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Liukkonen R, Karjalainen VL, Kvist R, Vaajala M, Ponkilainen V, Karjalainen T. Total joint arthroplasty for thumb carpometacarpal joint osteoarthritis: a systematic review and meta-analysis of randomized controlled trials. Acta Orthop 2024; 95:325-332. [PMID: 38887076 PMCID: PMC11184324 DOI: 10.2340/17453674.2024.40816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 04/13/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND AND PURPOSE Thumb carpometacarpal (CMC) joint osteoarthritis (OA) is increasingly treated with total joint arthroplasty (TJA). We aimed to perform a systematic review and meta-analysis of the benefits and harms of the TJA for thumb CMC OA compared with other treatment strategies. PATIENTS AND METHODS We performed a systematic search on MEDLINE and CENTRAL databases on August 2, 2023. We included randomized controlled trials investigating the effect of TJA in people with thumb CMC joint OA regardless of the stage or etiology of the disease or comparator. The outcomes were pooled with a random effect meta-analysis. RESULTS We identified 4 studies randomizing 420 participants to TJA or trapeziectomy. At 3 months, TJA's benefits for pain may exceed the clinically important difference. However, after 1-year follow-up TJA does not improve pain compared with trapeziectomy (mean difference 0.53 points on a 0 to 10 scale; 95% confidence interval [CI] 0.26-0.81). Furthermore, it provides a transient benefit in hand function at 3 months (measured with Disabilities of Arm, Shoulder, and Hand questionnaire, scale 0-100, lower is better) compared with trapeziectomy with or without ligament reconstruction tendon interposition. The benefit in function diminished to a clinically unimportant level at 1-year follow-up (4.4 points better; CI 0.42-8.4). CONCLUSION Transient benefit in hand function for TJA implies that it could be a preferable option over trapeziectomy for people who consider fast postoperative recovery important. However, current evidence fails to inform us if TJA carries long-term higher risks of revisions compared with trapeziectomy.
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Affiliation(s)
- Rasmus Liukkonen
- Faculty of Medicine and Health Technology, Tampere University, Tampere
| | | | - Reetta Kvist
- Central Finland Central Hospital Nova, Jyväskylä
| | - Matias Vaajala
- Faculty of Medicine and Health Technology, Tampere University, Tampere
| | | | - Teemu Karjalainen
- Central Finland Central Hospital Nova, Jyväskylä; Department of Hand and Microsurgery, Tampere University Hospital Tampere, Finland.
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Windhofer CM, Hirnsperger C, Lill M. [Base-of-thumb osteoarthritis: aspects to be considered with the indication of trapeziectomy and CMC I prosthesis]. HANDCHIR MIKROCHIR P 2024; 56:192-200. [PMID: 38861974 DOI: 10.1055/a-2316-8102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2024] Open
Abstract
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.
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Affiliation(s)
| | | | - Markus Lill
- Traumatologie, Praxisgemeinschaft Unfallchirurgie, Innsbruck, Austria
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Henkel C, Erikstrup C, Ostrowski SR, Pedersen OB, Troelsen A. Genetics may affect the risk of undergoing surgery for rhizarthrosis. J Orthop Res 2024; 42:1001-1008. [PMID: 38263870 DOI: 10.1002/jor.25753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 10/25/2023] [Accepted: 11/28/2023] [Indexed: 01/25/2024]
Abstract
Osteoarthritis is a prevalent and severe disease. Involvement of the trapeziometacarpal joint is common and can lead to both pain and disability. Genetics are known to affect the risk of osteoarthritis, but it remains unclear how genetics affect disease trajectories. In this study, we investigated whether the genetic associations of trapeziometacarpal osteoarthritis (rhizarthrosis) vary with the need for surgical treatment. The study was conducted as a case-control genome-wide association study using individuals from the Copenhagen Hospital Biobank pain and degenerative musculoskeletal disease study and the Danish Blood Donor Study (N = 208,342). We identified patients diagnosed with rhizarthrosis and grouped them by treatment status, resulting in two case groups: surgical (N = 1083) and nonsurgical (N = 1888). The case groups were tested against osteoarthritis-free controls in two genome-wide association studies. We then compared variants suggestive of association (p < 10-6) in either of these analyses directly between the treatment groups (surgical vs. nonsurgical rhizarthrosis). We identified 10 variants suggestive of association with either surgical (seven variants) or nonsurgical (three variants) rhizarthrosis. None of the variants reached nominal significance in the opposite treatment group (p ≥ 0.14), and all 10 variants were significantly different between the treatment groups at a false discovery rate of 5%. These results suggest possible differences in the genetic associations of rhizarthrosis depending on surgical treatment. Clinical significance: Uncovering genetic differences between clinically distinct patient groups can reveal biological determinants of disease trajectories.
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Affiliation(s)
- Cecilie Henkel
- Clinical Orthopaedic Research Hvidovre (CORH), Department of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Christian Erikstrup
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Health, Aarhus University, Aarhus, Denmark
| | - Sisse R Ostrowski
- Department of Clinical Immunology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Clinical Academic Group: Research OsteoArthritis Denmark (CAG ROAD), Greater Copenhagen Health Science Partners, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ole B Pedersen
- Clinical Academic Group: Research OsteoArthritis Denmark (CAG ROAD), Greater Copenhagen Health Science Partners, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Immunology, Zealand University Hospital Køge, Køge, Denmark
| | - Anders Troelsen
- Clinical Orthopaedic Research Hvidovre (CORH), Department of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
- Clinical Academic Group: Research OsteoArthritis Denmark (CAG ROAD), Greater Copenhagen Health Science Partners, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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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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Lachnish J, Titan AL, Sen S, Yao J. Long-Term Results of Suture-Button Suspensionplasty in the Treatment of Thumb Carpometacarpal Arthritis: A Minimum 10-Year Follow-Up. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2024; 6:206-211. [PMID: 38903836 PMCID: PMC11185894 DOI: 10.1016/j.jhsg.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 12/13/2023] [Indexed: 06/22/2024] Open
Abstract
Purpose Combined trapeziectomy and suture-button suspensionplasty (SBS) is a common and well-established surgical treatment for thumb carpometacarpal (CMC) osteoarthritis. Although short and mid-term follow-up studies have shown promising outcomes with patients retaining excellent range of motion and strength, long-term data are lacking. The aim of our study was to assess the long-term outcomes of patients who underwent SBS surgery for thumb CMC arthritis, with a minimum follow-up period of 10 years. Methods We evaluated 17 patients, at least 10 years after undergoing SBS surgery for thumb CMC arthritis. We measured grip and pinch strength, range of motion, and trapezial space height and compared it with the respective values measured on the routine postoperative 3-month follow-up visit. All patients have additionally completed the Quick Disabilities of the Arm, Shoulder, and Hand questionnaire. Results The study included 11 women and 6 men with an average age of 60.3 ± 6.4 years and a mean follow-up of 137.4 ± 11.4 months after surgery. The mean Quick Disabilities of the Arm, Shoulder, and Hand score was 9 (range: 0-40.9) at the long-term follow-up, compared with 26.2 (range: 4.5-75) recorded 3 months after the surgery. Grip and pinch strengths were 116% and 111% of the 3-month postoperative value, respectively. Radial abduction and palmar abduction were 98% and 94% of the 3-month postoperative value, respectively. Kapandji scores were either equal or higher than the previously documented scores. Average height of the trapezial space was 69% of the previous postoperative measurement. Conclusions Our findings demonstrate that patients who underwent SBS surgery for thumb CMC osteoarthritis achieve excellent long-term outcomes by maintaining favorable subjective and objective results, despite some radiographic subsidence over time. These results indicate SBS to be an effective and durable technique for the long-term management of thumb CMC osteoarthritis. Type of study/level of evidence Therapeutic IV.
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Affiliation(s)
- Jordan Lachnish
- Department of Orthopaedic Surgery, Stanford University Medical Center, Stanford, CA
| | - Ashley L. Titan
- Department of Orthopaedic Surgery, Stanford University Medical Center, Stanford, CA
| | - Subhro Sen
- Department of Orthopaedic Surgery, Stanford University Medical Center, Stanford, CA
| | - Jeffrey Yao
- Department of Orthopaedic Surgery, Stanford University Medical Center, Stanford, CA
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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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Herren DB. Basal thumb arthritis surgery: complications and its management. J Hand Surg Eur Vol 2024; 49:188-200. [PMID: 38315137 DOI: 10.1177/17531934231197787] [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: 02/07/2024]
Abstract
The management of complications after surgery for basal thumb arthritis is sometimes challenging, and there are no clear recommendations on how to evaluate and manage patients with residual symptoms. The aim of the present article was to review the most common complications after surgery for basal thumb arthritis, with an emphasis on resection arthroplasty, joint replacement and joint fusion. In addition, possible management strategies for the different types of complications will be highlighted.
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Affiliation(s)
- Daniel B Herren
- Schulthess Klinik, Department of Hand Surgery, Zurich, Switzerland
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Herren DB, Marks M, Neumeister S, Schindele S. Low complication rate and high implant survival at 2 years after Touch® trapeziometacarpal joint arthroplasty. J Hand Surg Eur Vol 2023; 48:877-883. [PMID: 37310049 DOI: 10.1177/17531934231179581] [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: 06/14/2023]
Abstract
We analysed complications, revision surgeries, and patient-reported and clinical outcomes 2 years after trapeziometacarpal joint implant arthroplasty using the Touch® prosthesis. Of 130 operated patients with trapeziometacarpal joint osteoarthritis, four had to be revised owing to implant dislocation, loosening or impingement, leading to an estimated 2-year survival rate of 96% (95% confidence interval: 90 to 99). Of 101 patients available for the 2-year follow-up, complications occurred in 17, with the most frequent being de Quervain stenosing vaginosis (n = 6) and trigger thumb (n = 5). Pain at rest decreased significantly from a median value of 5 (interquartile range [IQR]: 4 to 7) before surgery to 0 (IQR: 0 to 1) at 2 years. Key pinch strength increased significantly from 4.5 kg (IQR: 3.0 to 6.5) to 7.0 kg (IQR: 6.0 to 8.0). We recommend surgery with the Touch® prosthesis as the standard procedure for patients with isolated trapeziometacarpal joint osteoarthritis because of the high survival rate and promising outcomes at 2 years.Level of evidence: IV.
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Affiliation(s)
- Daniel B Herren
- Department of Hand Surgery, Schulthess Klinik, Zurich, Switzerland
| | - Miriam Marks
- Department of Teaching, Research and Development, Schulthess Klinik, Zurich, Switzerland
| | - Sara Neumeister
- Department of Teaching, Research and Development, Schulthess Klinik, Zurich, Switzerland
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Van Royen K, Van Royen A, Vanmierlo B, Goorens CK, De Vos J, Goubau J. Radiological imaging of the trapeziometacarpal joint: a historical and clinical perspective. J Hand Surg Eur Vol 2023; 48:90-100. [PMID: 36397201 DOI: 10.1177/17531934221137979] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The opposable thumb provides both stability and mobility and is needed to accomplish different prehensile tasks. The trapezium is a complex bone, with a distal articular surface that is convex in the sagittal plane of the thumb and concave in the coronal plane of the thumb. The numerous additional articulations with the carpus and the oblique orientation to the main plane of the hand makes it difficult to evaluate the trapeziometacarpal joint using standard hand or wrist radiographic views. This review gives an overview of the different radiological views that have been described for the thumb with an emphasis on their historical origin and positioning during radiography. We also describe different measurements and classifications that can be obtained using different thumb radiographs.
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Affiliation(s)
- Kjell Van Royen
- Department Orthopaedics and Traumatology, UZ Brussel, Brussels, Belgium.,Department Orthopaedics and Traumatology, AZ Damiaan, Ostend, Belgium.,Department Orthopaedics and Traumatology, OLV Aalst, Aalst, Belgium
| | - Arn Van Royen
- Department Orthopaedics and Traumatology, OLV Aalst, Aalst, Belgium
| | | | - Chul Ki Goorens
- Department Orthopaedics and Traumatology, AZ Delta, Roeselare, Belgium
| | - Joris De Vos
- Department Orthopaedics and Traumatology, UZ Brussel, Brussels, Belgium.,Department Orthopaedics and Traumatology, AZ Damiaan, Ostend, Belgium
| | - Jean Goubau
- Department Orthopaedics and Traumatology, UZ Brussel, Brussels, Belgium.,Department Orthopaedics and Traumatology, AZ Maria Middelares, Ghent, Belgium
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Muir L. Trapeziometacarpal joint arthritis - imaging and implants: commentary and personal opinions. J Hand Surg Eur Vol 2023; 48:159-161. [PMID: 36524279 DOI: 10.1177/17531934221143439] [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: 12/23/2022]
Affiliation(s)
- Lindsay Muir
- Salford Royal NHS Foundation Trust, Salford, UK.,
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