 3.5 years in MOOVIS, cumulative survival was 68.6% vs. 95.2%, respectively. CONCLUSIONS In this mid- to long-term retrospective analysis, total joint arthroplasty in primary trapeziometacarpal joint arthritis results in low pain levels, excellent mobility and clinical function. Patient satisfaction is overall high. While revision due to cup loosening occurred more often in patients with single-mobility implants, no cases of dislocation or loosening of components were observed in the dual-mobility group. TRIAL REGISTRATION The study was conducted in accordance with the Declaration of Helsinki, and approved by the Ethics Committee of the Medical Faculty of Heidelberg University, reference number S-150/2020.
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Affiliation(s)
- Pia-Elena Frey
- Department of Orthopedics, University Hospital Heidelberg, Heidelberg, Germany.
| | - Christin Bühner
- Department of Orthopedics, University Hospital Heidelberg, Heidelberg, Germany
| | - Florian Falkner
- Department of Hand, Plastic and Reconstructive Surgery, Burn Care Centre, BG Trauma Center Ludwigshafen, Ludwigshafen, Germany
| | - Leila Harhaus
- Department of Hand, Plastic and Reconstructive Surgery, Burn Care Centre, BG Trauma Center Ludwigshafen, Ludwigshafen, Germany
| | - Benjamin Panzram
- Department of Orthopedics, University Hospital Heidelberg, Heidelberg, Germany
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Lirola-Palmero S, Salva-Coll G, Yáñez-Juan AM, Sánchez-Iriso E. Cost-effectiveness and cost-utility of the ball-and-socket trapeziometacarpal prosthesis compared to trapeziectomy and ligament reconstruction: study protocol for a randomized controlled clinical trial. Trials 2024; 25:220. [PMID: 38532422 PMCID: PMC10967180 DOI: 10.1186/s13063-024-08057-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 03/13/2024] [Indexed: 03/28/2024] Open
Abstract
BACKGROUND Trapeziometacarpal (TMC) osteoarthritis (OA) is a common cause of pain and weakness during thumb pinch leading to disability. There is no consensus about the best surgical treatment in unresponsive cases. The treatment is associated with costs and the recovery may take up to 1 year after surgery depending on the procedure. No randomized controlled trials have been conducted comparing ball and socket TMC prosthesis to trapeziectomy with ligament reconstruction. METHODS A randomized, blinded, parallel-group superiority clinical trial comparing trapeziectomy with abductor pollicis longus (APL) arthroplasty and prosthetic replacement with Maïa® prosthesis. Patients, 18 years old and older, with a clinical diagnosis of unilateral or bilateral TMC OA who fulfill the trial's eligibility criteria will be invited to participate. The diagnosis will be made by experienced hand surgeons based on symptoms, clinical history, physical examination, and complementary imaging tests. A total of 106 patients who provide informed consent will be randomly assigned to treatment with APL arthroplasty and prosthetic replacement with Maïa® prosthesis. The participants will complete different questionnaires including EuroQuol 5D-5L (EQ-5D-5L), the Quick DASH, and the Patient Rated Wrist Evaluation (PRWE) at baseline, at 6 weeks, and 3, 6, 12, 24, 36, 48, and 60 months after surgical treatment. The participants will undergo physical examination, range of motion assessment, and strength measure every appointment. The trial's primary outcome variable is the change in the visual analog scale (VAS) from baseline to 12 months. A long-term follow-up analysis will be performed every year for 5 years to assess chronic changes and prosthesis survival rate. The costs will be calculated from the provider's and society perspective using direct and indirect medical costs. DISCUSSION This is the first randomized study that investigates the effectiveness and cost-utility of trapeziectomy and ligament reconstruction arthroplasty and Maïa prosthesis. We expect the findings from this trial to lead to new insights into the surgical approach to TMC OA. TRIAL REGISTRATION ClinicalTrials.gov NCT04562753. Registered on June 15, 2020.
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Affiliation(s)
- Serafín Lirola-Palmero
- Departmen of Hand Surgery and Microsurgery, Hospital Universitari Son Espases, Ctra. Valldemosa 79, Palma de Mallorca, 07120, Spain.
| | - Guillem Salva-Coll
- Departmen of Hand Surgery and Microsurgery, Hospital Universitari Son Espases, Ctra. Valldemosa 79, Palma de Mallorca, 07120, Spain
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Van Geel P, Decramer A, Top A, Muermans S, Ryckaert T, Vanmierlo B. Thumb Arthroplasty as Reliable Long-term Solution for Trapeziometacarpal Osteoarthritis: A Minimum of 15 Years of Follow-up. Hand (N Y) 2024:15589447241233367. [PMID: 38389259 DOI: 10.1177/15589447241233367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
BACKGROUND In patients with symptomatic trapeziometacarpal (TMC) joint arthritis resistant to conservative treatment, surgical treatment can be advised. One of the many surgical treatment options is TMC arthroplasty. The Arpe prosthesis is one example of these TMC arthroplasties. METHODS This retrospective study evaluated patients who underwent TMC arthroplasty with the Arpe prosthesis after a minimum of 15 years of follow-up. Clinical, radiologic, and qualitative outcomes were assessed for 43 Arpe arthroplasties in 41 patients, of whom 2 had bilateral arthroplasties. The female to male ratio was 39:4. The mean follow-up time was 197 months (range = 180-225). RESULTS The cumulative survival rate after a mean of 16.5 years was 84%. Seven failures (16%) were registered, of which 5 during the first 3 years after primary surgery. All patients were successfully converted to a trapeziectomy. Quick Disabilities of the Arm, Shoulder and Hand score improved with 44.9 points and visual analogue pain score with 97% and 91% at rest and during exercise, respectively. CONCLUSIONS This series demonstrates that thumb arthroplasty is a reliable long-term solution for thumb base arthritis, with significant pain reduction and functional improvement, even after 15 years of follow-up.
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Affiliation(s)
- Pieter Van Geel
- Department of Orthopaedic Surgery, AZ Delta, Roeselare, Belgium
| | - Arne Decramer
- Department of Orthopaedic Surgery, AZ Delta, Roeselare, Belgium
| | - Alexander Top
- Department of Orthopaedic Surgery, AZ Delta, Roeselare, Belgium
| | - Stijn Muermans
- Department of Orthopaedic Surgery, AZ Delta, Roeselare, Belgium
| | | | - Bert Vanmierlo
- Department of Orthopaedic Surgery, AZ Delta, Roeselare, Belgium
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7
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Ledoux P. Contribution to the study of stresses in the thumb column during key pinch grip. HAND SURGERY & REHABILITATION 2024; 43:101603. [PMID: 37806637 DOI: 10.1016/j.hansur.2023.09.370] [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: 07/03/2023] [Revised: 09/08/2023] [Accepted: 09/09/2023] [Indexed: 10/10/2023]
Abstract
OBJECTIVES The aim of this study was to calculate the stress acting on the trapeziometacarpal joint during an key pinch grip. METHOD We used profile X-rays of the thumb to measure the various bony and muscle lever arms. We assessed the angles of action of the muscular elements involved in the thumb column. Based on this data, we established a two-dimensional geometric model that enabled us to determine the forces at each joint level, as a function of stresses and muscular contributions. We were also able to calculate the participation of the different muscle groups in obtaining a balanced situation. RESULTS Our results, as a function of the degree of flexion of the interphalangeal and metacarpophalangeal joints, show a multiplying factor of 2.9-3.19 in relation to the key pinch grip force. DISCUSSION Previous studies modelling a key pinch grip are showed multiplying factors from 6 to 13 in relation to the key pinch grip force. They are not compatible with the characteristics of the polyethylene used for trapeziometacarpal prostheses, whereas numerous articles in the literature show survival rates that are more or less comparable to those of total hip prostheses. These studies required an excessive number of assumptions, which could lead to error. Our results are compatible with the results of trapeziometacarpal prosthesis and with those of a recent study measuring intra-articular trapeziometacarpal pressure in a cadaveric model. Our model allows us to test different configurations of the thumb spine depending on the degree of flexion of the interphalangeal and metacarpophalangeal joints.
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Affiliation(s)
- Pascal Ledoux
- Polyclinique des 3 Vallées, 4 Route de Saint Pons, 34600 Bédarieux, France.
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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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Farkash U, Sakhnini M, Dreyfuss D, Tordjman D, Rotem G, Luria S. Failure Rate and Early Complications of Thumb Carpometacarpal Joint Replacement-A Multicenter Retrospective Study of Two Modern Implant Designs. J Clin Med 2023; 13:121. [PMID: 38202128 PMCID: PMC10779986 DOI: 10.3390/jcm13010121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 12/08/2023] [Accepted: 12/21/2023] [Indexed: 01/12/2024] Open
Abstract
Joint replacement arthroplasty for the treatment of thumb osteoarthritis is gaining popularity as recent studies have demonstrated better pinch and grip strength and faster rehabilitation. Our aim was to identify early complications in modern implant designs using a multicenter study. A total of 381 patients who underwent thumb carpometacarpal replacement surgery in six participating hospitals were enrolled. The complications included were fractures, dislocations, infections, tendon and nerve injuries, and complex regional pain syndrome. Major complications were defined as a failure to implant the prosthesis, revision surgery to remove the implant, and any other need for further surgical intervention. The secondary outcomes were any other complications treated non-surgically and the timing of the complications. Eleven procedures failed, and these patients were treated with trapeziectomies. Twelve other patients required repeat surgical interventions. Minor adverse events occurred in 25.4% of the cases, and transient irritation of the superficial radial nerve and De Quervain tendinopathy were the most prevalent complications. Although this cohort depicted the learning curves of multiple surgeons, our study demonstrated low short-term failure rates. An inability to achieve primary stability of the cup in the trapezium was the leading cause of failure. Dislocations and other major complications with modern implants were very few.
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Affiliation(s)
- Uri Farkash
- Hand Surgery Unit, Department of Orthopedic Surgery, Assuta-Ashdod University Hospital, Ashdod 7747629, Israel
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva 8499000, Israel
| | - Mojahed Sakhnini
- Department of Orthopedic Surgery, Rivka Ziv Medical Center, Safed 1304435, Israel;
| | - Daniel Dreyfuss
- Hand and Microsurgery Unit, Rambam Health Care Campus, Haifa 3525408, Israel;
- Rappaport Faculty of Medicine, Technion, Haifa 3525408, Israel
| | - Daniel Tordjman
- Hand Surgery Unit, Orthopedic Division, Tel-Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel;
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv 6139001, Israel;
| | - Gilad Rotem
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv 6139001, Israel;
- Department of Hand Surgery, Sheba Medical Center, Tel Hashomer 5262000, Israel
| | - Shai Luria
- Department of Orthopedic Surgery, Hadassah Medical Center, Jerusalem 9371125, Israel;
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112102, Israel
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Simón-Pérez C, Chavez Valladares S, Rodríguez-Mateos JI, Plata Garcia M, Garcia Virto V, Aguado HJ, Martín-Ferrero MA. Functional survival of cementless trapeziometacarpal total joint arthroplasty after upper extremity trauma. Injury 2023; 54 Suppl 7:111156. [PMID: 38225159 DOI: 10.1016/j.injury.2023.111156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 10/21/2023] [Accepted: 10/23/2023] [Indexed: 01/17/2024]
Abstract
INTRODUCTION Our purpose with this publication is to document the survival of uncemented and unconstrained total trapeziometacarpal arthroplasty after energy trauma to the upper extremity. MATERIAL AND METHODS From 1999 to the present, ten patients carrying total TMC arthroplasty suffered major traumatic injuries on the hand. Eight patients had fractures of the distal radius, one patient had scapho-lunate dissociation and one patient had a dorsal pullout of the triquetrum. A clinical and radiological examination of the patients after the trauma was carried out and compared with the pre-traumatic prosthesis status. RESULTS Three patients required surgical intervention for the associated traumatic injury. The postraumatic clinical and functional follow-up of the patients was good, and no differences were documented with respect to mobility, strength and pain at the level of the thumb with respect to the prior to the trauma. No signs of loosening, instability or alteration in the alignment of the components of the protheses were observed in the radiological examinations following the trauma. CONCLUSIONS There is a high survival rate of uncemented total trapeziometacarpal arthroplasty in the long term, even in the face of energy trauma. It is then a safe implant. Despite of being non-constrained, a good alignment of the prosthetic components is the key to avoid dislocation of the prosthesis.
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Affiliation(s)
- C Simón-Pérez
- Discipline of Orthopaedics, University of Valladolid, Spain.
| | - S Chavez Valladares
- Department of Orthopaedics, Hospital Clínico Universitario, Valladolid, Spain
| | | | - M Plata Garcia
- Department of Orthopaedics, Hospital Clínico Universitario, Valladolid, Spain
| | - V Garcia Virto
- Department of Orthopaedics, Hospital Clínico Universitario, Valladolid, Spain
| | - H J Aguado
- Discipline of Orthopaedics, University of Valladolid, Spain
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11
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Tchurukdichian A, Delgove A, Essid L, Moris V, di Summa PG, Camuzard O, Ornetti P, Zwetyenga N, Guillier D. Time to return to work after total trapeziometacarpal prosthesis. HAND SURGERY & REHABILITATION 2023:S2468-1229(23)00116-0. [PMID: 37356569 DOI: 10.1016/j.hansur.2023.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 05/12/2023] [Accepted: 05/14/2023] [Indexed: 06/27/2023]
Abstract
OBJECTIVES This study assessed return to work and prosthesis survival after trapeziometacarpal prosthesis surgery. MATERIAL AND METHODS A multicenter retrospective study was carried out on patients operated on between 2002 and 2020. All working patients who had undergone trapeziometacarpal prosthesis surgery were included. Return to work was defined as resuming the same full-time position. Postoperative events and their specific treatment and failure to return to work were reported. RESULTS 240 prostheses in 211 patients were included. The complications rate was 7.5%, with 97% prosthesis survival. 94.3% of patients returned to work, at a mean 48 days (range, 29-210 days; SD, 22.7 days), with no significant difference according to age. Twelve patients did not return to work, half of whom because of prosthetic complications. CONCLUSION Trapeziometacarpal arthroplasty enables most patients to return to work within 6 weeks. In this series, the prosthetic survival rate was 97%.
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Affiliation(s)
- A Tchurukdichian
- Department of Plastic Reconstructive and Hand Surgery, Department of Oral and Maxillofacial Surgery - Dijon University Hospital, Boulevard de Lattre de Tassigny F-21000, Dijon, France; Chirurgie de la main, Cliniques de Valmy et de Drevon, 1 bis cours Général de Gaulle F-21000 Dijon, France
| | - A Delgove
- Service de chirurgie plastique, reconstructrice et esthétique, CHU de Bordeaux, place Amélie Raba Léon, 33000 Bordeaux, France
| | - L Essid
- Department of Plastic Reconstructive and Hand Surgery, Department of Oral and Maxillofacial Surgery - Dijon University Hospital, Boulevard de Lattre de Tassigny F-21000, Dijon, France
| | - V Moris
- Department of Plastic Reconstructive and Hand Surgery, Department of Oral and Maxillofacial Surgery - Dijon University Hospital, Boulevard de Lattre de Tassigny F-21000, Dijon, France
| | - P G di Summa
- Department of Plastic and Hand Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), University of Lausanne (UNIL), Rue de Bugnon 46, 1011 Lausanne, Switzerland
| | - O Camuzard
- Department of Plastic and Reconstructive Surgery, Hôpital Pasteur 2, CHU de Nice, Université Côte d'Azur, Nice, France
| | - P Ornetti
- Department of Rhumatology - Dijon University Hospital, Boulevard de Lattre de Tassigny, F-21000, Dijon, France
| | - N Zwetyenga
- Department of Plastic Reconstructive and Hand Surgery, Department of Oral and Maxillofacial Surgery - Dijon University Hospital, Boulevard de Lattre de Tassigny F-21000, Dijon, France
| | - D Guillier
- Department of Plastic Reconstructive and Hand Surgery, Department of Oral and Maxillofacial Surgery - Dijon University Hospital, Boulevard de Lattre de Tassigny F-21000, Dijon, France.
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12
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Tang JB. CORR Insights®: Dorsal Subluxation of the First Metacarpal During Thumb Flexion is an Indicator of Carpometacarpal Osteoarthritis Progression. Clin Orthop Relat Res 2023; 481:1238-1239. [PMID: 36892532 PMCID: PMC10194642 DOI: 10.1097/corr.0000000000002618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 02/08/2023] [Indexed: 03/10/2023]
Affiliation(s)
- Jin Bo Tang
- Professor of Hand Surgery, Affiliated Hospital of Nantong University, Nantong, Jiangsu, P. R. China
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13
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Van Vliet A, Léon M, Rattier S, Haddad B, David E. New radiographic monitoring indices for total trapeziometacarpal prostheses. HAND SURGERY & REHABILITATION 2023:S2468-1229(23)00076-2. [PMID: 37142124 DOI: 10.1016/j.hansur.2023.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 04/18/2023] [Accepted: 04/22/2023] [Indexed: 05/06/2023]
Abstract
OBJECTIVE The objective of this study is to propose and evaluate a method of monitoring implants via the calculation of a trapezial and metacarpal index from radiological measurements and to describe an initial patient analysis. METHODS This retrospective study describes the trapezial index which reflects the trapezial bone stock not occupied by the trapezial cup, while the metacarpal index reflects the rate of metacarpal occupation by the prosthetic stem. Those indexes were used on a series of 20 patients with a Maïa™ prosthesis with a minimum follow-up of seven years. The indexes were measured immediately postoperatively and at the various annual check-ups. Four observers measured each index on two occasions, to obtain an inter- and intra-observer correlation coefficient. RESULTS The average intra-observer correlation coefficient for the trapezium index was 0.94, for the metacarpal index 0.98. The inter-observer correlation coefficient was 0.93 for the trapezium index, 0.94 for the metacarpal index on average. The post-hoc calculated power was 0.98 as the number of subjects required was not usable. The mean immediate postoperative trapezial index was 45.74%, compared with a value at longest follow-up of 41.74%, reflecting a highly significant loss of height of 8,74%. The mean immediate postoperative metacarpal index was 77.69% compared with a mean value at longest follow-up of 78.99% indicating a non-significant increase in the index of 1,67%. CONCLUSION Proposed indexes had excellent inter- and intra-observer correlation, the metacarpal one is stable over time whereas the trapezial one reveals changes in some patients, requiring further investigations. These simple and reproducible indexes allow precise monitoring of trapeziometacarpal prostheses and identify radiographic changes that should lead to additional examinations to improve survival of implants. LEVEL OF EVIDENCE III, retrospective single cohort study.
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Affiliation(s)
- A Van Vliet
- CHU Amiens-Picardie, SOS mains, CHU Amiens Sud, 1 Rue du Pr Christian Cabrol, 80000 Amiens, France.
| | - M Léon
- CHU Amiens-Picardie, SOS mains, CHU Amiens Sud, 1 Rue du Pr Christian Cabrol, 80000 Amiens, France
| | - S Rattier
- CHU Amiens-Picardie, SOS mains, CHU Amiens Sud, 1 Rue du Pr Christian Cabrol, 80000 Amiens, France
| | - B Haddad
- Clinique Conti, 3 Chemin des Trois Sources, 95290 L'Isle-Adam, France
| | - E David
- CHU Amiens-Picardie, SOS mains, CHU Amiens Sud, 1 Rue du Pr Christian Cabrol, 80000 Amiens, France
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14
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Chiche L, Chammas PE, Vial D'Allais P, Lazerges C, Coulet B, Chammas M. Long-term survival analysis of 191 MAÏA® prostheses for trapeziometacarpal arthritis. J Hand Surg Eur Vol 2023; 48:101-107. [PMID: 36329561 DOI: 10.1177/17531934221136442] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Surgery for trapeziometacarpal osteoarthritis after failure of medical treatment remains controversial. The aim of this study was to determine the long-term results of the MAÏA® trapeziometacarpal prosthesis (Lépine, Genay, France). This was a retrospective clinical and radiographic study of 191 MAÏA® trapeziometacarpal prostheses implanted between 2001 and 2016 from a single centre. The survival rate of the implants at the final follow-up of 12 years (range 17 days to 140 months) was 88%. Median pain score was 1/10. The median Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score was 20. The rate of major complications was 9% (5% dislocations and 4% loosening) with all dislocations needing revision surgery. The risk of prosthetic dislocation was highest during the first 3 years, most often related to malposition of the trapezium implant. The MAÏA trapeziometacarpal prosthesis represents a long-term solution for surgical treatment of thumb rhizarthrosis. Level of evidence: IV.
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Affiliation(s)
- Leo Chiche
- Service de chirurgie de la main et du membre supérieur, CHU Lapeyronie, Montpellier, France
| | | | - Paul Vial D'Allais
- Service de chirurgie de la main et du membre supérieur, CHU Lapeyronie, Montpellier, France
| | - Cyril Lazerges
- Service de chirurgie de la main et du membre supérieur, CHU Lapeyronie, Montpellier, France
| | - Bertrand Coulet
- Service de chirurgie de la main et du membre supérieur, CHU Lapeyronie, Montpellier, France
| | - Michel Chammas
- Service de chirurgie de la main et du membre supérieur, CHU Lapeyronie, Montpellier, France
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15
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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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16
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Challoumas D, Murray E, Ng N, Putti A, Millar N. A Meta-analysis of Surgical Interventions for Base of Thumb Arthritis. J Wrist Surg 2022; 11:550-560. [PMID: 36504527 PMCID: PMC9731743 DOI: 10.1055/s-0042-1743117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 01/04/2022] [Indexed: 12/15/2022]
Abstract
Background There is a myriad of available surgical options for thumb carpometacarpal joint (CMCJ) arthritis and no robust evidence exists to guide the decisions of treating surgeons. Our aim was to assess the comparative effectiveness of different surgical interventions available for the treatment of thumb CMCJ arthritis. Methods We performed a systematic review, pairwise, and network meta-analysis of all randomized studies comparing surgical interventions for thumb CMCJ arthritis. Our primary outcomes were pain, function, and key pinch strength at long-term follow-up (> 6 months). Risk of bias and certainty of evidence were assessed for each outcome measure of compared interventions separately. Clinical recommendations were based on evidence of strong or moderate certainty. Results A total of 17 randomized studies were included in the systematic review. Where possible, pairwise and network meta-analyses were performed. Based on evidence of moderate certainty, trapeziectomy with a concomitant ligament reconstruction and tendon interposition (LRTI) does not appear to be associated with any long-term clinical benefits compared with simple trapeziectomy (function: mean difference [MD] -3.72 [-9.15, 1.71], p = 0.64 favoring simple trapeziectomy; key pinch strength: MD 0.07 kg [-0.28, 0.43], p = 0.68 favoring trapeziectomy with LRTI). Treatment rankings from the network meta-analysis favored trapeziectomy with and without LRTI, joint replacement, and arthrodesis. Trapeziectomy with LRTI appears to be associated with fewer major complications compared with joint replacement and arthrodesis, and more minor complications compared with simple trapeziectomy. Conclusion Until further high-quality research indicates otherwise, simple trapeziectomy should be the preferred surgical modality for base of the thumb arthritis. Level of Evidence This is a Level 1 study.
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Affiliation(s)
- Dimitris Challoumas
- Institute of Infection, Immunity and Inflammation, College of Medicine, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
- Department of Trauma & Orthopaedic Surgery, Ayr University Hospital, Ayr, United Kingdom
| | - Elspeth Murray
- Department of Trauma & Orthopaedic Surgery, Wishaw General Hospital, Wishaw, United Kingdom
| | - Nigel Ng
- Department of Trauma & Orthopaedic Surgery, Wishaw General Hospital, Wishaw, United Kingdom
| | - Amit Putti
- Department of Trauma & Orthopaedic Surgery, Forth Valley Royal Hospital, Larbert, United Kingdom
| | - Neal Millar
- Institute of Infection, Immunity and Inflammation, College of Medicine, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
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17
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Duerinckx J, Verstreken F. Total joint replacement for osteoarthritis of the carpometacarpal joint of the thumb: why and how? EFORT Open Rev 2022; 7:349-355. [PMID: 35638603 PMCID: PMC9257729 DOI: 10.1530/eor-22-0027] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Total joint replacement has certain advantages over other surgical treatment methods for osteoarthritis of the thumb carpometacarpal joint, including restoration of thumb length and alignment, good cosmetical result, fast recovery of hand function and prevention of iatrogenic complications at neighbouring joints. Disadvantages include the technical difficulty to perform this surgery and a possible higher complication rate. A meticulous surgical technique is mandatory. Combined with a cementless and modular ball-in-socket implant with a metal-on-polyethylene friction couple, a 10-year survival rate higher than 90% can be expected. Revision surgery is possible with implant exchange or conversion to trapeziectomy.
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18
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Buffet A, Lucot-Royer L, Marine P, Menu G, De Bie A, Obert L, Loisel F. ISIS trapeziometacarpal arthroplasty: What are the outcomes in male patients? HAND SURGERY & REHABILITATION 2022; 41:463-469. [DOI: 10.1016/j.hansur.2022.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 04/27/2022] [Accepted: 04/30/2022] [Indexed: 11/16/2022]
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19
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Kirkeby L, Frost P, Svendsen SW, Hansen TB. Revision rates of trapeziometacarpal total joint arthroplasty in relation to occupational hand force requirements. J Hand Surg Eur Vol 2021; 46:968-974. [PMID: 33709820 DOI: 10.1177/1753193421996980] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
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.
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Affiliation(s)
- Lone Kirkeby
- University Clinic of Hand, Hip and Knee Surgery, Regional Hospital West Jutland, Holstebro, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Poul Frost
- Department of Occupational and Environmental Medicine, University of Copenhagen, Copenhagen, Denmark.,Danish Ramazzini Centre, Aarhus University Hospital, Aarhus, Denmark
| | - Susanne W Svendsen
- Department of Occupational and Environmental Medicine, University of Copenhagen, Copenhagen, Denmark.,Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Danish Ramazzini Centre, Regional Hospital West Jutland - University Research Clinic, Herning, Denmark
| | - Torben B Hansen
- University Clinic of Hand, Hip and Knee Surgery, Regional Hospital West Jutland, Holstebro, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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20
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Sánchez-Crespo M, de la Red-Gallego M, Ayala-Gutiérrez H, Couceiro-Otero J, Rodríguez-Fernández J, del Canto-Alvarez F. Initial survival of the Isis® total trapeziometacarpal prosthesis with conical trunk threaded cups. Rev Esp Cir Ortop Traumatol (Engl Ed) 2021. [DOI: 10.1016/j.recote.2021.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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21
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Grunz JP, Gietzen CH, Christopoulos G, van Schoonhoven J, Goehtz F, Schmitt R, Hesse N. Osteoarthritis of the Wrist: Pathology, Radiology, and Treatment. Semin Musculoskelet Radiol 2021; 25:294-303. [PMID: 34374064 DOI: 10.1055/s-0041-1730948] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Osteoarthritis (OA) is a degenerative disease that can manifest in any synovial joint under certain conditions. It leads to destruction of articular cartilage and adjacent bone, as well as formation of osteophytes at the edges of afflicted joint surfaces. Regarding the wrist, typical degenerative arthritis affects particular joints at a specific patient age, due to asymmetric load distribution and repetitive microtrauma. However, in the presence of instability or systemic diseases, early-onset degeneration can also impair the range of motion and grip strength in younger patients. Although advanced stages of OA display characteristic signs in radiography, the detection of early manifestations frequently requires computed tomography or magnetic resonance imaging (in some cases with additional arthrography). If a wrist becomes unstable, timely diagnosis and precise treatment are essential to prevent rapid disease progression. Therefore, close collaboration between radiologists and hand surgeons is obligatory to preserve the carpal function of patients.
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Affiliation(s)
- Jan-Peter Grunz
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Würzburg, Germany
| | - Carsten Herbert Gietzen
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Würzburg, Germany
| | - Georgios Christopoulos
- Department of Diagnostic and Interventional Radiology, Rhön-Klinikum Campus Bad Neustadt, Bad Neustadt an der Saale, Germany
| | - Jörg van Schoonhoven
- Clinic for Hand Surgery, Rhön-Klinikum Campus Bad Neustadt, Bad Neustadt an der Saale, Germany
| | - Florian Goehtz
- Clinic for Hand Surgery, Rhön-Klinikum Campus Bad Neustadt, Bad Neustadt an der Saale, Germany
| | - Rainer Schmitt
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Würzburg, Germany.,Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Nina Hesse
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
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22
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Long-Term Results of Joint Arthroplasty with Total Prosthesis for Trapeziometacarpal Osteoarthritis in Patients over 65 Years of Age. Geriatrics (Basel) 2021; 6:geriatrics6030065. [PMID: 34209613 PMCID: PMC8293220 DOI: 10.3390/geriatrics6030065] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 06/17/2021] [Accepted: 06/19/2021] [Indexed: 11/16/2022] Open
Abstract
Trapeziometacarpal osteoarthritis (TMCOA) is a highly prevalent disease in the older population. Many different types of surgical treatments are possible, depending on the degree of joint involvement, the personal and professional circumstances of the patient and the preferences of the orthopedic surgeon. This paper evaluated the clinical and radiological results of consecutive cohorts of patients over 65 years old treated with total joint arthroplasties (TJA) of the ball and socket type (B&S) for TMCOA, with a minimum of 10 years follow-up. The survival rate (Kaplan–Meier) of the functional prostheses at 10 years was 92.2% (95% CI (89.1%, 96.1%). These functional arthroplasty patients, after 10 years of follow-up, showed little or no pain, good function and good key pinch, without radiological alterations. TJAs of the B&S type are a long lasting, effective and reliable alternative to surgical treatment of TMCOA in patients over 65 years of age, when they are performed with the patient selection criteria and surgical technique described throughout this study.
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23
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Sánchez-Crespo MR, de la Red-Gallego MA, Ayala-Gutiérrez H, Couceiro-Otero J, Rodríguez-Fernández J, Del Canto-Alvarez FJ. Initial survival of the Isis® total trapeziometacarpal prosthesis with conical trunk threaded cups. Rev Esp Cir Ortop Traumatol (Engl Ed) 2021; 65:S1888-4415(21)00081-3. [PMID: 34148810 DOI: 10.1016/j.recot.2021.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 01/20/2021] [Accepted: 02/10/2021] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The treatment of trapeziometacarpal osteoarthritis through the implantation of total trapeziometacarpal prostheses is in continuous expansion. The Isis® prosthesis is a trunk-conical threaded anchorage prosthesis. Our objective was to assess the functional results and survival of this implant for at least one year of follow-up. MATERIAL AND METHOD Prospective study on 53 Isis® prosthesis, implanted from april 2014 to january 2019. The Van Cappelle functional test, pain, strength, mobility, return to previous activity, radiological variables and placement of the trapezial component were evaluated. The surgical technique was performed with a guide wirefocused on the trapezius and control of the scopia. Observed complications were recorded and statistical analysis was performed. RESULTS Fifty-one implants (49 patients) were reviewed. Mean follow-up was 2.1 years (1-5.7). Van Cappelle's test, pain, mobility, and grip and clamp strength improved significantly, as did the distance between the metacarpal head and the trapezius base; 96% of the patients returned in less than 6 months to their activities. Minor complications, 3 De Quervain's tendinopathy and 2 intra-operative metacarpal and 2 trapezium fractures were recorded, and one carpal tunnel syndrome. There was no dislocation, mobilization, or implant infection. CONCLUSIONS The functional results of the Isis® prosthesis are excellent in the short term, far exceeding the first year of 100% of survival. The complications that arose were minor and few. The anchorage and placement of the trapezial component guided by scopia seem to be crucial for the good result.
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Affiliation(s)
- M R Sánchez-Crespo
- Servicio de Cirugía Ortopédica y Traumatología, Unidad de Mano y Muñeca, Hospital Universitario Marqués de Valdecilla, Santander, España; Universidad de Cantabria, Santander, España.
| | - M A de la Red-Gallego
- Servicio de Cirugía Ortopédica y Traumatología, Unidad de Mano y Muñeca, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - H Ayala-Gutiérrez
- Servicio de Cirugía Ortopédica y Traumatología, Unidad de Mano y Muñeca, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - J Couceiro-Otero
- Servicio de Cirugía Ortopédica y Traumatología, Unidad de Mano y Muñeca, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - J Rodríguez-Fernández
- Servicio de Cirugía Ortopédica y Traumatología, Unidad de Mano y Muñeca, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - F J Del Canto-Alvarez
- Servicio de Cirugía Ortopédica y Traumatología, Unidad de Mano y Muñeca, Hospital Universitario Marqués de Valdecilla, Santander, España; Universidad de Cantabria, Santander, España
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24
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Holme TJ, Karbowiak M, Clements J, Sharma R, Craik J, Ellahee N. Thumb CMCJ prosthetic total joint replacement: a systematic review. EFORT Open Rev 2021; 6:316-330. [PMID: 34150326 PMCID: PMC8183150 DOI: 10.1302/2058-5241.6.200152] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
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
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Affiliation(s)
- Thomas J Holme
- Epsom & St Helier University Hospitals NHS Trust, Trauma & Orthopaedics, Carshalton, UK
| | - Marta Karbowiak
- Royal Surrey NHS Foundation Trust, Trauma & Orthopaedics, Guildford, UK
| | - Jennifer Clements
- Epsom & St Helier University Hospitals NHS Trust, Trauma & Orthopaedics, Carshalton, UK
| | - Ritesh Sharma
- Epsom & St Helier University Hospitals NHS Trust, Trauma & Orthopaedics, Carshalton, UK
| | - Johnathan Craik
- Epsom & St Helier University Hospitals NHS Trust, Trauma & Orthopaedics, Carshalton, UK
| | - Najab Ellahee
- Epsom & St Helier University Hospitals NHS Trust, Trauma & Orthopaedics, Carshalton, UK
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25
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De la Red-Gallego MA, Barrera-Ochoa S, Sanchez Crespo MR. Total thumb carpometacarpal arthroplasty for failed trapeziometacarpal joint arthrodesis. HAND SURGERY & REHABILITATION 2021; 40:347-349. [PMID: 33640520 DOI: 10.1016/j.hansur.2020.12.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 12/15/2020] [Accepted: 12/16/2020] [Indexed: 11/17/2022]
Abstract
Trapeziometacarpal joint arthrodesis is a surgical option for osteoarthritis of the first carpometacarpal joint; however, it has well-known disadvantages such as non-union and reduced mobility. Revision procedures are often not discussed and lack consensus. We are reporting two cases of satisfactory thumb implant arthroplasty for failed trapeziometacarpal joint arthrodesis in order to discuss the surgical technique, its advantages compared with other surgical options and therefore its potential indications.
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Affiliation(s)
- M A De la Red-Gallego
- Hospital Universitario Marqués de Valdecilla, Avenida de Valdecilla s/n., 39010 Santander, Cantabria, Spain.
| | - S Barrera-Ochoa
- icatMA, Hand and Microsurgery Unit, ICATME, Hospital Universitari Quiron-Dexeus, Carrer de Sabino Arana, 5-19, 08028 Barcelona, Spain
| | - M R Sanchez Crespo
- Hospital Universitario Marqués de Valdecilla, Avenida de Valdecilla s/n., 39010 Santander, Cantabria, Spain
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26
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Ten Brinke B, Mathijssen NMC, Blom IF, Koster LA, Kraan GA. A radiostereometric and clinical long-term follow-up study of the surface replacement trapeziometacarpal joint prosthesis. BMC Musculoskelet Disord 2021; 22:148. [PMID: 33546653 PMCID: PMC7866696 DOI: 10.1186/s12891-021-03957-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 12/30/2020] [Indexed: 11/16/2022] Open
Abstract
Background The aim of this study was to determine long-term survival and clinical outcomes of the surface replacement trapeziometacarpal joint prosthesis (SR™TMC) and to evaluate implant migration using radiostereometric analysis (RSA). Methods In this clinical long-term follow-up study outcomes of ten patients who received the SR™TMC joint prosthesis were evaluated using DASH and Nelson scores, Visual Analogue Scale (VAS) of pain, and key pinch strength. RSA-radiographs were obtained direct postoperatively and 6 months, 1, 5 and 10 years postoperatively and were analyzed using model-based RSA software. Results During follow-up, two early revisions took place. Mean pre-operative DASH and Nelson scores were 54 (SD 15) and 54 (SD 17), improved significantly after 6 months (DASH 25 (SD 20), Nelson 75 (SD 18)) and remained excellent during long-term follow-up in all patients with a stable implant. At final follow-up, clinical scores deteriorated clearly in two patients with a loose implant in situ. Conclusions Long-term survival of the SR™TMC joint prosthesis is relatively poor. However, clinical outcomes improved significantly in the short-term and remained excellent in the long-term in those patients with a stable implant, but deteriorated clearly in case of loosening. The role of RSA in TMC joint arthroplasty is potentially valuable but needs to be further investigated. Several challenges of RSA in the TMC joint have been addressed by the authors and suggestions to optimize RSA-data are given. Trial registration This study was registered in the Netherlands Trial Register (NL7126).
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Affiliation(s)
- Bart Ten Brinke
- Department of Orthopaedic Surgery, Reinier de Graaf Groep, P.O. Box 5011, 2600, GA, Delft, The Netherlands.
| | - Nina M C Mathijssen
- Department of Orthopaedic Surgery, Reinier de Graaf Groep, P.O. Box 5011, 2600, GA, Delft, The Netherlands
| | - Ian F Blom
- Department of Radiology, Reinier de Graaf Groep, P.O. Box 5011, 2600, GA, Delft, The Netherlands
| | - Lennard A Koster
- Department of Orthopaedic Surgery, Leids Universitair Medisch Centrum, P.O. Box 5011, 2300, RC, Leiden, The Netherlands
| | - Gerald A Kraan
- Department of Orthopaedic Surgery, Reinier de Graaf Groep, P.O. Box 5011, 2600, GA, Delft, The Netherlands
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Boeckstyns MEH. Commentary on: Arpe total joint arthroplasty for trapeziometacarpal osteoarthritis: 80 thumbs in 63 patients with a minimum of 10 years follow-up. J Hand Surg Eur Vol 2020; 45:470-471. [PMID: 32407195 DOI: 10.1177/1753193420913460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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