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Kaptein BL, Pijls B, Koster L, Kärrholm J, Hull M, Niesen A, Heesterbeek P, Callary S, Teeter M, Gascoyne T, Röhrl SM, Flivik G, Bragonzoni L, Laende E, Sandberg O, Solomon LB, Nelissen R, Stilling M. Guideline for RSA and CT-RSA implant migration measurements: an update of standardizations and recommendations. Acta Orthop 2024; 95:256-267. [PMID: 38819193 PMCID: PMC11141406 DOI: 10.2340/17453674.2024.40709] [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: 01/10/2024] [Accepted: 04/08/2024] [Indexed: 06/01/2024] Open
Abstract
Opening remarks: These guidelines are the result of discussions within a diverse group of RSA researchers. They were approved in December 2023 by the board and selected members of the International Radiostereometry Society to update the guidelines by Valstar et al. [1]. By adhering to these guidelines, RSA studies will become more transparent and consistent in execution, presentation, reporting, and interpretation. Both authors and reviewers of scientific papers using RSA may use these guidelines, summarized in the Checklist, as a reference. Deviations from these guidelines should have the underlying rationale stated.
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Affiliation(s)
- Bart L Kaptein
- Department of Orthopedics, Leiden University Medical Center, Leiden, The Netherlands.
| | - Bart Pijls
- Department of Orthopedics, Leiden University Medical Center, Leiden, The Netherlands
| | - Lennard Koster
- Department of Orthopedics, Leiden University Medical Center, Leiden, The Netherlands
| | - Johan Kärrholm
- Department of Orthopedics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Maury Hull
- Orthopedic Surgery Department, University of California, Davis, United States
| | - Abby Niesen
- Orthopedic Surgery Department, University of California, Davis, United States
| | - Petra Heesterbeek
- Orthopedic Research Department, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Stuart Callary
- Department of Orthopedics and Trauma, Royal Adelaide Hospital, Adelaide, Australia
| | - Matthew Teeter
- Department of Medical Biophysics, Western University, London, Canada
| | | | - Stephan M Röhrl
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
| | - Gunnar Flivik
- Department of Orthopedics, Skane University Hospital, Lund, Sweden
| | | | - Elise Laende
- Department of Surgery, Dalhousie University, Halifax, Canada
| | | | - L Bogdan Solomon
- Department of Orthopedics and Trauma, Royal Adelaide Hospital, Adelaide, Australia
| | - Rob Nelissen
- Department of Orthopedics, Leiden University Medical Center, Leiden, The Netherlands
| | - Maiken Stilling
- Department of Orthopedics, Aarhus University Hospital, Aarhus, Denmark
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Stilling M, Dremstrup L, Hansen TB, Thillemann JK. Superior bone fixation of conical compared with hemispherical trapezial cup design: an experimental radiostereometry study. J Exp Orthop 2023; 10:127. [PMID: 38032446 PMCID: PMC10689311 DOI: 10.1186/s40634-023-00692-y] [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: 06/06/2023] [Accepted: 11/14/2023] [Indexed: 12/01/2023] Open
Abstract
PURPOSE The most used cup designs for trapeziometacarpal (TMC) arthroplasty are of hemispherical and conical geometrical shape. Using a validated pig bone model, we compared the bone fixation using radiostereometry (RSA). METHODS Twenty saddle-shaped pig forefoot bones were prepared with insertion of bone markers and reaming. Hemispherical Type T cups (Beznoska, Kladno, Czech Republic) (N = 10) and conical Moovis cups (Stryker, Pusignan, France) (N = 10) of 9-mm diameter were inserted press-fit. The bones were fixed in cement blocks for stability, and the cups were loaded in a motorized test stand. First, a low-pressure cyclic load test (0-150N) with 130 compression cycles was performed. Next, a push-in test of progressive loads with 50N increments (range: 150-900N) was applied until a visual change in cup position appeared. Cup migration was evaluated with RSA after every new load application. Cup failure was defined as total translation > 0.5 mm between two load applications. RESULTS Both cup types tolerated a compression load of 450 N without failure. Beyond this load level, the total translation cup migration of mean 0.20 mm (95% CI 0.11; 0.30) for the Type T group was higher than mean 0.10 mm (95% CI 0.06; 0.15) of the Moovis group (p = 0.046). The Hazard ratio for failure was 0.52 (95% CI 0.12; 2.17) (p = 0.37), indicating that the risk of failure was two-fold higher in the Type T group. CONCLUSION We conclude that conical TMC cups have superior fixation as compared to hemispherical cups above a loading level of 450 N, which correspond to a 3.8 kg tip-pinch. In a clinical perspective, based on the fixation strength of both cup types, it seems safe to allow light-load activities of daily living such as buttoning a shirt and using a key shortly after surgery and until sufficient osseointegration is achieved.
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Affiliation(s)
- Maiken Stilling
- Department of Orthopaedic Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 165 J801, DK- 8200, Aarhus N, Denmark.
- Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark.
- AutoRSA Research Group, Orthopaedic Research Unit, Aarhus University Hospital, Aarhus N, Denmark.
- Department of Orthopaedics, University Clinic for Hand, Hip and Knee Surgery, Gødstrup Hospital, Herning, Denmark.
| | - Lene Dremstrup
- Department of Orthopaedics, University Clinic for Hand, Hip and Knee Surgery, Gødstrup Hospital, Herning, Denmark
| | - Torben Bæk Hansen
- Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
- Department of Orthopaedics, University Clinic for Hand, Hip and Knee Surgery, Gødstrup Hospital, Herning, Denmark
| | - Janni Kjærgaard Thillemann
- Department of Orthopaedic Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 165 J801, DK- 8200, Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
- AutoRSA Research Group, Orthopaedic Research Unit, Aarhus University Hospital, Aarhus N, Denmark
- Department of Orthopaedics, University Clinic for Hand, Hip and Knee Surgery, Gødstrup Hospital, Herning, Denmark
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Klim SM, Glehr R, Graef A, Amerstorfer F, Leithner A, Glehr M. Total joint arthroplasty versus resection-interposition arthroplasty for thumb carpometacarpal arthritis: a randomized controlled trial. Acta Orthop 2023; 94:224-229. [PMID: 37140370 PMCID: PMC10158789 DOI: 10.2340/17453674.2023.11919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Indexed: 05/05/2023] Open
Abstract
BACKGROUND AND PURPOSE Thumb carpometacarpal (TCMC) osteoarthritis is a common condition that causes pain and functional limitations. We compared the outcomes of 2 surgical procedures for TCMC osteoarthritis, the Epping resection-suspension arthroplasty and the double-mobility TCMC prosthesis, and focused on pain relief, functional outcomes, and patient quality of life. PATIENTS AND METHODS Over a 7-year period a randomized controlled trial including 183 cases of TCMC osteoarthritis was conducted comparing a double mobility TCMC prosthesis (Moovis, Stryker, Kalamazoo, MI, USA) with the Epping resection-suspension arthroplasty. Pre- and postoperative examinations included the range of motion (ROM), SFMcGill score, visual analogue scale (VAS), the disabilities of the arm, shoulder and hand questionnaire (DASH), and the hospital anxiety and depression scale (HADS). RESULTS At the 6-week postoperative follow-up, significant differences were found in VAS: Epping median 4.0 (interquartile range [IQR] 2.0-5.0) vs. TCMC prosthesis 2.0 (IQR 0.25-4.0), p = 0.03, effect size (area under the curve [AUC]) 0.64 (95% confidence interval [CI] 0.55-0.73), in DASH score: Epping 61 (IQR 43-75) vs. TCMC prosthesis 45 (IQR 29-57), p < 0.001, AUC 0.69 (CI 0.61- 0.78), and in radial abduction: Epping 55 (IQR 50-60) vs. TCMC prosthesis 62 (IQR 60-70), p = 0.001, AUC 0.70 (CI 0.61-0.79). No significant group differences were found at the 6- and 12-months follow-up. During the follow-up period, 3 of 82 prostheses had to be revised but there was no revision in the Epping group. CONCLUSION The double mobility TCMC prosthesis had superior outcomes compared with the Epping procedure at 6 weeks; however, there were no significant differences in outcomes at 6 months and 1 year postoperatively. The implant survival rate of 96% after 12 months was acceptable.
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Affiliation(s)
- Sebastian M Klim
- Department for Orthopaedics and Trauma, Medical University of Graz, Graz.
| | - Reingard Glehr
- Institute of General Practice and Evidencebased Health Services Research, Medical University of Graz, Austria
| | - Armin Graef
- Department for Orthopaedics and Trauma, Medical University of Graz, Graz
| | | | - Andreas Leithner
- Department for Orthopaedics and Trauma, Medical University of Graz, Graz
| | - Mathias Glehr
- Department for Orthopaedics and Trauma, Medical University of Graz, Graz
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Seth I, Sinkjær Kenney P, Bulloch G, Hunter-Smith DJ, Bo Thomsen J, Rozen WM. Artificial or Augmented Authorship? A Conversation with a Chatbot on Base of Thumb Arthritis. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e4999. [PMID: 37250832 PMCID: PMC10219695 DOI: 10.1097/gox.0000000000004999] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 03/27/2023] [Indexed: 05/31/2023]
Abstract
ChatGPT is an open artificial intelligence chat box that could revolutionize academia and augment research writing. This study had an open conversation with ChatGPT and invited the platform to evaluate this article through series of five questions on base of thumb arthritis to test if its contributions and contents merely add artificial unusable input or help us augment the quality of the article. The information ChatGPT-3 provided was accurate, albeit surface-level, and lacks analytical ability to dissect for important limitations about base of thumb arthritis, which would not be conducive to potentiating creative ideas and solutions in plastic surgery. ChatGPT failed to provide relevant references and even "created" references instead of indicating its inability to perform the task. This highlights that as an AI-generator for medical publishing text, ChatGPT-3 should be used cautiously.
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Affiliation(s)
- Ishith Seth
- From the Faculty of Science, Medicine, and Health, Monash University, Victoria, Australia
- Faculty of Science, Medicine, and Health, University of Melbourne, Victoria, Australia
- Department of Plastic Surgery, Peninsula Health, Melbourne, Victoria, Australia
- Peninsula Clinical School, Central Clinical School at Monash University, The Alfred Centre, Melbourne, Victoria, Australia
| | - Peter Sinkjær Kenney
- Department of Plastic Surgery, Odense University Hospital, Odense, Denmark
- Department of Plastic and Breast Surgery, Aarhus University Hospital, Aarhus N, Denmark
| | - Gabriella Bulloch
- Faculty of Science, Medicine, and Health, University of Melbourne, Victoria, Australia
| | - David J. Hunter-Smith
- From the Faculty of Science, Medicine, and Health, Monash University, Victoria, Australia
- Department of Plastic Surgery, Peninsula Health, Melbourne, Victoria, Australia
- Peninsula Clinical School, Central Clinical School at Monash University, The Alfred Centre, Melbourne, Victoria, Australia
| | - Jørn Bo Thomsen
- Department of Plastic Surgery, Odense University Hospital, Odense, Denmark
- Research unit for Plastic Surgery, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Warren M. Rozen
- From the Faculty of Science, Medicine, and Health, Monash University, Victoria, Australia
- Department of Plastic Surgery, Peninsula Health, Melbourne, Victoria, Australia
- Peninsula Clinical School, Central Clinical School at Monash University, The Alfred Centre, Melbourne, Victoria, Australia
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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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Balesar VV, Koster LA, Kaptein BL, Keizer SB. Five-Year Prospective Roentgen Stereophotogrammetric and Clinical Outcomes of the BioPro MTP-1 Hemiarthroplasty. Foot Ankle Int 2022; 43:637-645. [PMID: 34962173 DOI: 10.1177/10711007211061366] [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: 02/01/2023]
Abstract
BACKGROUND Mixed results for functional outcomes and long-term fixation have been reported for first metatarsophalangeal arthroplasty. This prospective study was designed to evaluate the migration of the BioPro metatarsophalangeal-1 (MTP-1) joint hemiprosthesis with Roentgen stereophotogrammetric analysis (RSA). Migration patterns of the prosthesis, prosthesis-induced erosion of the metatarsal bone, and clinical outcomes were evaluated sequentially to 5 years postoperation (PO). METHODS Eleven female patients received the BioPro-1 hemiprosthesis. Prosthesis translation and metatarsal erosion were measured with RSA at immediately PO, 6 weeks, and 3, 6, 12, 36, and 60 months postoperatively. Clinical assessment was done by patient questionnaires. RESULTS RSA data of 9 patients were available for analysis. Median (range) number of markers used in RSA analysis, condition number, and mean error of markers around the prosthesis were 4 (3-7), 320 (208-862), and 0.13 (0.02-0.28), respectively. Progressive subsidence was seen up to 3 years PO (mean 2.1 mm, SE 0.32). Progressive metatarsal erosion was found from 1 year PO (mean 0.49 mm, SE 0.15). Pain, function, and quality scores improved after surgery and did not deteriorate at later follow-up moments. CONCLUSION Model-based RSA of the BioPro-1 prosthesis shows nonstabilizing medial and distal translation and metatarsal erosion. Despite the measured migration and erosion, clinical outcomes improved and remained similar up to 5 years postoperation. LEVEL OF EVIDENCE Level II, prospective analysis of MTP-1 hemiprosthesis.
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Affiliation(s)
| | | | - Bart L Kaptein
- Leiden Universitair Medisch Centrum, Leiden, the Netherlands
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SAHEB RICARDOLUCCACABARITE, VAZ BRENOALVESDESOUSA, SOEIRA THABATAPASQUINI, SHIMAOKA FILIPEJUN, HERRERO CARLOSFERNANDOPEREIRADASILVA, MAZZER NILTON. SURGICAL TREATMENT FOR RHIZARTHROSIS: A SYSTEMATIC REVIEW OF THE LAST 10 YEARS. ACTA ORTOPEDICA BRASILEIRA 2022; 30:e246704. [PMID: 35431632 PMCID: PMC8979356 DOI: 10.1590/1413-785220223001e246704] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 03/16/2021] [Indexed: 11/21/2022]
Abstract
Introduction Comparison of different surgical techniques to treat patients with rhizarthrosis or carpometacarpal osteoarthritis of the thumb. Materials and Methods A systematic review was conducted using three electronic databases. Randomized, controlled trials in patients who underwent surgery for the treatment of rhizarthrosis were included. The literature review followed the PRISMA protocol. Results A total of 15 articles involving a total population of 958 patients were selected. Seven different surgical techniques were compared. Conclusions We conclude that no procedure is superior to another in terms of pain, physical function, overall patient assessment, range of motion, or strength. Outcome measurements should be standardized to enable better comparison between surgical techniques. Level of evidence II, Systematic Review.
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Influence of Occupational Hand Force Requirements on Return to Work, Pain, and Disability After Trapeziometacarpal Total Joint Arthroplasty: A 12-Month Follow-Up Study. J Hand Surg Am 2021; 46:714.e1-714.e10. [PMID: 33781613 DOI: 10.1016/j.jhsa.2021.01.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 11/15/2020] [Accepted: 01/20/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE We aimed to determine the prognosis after trapeziometacarpal total joint arthroplasty for basal thumb osteoarthritis with respect to sustainable return to work (RTW), pain, and disability. Our main hypothesis was that high occupational hand force requirements are related to slower RTW. METHODS We conducted a 12-month follow-up study of patients who were treated with a trapeziometacarpal total joint arthroplasty in 2003 to 2015 and were active in the labor market at the time of surgery. We used registry information about RTW. Before surgery and at the 12-month follow-up, we obtained data on pain and disability. To obtain estimates of occupational hand force requirements for individual patients, we linked the patients' self-reported job title to a job exposure matrix based on experts' ratings. We used Cox regression models to analyze the time until sustainable RTW and logistic regression models to analyze pain and disability. RESULTS A total of 133 patients were included. Most patients returned to work within 12 months after surgery (86%). For those who returned to work within 12 months (n = 114), mean time until sustainable RTW was 14 weeks (SD, 9 weeks). Higher hand force requirements were associated with slower RTW (for medium- and high-force requirements, adjusted hazard ratios were 0.48 [95% confidence interval, 0.30-0.78] and 0.41 [95% confidence interval, 0.25-0.69]). Occupational hand force requirements were not associated with pain and disability at follow-up. CONCLUSIONS High occupational hand force requirements were associated with slower RTW, but not with pain and disability 12 months after surgery. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic I.
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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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Hamasaki T, Harris PG, Bureau NJ, Gaudreault N, Ziegler D, Choinière M. Efficacy of Surgical Interventions for Trapeziometacarpal (Thumb Base) Osteoarthritis: A Systematic Review. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2021; 3:139-148. [PMID: 35415551 PMCID: PMC8991854 DOI: 10.1016/j.jhsg.2021.02.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 02/16/2021] [Indexed: 11/01/2022] Open
Abstract
Purpose Methods Results Conclusions Type of study/level of evidence
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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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Thillemann JK, Dremstrup L, Hansen TB, Stilling M. The mechanical fixation of a cementless conical cup in cortical versus cancellous trapezial bone: an experimental study. J Hand Surg Eur Vol 2021; 46:146-153. [PMID: 33079604 DOI: 10.1177/1753193420963255] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
In a pig bone model mimicking the human trapezium, we assessed the cementless fixation of trapezial cups in cancellous and cortical bone. Thirty-two saddle-shaped pig forefoot bones were prepared for cup fixation. Conical Konos cups (Beznoska, Kladno, Czech Republic) size 9 mm or 10 mm diameter were impacted. Cup migration was evaluated with repeated radiostereometry after intervals of cyclic-load tests. Migration increased for every load-interval up to 750 N and was higher with cancellous bone fixation than with cortical bone fixation. In cancellous bone, 9 mm cups migrated more than 10 mm cups. At the highest load (1050 N), the cumulative implant survival was 88% for 10 mm cups with cortical bone fixation and 13% for 9 mm cups with cancellous bone fixation. We conclude that mechanical fixation of conical Konos cups was better in cortical than in cancellous bone. Our results further suggest that the largest possible cup diameter should be used.
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Affiliation(s)
- Janni K Thillemann
- Department of Orthopeadics, University Clinic for Hand, Hip and Knee Surgery, Hospital Unit West, Holstebro, Denmark.,Department of Clinical Medicine, Aarhus University, Skejby, Denmark
| | - Lene Dremstrup
- Department of Orthopeadics, University Clinic for Hand, Hip and Knee Surgery, Hospital Unit West, Holstebro, Denmark
| | - Torben B Hansen
- Department of Orthopeadics, University Clinic for Hand, Hip and Knee Surgery, Hospital Unit West, Holstebro, Denmark.,Department of Clinical Medicine, Aarhus University, Skejby, Denmark
| | - Maiken Stilling
- Department of Clinical Medicine, Aarhus University, Skejby, Denmark.,Department of Orthopaedics, Aarhus University Hospital, Skejby, Denmark
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13
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Abstract
For thumb carpometacarpal osteoarthritis, trapeziectomy provides generally good results with reduction of pain and restoration of thumb mobility, but shortening of the thumb may at least in theory lead to reduction in grip and pinch strength. Furthermore, instability of the base of the first metacarpal and contact with the scaphoid may occur regardless of the several described techniques with ligament reconstruction and tendon interposition. Thus, for years alternatives to trapeziectomy have been explored and reported with disputable success. Often the road from idea to implantation in patients seems to have been short, and high complication rates and failure of new implant designs have been fairly common. This has led to the general impression that the implants do not provide sufficient benefits compared with simple trapeziectomy. More recent uncemented total joint replacement designs have shown rapid rehabilitation, reduction of pain, restoration of grip strength and movement, and much improved long-term implant survival. These factors may make total joint replacement a realistic alternative to trapeziectomy. Still, patient selection has to be improved, as the benefits may be small in the low activity elderly patient.
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Affiliation(s)
- Torben Bæk Hansen
- University Clinic for Hand, Hip and Knee Surgery, Holstebro Hospital, Holstebro, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
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14
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Copeland A, Gallo L, Weber C, Moltaji S, Gallo M, Murphy J, Axelrod D, Thoma A. Reporting Outcomes and Outcome Measures in Thumb Carpometacarpal Joint Osteoarthritis: A Systematic Review. J Hand Surg Am 2021; 46:65.e1-65.e11. [PMID: 32819777 DOI: 10.1016/j.jhsa.2020.05.024] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 04/20/2020] [Accepted: 05/27/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE In the thumb carpometacarpal (CMC) joint osteoarthritis (OA) literature, there is substantial heterogeneity in outcome and outcome measure reporting. This could be rectified by a standardized core outcome set (COS). This study aimed to identify a comprehensive list of outcomes and outcome measures for thumb CMC joint OA, which represents the first step in developing a COS. METHODS A computerized search of MEDLINE, EMBASE, Cochrane, and CINAHL was performed to identify randomized controlled trials, as well as observational studies involving at least 50 participants aged greater than 18 years undergoing surgery for thumb CMC joint OA. Reported outcomes and outcome measures were extracted from these trials and summarized. RESULTS This search yielded 3,498 unique articles, 97 of which were used for analysis. A total of 33 unique outcomes and 25 unique outcome measures were identified. The most frequently used outcomes were complications (78), postoperative pain (73), radiologic outcomes (64), and grip strength (63). Within each reported outcome, there was substantial variation in how the outcome was measured. Of the 25 unique outcome measures, 10 were validated. Of the remaining 15, 12 were created ad hoc by the author. The Disabilities of the Arm, Shoulder, and Hand questionnaire was the most commonly reported outcome measure (34%). CONCLUSIONS There is a lack of consensus on critical outcomes after surgery for thumb CMC joint OA. A standardized COS created by stakeholder consensus would improve the consistency and therefore the quality of future research. CLINICAL RELEVANCE This systematic review of outcomes represents the first step in developing a core outcome set for thumb CMC joint OA.
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Affiliation(s)
- Andrea Copeland
- Division of Plastic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Lucas Gallo
- Division of Plastic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Christina Weber
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Syena Moltaji
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Matteo Gallo
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Jessica Murphy
- Division of Plastic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Daniel Axelrod
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Achilleas Thoma
- Division of Plastic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.
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15
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Mahmood I, Burton R, Choudhry MN, Coapes C. Early to Mid-Term Results in Trapezio-metacarpal Joint Replacement using the ARPE Implant. Open Orthop J 2020. [DOI: 10.2174/1874325002014010198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
Abstract
Background:
Trapezio-Metacarpal Joint (TMJ) arthritis is a common cause of radial sided wrist pain. After conservative measures have been exhausted, the current mainstay of surgical treatment is trapeziectomy. Some surgeons combine this with additional ligament reconstruction and tendon or capsular interposition techniques to provide a more stable base for the thumb metacarpal.
Purpose:
In modern Orthopaedic practice, arthroplasty is the procedure of choice for many end-stage arthritic joints. However, due to the reliable and reproducible outcomes of trapeziectomy, this has yet to be widely adopted by hand surgeons in the management of TMJ arthritis. Recent series of arthroplasty implants have consistently shown good outcomes and trapezio-metacarpal joint replacement has been observed to provide excellent long-term function in the fit and active patient.
Methods:
We have performed a total of 52 TMJ arthroplasties in 46 patients in our institution for over 5 years (2011 to 2016). After excluding 3 cases, 43 available patients (49 implants) were subsequently asked to submit QuickDASH scores and a patient satisfaction survey.
Results:
Average QuickDASH score was 16.6, with high patient satisfaction postoperatively at 1 year. Complications included one intraoperative fracture, and five cases of post-operative instability/ dislocation. Dislocations were treated successfully with open reduction and revision.
Conclusion:
TMJ arthroplasty has shown good outcomes and patient satisfaction with a low revision rate and we recommend its use in active patients with well-preserved scapho-trapezio-trapezoid (STT) joints.
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16
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Remy S, Detrembleur C, Libouton X, Bonnelance M, Barbier O. Trapeziometacarpal prosthesis: an updated systematic review. HAND SURGERY & REHABILITATION 2020; 39:492-501. [PMID: 32860986 DOI: 10.1016/j.hansur.2020.08.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 07/29/2020] [Accepted: 08/04/2020] [Indexed: 12/23/2022]
Abstract
The trapeziometacarpal prosthesis is mostly used in Europe to treat osteoarthritis of the basal joint of the thumb. Its supposed benefits are that it restores the length of the thumb, improves strength, function and mobility while reducing recovery time compared to other surgical treatments. However, previous reviews of the literature could not confirm these assumptions. This article provides an updated systematic review to help answer to these questions through a methodical statistical analysis and to quantify the two main complications, namely failure and deep infection. To achieve these aims, a selection of articles including implant case series was done in the Medline database based on specific criteria. Data about pain, function, strength, infection, and failure were compiled and a statistical analysis was performed. Results show a fast recovery in terms of pain and function but the positive effect on strength seems limited. The failure rate represented by the revision rate is high and the deep infection rate is fairly low. Randomized controlled studies are needed to obtain reliable data to compare the prosthesis to other surgical treatments.
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Affiliation(s)
- S Remy
- Cliniques Universitaires Saint-Luc, Service d'Orthopédie et de Traumatologie de l'Appareil Locomoteur, Avenue Hippocrate 10, 1200 Brussels, Belgium.
| | - C Detrembleur
- Université Catholique de Louvain, Secteur des Sciences de la Santé, Institut de Recherche Expérimentale et Clinique, Neuro Musculo Skeletal Lab (NMSK), Avenue Mounier 53, 1200 Brussels, Belgium
| | - X Libouton
- Cliniques Universitaires Saint-Luc, Service d'Orthopédie et de Traumatologie de l'Appareil Locomoteur, Avenue Hippocrate 10, 1200 Brussels, Belgium; Université Catholique de Louvain, Secteur des Sciences de la Santé, Institut de Recherche Expérimentale et Clinique, Neuro Musculo Skeletal Lab (NMSK), Avenue Mounier 53, 1200 Brussels, Belgium
| | - M Bonnelance
- Cliniques Universitaires Saint-Luc, Service d'Orthopédie et de Traumatologie de l'Appareil Locomoteur, Avenue Hippocrate 10, 1200 Brussels, Belgium
| | - Olivier Barbier
- Cliniques Universitaires Saint-Luc, Service d'Orthopédie et de Traumatologie de l'Appareil Locomoteur, Avenue Hippocrate 10, 1200 Brussels, Belgium; Université Catholique de Louvain, Secteur des Sciences de la Santé, Institut de Recherche Expérimentale et Clinique, Neuro Musculo Skeletal Lab (NMSK), Avenue Mounier 53, 1200 Brussels, Belgium
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17
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Froschauer SM, Holzbauer M, Schnelzer RF, Behawy M, Kwasny O, Aitzetmüller MM, Machens HG, Duscher D. Total arthroplasty with Ivory ® prosthesis versus resection-suspension arthroplasty: a retrospective cohort study on 82 carpometacarpal-I osteoarthritis patients over 4 years. Eur J Med Res 2020; 25:13. [PMID: 32295633 PMCID: PMC7161197 DOI: 10.1186/s40001-020-00411-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 03/26/2020] [Indexed: 11/30/2022] Open
Abstract
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.
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Affiliation(s)
- Stefan M Froschauer
- Department for Trauma Surgery and Sport Traumatology, Kepler University Hospital Linz, Medcampus III, Krankenhausstrasse 3, 4020, Linz, Austria.,Medical Faculty, Johannes Kepler University Linz, Krankenhausstrasse 9, 4020, Linz, Austria
| | - Matthias Holzbauer
- Department for Trauma Surgery and Sport Traumatology, Kepler University Hospital Linz, Medcampus III, Krankenhausstrasse 3, 4020, Linz, Austria.,Medical Faculty, Johannes Kepler University Linz, Krankenhausstrasse 9, 4020, Linz, Austria
| | - Richard F Schnelzer
- Department for Trauma Surgery and Sport Traumatology, Kepler University Hospital Linz, Medcampus III, Krankenhausstrasse 3, 4020, Linz, Austria
| | - Manfred Behawy
- Department for Trauma Surgery and Sport Traumatology, Kepler University Hospital Linz, Medcampus III, Krankenhausstrasse 3, 4020, Linz, Austria
| | - Oskar Kwasny
- Department for Trauma Surgery and Sport Traumatology, Kepler University Hospital Linz, Medcampus III, Krankenhausstrasse 3, 4020, Linz, Austria.,Medical Faculty, Johannes Kepler University Linz, Krankenhausstrasse 9, 4020, Linz, Austria
| | - Matthias M Aitzetmüller
- Department for Plastic and Hand Surgery, Technical University Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Hans-Günther Machens
- Department for Plastic and Hand Surgery, Technical University Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Dominik Duscher
- Department for Trauma Surgery and Sport Traumatology, Kepler University Hospital Linz, Medcampus III, Krankenhausstrasse 3, 4020, Linz, Austria. .,Department for Plastic and Hand Surgery, Technical University Munich, Ismaninger Strasse 22, 81675, Munich, Germany. .,Section for Plastic and Reconstructive Surgery, Kepler University Hospital Linz, Medcampus III, Krankenhausstrasse 3, 4020, Linz, Austria. .,Medical Faculty, Johannes Kepler University Linz, Krankenhausstrasse 9, 4020, Linz, Austria.
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18
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Mosegaard SB, Stilling M, Hansen TB. Risk factors for limited improvement after total trapeziometacarpal joint arthroplasty. Health Qual Life Outcomes 2020; 18:90. [PMID: 32228611 PMCID: PMC7106898 DOI: 10.1186/s12955-020-01333-z] [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: 12/17/2018] [Accepted: 03/18/2020] [Indexed: 12/02/2022] Open
Abstract
Background Trapeziometacarpal (TMC) osteoarthritis can be painful and cause disability for patients. Total joint replacement of the TMC joint provides a pseudo arthrosis with good restoration of the thumb motion and pain relief in most patients. But there is also a risk of no improvement following the operation. The purpose of this study was to identify patients at risk of no clinically important improvement following operative treatment of osteoarthritis of the TMC joint. Methods We included 287 consecutive patients (225 women, 62 men) treated with total joint replacement of the TMC joint due to osteoarthritis with a mean age of 58.9 years (range 41–80) in a prospective cohort study. We collected information preoperatively and 12 months postoperatively on disabilities of the arm, shoulder and hand score (DASH), grip strength and pain at rest and activity on a visual analogue scale (VAS).Results: We found a statistically significant improvement in DASH from 42.0 to 15.9 (p < 0.001), VAS at rest from 3.5 to 0.6 (p < 0.001), VAS at activity from 7.9 to 2.5 (p < 0.001) and grip strength from 21.6 kg to 27.6 kg (p < 0.001) 12 months after the operation, when analysed as a group. There was an increased risk of no clinically important improvement in hand function for patients with preoperative high preoperative grip strength. Also, we found an increased risk of no clinically important improvement in female patients when using VAS as outcome. Conclusion However, we were unable to detect one isolated preoperative predictor as indicator of successful result after operative treatment of TMC osteoarthritis, and as so it was not possible to establish a clinical valid tool for patient selection before surgery. Informed consent was obtained from all patients for being included in the study. The study needed no approval from The Regional Committee of Biomedical Research Ethics as the data was collected, as part of our normal pre- and postoperative clinical pathway, but the study is part of an outcome study of the results after total joint arthroplasty (TJA) of the TMC joint registered in Clinicaltrials.gov (NCT01554748). Trial registration Clinicaltrials.gov (NCT01554748). Registered 15 March 2012.
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Affiliation(s)
- Sebastian Breddam Mosegaard
- University Clinic for Hand, Hip and Knee Surgery, Department of Orthopaedics, Lægårdvej 12, 7500, Holstebro, Denmark. .,Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 99, Aarhus N, 8200, Denmark.
| | - Maiken Stilling
- University Clinic for Hand, Hip and Knee Surgery, Department of Orthopaedics, Lægårdvej 12, 7500, Holstebro, Denmark.,Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 99, Aarhus N, 8200, Denmark
| | - Torben Bæk Hansen
- University Clinic for Hand, Hip and Knee Surgery, Department of Orthopaedics, Lægårdvej 12, 7500, Holstebro, Denmark.,Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 99, Aarhus N, 8200, Denmark
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19
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Thorkildsen RD, Johansson CB, Hogmalm J, Johansson PH, Røkkum M. Early Cup Loosening After Metal-on-Metal Total Joint Replacement of the Trapeziometacarpal Joint: A Retrieval Study. J Hand Surg Am 2020; 45:213-222. [PMID: 31537396 DOI: 10.1016/j.jhsa.2019.06.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 05/21/2019] [Accepted: 06/28/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To investigate the possible mechanisms behind early cup loosening in a metal-on-metal trapeziometacarpal joint replacement. METHODS The trapezia from 5 female patients were removed as part of a salvage procedure after a median of 22 months (range, 7-43 months) after implantation. Three osteoarthritic patients with symptomatic cup loosening and 2 with instability had a median age of 62 years (range, 59-65 years) at primary surgery. The trapezia with cups in situ were preserved and processed for histomorphometry. Studies with laser ablation inductively coupled plasma mass spectrometry and scanning electron microscopy with energy dispersive x-ray spectroscopy were also performed on 2 of the specimens. RESULTS In all 5 specimens, osteolytic lesions undermined the cups and were also seen at the cup edges, completely surrounding the loose cups. Large amounts of dark particular material were seen in the periprosthetic tissues, mostly internalized by macrophages. The presence of chrome and cobalt in these regions was confirmed. Four of the 5 cups showed marked or complete loss of hydroxyapatite. CONCLUSIONS We have found several possible explanations for the poor performance of this cup, including its cannulated design and metal-on-metal bearing. The changes seen are early and advanced, raising serious concerns about the implant and particularly the articulation. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic V.
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Affiliation(s)
- Rasmus D Thorkildsen
- Division of Orthopedic Surgery, Oslo University Hospital, Gothenburg, Sweden; Institute of Clinical Medicine, University of Oslo, Oslo, Norway, Gothenburg, Sweden.
| | - Carina B Johansson
- Department of Prosthodontics/Dental Materials Science, Institute of Odontology, The Sahlgrenska Academy, Gothenburg, Sweden
| | - Johan Hogmalm
- Department of Earth Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Petra H Johansson
- Department of Prosthodontics/Dental Materials Science, Institute of Odontology, The Sahlgrenska Academy, Gothenburg, Sweden
| | - Magne Røkkum
- Division of Orthopedic Surgery, Oslo University Hospital, Gothenburg, Sweden; Institute of Clinical Medicine, University of Oslo, Oslo, Norway, Gothenburg, Sweden
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20
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Ganhewa AD, Wu R, Chae MP, Tobin V, Miller GS, Smith JA, Rozen WM, Hunter-Smith DJ. Failure Rates of Base of Thumb Arthritis Surgery: A Systematic Review. J Hand Surg Am 2019; 44:728-741.e10. [PMID: 31262534 DOI: 10.1016/j.jhsa.2019.05.003] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 02/27/2019] [Accepted: 05/01/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of the current review was to estimate failure rates of trapeziometacarpal (TMC) implants and compare against failure rates of nonimplant techniques for surgical treatment of TMC joint (basal thumb joint) arthritis. METHODS A systematic review was conducted to identify articles reporting on thumb implant arthroplasty and on nonimplant arthroplasty techniques for treatment of base of thumb arthritis in the English literature. The collected data were combined to calculate failure rates per 100 procedure-years. Failure was defined by the requirement for a secondary salvage procedure. The failure rates between different implant and nonimplant arthroplasty groups were compared directly and implants with higher than anticipated failure rates were identified. RESULTS One hundred twenty-five articles on implant arthroplasty and 33 articles on the outcome of nonimplant surgical arthroplasty of the TMC joint were included. The implant arthroplasty failure rates per 100 procedure-years were total joint replacement (2.4), hemiarthroplasty (2.5), interposition with partial trapezial resection (4.5), interposition with complete trapezial resection (1.7), and interposition with no trapezial resection (4.5). The nonimplant arthroplasty failure rates per 100 procedure-years were: trapeziectomy (0.49), joint fusion (0.52), and trapeziectomy with ligament reconstruction ± tendon interposition (0.23). CONCLUSIONS Several implant designs (arthroplasties) had high rates of failure due to aseptic loosening, dislocation, and persisting pain. Furthermore, some implants had higher than anticipated failure rates than other implants within each class. Overall, the failure rates of nonimplant techniques were lower than those of implant arthroplasty. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Aparna D Ganhewa
- Department of Plastic, Reconstructive and Hand Surgery, Peninsula Health, Frankston
| | - Rui Wu
- Department of Plastic, Reconstructive and Hand Surgery, Peninsula Health, Frankston
| | - Michael P Chae
- Department of Plastic, Reconstructive and Hand Surgery, Peninsula Health, Frankston; Peninsula Clinical School, Central Clinical School, Monash University, The Alfred Centre, Melbourne; Department of Surgery, School of Clinical Sciences, Monash Medical Centre, Clayton, Victoria, Australia
| | - Vicky Tobin
- Department of Plastic, Reconstructive and Hand Surgery, Peninsula Health, Frankston
| | - George S Miller
- Department of Plastic, Reconstructive and Hand Surgery, Peninsula Health, Frankston
| | - Julian A Smith
- Department of Surgery, School of Clinical Sciences, Monash Medical Centre, Clayton, Victoria, Australia
| | - Warren M Rozen
- Department of Plastic, Reconstructive and Hand Surgery, Peninsula Health, Frankston; Peninsula Clinical School, Central Clinical School, Monash University, The Alfred Centre, Melbourne; Department of Surgery, School of Clinical Sciences, Monash Medical Centre, Clayton, Victoria, Australia
| | - David J Hunter-Smith
- Department of Plastic, Reconstructive and Hand Surgery, Peninsula Health, Frankston; Peninsula Clinical School, Central Clinical School, Monash University, The Alfred Centre, Melbourne; Department of Surgery, School of Clinical Sciences, Monash Medical Centre, Clayton, Victoria, Australia.
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21
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Thorkildsen RD, Røkkum M. Trapeziectomy with LRTI or joint replacement for CMC1 arthritis, a randomised controlled trial. J Plast Surg Hand Surg 2019; 53:361-369. [PMID: 31271330 DOI: 10.1080/2000656x.2019.1635490] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
We compared an uncemented joint replacement (Elektra) with trapeziectomy (with ligament reconstruction and tendon interposition, LRTI) for the treatment of primary osteoarthritis in the first carpometacarpal joint (CMC1) in a randomised controlled trial. Forty patients were included (20 in each group) and followed for 2 years. The median age in the groups was 64 and 61, respectively, with 14 females in each. At final follow-up, there was no difference in the primary outcome measure (the quick disabilities of the arm, shoulder and hand score, QDASH), but the joint replacement group had significantly better motion and strength during the early rehabilitation period and significantly better range of thumb abduction and extension at the last follow-up. There were more complications in the joint replacement group with revision of prosthetic components in five cases, two of them due to cup loosening. Radiologically, lucency zones were seen around either cup or stem in 15 patients. Most were small, but two cases with major osteolysis resulted in revision. Shortening of the thumb ray was observed after trapeziectomy.
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Affiliation(s)
- Rasmus D Thorkildsen
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Magne Røkkum
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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22
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Holm-Glad T, Reigstad O, Tsukanaka M, Røkkum M, Röhrl SM. High precision and accuracy of model-based RSA for analysis of wrist arthroplasty. J Orthop Res 2018; 36:3053-3063. [PMID: 29873422 DOI: 10.1002/jor.24063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 06/03/2018] [Indexed: 02/04/2023]
Abstract
Radiostereometric analysis (RSA) is a method for measuring micromotion in joint arthroplasties. RSA has never been used in total wrist arthroplasties. We evaluated: (i) the precision of model-based RSA in total wrist arthroplasties measured in a phantom model and in patients; (ii) the number of bone markers necessary to ensure the precision; and (iii) the accuracy of model-based RSA in a phantom model. Reverse engineered models of radial and carpal/metacarpal components of two wrist arthroplasties (ReMotion® and Motec®) were obtained by laser scanning. Precision and accuracy of each arthroplasty were analyzed with regards to translation and rotation along the three coordinate axes. Precision was analyzed in 10 phantom and 30 clinical double examinations for each arthroplasty, and was expressed by a repeatability coefficient. The precision of different numbers and configurations of bone markers in the phantom model were compared. Accuracy was tested in a phantom model where the implants were attached to a micrometer, and was defined as the mean difference between measured and true migration. In the phantom model the precision for translations ranged from 0.03 to 0.14 mm and for rotations from 0.18 to 1.52°. In patients the precision for translations ranged from 0.06 to 0.18 mm, and for rotations from 0.32 to 2.18°. Less than four bone markers resulted in inferior precision. Accuracy ranged from -0.06 to 0.04 mm, and from -0.38 to -0.01°. Y-rotations could not be obtained from the Motec® due to rotational symmetry about the longitudinal axis. We conclude that model-based RSA in total wrist arthroplasties is precise, accurate, and feasible to use for clinical evaluation of micromotion in wrist arthroplasties. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:3053-3063, 2018.
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Affiliation(s)
- Trygve Holm-Glad
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ole Reigstad
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Masako Tsukanaka
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Magne Røkkum
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Stephan M Röhrl
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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23
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Spartacus V, Mayoly A, Gay A, Le Corroller T, Némoz-Gaillard M, Roffino S, Chabrand P. Biomechanical analysis of the trapeziometacarpal arthroplasty failures. Comput Methods Biomech Biomed Engin 2017; 20:193-194. [PMID: 29088595 DOI: 10.1080/10255842.2017.1382928] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- V Spartacus
- a Aix Marseille University, CNRS , ISM, Inst Movement Sci , France.,b Department of orthopaedics and Traumatology , APHM, Sainte Marguerite Hospital, Institute for Locomotion , 13009 , Marseille , France.,d Orthopaedic and Spine Development , 84911 , Avignon , France
| | - A Mayoly
- a Aix Marseille University, CNRS , ISM, Inst Movement Sci , France.,e Department of hand and reconstruction surgery , Aix Marseille University , La Timone Teaching Hospital, 13005 , Marseille , France
| | - A Gay
- a Aix Marseille University, CNRS , ISM, Inst Movement Sci , France.,b Department of orthopaedics and Traumatology , APHM, Sainte Marguerite Hospital, Institute for Locomotion , 13009 , Marseille , France.,e Department of hand and reconstruction surgery , Aix Marseille University , La Timone Teaching Hospital, 13005 , Marseille , France
| | - T Le Corroller
- a Aix Marseille University, CNRS , ISM, Inst Movement Sci , France.,c Department of radiology , APHM, Sainte Marguerite Hospital, Institute for Locomotion , 13009 , Marseille
| | | | - S Roffino
- a Aix Marseille University, CNRS , ISM, Inst Movement Sci , France.,b Department of orthopaedics and Traumatology , APHM, Sainte Marguerite Hospital, Institute for Locomotion , 13009 , Marseille , France.,f University of Nice Sophia Antipolis, CNRS , ISM, Inst Movement Sci , France
| | - P Chabrand
- a Aix Marseille University, CNRS , ISM, Inst Movement Sci , France.,b Department of orthopaedics and Traumatology , APHM, Sainte Marguerite Hospital, Institute for Locomotion , 13009 , Marseille , France
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Abstract
The purpose of this update is to report on a variety of topics related to trapezium implants that have been investigated during the past three years. The keyword trapezium implant was utilized to query the PubMed database of the U.S. National Library of Medicine. From the resulting list, papers published from the beginning of January 2012 through the beginning of April 2015 were reviewed. The twenty-three studies identified are reviewed here and referenced at the end of the review. Based on level of evidence criteria for therapeutic studies as adopted by the American Academy of Orthopedic Surgeons, the most frequent level of evidence for reviewed clinical studies was Level IV (13/19 studies), followed by Level III (4/19), and Levels II (1/19) and I (1/19).
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Spartacus V, Mayoly A, Gay A, Le Corroller T, Némoz-Gaillard M, Roffino S, Chabrand P. Biomechanical causes of trapeziometacarpal arthroplasty failure. Comput Methods Biomech Biomed Engin 2017; 20:1233-1235. [DOI: 10.1080/10255842.2017.1348502] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- V. Spartacus
- CNRS, ISM, Inst Movement Sci, Aix Marseille University, Marseille, France
- Department of Orthopaedics and Traumatology, APHM, Institute for Locomotion, Sainte-Marguerite Hospital, , Marseille, France
- Orthopaedic and Spine Development, Avignon, France
| | - A. Mayoly
- CNRS, ISM, Inst Movement Sci, Aix Marseille University, Marseille, France
- Department of hand and reconstruction surgery, La Timone Teaching Hospital, Aix Marseille University, Marseille, France
| | - A. Gay
- CNRS, ISM, Inst Movement Sci, Aix Marseille University, Marseille, France
- Department of Orthopaedics and Traumatology, APHM, Institute for Locomotion, Sainte-Marguerite Hospital, , Marseille, France
- Department of hand and reconstruction surgery, La Timone Teaching Hospital, Aix Marseille University, Marseille, France
| | - T. Le Corroller
- CNRS, ISM, Inst Movement Sci, Aix Marseille University, Marseille, France
- Department of Radiology, APHM, Institute for Locomotion, Sainte-Marguerite Hospital, Marseille, France
| | | | - S. Roffino
- CNRS, ISM, Inst Movement Sci, Aix Marseille University, Marseille, France
- Department of Orthopaedics and Traumatology, APHM, Institute for Locomotion, Sainte-Marguerite Hospital, , Marseille, France
- CNRS, ISM, Inst Movement Sci, University of Nice Sophia Antipolis, Nice, France
| | - P. Chabrand
- CNRS, ISM, Inst Movement Sci, Aix Marseille University, Marseille, France
- Department of Orthopaedics and Traumatology, APHM, Institute for Locomotion, Sainte-Marguerite Hospital, , Marseille, France
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Ten Brinke B, Beumer A, Koenraadt KLM, Eygendaal D, Kraan GA, Mathijssen NMC. The accuracy and precision of radiostereometric analysis in upper limb arthroplasty. Acta Orthop 2017; 88:320-325. [PMID: 28464752 PMCID: PMC5434603 DOI: 10.1080/17453674.2017.1291872] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Radiostereometric analysis (RSA) is an accurate method for measurement of early migration of implants. Since a relation has been shown between early migration and future loosening of total knee and hip prostheses, RSA plays an important role in the development and evaluation of prostheses. However, there have been few RSA studies of the upper limb, and the value of RSA of the upper limb is not yet clear. We therefore performed a systematic review to investigate the accuracy and precision of RSA of the upper limb. Patients and methods - PRISMA guidelines were followed and the protocol for this review was published online at PROSPERO under registration number CRD42016042014. A systematic search of the literature was performed in the databases Embase, Medline, Cochrane, Web of Science, Scopus, Cinahl, and Google Scholar on April 25, 2015 based on the keywords radiostereometric analysis, shoulder prosthesis, elbow prosthesis, wrist prosthesis, trapeziometacarpal joint prosthesis, humerus, ulna, radius, carpus. Articles concerning RSA for the analysis of early migration of prostheses of the upper limb were included. Quality assessment was performed using the MINORS score, Downs and Black checklist, and the ISO RSA Results - 23 studies were included. Precision values were in the 0.06-0.88 mm and 0.05-10.7° range for the shoulder, the 0.05-0.34 mm and 0.16-0.76° range for the elbow, and the 0.16-1.83 mm and 11-124° range for the TMC joint. Accuracy data from marker- and model-based RSA were not reported in the studies included. Interpretation - RSA is a highly precise method for measurement of early migration of orthopedic implants in the upper limb. However, the precision of rotation measurement is poor in some components. Challenges with RSA in the upper limb include the symmetrical shape of prostheses and the limited size of surrounding bone, leading to over-projection of the markers by the prosthesis. We recommend higher adherence to RSA guidelines and encourage investigators to publish long-term follow-up RSA studies.
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Affiliation(s)
- Bart Ten Brinke
- Department of Orthopaedic Surgery, Amphia Ziekenhuis, Breda;,Department of Orthopaedic Surgery, Reinier de Graaf Hospital, Delft;,Correspondence:
| | | | - Koen L M Koenraadt
- FORCE Foundation, Department of Orthopaedic Surgery, Amphia Ziekenhuis, Breda
| | - Denise Eygendaal
- Department of Orthopaedic Surgery, Amphia Ziekenhuis, Breda;,Department of Orthopaedic Surgery, Academic Medical Center, Amsterdam, the Netherlands
| | - Gerald A Kraan
- Department of Orthopaedic Surgery, Reinier de Graaf Hospital, Delft
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Wall PDH, Richards BL, Sprowson A, Buchbinder R, Singh JA. Do outcomes reported in randomised controlled trials of joint replacement surgery fulfil the OMERACT 2.0 Filter? A review of the 2008 and 2013 literature. Syst Rev 2017; 6:106. [PMID: 28558822 PMCID: PMC5450048 DOI: 10.1186/s13643-017-0498-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 05/10/2017] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND It is not known, whether outcome reporting in trials of total joint arthroplasty in the recent years is adequate or not. Our objective was to assess whether outcomes reported in total joint replacement (TJR) trials fulfil the Outcome Measures in Rheumatology (OMERACT) Filter 2.0. METHODS We systematically reviewed all TJR trials in adults, published in English in 2008 or 2013. Searches were conducted in the Cochrane Central Register of Controlled Trials, MEDLINE, and EMBASE. Two authors independently applied the inclusion criteria for the studies, and any disagreement was resolved with a third review author. All outcome measures were abstracted using a pre-piloted standardised data extraction form and assessed for whether they mapped to one of the three OMERACT Filter 2.0 core areas: pathophysiological, life impact, and death. RESULTS From 1635 trials identified, we included 70 trials (30 in 2008 and 40 in 2013) meeting the eligibility criteria. Twenty-two (31%) trials reported the three essential OMERACT core areas. Among the 27 hip replacement surgery trials and 39 knee replacement surgery trials included, 11 hip (41%) and nine knee (23%) trials reported all three essential OMERACT core areas. The most common outcome domains/measures were pain (20/27, 74%) and function (23/27, 85%) in hip trials and pain (26/39, 67%) and function (27/39, 69%) in knee trials. Results were similar for shoulder and hand joint replacement trials. CONCLUSIONS We identified significant gaps in the measurement of OMERACT core outcome areas in TJR trials, despite the majority reporting outcome domains of pain and function. An international consensus of key stakeholders is needed to develop a core domain set for reporting of TJR trials. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42014009216.
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Affiliation(s)
- Peter D H Wall
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Bethan L Richards
- Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital, Sydney, Australia.,Sydney Medical School, University of Sydney, Sydney, Australia
| | - Andrew Sprowson
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Rachelle Buchbinder
- Department of Epidemiology and Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Frankston, VIC, Australia.,Monash Department of Clinical Epidemiology, Cabrini Institute, Melbourne, VIC, Australia
| | - Jasvinder A Singh
- Birmingham Veterans Affairs Medical Center and University of Alabama at Birmingham, Faculty Office Tower 805B, 510 20th Street S, Birmingham, AL, 35294, USA. .,Mayo Clinic School of Medicine, Rochester, MN, USA.
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Richards BL, Wall PDH, Sprowson AP, Singh JA, Buchbinder R. Outcome Measures Used in Arthroplasty Trials: Systematic Review of the 2008 and 2013 Literature. J Rheumatol 2017; 44:1277-1287. [PMID: 28507180 DOI: 10.3899/jrheum.161477] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2017] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Previously published literature assessing the reporting of outcome measures used in joint replacement randomized controlled trials (RCT) has revealed disappointing results. It remains unknown whether international initiatives have led to any improvement in the quality of reporting and/or a reduction in the heterogeneity of outcome measures used. Our objective was to systematically assess and compare primary outcome measures and the risk of bias in joint replacement RCT published in 2008 and 2013. METHODS We searched MEDLINE, EMBASE, and CENTRAL for RCT investigating adult patients undergoing joint replacement surgery. Two authors independently identified eligible trials, extracted data, and assessed risk of bias using the Cochrane tool. RESULTS Seventy RCT (30 in 2008, 40 in 2013) met the eligibility criteria. There was no significant difference in the number of trials judged to be at low overall risk of bias (n = 6, 20%) in 2008 compared with 2013 [6 (15%); chi-square = 0.302, p = 0.75]. Significantly more trials published in 2008 did not specify a primary outcome measure (n = 25, 83%) compared with 18 trials (45%) in 2013 (chi-square = 10.6316, p = 0.001). When specified, there was significant heterogeneity in the measures used to assess primary outcomes. CONCLUSION While less than a quarter of trials published in both 2008 and 2013 were judged to be at low overall risk of bias, significantly more trials published in 2013 specified a primary outcome. Although this might represent a temporal trend toward improvement, the overall frequency of primary outcome reporting and the wide heterogeneity in primary outcomes reported remain suboptimal.
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Affiliation(s)
- Bethan L Richards
- From the Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital; Sydney Medical School, University of Sydney, Sydney; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University; Monash Department of Clinical Epidemiology, Cabrini Institute, Melbourne, Victoria, Australia; Birmingham Veterans Affairs Warwick Orthopaedics, University of Warwick, Coventry, UK; Medical Center and University of Alabama at Birmingham, Birmingham, Alabama; Mayo Clinic College of Medicine, Rochester, Minnesota, USA.,B.L. Richards, FRACP, MClinEpi, MSportsMed, Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital, and Sydney Medical School, University of Sydney; P.D. Wall, MBChB (Hons), MRCS (Edin), PhD, Birmingham Veterans Affairs Warwick Orthopaedics, University of Warwick; A.P. Sprowson, MD, FRCS, Birmingham Veterans Affairs Warwick Orthopaedics, University of Warwick; J.A. Singh, MD, MPH, Medical Center and University of Alabama at Birmingham, and Mayo Clinic College of Medicine; R. Buchbinder, MBBS (Hons), PhD, Dept. of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, and Monash Dept. of Clinical Epidemiology, Cabrini Hospital. Dr. Sprowson died on March 13, 2015
| | - Peter D H Wall
- From the Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital; Sydney Medical School, University of Sydney, Sydney; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University; Monash Department of Clinical Epidemiology, Cabrini Institute, Melbourne, Victoria, Australia; Birmingham Veterans Affairs Warwick Orthopaedics, University of Warwick, Coventry, UK; Medical Center and University of Alabama at Birmingham, Birmingham, Alabama; Mayo Clinic College of Medicine, Rochester, Minnesota, USA.,B.L. Richards, FRACP, MClinEpi, MSportsMed, Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital, and Sydney Medical School, University of Sydney; P.D. Wall, MBChB (Hons), MRCS (Edin), PhD, Birmingham Veterans Affairs Warwick Orthopaedics, University of Warwick; A.P. Sprowson, MD, FRCS, Birmingham Veterans Affairs Warwick Orthopaedics, University of Warwick; J.A. Singh, MD, MPH, Medical Center and University of Alabama at Birmingham, and Mayo Clinic College of Medicine; R. Buchbinder, MBBS (Hons), PhD, Dept. of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, and Monash Dept. of Clinical Epidemiology, Cabrini Hospital. Dr. Sprowson died on March 13, 2015
| | - Andrew P Sprowson
- From the Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital; Sydney Medical School, University of Sydney, Sydney; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University; Monash Department of Clinical Epidemiology, Cabrini Institute, Melbourne, Victoria, Australia; Birmingham Veterans Affairs Warwick Orthopaedics, University of Warwick, Coventry, UK; Medical Center and University of Alabama at Birmingham, Birmingham, Alabama; Mayo Clinic College of Medicine, Rochester, Minnesota, USA.,B.L. Richards, FRACP, MClinEpi, MSportsMed, Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital, and Sydney Medical School, University of Sydney; P.D. Wall, MBChB (Hons), MRCS (Edin), PhD, Birmingham Veterans Affairs Warwick Orthopaedics, University of Warwick; A.P. Sprowson, MD, FRCS, Birmingham Veterans Affairs Warwick Orthopaedics, University of Warwick; J.A. Singh, MD, MPH, Medical Center and University of Alabama at Birmingham, and Mayo Clinic College of Medicine; R. Buchbinder, MBBS (Hons), PhD, Dept. of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, and Monash Dept. of Clinical Epidemiology, Cabrini Hospital. Dr. Sprowson died on March 13, 2015
| | - Jasvinder A Singh
- From the Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital; Sydney Medical School, University of Sydney, Sydney; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University; Monash Department of Clinical Epidemiology, Cabrini Institute, Melbourne, Victoria, Australia; Birmingham Veterans Affairs Warwick Orthopaedics, University of Warwick, Coventry, UK; Medical Center and University of Alabama at Birmingham, Birmingham, Alabama; Mayo Clinic College of Medicine, Rochester, Minnesota, USA. .,B.L. Richards, FRACP, MClinEpi, MSportsMed, Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital, and Sydney Medical School, University of Sydney; P.D. Wall, MBChB (Hons), MRCS (Edin), PhD, Birmingham Veterans Affairs Warwick Orthopaedics, University of Warwick; A.P. Sprowson, MD, FRCS, Birmingham Veterans Affairs Warwick Orthopaedics, University of Warwick; J.A. Singh, MD, MPH, Medical Center and University of Alabama at Birmingham, and Mayo Clinic College of Medicine; R. Buchbinder, MBBS (Hons), PhD, Dept. of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, and Monash Dept. of Clinical Epidemiology, Cabrini Hospital. Dr. Sprowson died on March 13, 2015.
| | - Rachelle Buchbinder
- From the Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital; Sydney Medical School, University of Sydney, Sydney; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University; Monash Department of Clinical Epidemiology, Cabrini Institute, Melbourne, Victoria, Australia; Birmingham Veterans Affairs Warwick Orthopaedics, University of Warwick, Coventry, UK; Medical Center and University of Alabama at Birmingham, Birmingham, Alabama; Mayo Clinic College of Medicine, Rochester, Minnesota, USA.,B.L. Richards, FRACP, MClinEpi, MSportsMed, Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital, and Sydney Medical School, University of Sydney; P.D. Wall, MBChB (Hons), MRCS (Edin), PhD, Birmingham Veterans Affairs Warwick Orthopaedics, University of Warwick; A.P. Sprowson, MD, FRCS, Birmingham Veterans Affairs Warwick Orthopaedics, University of Warwick; J.A. Singh, MD, MPH, Medical Center and University of Alabama at Birmingham, and Mayo Clinic College of Medicine; R. Buchbinder, MBBS (Hons), PhD, Dept. of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, and Monash Dept. of Clinical Epidemiology, Cabrini Hospital. Dr. Sprowson died on March 13, 2015
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Wajon A, Vinycomb T, Carr E, Edmunds I, Ada L. WITHDRAWN: Surgery for thumb (trapeziometacarpal joint) osteoarthritis. Cochrane Database Syst Rev 2017; 4:CD004631. [PMID: 28368089 PMCID: PMC6478278 DOI: 10.1002/14651858.cd004631.pub5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Surgery is used to treat persistent pain and dysfunction at the base of the thumb when conservative management, such as splinting, or medical management, such as oral analgesics, is no longer adequate in reducing disability and pain. This is an update of a Cochrane Review first published in 2005. OBJECTIVES To assess the effects of different surgical techniques for trapeziometacarpal (thumb) osteoarthritis. SEARCH METHODS We searched the following sources up to 08 August 2013: CENTRAL (The Cochrane Library 2013, Issue 8), MEDLINE (1950 to August 2013), EMBASE (1974 to August 2013), CINAHL (1982 to August 2013), Clinicaltrials.gov (to August 2013) and World Health Organization (WHO) Clinical Trials Portal (to August 2013). SELECTION CRITERIA Randomised controlled trials (RCTs) or quasi-RCTs where the intervention was surgery for people with thumb osteoarthritis. Outcomes were pain, physical function, quality of life, patient global assessment, adverse events, treatment failure or trapeziometacarpal joint imaging. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by the Cochrane Collaboration. Two review authors independently screened and included studies according to the inclusion criteria, assessed the risk of bias and extracted data, including adverse events. MAIN RESULTS We included 11 studies with 670 participants. Seven surgical procedures were identified (trapeziectomy with ligament reconstruction and tendon interposition (LRTI), trapeziectomy, trapeziectomy with ligament reconstruction, trapeziectomy with interpositional arthroplasty (IA), Artelon joint resurfacing, arthrodesis and Swanson joint replacement). We did not find any studies that compared surgery with sham surgery or surgery with non-surgical interventions.Most included studies had an unclear risk of most biases which raises doubt about the results. No procedure demonstrated any superiority over another in terms of pain, physical function, quality of life, patient global assessment, adverse events, treatment failure (re-operation) or trapeziometacarpal joint imaging. One study demonstrated a difference in adverse events (mild-moderate swelling) between Artelon joint replacement and trapeziectomy with tendon interposition. However, the quality of evidence was very low due to a high risk of bias and imprecision of results.Low quality evidence suggests trapeziectomy with LRTI may not provide additional benefits or result in more adverse events over trapeziectomy alone. Mean pain (three studies, 162 participants) was 26 mm on a 0 to 100 mm VAS (0 is no pain) for trapeziectomy alone, trapeziectomy with LRTI reduced pain by a mean of 2.8 mm (95% confidence interval (CI) -9.8 to 4.2) or an absolute reduction of 3% (-10% to 4%). Mean physical function (three studies, 211 participants) was 31.1 points on a 0 to 100 point scale (0 is best physical function, or no disability) with trapeziectomy alone, trapeziectomy with LRTI resulted in sightly lower function scores (standardised mean difference 0.1, 95% CI -0.30 to 0.32), an equivalent to a worsening of 0.2 points (95% CI -5.8 to 6.1) on a 0 to 100 point scale (absolute decrease in function 0.03% (-0.83% to 0.88%)). Low quality evidence from four studies (328 participants) indicates that the mean number of adverse events was 10 per 100 participants for trapeziectomy alone, and 19 events per 100 participants for trapeziectomy with LRTI (RR 1.89, 95% CI 0.96 to 3.73) or an absolute risk increase of 9% (95% CI 0% to 28%). Low quality evidence from one study (42 participants) indicates that the mean scapho-metacarpal distance was 2.3 mm for the trapeziectomy alone group, trapeziectomy with LRTI resulted in a mean of 0.1 mm less distance (95% CI -0.81 to 0.61). None of the included trials reported global assessment, quality of life, and revision or re-operation rates.Low-quality evidence from two small studies (51 participants) indicated that trapeziectomy with LRTI may not improve function or slow joint degeneration, or produce additional adverse events over trapeziectomy and ligament reconstruction.We are uncertain of the benefits or harms of other surgical techniques due to the mostly low quality evidence from single studies and the low reporting rates of key outcomes. There was insufficient evidence to assess if trapeziectomy with LRTI had additional benefit over arthrodesis or trapeziectomy with IA. There was also insufficient evidence to assess if trapeziectomy with IA had any additional benefit over the Artelon joint implant, the Swanson joint replacement or trapeziectomy alone. AUTHORS' CONCLUSIONS We did not identify any studies that compared surgery to sham surgery or to non-operative treatments. We were unable to demonstrate that any technique confers a benefit over another technique in terms of pain and physical function. Furthermore, the included studies were not of high enough quality to provide conclusive evidence that the compared techniques provided equivalent outcomes.
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Affiliation(s)
- Anne Wajon
- Macquarie University ClinicMacquarie Hand Therapy2 Technology PlaceMacquarie UniversityNew South WalesAustralia2109
| | - Toby Vinycomb
- Monash UniversityDepartment of Surgery (MMC)MelbourneAustralia
| | - Emma Carr
- Pacific Hand Therapy Services812 Pittwater RoadDee WhyNew South WalesAustralia2099
| | - Ian Edmunds
- Hornsby Hand Centre2/49 Palmerston RdHornsbyNew South WalesAustralia2077
| | - Louise Ada
- University of SydneySchool of PhysiotherapyCumberland CampusPO Box 170LidcombeNew South WalesAustralia1825
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30
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Completo A, Nascimento A, Neto F. Total arthroplasty of basal thumb joint with Elektra prothesis: an in vitro analysis. J Hand Surg Eur Vol 2016; 41:930-938. [PMID: 27424207 DOI: 10.1177/1753193416659230] [Citation(s) in RCA: 2] [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
UNLABELLED The reported outcomes of the Elektra thumb carpo-metacarpal joint implant have been very variable. This study evaluates the influence of daily cyclic loads and the type of the screw-fit cup insertion technique in the trapezium, with and without prior threading, on the structural bone behaviour. The study was performed experimentally to predict initial implant stability and cortical bone strains. Computational models were developed to assess the structural cancellous bone behaviour. The use of Elektra implant considerably changed the bone strain behaviour compared with the intact joint. This may be associated with risks of cancellous bone fatigue failure due to overload, particularly in the trapezium. The joint load magnitude has a more important structural role than that of the screw-fit cup insertion technique. Limiting the magnitude of thumb loads after arthroplasty may contribute positively to the longevity of this procedure. LEVEL OF EVIDENCE V.
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Affiliation(s)
- A Completo
- 1 Mechanical Engineering Department, University of Aveiro, Aveiro, Portugal
| | - A Nascimento
- 2 Orthopaedics Department, Coimbra University Hospital, Portugal
| | - F Neto
- 1 Mechanical Engineering Department, University of Aveiro, Aveiro, Portugal
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31
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Ten Brinke B, Mathijssen NMC, Blom I, Deijkers RLM, Ooms EM, Kraan GA. Model-based roentgen stereophotogrammetric analysis of the surface replacement trapeziometacarpal total joint arthroplasty. J Hand Surg Eur Vol 2016; 41:925-929. [PMID: 26852245 DOI: 10.1177/1753193416629070] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
UNLABELLED The primary aim of this clinical and radiostereometric study was to study the migration pattern of the surface replacement trapeziometacarpal joint prosthesis (SRTMTMC, Avanta®, San Diego, CA). The secondary aims were to assess patient-related outcomes and prosthesis survival 5 years after surgery. Ten patients received the prosthesis. Radiostereometric radiographs were obtained 6 weeks, 6 months, 1 year and 5 years post-operatively and were analysed using model-based software. All patients completed DASH and Nelson Hospital scores at these follow-ups. Mean translations varied between 0.0 and 0.5 mm after 5 years. Rotation values could be calculated in six patients and mean rotations varied between -0.3 and 2.3°, although the precision of rotation values seems to be poor. The 5-year survival rate was 80%. Mean pre-operative DASH and Nelson Hospital scores were 53 (SD 14) and 51 (SD 13), respectively. Six months post-operatively, the DASH and Nelson Hospital scores had both significantly improved to 25 (SD 20) and 74 (SD 18) and remained high after 5 years. Implant stability was good 5 years post-operatively, and early migration did not predict implant failure in this study. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- B Ten Brinke
- 1 Department of Orthopaedic Surgery, Reinier de Graaf Groep, Delft, The Netherlands
| | - N M C Mathijssen
- 1 Department of Orthopaedic Surgery, Reinier de Graaf Groep, Delft, The Netherlands
| | - I Blom
- 2 Department of Radiology, Reinier de Graaf Groep, Delft, The Netherlands
| | - R L M Deijkers
- 3 Department of Orthopaedic Surgery, Haga Ziekenhuis, Den Haag, The Netherlands
| | - E M Ooms
- 4 Centre for Orthopaedic Surgery, OCON, Hand and Wrist unit, Hengelo, The Netherlands
| | - G A Kraan
- 1 Department of Orthopaedic Surgery, Reinier de Graaf Groep, Delft, The Netherlands
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Knak J, Hansen TB. Trapeziectomy or revision into a cemented polyethylene cup in failed trapeziometacarpal total joint arthroplasty. J Plast Surg Hand Surg 2016; 50:286-90. [DOI: 10.3109/2000656x.2016.1162796] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Castarlenas E, de la Vega R, Jensen MP, Miró J. Self-Report Measures of Hand Pain Intensity: Current Evidence and Recommendations. Hand Clin 2016; 32:11-9. [PMID: 26611384 DOI: 10.1016/j.hcl.2015.08.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Successful management of problems related to the hands and upper extremities begins with a comprehensive assessment of the pain experience and related factors. Pain intensity is the domain most commonly assessed, and pain relief is often the primary goal of treatment. Because pain is a private and subjective experience, self-report is considered the gold standard of pain measurement. This article describes and discusses the strengths and weaknesses of the most commonly used self-report scales used to measure hand pain intensity, and gives recommendations to help clinicians select from among the various options for measuring the intensity of hand pain.
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Affiliation(s)
- Elena Castarlenas
- Unit for the Study and Treatment of Pain - ALGOS, Universitat Rovira i Virgili, Catalonia, Carretera de Valls, s/n 43007, Spain; Department of Psychology, Research Center for Behavior Assessment (CRAMC), Universitat Rovira i Virgili, Catalonia, Carretera de Valls, s/n 43007, Spain; Pere Virgili Institute for Health Research (IISPV), Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Catalonia, Carretera de Valls, s/n 43007, Spain
| | - Rocío de la Vega
- Unit for the Study and Treatment of Pain - ALGOS, Universitat Rovira i Virgili, Catalonia, Carretera de Valls, s/n 43007, Spain; Department of Psychology, Research Center for Behavior Assessment (CRAMC), Universitat Rovira i Virgili, Catalonia, Carretera de Valls, s/n 43007, Spain; Pere Virgili Institute for Health Research (IISPV), Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Catalonia, Carretera de Valls, s/n 43007, Spain
| | - Mark P Jensen
- Department of Rehabilitation Medicine, Harborview Medical Center, University of Washington, Box 359612, 325 Ninth Avenue, Seattle, WA 98104, USA.
| | - Jordi Miró
- Unit for the Study and Treatment of Pain - ALGOS, Universitat Rovira i Virgili, Catalonia, Carretera de Valls, s/n 43007, Spain; Department of Psychology, Research Center for Behavior Assessment (CRAMC), Universitat Rovira i Virgili, Catalonia, Carretera de Valls, s/n 43007, Spain; Pere Virgili Institute for Health Research (IISPV), Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Catalonia, Carretera de Valls, s/n 43007, Spain
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Ooms EM, ten Brinke B, Mathijssen NMC, Blom IF, Deijkers RLM, Kraan GA. Feasibility of model-based Roentgen Stereophotogrammetric Analysis to evaluate early migration of the trapeziometacarpal joint prosthesis. BMC Musculoskelet Disord 2015; 16:295. [PMID: 26466802 PMCID: PMC4607147 DOI: 10.1186/s12891-015-0747-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 10/02/2015] [Indexed: 11/15/2022] Open
Abstract
Background The purpose of this study was to determine the feasibility of Roentgen Stereophotogrammetric Analysis (RSA) in total joint arthroplasty of the trapeziometacarpal (TMC) joint of the thumb. Methods In five cadaveric hands the TMC-joint was replaced by the Surface Replacement Trapeziometacarpal prosthesis (SR™ TMC prosthesis; Avanta, San Diego, CA) and tantalum beads of 0.8 mm were implanted for RSA. RSA radiographs in two directions were made in ten positions to calculate the measurement error. Migration values from zero are indicative for the measurement error. The number of detected markers was recorded. Results The accuracy analysis showed that for the translations the mean measurement error varied between 0.003 mm (SD 0.057) and 0.055 mm (SD 0.133). For the rotations values ranged from 0.034° (SD 1.759) to 0.502° (SD 1.617). Conclusions RSA analysis of the SR™ TMC prosthesis is feasible. The measurement error is good for the translations but high for the rotations. The latter is due to the close position of the markers relative to each other. Level of evidence III.
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Affiliation(s)
- E M Ooms
- Centre for Orthopaedic Surgery, OCON, Hand and Wrist unit, Hengelo, The Netherlands.
| | - B ten Brinke
- Department of Orthopaedic Surgery, Reinier de Graaf Groep, Delft, The Netherlands.
| | - N M C Mathijssen
- Department of Orthopaedic Surgery, Reinier de Graaf Groep, Delft, The Netherlands.
| | - I F Blom
- Departments of Radiology and Orthopaedic Surgery, Reinier de Graaf Groep, P.O. Box 5011, 2600 GA, Delft, The Netherlands.
| | - R L M Deijkers
- Department of Orthopaedic Surgery, Haga Ziekenhuis, Den Haag, The Netherlands.
| | - G A Kraan
- Department of Orthopaedic Surgery, Reinier de Graaf Groep, Delft, The Netherlands.
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Martinkevich P, Rahbek O, Møller-Madsen B, Søballe K, Stilling M. Precise and feasible measurements of lateral calcaneal lengthening osteotomies by radiostereometric analysis in cadaver feet. Bone Joint Res 2015; 4:78-83. [PMID: 25957380 PMCID: PMC4448599 DOI: 10.1302/2046-3758.45.2000292] [Citation(s) in RCA: 3] [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] [Indexed: 11/14/2022] Open
Abstract
Objectives Lengthening osteotomies of the calcaneus in children are in general grafted with bone from the
iliac crest. Artificial bone grafts have been introduced, however, their structural and clinical
durability has not been documented. Radiostereometric analysis (RSA) is a very accurate and precise
method for measurements of rigid body movements including the evaluation of joint implant and
fracture stability, however, RSA has not previously been used in clinical studies of calcaneal
osteotomies. We assessed the precision of RSA as a measurement tool in a lateral calcaneal
lengthening osteotomy (LCLO). Methods LCLO was performed in six fixed adult cadaver feet. Tantalum markers were inserted on each side
of the osteotomy and in the cuboideum. Lengthening was done with a plexiglas wedge. A total of 24
radiological double examinations were obtained. Two feet were excluded due to loose and poorly
dispersed markers. Precision was assessed as systematic bias and 95% repeatability limits. Results Systematic bias was generally below 0.10 mm for translations. Precision of migration measurements
was below 0.2 mm for translations in the osteotomy. Conclusion RSA is a precise tool for the evaluation of stability in LCLO. Cite this article: Bone Joint Res 2015;4:78–83.
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Affiliation(s)
- P Martinkevich
- Department of Children's Orthopaedics, Aarhus University Hospital, Nørrebrogade 44, Building 1A, 2nd floor, 8000, Denmark
| | - O Rahbek
- Department of Children's Orthopaedics, Aarhus University Hospital, Nørrebrogade 44, Building 1A, 2nd floor, 8000, Denmark
| | - B Møller-Madsen
- Department of Children's Orthopaedics, Aarhus University Hospital, Nørrebrogade 44, Building 1A, 2nd floor, 8000, Denmark
| | - K Søballe
- Aarhus University Hospital, Tage-Hansens Gade 4, 8000 Aarhus C, Denmark
| | - M Stilling
- Aarhus University Hospital, Palle Juul-Jensens Boulevard 82, 8200 Aarhus N, Denmark
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Huang K, Hollevoet N, Giddins G. Thumb carpometacarpal joint total arthroplasty: a systematic review. J Hand Surg Eur Vol 2015; 40:338-50. [PMID: 25600851 DOI: 10.1177/1753193414563243] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Accepted: 11/14/2014] [Indexed: 02/03/2023]
Abstract
Thumb carpometacarpal joint total arthroplasty has been undertaken for many years. The proponents believe the short-term outcomes are better than trapeziectomy and its variants, but the longer term complications are often higher. This systematic review of all peer reviewed articles on thumb carpometacarpal joint total arthroplasty for osteoarthritis shows that there are reports of many implants. Some are no longer available. The reported outcomes are very variable: for some there are good long-term outcomes to beyond 10 years ; for others there are unacceptably high early rates of failure. Overall the published evidence does not show that total arthroplasty is better than trapeziectomy and its variants yet there is a higher complication rate and significant extra cost of using an implant. Future research needs to compare total arthroplasty with trapeziectomy to assess short term results where the arthroplasties may be better, long-term outcomes and the healthcare and personal costs so that surgeons and patients can make fully informed choices about the treatment of symptomatic thumb carpometacarpal joint osteoarthritis.
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Affiliation(s)
- K Huang
- Tongde Hospital of Zhejiang Province, Zhejiang, People's Republic of China
| | | | - G Giddins
- Royal United Hospital Bath, Bath, UK
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Tandara AA, Capeller LJ, Jarczok MN, Mayrhofer P, Jung M, Daecke W. A software tool for prediction of prosthesis failure at the carpometacarpal joint of the thumb. J Hand Surg Eur Vol 2015; 40:364-9. [PMID: 25190607 DOI: 10.1177/1753193414548644] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2013] [Accepted: 12/16/2013] [Indexed: 02/03/2023]
Abstract
Early recognition of prosthesis failure is difficult. A tool that helps to identify faulty prosthesis - a cause of early implant loosening - is needed. The aim of this study was to detect early implant loosening by applying a software program EBRA (Ein-Bild-Röntgen-Analyse). EBRA was applied to the radiographs of a series of 76 patients, with a total of 102 thumb carpometacarpal joint de la Caffinière prostheses, with an average follow-up of 14.5 months (range 0.5-24). The data were used to draw graphs of cup migration and inclination over time. Corresponding regression lines of migration and inclination in relation to time were made up to the point of loosening. The gradient of regression was calculated for all implants. The gradient of regression on the x and y axes differed significantly between stable and loose implants. Loose and stable implants showed significantly different cup migration on the x and y axes over time. EBRA proved to be a reliable tool to visualize cup migration in the trapeziometacarpal joint and to predict implant failure.
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Affiliation(s)
- A A Tandara
- Department of Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - L J Capeller
- Surgical Outpatient-Clinic Wiesloch, Wiesloch, Germany
| | - M N Jarczok
- Mannheim Institute of Public Health, Social and Preventive Medicine, Heidelberg University, Mannheim, Germany
| | - P Mayrhofer
- Geometry and CAD, Leopold-Franzens-University Innsbruck, Innsbruck, Austria
| | | | - W Daecke
- Frankfurt Höchst Clinic, Frankfurt, Germany
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Abstract
BACKGROUND Surgery is used to treat persistent pain and dysfunction at the base of the thumb when conservative management, such as splinting, or medical management, such as oral analgesics, is no longer adequate in reducing disability and pain. This is an update of a Cochrane Review first published in 2005. OBJECTIVES To assess the effects of different surgical techniques for trapeziometacarpal (thumb) osteoarthritis. SEARCH METHODS We searched the following sources up to 08 August 2013: CENTRAL (The Cochrane Library 2013, Issue 8), MEDLINE (1950 to August 2013), EMBASE (1974 to August 2013), CINAHL (1982 to August 2013), Clinicaltrials.gov (to August 2013) and World Health Organization (WHO) Clinical Trials Portal (to August 2013). SELECTION CRITERIA Randomised controlled trials (RCTs) or quasi-RCTs where the intervention was surgery for people with thumb osteoarthritis. Outcomes were pain, physical function, quality of life, patient global assessment, adverse events, treatment failure or trapeziometacarpal joint imaging. We excluded trials that compared non-surgical interventions with surgery. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by the Cochrane Collaboration. Two review authors independently screened and included studies according to the inclusion criteria, assessed the risk of bias and extracted data, including adverse events. MAIN RESULTS We included 11 studies with 670 participants. Seven surgical procedures were identified (trapeziectomy with ligament reconstruction and tendon interposition (LRTI), trapeziectomy, trapeziectomy with ligament reconstruction, trapeziectomy with interpositional arthroplasty (IA), Artelon joint resurfacing, arthrodesis and Swanson joint replacement).Most included studies had an unclear risk of most biases which raises doubt about the results. No procedure demonstrated any superiority over another in terms of pain, physical function, quality of life, patient global assessment, adverse events, treatment failure (re-operation) or trapeziometacarpal joint imaging. One study demonstrated a difference in adverse events (mild-moderate swelling) between Artelon joint replacement and trapeziectomy with tendon interposition. However, the quality of evidence was very low due to a high risk of bias and imprecision of results.Low quality evidence suggests trapeziectomy with LRTI may not provide additional benefits or result in more adverse events over trapeziectomy alone. Mean pain (three studies, 162 participants) was 26 mm on a 0 to 100 mm VAS (0 is no pain) for trapeziectomy alone, trapeziectomy with LRTI reduced pain by a mean of 2.8 mm (95% confidence interval (CI) -9.8 to 4.2) or an absolute reduction of 3% (-10% to 4%). Mean physical function (three studies, 211 participants) was 31.1 points on a 0 to 100 point scale (0 is best physical function, or no disability) with trapeziectomy alone, trapeziectomy with LRTI resulted in sightly lower function scores (standardised mean difference 0.1, 95% CI -0.30 to 0.32), an equivalent to a worsening of 0.2 points (95% CI -5.8 to 6.1) on a 0 to 100 point scale (absolute decrease in function 0.03% (-0.83% to 0.88%)). Low quality evidence from four studies (328 participants) indicates that the mean number of adverse events was 10 per 100 participants for trapeziectomy alone, and 19 events per 100 participants for trapeziectomy with LRTI (RR 1.89, 95% CI 0.96 to 3.73) or an absolute risk increase of 9% (95% CI 0% to 28%). Low quality evidence from one study (42 participants) indicates that the mean scapho-metacarpal distance was 2.3 mm for the trapeziectomy alone group, trapeziectomy with LRTI resulted in a mean of 0.1 mm less distance (95% CI -0.81 to 0.61). None of the included trials reported global assessment, quality of life, and revision or re-operation rates.Low-quality evidence from two small studies (51 participants) indicated that trapeziectomy with LRTI may not improve function or slow joint degeneration, or produce additional adverse events over trapeziectomy and ligament reconstruction.We are uncertain of the benefits or harms of other surgical techniques due to the mostly low quality evidence from single studies and the low reporting rates of key outcomes. There was insufficient evidence to assess if trapeziectomy with LRTI had additional benefit over arthrodesis or trapeziectomy with IA. There was also insufficient evidence to assess if trapeziectomy with IA had any additional benefit over the Artelon joint implant, the Swanson joint replacement or trapeziectomy alone.We did not find any studies that compared any other combination of the other techniques mentioned above or any other techniques including a sham procedure. AUTHORS' CONCLUSIONS We did not identify any studies that compared surgery to sham surgery and we excluded studies that compared surgery to non-operative treatments. We were unable to demonstrate that any technique confers a benefit over another technique in terms of pain and physical function. Furthermore, the included studies were not of high enough quality to provide conclusive evidence that the compared techniques provided equivalent outcomes.
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Affiliation(s)
- Anne Wajon
- Macquarie Hand Therapy, Macquarie University Clinic, 2 Technology Place, Macquarie University, New South Wales, Australia, 2109.
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Goubau JF, Goubau L, Goorens CK, van Hoonacker P, Kerckhove D, Vanmierlo B, Berghs B. De Quervain Tenosynovitis Following Trapeziometacarpal Ball-and-Socket Joint Replacement. J Wrist Surg 2015; 4:35-42. [PMID: 25709877 PMCID: PMC4327722 DOI: 10.1055/s-0034-1398487] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background One of the surgical treatment options for trapeziometacarpal (TMC) joint arthritis is a prosthetic ball-and-socket replacement. One of the complications in the postoperative setting is de Quervain tendinopathy. Purposes Although this complication has been reported following a resection athroplasty, we questioned whether lengthening of the thumb following the Ivory (Memometal, Stryker Corporate, Kalamazoo, MI, USA) ball-and-socket arthroplasty could be a causal factor. Methods In a prospective study regarding the overall outcome of the Ivory prosthesis, we analyzed 96 cases (83 patients; 69 female, 12 male, 8 bilateral) of primary implanted Ivory prosthesis and the incidence of de Quervain disease during the first year following surgery. We found a particularly high incidence (17%) of de Quervain tendinopathy the first year following this ball-and-socket arthroplasty. We measured the lengthening of the thumb radiographically in the group presenting de Quervain and the asymptomatic group and compared this measure between the two groups. Results We did not find any measurable or statistically significant difference between the groups regarding lengthening. Discussion These findings suggest that lengthening of the thumb following ball-and-socket arthroplasty is not a causal factor in the development of de Quervain tendinopathy within one year after surgery.
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Affiliation(s)
- Jean F. Goubau
- Department of Orthopaedics and Traumatology, Upper Limb Unit, Orthoclinic, AZ Sint-Jan AV Brugge – Oostende, AZ Sint Lucas, Brugge, Belgium
- Department of Orthopaedics and Traumatology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Laurent Goubau
- Department of Orthopaedics and Traumatology, Universitair Ziekenhuis Gent, Universiteit Gent (UG), Gent, Belgium
| | - Chul Ki Goorens
- Department of Orthopaedics and Traumatology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB), Brussels, Belgium
- Hagelandse Orthopedische Praktijk, Regionaal Ziekenhuis Tienen, Tienen, Belgium
| | - Petrus van Hoonacker
- Department of Orthopaedics and Traumatology, Upper Limb Unit, Orthoclinic, AZ Sint-Jan AV Brugge – Oostende, AZ Sint Lucas, Brugge, Belgium
| | - Diederick Kerckhove
- Department of Orthopaedics and Traumatology, Upper Limb Unit, Orthoclinic, AZ Sint-Jan AV Brugge – Oostende, AZ Sint Lucas, Brugge, Belgium
| | - Bert Vanmierlo
- Department of Orthopaedics and Traumatology, Upper Limb Unit, Orthoclinic, AZ Sint-Jan AV Brugge – Oostende, AZ Sint Lucas, Brugge, Belgium
| | - Bart Berghs
- Department of Orthopaedics and Traumatology, Upper Limb Unit, Orthoclinic, AZ Sint-Jan AV Brugge – Oostende, AZ Sint Lucas, Brugge, Belgium
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Chug M, Williams N, Benn D, Brindley S. Outcome of uncemented trapeziometacarpal prosthesis for treatment of thumb carpometacarpal joint arthritis. Indian J Orthop 2014; 48:394-8. [PMID: 25143644 PMCID: PMC4137518 DOI: 10.4103/0019-5413.136270] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Osteoarthritis of the trapeziometacarpal joint of thumb occurs frequently and can be very disabling. Numerous surgical techniques including trapeziectomy with or without tendon interposition arthrodesis and partial or total joint arthroplasty with cemented and noncemented prosthesis have been described for the treatment of trapeziometacarpal joint osteoarthritis. Initial problems of osteolysis and implant loosening have been substantially reduced with improvement in implant design. The aim of this study is to demonstrate that trapeziometacarpal osteoarthritis of the thumb can be effectively treated with uncemented total joint replacement prosthesis. MATERIALS AND METHODS We retrospectively collected data for 16 trapeziometacarpal joint replacements in 14 patients. One patient was excluded as they required revision with trapeziectomy and ligament reconstruction following fracture of Trapezium. The trapeziometacarpal joint prosthesis was used in all cases and all operations were carried out by one surgeon. Clinical outcome was determined by a pre and postoperative patient rated wrist evaluation (PRWE) and Michigan Hand Questionnaire Score. Range of motion, grip, tip pinch and key pinch strength were measured and compared with the unoperated hand. Radiological assessment was carried out by plain radiographs for preoperative staging of arthritis and postoperative radiographs at latest followup for evaluation of osteolysis and implant loosening. Average followup period was 26 months. RESULTS There was an improvement in hand function and pain level based on PRWE and Mischigan Hand outcome Questionnaire Score. One patient had intraoperative fracture of Trapezium and subsequent radiographs at 14 months followup showed loosening of the trapezial component due to nonunion of the fracture and complete disintegration of the trapezium. There were no cases of dislocation or implant loosening for the remaining 15 CMC joints at the latest followup. CONCLUSION The use of uncemented prosthesis in treatment of Questionnaire Score. Range of motion joint osteoarthritis gives excellent short term results in improving hand function in terms of strength and stability and achieving pain relief.
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Affiliation(s)
- Manish Chug
- Department of Hand Surgery, John Hunter Hospital, Hunter New England Area Health Services, Lookout Road, New Lambton, Newcastle, NSW 2290, Australia,Address for correspondence: Dr. Manish Chug, 506/18-20, Smart Street, Sky Central Apartments, Charlestown, Newcastle, NSW 2290, Australia. E-mail:
| | - Nicole Williams
- Department of Hand Surgery, John Hunter Hospital, Hunter New England Area Health Services, Lookout Road, New Lambton, Newcastle, NSW 2290, Australia
| | - David Benn
- Department of Hand Surgery, John Hunter Hospital, Hunter New England Area Health Services, Lookout Road, New Lambton, Newcastle, NSW 2290, Australia
| | - Stephen Brindley
- Department of Hand Surgery, John Hunter Hospital, Hunter New England Area Health Services, Lookout Road, New Lambton, Newcastle, NSW 2290, Australia
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Hansen TB, Dremstrup L, Stilling M. Patients with metal-on-metal articulation in trapeziometacarpal total joint arthroplasty may have elevated serum chrome and cobalt. J Hand Surg Eur Vol 2013; 38:860-5. [PMID: 23677963 DOI: 10.1177/1753193413487685] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Serum chrome and cobalt was measured in 50 patients with trapeziometacarpal total joint replacement with metal-on-metal articulation and compared with serum chrome and cobalt values in 23 patients with trapeziometacarpal total joint replacement with metal-on-polyethylene articulation. In 10 of 50 (20%) patients with metal-on-metal articulation, slightly elevated serum chrome or cobalt values were found compared with only one in 23 (4%) patients with metal-on-polyethylene articulation. All metal values were lower than accepted 'normal values' for metal-on-metal hip arthroplasty and so considered not to be a general health risk. However, the mean disabilities of the arm, shoulder and hand (DASH) score was 24 in patients with elevated serum chrome or cobalt compared with 10 in patients with normal metal values (p < 0.05) suggesting a local clinical effect of the elevated serum chrome or cobalt values. We recommend that patients with trapeziometacarpal total joint replacement with metal-on-metal articulation are followed with DASH score and radiological examination every 3-5 years and serum chrome and cobalt should be analysed in symptomatic cases to learn more about possible local complications leading to, or arising from, metal debris.
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Affiliation(s)
- T B Hansen
- Department of Orthopaedics, Regional Hospital Holstebro, Lægårdvej, Denmark
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