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Philips T, Van Melkebeke L, Popleu L, Van Hove B, Caekebeke P, Duerinckx J. De Quervain tendinitis after total trapeziometacarpal joint arthroplasty: Biomechanical evaluation of tendon excursion in the first extensor tendon compartment. Hand Surg Rehabil 2024:101686. [PMID: 38583707 DOI: 10.1016/j.hansur.2024.101686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 03/10/2024] [Accepted: 03/12/2024] [Indexed: 04/09/2024]
Abstract
De Quervain's tenosynovitis is the most common complication after total trapeziometacarpal joint replacement. Etiology is unclear. Implantation of a ball-in-socket implant changes the biomechanics of the normal trapeziometacarpal saddle joint and increases its range of motion. The present study demonstrates that this procedure also significantly increases excursion of the abductor pollicis longus and extensor pollicis brevis tendons during thumb flexion-extension, and not during thumb abduction-adduction. Increased tendon gliding under the retinaculum of the first extensor tendon compartment could predispose to the development frictional tenosynovitis and play a role in the development of de Quervain's syndrome after total trapeziometacarpal joint replacement. LEVEL OF EVIDENCE: Not applicable (laboratory study).
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Affiliation(s)
- T Philips
- Department of Orthopedic Surgery and Traumatology, Ziekenhuis Oost-Limburg, Synaps Park 1, 3600 Genk, Belgium
| | - L Van Melkebeke
- Department of Orthopedic Surgery and Traumatology, Ziekenhuis Oost-Limburg, Synaps Park 1, 3600 Genk, Belgium; Hasselt University, Faculty of Rehabilitation Sciences, Agoralaan 5, 3590 Diepenbeek, Belgium
| | - L Popleu
- Hasselt University, Faculty of Medicine and Life Sciences, Department of Anatomy, Agoralaan 5, 3590 Diepenbeek, Belgium
| | - B Van Hove
- Department of Orthopedic Surgery and Traumatology, Ziekenhuis Oost-Limburg, Synaps Park 1, 3600 Genk, Belgium; Department of Orthopedic Surgery, Regionaal Ziekenhuis Heilig Hart, Naamsestraat 105, 3000 Leuven, Belgium
| | - P Caekebeke
- Department of Orthopedic Surgery and Traumatology, Ziekenhuis Oost-Limburg, Synaps Park 1, 3600 Genk, Belgium
| | - J Duerinckx
- Department of Orthopedic Surgery and Traumatology, Ziekenhuis Oost-Limburg, Synaps Park 1, 3600 Genk, Belgium; Hasselt University, Faculty of Rehabilitation Sciences, Agoralaan 5, 3590 Diepenbeek, Belgium.
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Vanderstappen M, VAN Melkebeke L, Duerinckx J, Caekebeke P. Perioperative steroid injection in elbow arthroscopy. Acta Orthop Belg 2024; 90:67-71. [PMID: 38669652 DOI: 10.52628/90.1.12493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024]
Abstract
The goal of the present study was to evaluate the incidence of infection after perioperative intra-articular steroid injection during elbow arthroscopy. Starting from May 2019, we prospectively included all patients that underwent an elbow arthroscopy for various indications. All patients received preoperative antibiotics intravenously and a corticosteroid injection immediately after portal closure. Patients who needed ligamentous repair and aged below 18 years old were excluded. Final follow up of all patients was 3 months. In total, 108 elbow arthroscopies were performed in 100 patients. No major complications and 1 minor complication were seen. One patient developed a seroma that resolved spontaneously after 14 days without intervention or antibiotics. In this patient group, a perioperative corticosteroid injection following elbow arthroscopy did not increase the chance of infection.
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Caekebeke P, VAN Melkebeke L, Duerinckx J. Minimally invasive corrective derotational osteotomy for proximal phalanx malrotation. Acta Orthop Belg 2023; 89:691-694. [PMID: 38205762 DOI: 10.52628/89.4.12008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
Fractures of the phalanges may result in a challenging complication known as malrotation, which can adversely affect the functionality of the fingers during flexion, leading to scissoring. The standard surgical approach for correcting this condition involves open corrective osteotomy and derotation, often at the level of the metacarpal, which includes the use of different techniques for osteotomy and fixation. However, postoperative complications such as finger stiffness and hardware irritation are common. To overcome these limitations, we present a novel and minimally invasive corrective osteotomy technique for malunited proximal phalanx fractures with rotational malalignment, which offers several advantages, such as accelerated rehabilitation and no prominent hardware.
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Geuskens W, Caekebeke P, VAN Riet R. Prevalence and clinical implications of heterotopic ossification after distal biceps tendon repair. Acta Orthop Belg 2023; 89:695-700. [PMID: 38205763 DOI: 10.52628/89.4.12447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
Complete distal biceps tendon ruptures are relatively uncommon. Conservative treatment may result in persistent pain and weakness. Therefore, surgical repair is usually indicated in order to restore strength. Different surgical techniques and fixation methods have been described. The most reported complications after surgery are iatrogenic nerve damage, heterotopic ossification (HO) and re-rupture. Heterotopic ossification can be variable in size. Significant HO can limit range of motion while minor HO often remains asymptomatic. The overall presence of HO is likely underreported in literature, as imaging is reserved for symptomatic patients. The purpose of this study is to report the prevalence and clinical implications of heterotopic ossification after surgical repair of the distal biceps tendon. This retrospective study assessed the prevalence and clinical relevance of postoperative HO after distal biceps tendon repair. CT-scans were used to evaluate size and location of the HO. VAS scores, DASH scores, MEPI, and range of motion (ROM) were assessed to evaluate pain, patient satisfaction and elbow function. HO was observed on CT images of 19 out of 35 patients (54%). The use of interference screws, timing of surgery after rupture and timing of radiographic assessment postoperatively did not influence the prevalence of HO. The presence of HO had no statistically significant impact on the VAS scores, ROM measurements and MEPI and DASH scores. According to our findings, the overall incidence of HO is higher than previously reported but there are no differences in clinical outcomes when compared to patients without HO.
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Duerinckx J, Huijs S, Caekebeke P, Driesen R, Corten K. Cortical contact is not necessary to prevent stem subsidence in cementless trapeziometacarpal arthroplasty: A follow-up study. Hand Surg Rehabil 2022; 41:707-708. [PMID: 36150691 DOI: 10.1016/j.hansur.2022.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 09/07/2022] [Accepted: 09/09/2022] [Indexed: 01/04/2023]
Affiliation(s)
- J Duerinckx
- Departement of Orthopaedic Surgery and Traumatology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600 Genk, Belgium; Hasselt University, Faculty of Rehabilitation Sciences, Agoralaan Building A, 3590 Diepenbeek, Belgium.
| | - S Huijs
- Departement of Orthopaedic Surgery and Traumatology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600 Genk, Belgium
| | - P Caekebeke
- Departement of Orthopaedic Surgery and Traumatology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600 Genk, Belgium
| | - R Driesen
- Departement of Orthopaedic Surgery and Traumatology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600 Genk, Belgium
| | - K Corten
- Departement of Orthopaedic Surgery and Traumatology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600 Genk, Belgium; Hasselt University, Faculty of Rehabilitation Sciences, Agoralaan Building A, 3590 Diepenbeek, Belgium
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Dirkx G, Caekebeke P, Duerinckx J. Fluoroscopy-guided cup placement in total trapeziometacarpal joint arthroplasty. Hand Surg Rehabil 2020; 40:205-206. [PMID: 33285306 DOI: 10.1016/j.hansur.2020.10.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 10/04/2020] [Accepted: 10/09/2020] [Indexed: 11/18/2022]
Affiliation(s)
- G Dirkx
- Department of Orthopedic Surgery and Traumatology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600 Genk, Belgium
| | - P Caekebeke
- Department of Orthopedic Surgery and Traumatology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600 Genk, Belgium
| | - J Duerinckx
- Department of Orthopedic Surgery and Traumatology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600 Genk, Belgium.
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Van Hove B, Vantilt J, Bruijnes A, Caekebeke P, Corten K, Degreef I, Duerinckx J. Trapeziometacarpal total joint arthroplasty: The effect of capsular release on range of motion. Hand Surg Rehabil 2020; 39:413-416. [PMID: 32387691 DOI: 10.1016/j.hansur.2020.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 04/25/2020] [Accepted: 04/27/2020] [Indexed: 11/28/2022]
Abstract
It has been suggested that trapeziometacarpal total joint arthroplasty be combined with complete release of the joint capsule to prevent ligament tethering and implant dislocation. Our goal was to evaluate the consequences of capsular release on range of motion. Trapeziometacarpal joint motion was measured with a 3D motion tracking system in seven fresh frozen human cadaver hands before and after capsular release and total joint arthroplasty with subsequently longer neck lengths. Relative to the native trapeziometacarpal joint with intact joint capsule, mean flexion-extension was significantly increased after the arthroplasty with released capsule and lengthening up to 6 mm. Mean abduction-adduction did not increase significantly. Total joint replacement combined with capsular release increases the trapeziometacarpal joint's range of motion, but not beyond the limits of most trapeziometacarpal implant designs. Lengthening of the implant neck progressively decreases the excess motion.
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Affiliation(s)
- B Van Hove
- Department of Orthopedic Surgery and Traumatology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600 Genk, Belgium
| | - J Vantilt
- Orthopedic Research Foundation Genk vzw, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600 Genk, Belgium
| | - A Bruijnes
- Orthopedic Research Foundation Genk vzw, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600 Genk, Belgium
| | - P Caekebeke
- Department of Orthopedic Surgery and Traumatology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600 Genk, Belgium
| | - K Corten
- Department of Orthopedic Surgery and Traumatology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600 Genk, Belgium
| | - I Degreef
- Department of Orthopedic Surgery, UZ Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - J Duerinckx
- Department of Orthopedic Surgery and Traumatology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600 Genk, Belgium.
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Abstract
In trapeziometacarpal arthroplasty, correct implant position may be necessary to prevent complications such as dislocation, component loosening and premature wear. The metacarpal stem more easily fits anatomically. However, the cup in the trapezium is not anatomical and guidelines for its orientation are not uniformly defined. We determined the centre of the range of motion of the trapeziometacarpal joint in 30 healthy patients on postero-anterior and lateral radiographs and its relationship to the proximal articular surface of the trapezium. Our study suggests that in thumb carpo-metacarpal total joint arthroplasty, the prosthetic cup in the trapezium should be placed parallel to the proximal articular surface of the trapezium and combined with a metacarpal neck with 7° palmar offset. This should optimize arthroplasty ranges of motion and may minimize the risk of postoperative complications. Our study provides a reference for the surgeon to check correct cup alignment intra-operatively with fluoroscopy.
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Affiliation(s)
- J Duerinckx
- Orthopaedic Departement, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - P Caekebeke
- Orthopaedic Departement, Ziekenhuis Oost-Limburg, Genk, Belgium
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