1
|
Lajoinie L, Barbary S. Total trapeziometacarpal prosthesis: Radio-clinical advice on cup implantation. Hand Surg Rehabil 2023:S2468-1229(23)00079-8. [PMID: 37182837 DOI: 10.1016/j.hansur.2023.04.009] [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: 03/10/2023] [Revised: 04/28/2023] [Accepted: 04/30/2023] [Indexed: 05/16/2023]
Affiliation(s)
- Louis Lajoinie
- Interne en Chirurgie Orthopédique et Traumatologique, Unité de Chirurgie Orthopédique, Centre Chirurgical Emile Gallé, Centre Hospital-Universitaire de Nancy, 49 Rue Hermite, 54000 Nancy, France.
| | - Stéphane Barbary
- Chirurgien de la Main et des Nerfs Périphériques, Centre Chirurgical ADR, 6 Rue Colette, 54100 Nancy, France.
| |
Collapse
|
2
|
Rath R, Haerle M, Stollberg C, Herrmann S, Lampert F. Denervation of the thumb carpometacarpal joint for symptomatic osteoarthritis in 46 patients. Hand Surg Rehabil 2023; 42:51-55. [PMID: 36436810 DOI: 10.1016/j.hansur.2022.11.008] [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: 09/02/2022] [Revised: 10/30/2022] [Accepted: 11/19/2022] [Indexed: 11/25/2022]
Abstract
We investigated the effect of an extended denervation procedure in the thumb carpometacarpal (CMC) joint in patients suffering from CMC osteoarthritis. Between 2006 and 2018, 46 patients underwent the procedure in our clinic and were included in this retrospective study. Pain, strength, range of motion, DASH score, complications and overall satisfaction were determined. Assessment showed a significant decrease in pain and excellent physical function at a median 5 years' follow-up. Twelve patients needed secondary surgery due to persistent pain. Overall, 28 of the 46 patients were satisfied with the results of the denervation. Even though the results of CMC denervation are poorer than with simple trapeziectomy, considerable pain relief can be achieved in selected young, physically active patients by exclusively soft-tissue surgery, conserving the biomechanical properties of the joint. In case of failure of the procedure, all other options remain available.
Collapse
Affiliation(s)
- R Rath
- Clinic for Hand Surgery and Plastic Surgery, Orthopädische Klinik Markgröningen, Kurt-Lindemann-Weg 10, 71706 Markgröningen, Germany; Clinic for Hand, Plastic and Aesthetic Surgery, Klinikum Bad Cannstatt, Prießnitzweg 24, 70374 Stuttgart, Germany.
| | - M Haerle
- Clinic for Hand Surgery and Plastic Surgery, Orthopädische Klinik Markgröningen, Kurt-Lindemann-Weg 10, 71706 Markgröningen, Germany.
| | - C Stollberg
- Clinic for Hand Surgery and Plastic Surgery, Orthopädische Klinik Markgröningen, Kurt-Lindemann-Weg 10, 71706 Markgröningen, Germany; Clinic for Plastic and Aesthetic Surgery, Pflugfelder Straße 22, 71636 Ludwigsburg, Germany.
| | - S Herrmann
- Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Strasse 55, 79106 Freiburg, Germany.
| | - F Lampert
- Clinic for Hand Surgery and Plastic Surgery, Orthopädische Klinik Markgröningen, Kurt-Lindemann-Weg 10, 71706 Markgröningen, Germany; Department of Plastic and Hand Surgery, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Strasse 55, 79106 Freiburg, Germany.
| |
Collapse
|
3
|
Ledoux P. Metacarpophalangeal hyperextension in thumb basal joint osteoarthritis: Radiological study and implications for treatment. Hand Surg Rehabil 2023; 42:56-60. [PMID: 36396115 DOI: 10.1016/j.hansur.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 10/25/2022] [Accepted: 11/01/2022] [Indexed: 11/16/2022]
Abstract
We report a series of 95 consecutive patients operated on for total trapeziometacarpal joint replacement, screening for radiological characteristics to differentiating patients with and without preoperative MCP hyperextension. Loss of thumb column length and metacarpal head circularity on lateral view were quantified. Statistically, a combination of reduced length and circular metacarpal head was a determining factor for MCP hyperextension. We therefore believe it is essential to restore thumb column length in surgery for trapeziometacarpal osteoarthritis and to avoid trapeziectomy in patients with a circular head on lateral view. LEVEL OF EVIDENCE: III; prospective cohort study.
Collapse
|
4
|
Lee JH, Hwang JS, Kang SY, Kim J. Postoperative evaluation of modified abductor pollicis longus suspensionplasty using two anchors: Preliminary results. Hand Surg Rehabil 2022; 41:669-674. [PMID: 36210046 DOI: 10.1016/j.hansur.2022.09.240] [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: 06/22/2022] [Revised: 09/06/2022] [Accepted: 09/25/2022] [Indexed: 11/29/2022]
Abstract
Among the various surgical treatments for basal joint arthritis, we modified abductor pollicis longus (APL) suspensionplasty by using two anchors. We hypothesized that this modification would prevent not only subsidence but also lateral migration of the first metacarpal. Thirteen thumbs that underwent APL suspensionplasty were investigated. Mean follow-up was 25 months (range, 12-69 months). Clinical and radiographic parameters were assessed preoperatively and postoperatively. Progression of subsidence (trapezial space) and lateral migration of the first metacarpal were investigated sequentially and with the thumb abducted or adducted against stress in a specifically designed mold. Clinical improvement was assessed by decrease in QuickDASH score (from 49.6 to 19.7). The immediate postoperative trapezial space decreased significantly by 39% (p = 0.003), and lateral migration was improved significantly by 14% (p = 0.007). At final follow-up, subsidence and lateral migration had not significantly progressed (p = 0.059 and 0.278, respectively). Under stress, the trapezial space ratio decreased significantly with the thumb in abduction (from 0.63 to 0.59, p = 0.011). APL suspensionplasty using two anchors in patients with basal joint arthritis maintained the position of the first metacarpal bone, and especially lateral subluxation. LEVEL OF EVIDENCE: IV.
Collapse
Affiliation(s)
- J H Lee
- Department of Orthopedic Surgery, Seoul National University College of Medicine, 103, Daehakro, Jongro-gu, Seoul, 03080, Republic of Korea.
| | - J S Hwang
- Department of Orthopedic Surgery, Seoul National University Hospital, 101, Daehakro, Jongro-gu, Seoul, 03080, Republic of Korea.
| | - S Y Kang
- Department of Orthopedic Surgery, Seoul National University Hospital, 101, Daehakro, Jongro-gu, Seoul, 03080, Republic of Korea.
| | - J Kim
- Department of Orthopedic Surgery, Seoul National University Hospital, 101, Daehakro, Jongro-gu, Seoul, 03080, Republic of Korea.
| |
Collapse
|
5
|
Guerra Bresson H, Desmoineaux P, Maillot C, Delcourt T, Pujol N. Survey of practices in surgical management of trapeziometacarpal osteoarthritis in France in 2020. Hand Surg Rehabil 2022; 41:613-623. [PMID: 35781064 DOI: 10.1016/j.hansur.2022.06.003] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 06/13/2022] [Accepted: 06/20/2022] [Indexed: 06/15/2023]
Abstract
The purpose of this study was to obtain an overview of French surgical practices for treating trapeziometacarpal osteoarthritis in 2020. An online survey was sent to 64 French hand surgeons: 32 authors of articles on carpometacarpal osteoarthritis of the thumb and 32 other surgeons randomly selected from the membership of the French Society of Hand Surgery (SFCM). The questions concerned demographic data, surgical practice, operative indications, choices for revision surgery, and eight clinical cases. The response rate was 56.2%. The most popular technique was trapeziometacarpal replacement (63.9%). During the previous 5 years, 31.6% of respondents had changed their practices, 69.2% of whom had adopted total joint replacement. Total trapeziectomy with ligamentoplasty and interposition was the second most frequent method. Most surgeons (77.8%) implemented medical treatment for 6 months to 1 year before resorting to surgery. In the clinical cases, agreement between surgeons was very low, with an overall inter-rater concordance coefficient of 0.182. Except for two cases (a young manual worker and a patient with a flattened trapezium) where no technique was significantly preferred, trapeziometacarpal replacement was chosen by a majority of respondents (p < 0.001). It was the most frequently performed surgical technique in France in 2020. However, there is no real consensus on choice of technique, which reflects the absence of guidelines.
Collapse
Affiliation(s)
- H Guerra Bresson
- Service de chirurgie orthopédique et traumatologique, Centre hospitalier de Versailles, 177 Rue de Versailles, 78150 Le Chesnay, France.
| | - P Desmoineaux
- Service de chirurgie orthopédique et traumatologique, Centre hospitalier de Versailles, 177 Rue de Versailles, 78150 Le Chesnay, France.
| | - C Maillot
- Service de chirurgie orthopédique et traumatologique, Hôpital Bichat-Beaujon, 46 Rue Henri Huchard, 75018 Paris, France
| | - T Delcourt
- Service de chirurgie orthopédique et traumatologique, Centre hospitalier de Versailles, 177 Rue de Versailles, 78150 Le Chesnay, France
| | - N Pujol
- Service de chirurgie orthopédique et traumatologique, Centre hospitalier de Versailles, 177 Rue de Versailles, 78150 Le Chesnay, France
| |
Collapse
|
6
|
Laronde P, Duriez P, Oca V, d'Almeida MA, Hustin C. Thumb basal joint arthritis: new classification, diagnostic and therapeutic algorithm. Hand Surg Rehabil 2022:S2468-1229(22)00135-9. [PMID: 35597542 DOI: 10.1016/j.hansur.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 05/12/2022] [Accepted: 05/12/2022] [Indexed: 11/22/2022]
Abstract
The assessment of thumb basal joint arthritis requires a radiographic evaluation and a classification of the lesions to guide the treatment choice. Arthritis of the thumb basal joint is not limited to trapeziometacarpal arthritis. The radiographic assessment must consider the scaphotrapeziotrapezoid joint, the entire carpus and the rest of the thumb column, in particular the metacarpophalangeal joint. There is currently no classification that captures all these items. This article reviews the existing classifications, proposes a new classification system that takes into account the entire thumb column and sets out the therapeutic options.
Collapse
|
7
|
Efremova L, Igeta Y, Fabacher T, Hidalgo Diaz JJ, Gouzou S, Liverneaux P, Facca S. Immobilization protocols following trapeziectomy for osteoarthritis of the thumb: 2 weeks versus 4 weeks. Hand Surg Rehabil 2021; 41:73-77. [PMID: 34781000 DOI: 10.1016/j.hansur.2021.10.318] [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: 07/24/2020] [Revised: 10/05/2021] [Accepted: 10/31/2021] [Indexed: 11/26/2022]
Abstract
We compared the clinical outcomes of post-trapeziectomy protocols according to their duration. The main hypothesis was that there would be no significant difference in postoperative function whether immobilization duration was 2 or 4 weeks. The secondary hypotheses were that there would be no significant difference in postoperative pain, motion, or strength. 40 trapeziectomies were reviewed. Two weeks' postoperative commissural immobilization was systematic. Patients were then divided in two groups. For the first 20 patients (group I), immobilization stopped at 2 weeks. For the next 20 patients (group II) it was replaced by a splint for further 2 weeks. We compared mean pre- and post-operative (10-20 weeks) function (QuickDASH score), pain (visual analog scale - VAS), thumb opposition (Kapandji score) and strength (palmar pinch test) between the two groups. There was no significant difference between groups in postoperative values or in pre- to post-operative progression. The main hypothesis was confirmed: there was no significant difference in the postoperative function whether the immobilization was for 2 or 4 weeks. The secondary hypotheses regarding postoperative pain, motion and strength were also confirmed.
Collapse
Affiliation(s)
- L Efremova
- Department of Hand Surgery, SOS Hand, Hautepierre 2, Strasbourg University Hospital, University of Strasbourg, 1 Avenue Molière, 67000 Strasbourg, France
| | - Y Igeta
- Jutendo University, 2 Chome-1-1 Hongo, Bunkyo City, Tokyo 113-8421, Japan
| | - T Fabacher
- Department of Public Health, Methodology and Biostatistics Sector, University Hospital of Strasbourg, 1 Rue David Richard, 67000 Strasbourg, France
| | - J J Hidalgo Diaz
- Department of Hand Surgery, SOS Hand, Hautepierre 2, Strasbourg University Hospital, University of Strasbourg, 1 Avenue Molière, 67000 Strasbourg, France
| | - S Gouzou
- Department of Hand Surgery, SOS Hand, Hautepierre 2, Strasbourg University Hospital, University of Strasbourg, 1 Avenue Molière, 67000 Strasbourg, France
| | - P Liverneaux
- Department of Hand Surgery, SOS Hand, Hautepierre 2, Strasbourg University Hospital, University of Strasbourg, 1 Avenue Molière, 67000 Strasbourg, France; Icube Laboratory, UMR 7357, CNRS, 2-4 Rue Boussingault, 67000 Strasbourg, France
| | - S Facca
- Department of Hand Surgery, SOS Hand, Hautepierre 2, Strasbourg University Hospital, University of Strasbourg, 1 Avenue Molière, 67000 Strasbourg, France; Icube Laboratory, UMR 7357, CNRS, 2-4 Rue Boussingault, 67000 Strasbourg, France.
| |
Collapse
|
8
|
Daoudi I, Pélissier P, Dargai F, Choughri H, Delgove A. Intra-articular injection of autologous bone marrow aspirate concentrate in the treatment of osteoarthritis of the thumb first carpometacarpal joint: A pilot study. Hand Surg Rehabil 2021:S2468-1229(21)00625-3. [PMID: 34774841 DOI: 10.1016/j.hansur.2021.10.317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 10/23/2021] [Accepted: 10/30/2021] [Indexed: 11/22/2022]
Abstract
This study aimed to evaluate the effect of bone marrow aspirate concentrate (BMAC) in the treatment of osteoarthritis of the thumb first carpometacarpal joint. Injections were carried out in 27 thumbs. According to the Dell classification, there were 2 stage I, 11 stage II, 13 stage III and 1 stage IV cases. The bone marrow was aspirated from the iliac crest, concentrated by centrifugation, and injected under fluoroscopic control into the pathological thumb. Results were assessed at a mean 16 months' follow-up (range, 8-26). Clinical evaluation comprised QuickDASH and PRWE scores, pain at rest on a numerical analog scale (NAS), and thumb column abduction on goniometry. QuickDASH and PRWE scores were 59 (range, 27-82) and 88 range, 37-125) preoperatively and 29 (range, 0-64) and 50 (range, 1-99) postoperatively, respectively. Mean pain at rest on NAS improved from 7 (range, 1-10) to 4 (range, 0-9). Thumb abduction improved by a mean 18° over preoperative data. No postoperative complications were found. Two patients had to be operated on for inefficacy of injection. This is the first article presenting the effect of an intra-articular injection of BMAC in the thumb first carpometacarpal joint and the results were encouraging. Many patients showed improved quality of life and pain relief. These injections appear to be an effective means of postponing surgery.
Collapse
|
9
|
Dietrich AKIM, Winkelmann M, O'Loughlin PF, Krettek C, Gaulke R. Arthroplasty of the trapeziometacarpal joint with or without bioabsorbable polylactide scaffold (RegJoint™) interposition. Hand Surg Rehabil 2021; 41:65-72. [PMID: 34673276 DOI: 10.1016/j.hansur.2021.09.010] [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: 05/28/2021] [Revised: 09/22/2021] [Accepted: 09/30/2021] [Indexed: 10/20/2022]
Abstract
The RegJoint™, a bioabsorbable polylactide scaffold, was introduced in 2011 for scaphometacarpal interposition following trapeziectomy for osteoarthritis. As previous clinical trials provided controversial results, we aimed to prove the non-inferiority of RegJoint™ interposition. In this retrospective study, first metacarpal suspension arthroplasty alone (SA) was compared to suspension with RegJoint™ interposition (RJ). Thirty-four patients with 37 treated thumbs (SA: 14; RJ: 23) were assessed clinically and radiologically at a mean follow-up of 5.3 ± 2.6 years (SA: 7.96; RJ: 3.73). Patient-reported outcomes were measured on three questionnaires (DASH, PRWE and PEM) and a visual analogue pain scale; there were no significant differences between the 2 groups. Clinical assessment comprised range of motion, opposition, pain, first-ray length, hand span, prominence, instability, force and sensitivity to touch. The RJ group showed significantly better palmar abduction (p = 0.026); the other outcome parameters were comparable in the 2 groups. Follow-up radiographs showed osteolysis in 2 SA hands and 3 RJ hands (p = 0.551). First-ray length had decreased by a mean 4.7 ± 2.7 mm at follow-up (SA: -3.8; RJ: -5.2; p = 0.056). No signs of adverse tissue reactions were observed. We conclude that RegJoint™ spacers do not produce more complications than suspension alone but provide no added benefit.
Collapse
Affiliation(s)
- A K I M Dietrich
- Hannover Medical School (MHH), Trauma Department, Carl-Neuberg-Straße 1, 30625 Hannover, Germany.
| | - M Winkelmann
- Hannover Medical School (MHH), Trauma Department, Carl-Neuberg-Straße 1, 30625 Hannover, Germany.
| | - P F O'Loughlin
- Department of Orthopedics, Cork University Hospital, Wilton, Cork, Ireland.
| | - C Krettek
- Hannover Medical School (MHH), Trauma Department, Carl-Neuberg-Straße 1, 30625 Hannover, Germany.
| | - R Gaulke
- Hannover Medical School (MHH), Trauma Department, Carl-Neuberg-Straße 1, 30625 Hannover, Germany.
| |
Collapse
|
10
|
Fontès D. Basal joint arthroscopy indications in first CMC joint arthritis. Hand Surg Rehabil 2021; 40S:S117-S125. [PMID: 33444782 DOI: 10.1016/j.hansur.2020.05.014] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 05/19/2020] [Accepted: 05/21/2020] [Indexed: 10/22/2022]
Abstract
Basal joint arthroscopy is one of the more recent evolutions of small joint arthroscopy in upper limb surgery. Conventional arthroscopy equipment is generally sufficient to perform these procedures without any specific adaptation. Arthroscopic exploration of the trapeziometacarpal joint is performed through 1R, 1U portals with the addition of a thenar portal in some indications. In the context of basal joint arthritis, we can distinguish diagnostic, preventive and therapeutic indications for arthroscopy. Diagnostic indications are the assessment of painful post-traumatic basal joint lesions of cartilage and ligaments, and the evaluation of chondromalacia and ligament attenuation to help classify basal joint osteoarthritis to provide additional clinical information, which can influence further treatment depending on the stage of the disease. Preventive indications are reduction of Bennett's fracture, basal joint dislocation management to avoid post-traumatic instability and chondromalacia; it can also be indicated after decompensation of hyperlaxity. Therapeutic indications are debridement, ligament augmentation procedures or shrinkage ± interposition ± partial or total trapeziectomy, ligamentoplasty, etc. Basal joint arthroscopy appears to be the seat of advances in arthroscopic procedures with clinical results at least as effective as classical open surgery, but this technique still requires long-term evaluation.
Collapse
Affiliation(s)
- D Fontès
- Clinique du Sport, 36, Boulevard Saint Marcel, 75005 Paris, France; Espace Médical Vauban, 2A, Avenue de Ségur, 75007 Paris, France.
| |
Collapse
|
11
|
Fontaine C, D'Agostino P, Maes-Clavier C, Boutan M, Sturbois-Nachef N. Anatomy and biomechanics of healthy and arthritic trapeziometacarpal joints. Hand Surg Rehabil 2021; 40S:S3-S14. [PMID: 34118467 DOI: 10.1016/j.hansur.2020.09.014] [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: 05/29/2020] [Revised: 09/18/2020] [Accepted: 09/29/2020] [Indexed: 10/21/2022]
Abstract
Understanding the biomechanics of the trapeziometacarpal (TMC) or first carpometacarpal (CMC1) joint, the pathophysiology of basal thumb arthritis, the design and performance of surgical procedures require a solid anatomical basis. This review of literature summarizes the most recent data on the descriptive, functional, and comparative anatomy of healthy and arthritic TMC joints.
Collapse
Affiliation(s)
- C Fontaine
- Laboratoire d'Anatomie et Organogenèse, Faculté de Médecine Henri Warembourg, Université de Lille, Rue Michel Polonovski, 59045 Lille cedex, France; Laboratoire d'Automatique, de Mécanique et d'Informatique Industrielle et Humaine LAMIH, Université de Valenciennes et du Hainaut-Cambrésis, Le Mont Houy, 59313 Valenciennes cedex, France; Clinique de Traumatologie-Orthopédie, Hôpital Roger Salengro, Rue du Professeur Emile Laine, CHRU de Lille, 59037 Lille cedex, France.
| | - P D'Agostino
- Clinique de la Main, Bruxelles et Brabant-Wallon, Avenue Louise 284, 1050 Bruxelles, Belgique
| | - C Maes-Clavier
- Service de Chirurgie Orthopédique et Traumatologique, CHU Amiens-Picardie, Site sud Route départementale 408, 80054 Amiens cedex 1, France
| | - M Boutan
- Résidence Dryades, Bâtiment A1, 1, rue du 11 novembre, 40990 Saint-Paul-les-Dax, France
| | - N Sturbois-Nachef
- Clinique de Traumatologie-Orthopédie, Hôpital Roger Salengro, Rue du Professeur Emile Laine, CHRU de Lille, 59037 Lille cedex, France
| |
Collapse
|
12
|
Rouveyrol M, de Villeneuve Bargemon JB, Levet P, Mattéi JC, Legré R, Jaloux C. Revision of trapeziectomy failures in thumb base osteoarthritis: retrospective analysis of ten cases and review of the literature. Hand Surg Rehabil 2021; 40:464-471. [PMID: 33836280 DOI: 10.1016/j.hansur.2021.03.014] [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: 01/31/2021] [Revised: 03/22/2021] [Accepted: 03/31/2021] [Indexed: 10/21/2022]
Abstract
Controversy persists around trapeziectomy as standard of care in thumb base osteoarthritis. The difficulty of management of failure requires the utmost caution in choice of the initial technique. We here report a retrospective series of 10 revision procedures following trapeziectomy, supported by a review of literature. The main cause of revision was collapse of the thumb column resulting in arthrogenic contact of the first metacarpal with the scaphoid. At a mean 73.3 months' follow-up, 5 patients had to undergo additional surgery. Mean VAS pain score was 2.9; 5 patients were pain-free. Strength was more severely impaired than joint motion, resulting in disappointing functional results. The present outcomes are consistent with the literature, which mostly comprises heterogeneous series, making it impossible draw conclusions to guide practice. The most common option seems to be to perform a new ligament procedure, with or without tendon or pyrocarbon interposition, and was the one that provided the only good result in the present series. Other techniques (composite graft, non-autogenic interposition, scaphometacarpal prosthesis) seem promising, and deserve large-scale evaluation. Thus, the gold-standard status of trapeziectomy should be weighed against the observation of these multi-operated patients in situations of therapeutic impasse. Should indications for first-line trapeziectomy be restricted, especially in patients with a revision risk factor? LEVEL OF EVIDENCE: 4.
Collapse
Affiliation(s)
- M Rouveyrol
- Chirurgie de la Main - Chirurgie Plastique Réparatrice des Membres, Hôpital de la Timone, 264 Rue Saint-Pierre, 13005 Marseille, France.
| | - J-B de Villeneuve Bargemon
- Chirurgie de la Main - Chirurgie Plastique Réparatrice des Membres, Hôpital de la Timone, 264 Rue Saint-Pierre, 13005 Marseille, France
| | - P Levet
- Chirurgie de la Main - Chirurgie Plastique Réparatrice des Membres, Hôpital de la Timone, 264 Rue Saint-Pierre, 13005 Marseille, France
| | - J-C Mattéi
- Chirurgie de la Main - Chirurgie Plastique Réparatrice des Membres, Hôpital de la Timone, 264 Rue Saint-Pierre, 13005 Marseille, France
| | - R Legré
- Chirurgie de la Main - Chirurgie Plastique Réparatrice des Membres, Hôpital de la Timone, 264 Rue Saint-Pierre, 13005 Marseille, France
| | - C Jaloux
- Chirurgie de la Main - Chirurgie Plastique Réparatrice des Membres, Hôpital de la Timone, 264 Rue Saint-Pierre, 13005 Marseille, France
| |
Collapse
|
13
|
Baki ME, Okutan AE, Cıtlak A, Yıldız M. The effect of remaining trapezial space on outcomes after trapeziectomy with ligament reconstruction tendon interposition for trapeziometacarpal osteoarthritis. Hand Surg Rehabil 2021; 40:309-313. [PMID: 33662583 DOI: 10.1016/j.hansur.2021.01.002] [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: 09/30/2020] [Revised: 01/02/2021] [Accepted: 01/03/2021] [Indexed: 10/22/2022]
Abstract
Ligament reconstruction and tendon interposition (LRTI) procedures for trapeziometacarpal osteoarthritis aim to prevent proximal metacarpal migration to improve thumb function. We sought to evaluate the effect of the remaining trapezial space on outcomes after trapeziectomy with LRTI. Forty-seven patients were included in this study. Patients were evaluated clinically and radiologically. They were divided into two groups according to the remaining trapezial space at last follow-up. Postoperative to preoperative trapezial space ratio was >50% in group 1 and <50% in group 2. Mean follow-up was 30.8 months. Mean age, sex, dominant side, preoperative stage, and follow-up were similar in both groups. The mean QuickDASH scores were significantly better in group 1 than group 2. Mean tip and key pinch were significantly stronger in group 1, than group 2. Trapeziectomy with LRTI is the most used surgical technique and it produces satisfactory results. Improved clinical outcomes can be achieved when more than 50% of the preoperative trapezial space remains.
Collapse
Affiliation(s)
- M E Baki
- Karadeniz Technical University, School of Medicine, Orthopedic and Traumatology Department, Farabi Cd. No: 66, 61080 Ortahisar/Trabzon, Turkey
| | - A E Okutan
- Karadeniz Technical University, School of Medicine, Orthopedic and Traumatology Department, Farabi Cd. No: 66, 61080 Ortahisar/Trabzon, Turkey.
| | - A Cıtlak
- Karadeniz Technical University, School of Medicine, Orthopedic and Traumatology Department, Farabi Cd. No: 66, 61080 Ortahisar/Trabzon, Turkey
| | - M Yıldız
- Karadeniz Technical University, School of Medicine, Orthopedic and Traumatology Department, Farabi Cd. No: 66, 61080 Ortahisar/Trabzon, Turkey
| |
Collapse
|
14
|
De la Red-Gallego MA, Barrera-Ochoa S, Sanchez Crespo MR. Total thumb carpometacarpal arthroplasty for failed trapeziometacarpal joint arthrodesis. Hand Surg Rehabil 2021; 40:347-349. [PMID: 33640520 DOI: 10.1016/j.hansur.2020.12.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 12/15/2020] [Accepted: 12/16/2020] [Indexed: 11/17/2022]
Abstract
Trapeziometacarpal joint arthrodesis is a surgical option for osteoarthritis of the first carpometacarpal joint; however, it has well-known disadvantages such as non-union and reduced mobility. Revision procedures are often not discussed and lack consensus. We are reporting two cases of satisfactory thumb implant arthroplasty for failed trapeziometacarpal joint arthrodesis in order to discuss the surgical technique, its advantages compared with other surgical options and therefore its potential indications.
Collapse
Affiliation(s)
- M A De la Red-Gallego
- Hospital Universitario Marqués de Valdecilla, Avenida de Valdecilla s/n., 39010 Santander, Cantabria, Spain.
| | - S Barrera-Ochoa
- icatMA, Hand and Microsurgery Unit, ICATME, Hospital Universitari Quiron-Dexeus, Carrer de Sabino Arana, 5-19, 08028 Barcelona, Spain
| | - M R Sanchez Crespo
- Hospital Universitario Marqués de Valdecilla, Avenida de Valdecilla s/n., 39010 Santander, Cantabria, Spain
| |
Collapse
|
15
|
Tchurukdichian A, Lussiez B. Surgical approaches to the trapeziometacarpal joint for the insertion of implants and prostheses (non-arthroscopy). Hand Surg Rehabil 2021; 40S:S29-S32. [PMID: 33581362 DOI: 10.1016/j.hansur.2020.10.019] [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: 06/08/2020] [Revised: 10/06/2020] [Accepted: 10/08/2020] [Indexed: 10/22/2022]
Abstract
The two approaches most often used for placing implants and trapeziometacarpal prostheses are the laterodorsal approach and the lateropalmar approach. The advantages and disadvantages of these two approaches are set out. Each one allows optimal joint exposure while preserving or repairing the peritrapezial musculotendinous structures. They allow the insertion of partial or total trapeziometacarpal implants and modern coupled trapeziometacarpal prostheses. Each approach must be practiced and mastered on cadaver specimens before being used for trapeziometacarpal surgery.
Collapse
Affiliation(s)
| | - B Lussiez
- IM2S, 11, Avenue d'Ostende, 98000 Monaco, Monaco.
| |
Collapse
|
16
|
Roux JL. Double Oblique Osteotomy and Rotation of the trapeziometacarpal Joint (DOOR procedure). Hand Surg Rehabil 2021; 40S:S53-S61. [PMID: 33529793 DOI: 10.1016/j.hansur.2020.09.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 08/18/2020] [Accepted: 09/08/2020] [Indexed: 11/18/2022]
Abstract
The double oblique osteotomy with rotation of the trapeziometacarpal (TMC) joint procedure (DOOR procedure) is a surgical technique conceived to treat non-traumatic TMC instability, often responsible for TMC joint osteoarthritis. The main goal of this procedure is to correct the exaggerated slope of the trapezium. It also allows opening of the first web space, transfers pressure to healthy cartilage areas, and reverses the forces exerted on the trapeziometacarpal ligaments. The technique is demanding and should be learned in the anatomy laboratory. Since 2000, we have carried out 96 cases, evidence that this technique is reliable. Our case series consists of 88 patients (71 females, 17 males), with 8 patients operated bilaterally. The average age at the time of the procedure was 48 years. The first 22 operated (24 cases) between 2000 and 2005 were reviewed in 2015 with an average follow-up of 13 years. Pain averaged 0.5 on VAS. The average QuickDASH score was 6. The average mobility according to Kapandji's index was 9 for opposition and 3 for retropulsion. The grip strength compared to that of the contralateral side was 180%, the key pinch strength was 100% of the contralateral side and the tip pinch strength was 98%. This intervention makes up approximately 10% of our surgical indications in thumb basal joint arthritis. It is reserved for young women with early arthritis or unstable thumbs, and for men who perform manual labor. While the results take a long time to achieve (about 3 months), they remain highly satisfactory at the average follow-up of 13 years.
Collapse
Affiliation(s)
- J-L Roux
- Institut Montpelliérain de la Main (IMM), Clinique Saint Roch, 560, Avenue du Colonel Pavelet, 34070 Montpellier, France.
| |
Collapse
|
17
|
Teissier J, Teissier P, Toffoli A. Trapeziometacarpal prostheses. Hand Surg Rehabil 2021; 40S:S106-16. [PMID: 33540123 DOI: 10.1016/j.hansur.2020.09.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 09/13/2020] [Accepted: 09/15/2020] [Indexed: 11/20/2022]
Abstract
In 1970, Jean-Yves de la Caffinière developed the first trapeziometacarpal (TMC) joint prosthesis, a ball-and-socket design based on hip replacement implants. From 1970 to 1990, the first generation of cemented prostheses was developed. At that time, trapeziectomy, with tendon interposition or suspension arthroplasty, and Swanson silastic spacers remained the most widely used surgical procedures for thumb basal joint arthritis. From 1990 to 2010, a second generation of cementless prostheses was developed. The third generation was introduced after 2010 and consisted of dual mobility prostheses. In 2020, TMC arthroplasty (simple or dual mobility) is a reliable option in thumb basal joint arthritis with an implant survival rate of 90% at 10 years of follow-up, while providing pain relief and restoring strength and mobility. Restoration of the thumb's length corrects most thumb Z-deformities, so the TMC joint prosthesis may be a viable alternative surgical solution to trapeziectomy, which remains the gold standard in English-speaking countries. Moreover, trapeziectomy after failed TMC arthroplasty provides outcomes equivalent to those of primary trapeziectomy.
Collapse
|
18
|
Goubau JF, Vanmierlo B, Van Royen K, Goorens CK. Osteotomies around the thumb base in CMC 1 arthritis. Hand Surg Rehabil 2021; 40S:S46-S52. [PMID: 33482391 DOI: 10.1016/j.hansur.2020.08.014] [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: 04/02/2020] [Revised: 06/07/2020] [Accepted: 08/07/2020] [Indexed: 10/22/2022]
Abstract
The trapeziometacarpal joint (TMC) is a saddle joint that is subjected to tremendous repetitive loads through our lifetime. This joint is apparently congruent, but only a small part of the articular surface is loaded during pinch grips. This design implies a perfect bony anatomy, high quality articular cartilage and no ligament laxity. Under certain circumstances, where these different anatomical variables are imperfect, symptoms and pain can start at a very early stage in life. They are mainly acquired, but can be posttraumatic in origin. High quality radiographic views are needed: these radiographs must be done methodically by well-trained radiologists. The symptoms and radiographic changes may not match, such as when radiographic changes are minimal but functional impairment is significant. The primary goal of treatment is conservative. This cannot be stressed enough since conservative treatment can be successful with good follow-up by the hand surgeon: resting splint, good postures at work and if necessary, anti-inflammatory drugs and paracetamol. If this fails after a minimum of 6 months, different osteotomies can be proposed, combined with ligament augmentation in some cases. These osteotomies are mainly extra-articular, can be at the level of the base of the first metacarpal and the trapezium, or can be solely at the base of the first metacarpal. Isolated osteotomies of the trapezium should be avoided since they tend to close the first web space. In certain posttraumatic cases, intra-articular osteotomy of the malunion can be done to restore congruency and provide pain relief.
Collapse
Affiliation(s)
- J F Goubau
- Department of Orthopedics and Traumatology, Maria Middelares Ziekenhuis, Buitenring-Sint-Denijs 30, 9000 Gent, Belgium; Department of Orthopedics and Traumatology, University Hospital Brussels VUB (Vrije Universiteit Brussel), Laarbeeklaan 101, 1090 Brussels, Belgium.
| | - B Vanmierlo
- Department of Orthopedics and Traumatology, Delta Ziekenhuis, Deltalaan 1, 8800 Roeselare, Belgium
| | - K Van Royen
- Department of Orthopedics and Traumatology, University Hospital Brussels VUB (Vrije Universiteit Brussel), Laarbeeklaan 101, 1090 Brussels, Belgium; Department of Orthopedics and Traumatology, Damiaan Ziekenhuis, Gouwelozestraat 100, 8400 Oostende, Belgium
| | - C K Goorens
- Department of Orthopedics and Traumatology, University Hospital Brussels VUB (Vrije Universiteit Brussel), Laarbeeklaan 101, 1090 Brussels, Belgium; Department of Orthopedics and Traumatology, Regionaal Ziekenhuis Heilig Hart Tienen, Kliniekstraat 45, 3300 Tienen, Belgium
| |
Collapse
|
19
|
Pomares G. Trapeziometacarpal osteoarthritis and arthritis of the wrist. Hand Surg Rehabil 2021; 40S:S135-S142. [PMID: 33482390 DOI: 10.1016/j.hansur.2020.08.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 08/17/2020] [Accepted: 08/18/2020] [Indexed: 12/21/2022]
Abstract
Although the simultaneous occurrence of arthritis of the wrist and the base of the thumb is rare, it is nonetheless imperative to carry out a preoperative clinical and radiological assessment of the wrist when managing trapeziometacarpal osteoarthritis. The presence of pre-arthritic lesions or established wrist arthritis, even if treated, must be taken into consideration when treating osteoarthritis at the base of the thumb. The coexistence of these lesions determines the entire surgical strategy. Failure to take them into account during the surgical treatment often results in a compromised postoperative course and it often adversely impacts the outcome of secondary surgeries.
Collapse
Affiliation(s)
- G Pomares
- European Hand Institute Luxembourg - Kirchberg Hospital, 9, Edward Steichen Street, 2540 Luxembourg, Luxembourg.
| |
Collapse
|
20
|
Messina JC, Torretta F, Randelli PS. Autologous chondrocyte transplantation in the treatment of thumb CMC joint osteoarthritis. Hand Surg Rehabil 2021; 40S:S21-S28. [PMID: 33486105 DOI: 10.1016/j.hansur.2020.11.008] [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: 05/02/2020] [Revised: 11/17/2020] [Accepted: 11/18/2020] [Indexed: 10/22/2022]
Abstract
Degenerative thumb carpometacarpal (CMC) joint osteoarthritis is a common disease in women starting at 40-50 years of age. Nevertheless, synovitis and initial cartilage damage start earlier, and then degenerative arthritis develops leading to joint narrowing with progressive exposure of subchondral bone, subluxation, osteophyte formation and joint deformity that can impact the surrounding joints. The aim of this study was to evaluate the outcome of patients treated with autologous chondrocyte transplantation at the thumb CMC joint at early stages. A prospective study on 10 cases of thumb CMC osteoarthritis in 8 patients was done. The thumbs were stage Eaton II (2 cases) and III (8 cases) and were treated by CMC arthroplasty with the implant of autologous chondrocytes by an open or arthroscopic technique. Two patients were treated bilaterally. Preoperatively all patients had persistent pain resistant to various kinds of nonoperative treatments for at least 1 year. Mean preoperative pinch strength was 3.7 Kg pain on VAS was 8, DASH was 55. All patients had limited abduction and flexion at the end range. Ethics committee approval was obtained for this study. Fragments of 3-4 mm of cartilage were harvested by arthroscopy or by an open technique from the wrist or elbow joint. Cartilage cells were sent to the laboratory to be grown on a collagenous biphasic matrix (MACI/Novocart®). After 3 weeks, the chondrocyte augmented scaffold was ready to be implanted in the thumb CMC joint, or frozen for a second operation later. All patients were females aged 42-67 years (mean 52 years). The dominant hand was treated in 6 cases. In 7 cases, the patients were operated with an open technique and in three cases by arthroscopy. Partial trapezium resection and dorsoradial ligament reconstruction was added to stabilize the CMC joint in most cases. Patients were seen in person at 1, 3, and 6, months, 1 year, 2 years, and 5 years after the initial surgery. Patients (nine thumbs) were then reviewed at a mean follow up 8 years (range 4.4-11 years); pain on VAS, Mayo, DASH and PRWE scores were evaluated at follow-up. One patient was lost to follow-up after 2 years. Of those nine hands, seven had an excellent result according to Mayo score, one had a good result. One thumb CMC joint was still painful and was reoperated and converted to arthroplasty after 4.4 years. All patients regained full range of motion. Mean pinch strength increased to 6.25 ± 1.3 Kg, mean DASH score was 7.3 ± 6.7; pain on VAS was 1.0 ± 1.5; these data were statistically significant compared to preoperative values (p < 0.01). Grip strength also increased in all cases, but this was not statistically significant. PRWE was 7.7 ± 6.4. No complications occurred postoperatively. The results obtained are encouraging since the implanted cartilage has lasted a mean of 8 years and up to 11 years. Biological tissue engineering techniques are being developed and could be a new solution to restore normal cartilage in young patients to postpone more aggressive surgical procedures until an older age. In cases of CMC joint instability, a ligament stabilization procedure was added to avoid subsequent damage to the implanted neocartilage. A longer follow-up and a greater number of cases are necessary to definitively establish the usefulness of this procedure, which has the advantage of being completely biological but the disadvantage of being costly.
Collapse
Affiliation(s)
- J C Messina
- First Orthopedic Clinic, University of Milan, Gaetano Pini Orthopedic Institute- CTO Orthopedic and Traumatology Centre, Via Gaetano Pini, 9, 20122 Milano MI, Italy.
| | - F Torretta
- Former Head of Hand Surgery Unit - Gaetano Pini Ortohopaedic Institute Milano, MI Italy
| | - P S Randelli
- First Orthopedic Clinic, University of Milan, Gaetano Pini Orthopedic Institute- CTO Orthopedic and Traumatology Centre, Via Gaetano Pini, 9, 20122 Milano MI, Italy; Laboratory of Applied Biomechanics, Department of Biomedical Sciences, University of Milan, Via Gaetano Pini, 9, 20122 Milano MI, Italy
| |
Collapse
|
21
|
Dréant N. Mini TightRope® suture button indications for thumb basal joint arthritis. Hand Surg Rehabil 2021; 40S:S77-S82. [PMID: 33484877 DOI: 10.1016/j.hansur.2020.05.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 05/25/2020] [Accepted: 05/27/2020] [Indexed: 11/27/2022]
Abstract
Our aim was to explore the different indications of the Mini TightRope® suture button whether during first-line treatment or secondary surgery of thumb carpometacarpal osteoarthritis (OA). The indications for this new device are presented and discussed based on our own small case series and published data. Twenty-one patients treated with the Mini TightRope® were included in a prospective study. One of them was operated on both sides. Fourteen devices were used in first intention for Eaton stage IV OA; the patients underwent trapeziectomy and suture button suspensioplasty only. Four cases consisted of revision surgery for painful proximalization of the first metacarpal after trapeziectomy and ligamentoplasty. Four cases consisted of secondary surgery after trapeziectomy and implant interposition (two silicone implants and two pyrocarbon implants). We captured the demographic data, follow-up time, pain level, pinch strength before and after surgery, range of motion, metacarpal subsidence, and postoperative complications. The average age of the patients was 60 years. There were 19 women and 2 men. The average follow-up time was 2.5 years (1-4). The average pain level, according to a visual analog scale (1-10) was 3.5 (2-5) preoperatively and 2 (1-4) postoperatively at rest and 7 (6-8) preoperatively and 4 (3-6) postoperatively with maximum load. The mean Kapandji score was 9 (7-10) and the retropulsion score was 3 (1-4). The average key pinch and tip pinch strengths were 80% and 78% of the contralateral side at the final follow-up. The trapeziectomy-suspensioplasty group had greater average trapezial space height compared to the revision surgery group (7.0 mm vs. 4.5 mm). There are several indications for the Mini TightRope® device in the treatment of severe thumb carpometacarpal OA: first metacarpal suspension during open or arthroscopic total or partial trapeziectomy and secondary surgery after failure of trapeziectomy with or without implant interposition. The advantage of this new device, which suspends the first metacarpal off the second metacarpal, is the very short immobilization period contrary to other suspensioplasty procedures.
Collapse
Affiliation(s)
- N Dréant
- Pôle Urgences Main Nice, 10, Boulevard Pasteur, 06000 Nice, France.
| |
Collapse
|
22
|
Abstract
Total trapeziectomy has been extensively studied and has been used to treat thumb basal joint arthritis for decades. It remains a simple and reliable technique that every hand surgeon must learn and master, as a primary or revision procedure. Several techniques have been described, but none of them seems better than the others. Without the need for an implant and because of its long-lasting benefits, total trapeziectomy is currently the only surgical technique for thumb basal joint arthritis that can lay claim to being a potential life-long procedure.
Collapse
Affiliation(s)
- T Jager
- Institut Européen de la Main Luxembourg - 9, rue Edward Steichen, L-2540 Luxembourg, Luxembourg.
| |
Collapse
|
23
|
Desmoineaux P, Delaroche C, Moslemi A, Delcourt T. Partial arthroscopic trapeziectomy with or without ligament reconstruction to treat primary thumb carpometacarpal joint osteoarthritis. Hand Surg Rehabil 2021; 40S:S62-S70. [PMID: 33453445 DOI: 10.1016/j.hansur.2020.08.011] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 08/18/2020] [Accepted: 08/19/2020] [Indexed: 11/19/2022]
Abstract
Many surgical options have been proposed for the treatment of first carpometacarpal (CMC1) osteoarthritis. Conventional techniques are invasive, so we wanted to develop an arthroscopic technique. Partial trapeziectomy combined with various interpositions and ligament reconstruction is a long-standing intervention. As in total trapeziectomy, the combination with ligament reconstruction remains controversial. The aim of this study was to demonstrate the benefits of adding an abductor pollicis longus (APL) ligament reconstruction to partial trapeziectomy performed under arthroscopy. This study analyzes the results of two consecutive case series carried out by a single surgeon. Thirty-four patients underwent an isolated partial trapeziectomy and 49 patients underwent partial trapeziectomy with ligament reconstruction using the APL. The patients were reviewed with an average follow-up of 3.7 years (13 months to 8.6 years) by an independent observer. The assessment included the analysis of pain, thumb appearance, QuickDASH score, Nelson Hospital score, and measurements of mobility and strength. For all patients, there was a marked reduction in pain (7.13 preoperatively vs.1.37 postoperatively) with 71% of patients having a painless thumb, the Nelson (11.14) and QuickDASH (17.89) scores as well as a clinical improvement in mobility and grip strength (14.5 KgF preop vs. 19.6 KgF postop) and key pinch (4.4 KgF preop vs. 5.4 KgF postop). The mean recovery time was 18.8 weeks. Eighty-four percent of patients were satisfied with the procedure with 90% having a stable thumb. No CRPS was found. However, the results were better for patients who underwent ligament reconstruction. There was a significant gain in grip strength, better first web opening and a lower percentage of painful thumbs. The other items were also slightly improved, but not significantly (Nelson Hospital score, QuickDASH score, key grip strength, percentage of stable thumbs, subjective thumb value estimated by patients). This technique is a less aggressive treatment of CMC1 osteoarthritis, with simplified and rapid rehabilitation. The addition of ligament reconstruction using the APL appears useful. The advantages of arthroscopy are a less painful postoperative course, low morbidity, ligament conservation, along with better access to remove loose bodies, osteophytes and to perform synovectomy. Partial trapeziectomy, which is especially indicated when the scaphotrapeziotrapezoid joint is not symptomatic, is much less used than total trapeziectomy; however, it is an attractive surgical option for young patients with significant functional demands. Arthroscopic partial trapeziectomy is a safe and reliable procedure.
Collapse
Affiliation(s)
- P Desmoineaux
- Centre hospitalier de Versailles, 177, rue de Versailles, 78157 Le Chesnay, France.
| | - C Delaroche
- Centre hospitalier de Versailles, 177, rue de Versailles, 78157 Le Chesnay, France
| | - A Moslemi
- Centre hospitalier de Versailles, 177, rue de Versailles, 78157 Le Chesnay, France
| | - T Delcourt
- Centre hospitalier de Versailles, 177, rue de Versailles, 78157 Le Chesnay, France.
| |
Collapse
|
24
|
Pluvy I, Lepage D, Haight H, Echalier C, Menu G, Vidal C, Gindraux F, Gallinet D, Adam A, Aubry S, Obert L, Ferreira D, Tropet Y, Loisel F. Cartilage graft from rib to treat trapeziometacarpal arthritis. Hand Surg Rehabil 2021; 40S:S83-9. [PMID: 33454426 DOI: 10.1016/j.hansur.2020.05.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 05/26/2020] [Accepted: 05/28/2020] [Indexed: 11/22/2022]
Abstract
Trapeziectomy has been considered as the gold standard for treating trapeziometacarpal arthritis. But trapezial space collapse is responsible for thumb strength decrease and intracarpal deformities (with or without tendon interposition). Partial trapeziectomy with interposition of a chondrocostal autograft combines the advantages of trapeziectomy and a biological spacer without the disadvantages of arthroplasty. Partial trapeziectomy is performed by a dorsal approach, under regional anaesthesia. The graft is harvested by a direct approach of the 9th rib during a short bout of general anaesthesia and inserted in the trapeziectomy space. A thumb spica cast is used for 3-6 weeks. In our experience, long-term outcomes and radiological evolution of the graft are good, similar to that of other procedures reported in the literature, except for strength, which is better in this scenario. With more than 5 years of follow-up, the graft is viable, the length of the thumb is maintained, and any areas of graft metaplasia are localized. The result is stable over time and any donor site morbidity is anecdotal. The interposition of a biological material is feasible and produces a stable and strong thumb.
Collapse
|
25
|
Ledoux P. Revision procedures after trapeziometacarpal surgery. Hand Surg Rehabil 2021; 40S:S143-S150. [PMID: 33450417 DOI: 10.1016/j.hansur.2020.08.010] [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: 03/31/2020] [Revised: 08/14/2020] [Accepted: 08/15/2020] [Indexed: 10/22/2022]
Abstract
Surgical treatment of thumb basal joint arthritis generally yields good and excellent results. In case of failure, the surgeon will propose an appropriate solution to the patient, one that can be performed easily. Each technique has its own complications: shortening with trapeziometacarpal pain following trapeziectomy, loosening and instability following total arthroplasty, instability for some implants. There are also intolerances such as allergies to nickel, foreign body reactions to silicone and inflammatory reactions to some synthetic ligament implants. It is important to bear these complications in mind when determining the best possible surgical technique initially. The different surgical solutions are exposed here. Prosthetic replacement is preferred in case of loosening when it is technically possible in order to preserve the thumb's length. A conversion to trapeziectomy with or without interposition (implant or ligament reconstruction) will be carried out in the other cases. In case of trapeziectomy failure, solutions are more difficult to find. In the current state of things, it seems that implant or biological tissue interposition is the best solution.
Collapse
Affiliation(s)
- Pascal Ledoux
- Clinique du Parc, 48 bis, rue Henri Barbusse, 59880 Saint-Saulve, France.
| |
Collapse
|
26
|
Abstract
Arthrodesis of the trapeziometacarpal (TMC) joint is one of the first surgical procedures used to treat thumb basal joint arthritis. From 1970 to 1990, we performed 254 TMC arthrodeses with crossed K-wires. From 2015 to 2016, we performed 12 TMC arthrodesis procedures with shape-memory staples. The results were evaluated with De La Caffinière's classification and took into account patient satisfaction and any complications. The results were satisfactory overall, without any significant difference between the two fixation methods but with a rather high complication rate. The indication for arthrodesis in surgical treatment of thumb basal joint arthritis is based on the patient's age and occupation. The best indication is a young active patient.
Collapse
|
27
|
Athlani L. Trapeziometacarpal joint ligament reconstruction in early stages of first carpometacarpal joint osteoarthritis. Hand Surg Rehabil 2021; 40S:S42-5. [PMID: 33401008 DOI: 10.1016/j.hansur.2020.04.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 04/16/2020] [Accepted: 04/17/2020] [Indexed: 11/23/2022]
Abstract
Trapeziometacarpal joint ligament reconstruction is a surgical option in the early stages of thumb basal joint arthritis when the joint is painful and unstable without chondropathy. Arthroscopy is invaluable here to ensuring the joint surfaces are intact, which is often underestimated by radiography. The Eaton-Littler procedure using a distally pedicled flexor carpi radialis slip has been studied the most in this context. This reconstruction provides pain relief while slowing the rapid development of osteoarthritis.
Collapse
|
28
|
Degeorge B, Chiche L, Coulet B, Lazerges C, Chammas M. Metacarpophalangeal joint instability in trapeziometacarpal osteoarthritis: A systematic review. Hand Surg Rehabil 2020; 40S:S126-S134. [PMID: 33378715 DOI: 10.1016/j.hansur.2020.05.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 04/30/2020] [Accepted: 05/05/2020] [Indexed: 11/28/2022]
Abstract
Thumb metacarpophalangeal instability is commonly found in conjunction with trapeziometacarpal osteoarthritis. If not corrected, it can have detrimental effects on the outcome. The authors describe the two types of metacarpophalangeal deformities - hyperextension and valgus - their pathophysiology and the surgical repair techniques available to surgeons. An algorithm for treating this instability is presented.
Collapse
Affiliation(s)
- B Degeorge
- Département de chirurgie orthopédique, unité de chirurgie du membre supérieur, de la main et des nerfs périphériques, CHU Lapeyronie, 191, avenue du Doyen Gaston Giraud, 34295 Montpellier, France.
| | - L Chiche
- Département de chirurgie orthopédique, unité de chirurgie du membre supérieur, de la main et des nerfs périphériques, CHU Lapeyronie, 191, avenue du Doyen Gaston Giraud, 34295 Montpellier, France
| | - B Coulet
- Département de chirurgie orthopédique, unité de chirurgie du membre supérieur, de la main et des nerfs périphériques, CHU Lapeyronie, 191, avenue du Doyen Gaston Giraud, 34295 Montpellier, France
| | - C Lazerges
- Département de chirurgie orthopédique, unité de chirurgie du membre supérieur, de la main et des nerfs périphériques, CHU Lapeyronie, 191, avenue du Doyen Gaston Giraud, 34295 Montpellier, France
| | - M Chammas
- Département de chirurgie orthopédique, unité de chirurgie du membre supérieur, de la main et des nerfs périphériques, CHU Lapeyronie, 191, avenue du Doyen Gaston Giraud, 34295 Montpellier, France
| |
Collapse
|
29
|
Ebelin M, Hérisson O. Zancolli's procedure: technique and indications. Hand Surg Rehabil 2020; 40S:S38-S41. [PMID: 33373713 DOI: 10.1016/j.hansur.2020.06.006] [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: 03/27/2020] [Revised: 05/23/2020] [Accepted: 06/03/2020] [Indexed: 11/15/2022]
Abstract
Anatomical variations in the distal insertion of the abductor pollicis longus (APL) muscle onto the 1st metacarpal bone and around the 1st carpometacarpal joint led Eduardo Zancolli to introduce a surgical yet conservative partial APL tenotomy targeting its accessory or supernumerary distal bundles. Following an anatomical and pathophysiological review, we will describe the surgical technique for this minimally invasive extra-capsular procedure. Results and operative indications of this very simple technique are reported as well, which can be performed in Dell stage I or II of trapeziometacarpal osteoarthritis when well-conducted conservative medical treatment has failed to achieve pain relief.
Collapse
Affiliation(s)
- M Ebelin
- Hôpital Privé des Peupliers, Unité de Chirurgie de la main, 8, place de l'Abbé Georges Hénocque, 75013, France.
| | - O Hérisson
- Hôpital Privé des Peupliers, Unité de Chirurgie de la main, 8, place de l'Abbé Georges Hénocque, 75013, France
| |
Collapse
|
30
|
Allieu Y. Anatomically based radiological classification of thumb basal joint arthritis. Hand Surg Rehabil 2020; 40S:S15-S20. [PMID: 33373714 DOI: 10.1016/j.hansur.2020.04.013] [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: 03/26/2020] [Revised: 04/21/2020] [Accepted: 04/23/2020] [Indexed: 10/22/2022]
Abstract
The numerous surgical techniques proposed for treating thumb basal joint arthritis (osteotomy of the first metacarpal, trapezial osteotomy, simple trapeziectomy, trapeziectomy with implant, total joint prosthesis, arthroplasty by interposition, etc.) necessitate an anatomically based radiological evaluation of the different pathological forms of thumb basal joint arthritis. Here, the author defines three parameters: narrowing of the trapeziometacarpal (TM) joint space: TMA; TM instability and subluxation: TM I; scaphotrapeziotrapezoid damage: STT. Four stages of TM osteoarthritic deterioration are defined: TMA0: no joint narrowing (painful and unstable joint); TMA1: narrowing <50%; TMA2: narrowing>50%; TMA3: disappearance of the joint space, bone erosions. For TM instability/subluxation: TMI 0: reducible subluxation (unstable and painful TM); TMI 1: reducible subluxation but with imperfect reintegration; TMI 2: non-reducible subluxation <1/3; TMI 3: subluxation>1/3. For STT damage, STT 0: radiograph is normal but anatomical damage is visible intraoperatively; STT 1: joint space narrowing <50%; STT 2: joint space is barely visible; STT 3: presence of erosion, sclerosis, irregularities. He outlines the shortcomings of the often-used Dell and Eaton-Littler classifications. A prospective study involving multiple cases having the same anatomical and radiological appearance that are assessed with sufficient follow-up is needed to standardize the modalities of surgical treatment.
Collapse
Affiliation(s)
- Y Allieu
- Institut Montpelliérain de la main et du membre supérieur (I.M.M.), 560, avenue du Colonel Pavelet, 34070 Montpellier, France.
| |
Collapse
|
31
|
Van Royen K, Gevers M, Vanmierlo B, Scheerlinck T, Goubau J. Radiological measurement of trapezial dysplasia - variation of trapezial tilt and trapezial inclination. Hand Surg Rehabil 2021; 40:44-50. [PMID: 33157271 DOI: 10.1016/j.hansur.2020.10.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 10/04/2020] [Accepted: 10/09/2020] [Indexed: 11/22/2022]
Abstract
Trapeziometacarpal instability is a well-known condition that could lead to trapeziometacarpal osteoarthritis. With the focus in the literature being on ligament insufficiency, bony deformity has received much less attention. Although trapezial tilt is currently used to measure trapezial dysplasia, we believe trapezial inclination is a more reliable measurement. The purpose of this study is to compare these two methods for evaluating trapezial dysplasia and to define the most reproducible measurement. Fifty patients were identified who had three consecutive radiographs of the trapeziometacarpal joint. Eaton views with little to no signs of osteoarthritis (Eaton stage I or II) were used. Both trapezial tilt and trapezial inclination were measured by two independent observers on three radiographs for every patient. Intra-observer variation, absolute agreement and consistency, and intra-observer variation and consistency were assessed for both measurements. Mean trapezial tilt was 135° and mean trapezial inclination was 10°. For both observers, intra-observer variation of trapezial inclination was significantly less than for trapezial tilt. Our study shows that mean trapezial inclination in a middle-aged adult population is approximately 10°. This measurement is more reproducible than the more frequently used trapezial tilt and may be a better parameter to define trapezial dysplasia and to guide its treatment.
Collapse
|
32
|
Remy S, Detrembleur C, Libouton X, Bonnelance M, Barbier O. Trapeziometacarpal prosthesis: an updated systematic review. Hand Surg Rehabil 2020; 39:492-501. [PMID: 32860986 DOI: 10.1016/j.hansur.2020.08.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| |
Collapse
|
33
|
Decot B, Manon J, Lambeaux G, Mathieu D, Barbier O, Libouton X. Trapeziometacarpal total joint replacement as an alternative to trapeziectomy depends on trapezium height: Retrospective study of 67 patients. Hand Surg Rehabil 2020; 39:113-9. [PMID: 32006718 DOI: 10.1016/j.hansur.2019.11.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 09/19/2019] [Accepted: 11/26/2019] [Indexed: 11/22/2022]
Abstract
Surgical indications for trapeziometacarpal (TMC) total joint replacement for thumb basal joint osteoarthritis (OA) are increasing. However, complications following this procedure are not insignificant. To avoid complications, preoperative planning with measurement of trapezium height is indicated to ensure a cup is not implanted in the trapezium if its height is less than 8 millimeters. The objective of our study was to analyze a series of preoperative radiographs of patients managed by trapeziectomy and suspensionplasty in our department, and to assess the possibility of a surgical alternative-total joint replacement-based on the trapezium's height. We also wanted to determine whether radiological height was influenced by the radiological progression of the thumb OA. A single-center retrospective study based on available medical records was conducted. The patients included had TMC OA refractory to conservative treatment and were managed surgically by trapeziectomy and suspensionplasty between 2012 and 2018. Sixty-seven patients were eligible. Based on the Eaton-Littler classification of radiological TMC OA, our case series had 0% (n=0) stage I, 36% (n=24) stage II, 42% (n=28) stage III and 22% (n=15) stage IV findings. We measured the radiological trapezium height on AP and lateral views as described by Kapandji. These were 10.6mm and 10.8mm for stage II, 9.6mm and 8.9mm for stage III, 8.6mm and 7.8mm for stage IV, respectively. Eighty-six percent of patients had a trapezium height suitable for total joint replacement. The radiological height decreased significantly with the OA stage. At stage IV, the average height fell below the 8-mm threshold, compromising the surgical indication for total arthroplasty.
Collapse
|
34
|
Andrzejewski A, Ledoux P. Maïa ® trapeziometacarpal joint arthroplasty: Survival and clinical outcomes at 5 years' follow-up. Hand Surg Rehabil 2019; 38:169-173. [PMID: 30951876 DOI: 10.1016/j.hansur.2019.03.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 03/19/2019] [Accepted: 03/21/2019] [Indexed: 11/16/2022]
Abstract
We sought to report the clinical and radiological outcomes and the survival of Maïa® trapeziometacarpal joint arthroplasty retrospectively at a mean 5 years' follow-up. We evaluated the implant survival and the clinical outcomes of 93 patients (113 prostheses). Patients were examined during a consultation and their mobility, key pinch strength and satisfaction were recorded. Patients also completed a QuickDASH evaluation. The 5-year survival rate was 92.2%. The mean QuickDASH Score was 26.7. The complication rate was 31% and the revision rate was 12.4%. The most common complication was dislocation and the most frequent cause of surgical revision was periprosthetic ossification. We identified two cases of aseptic loosening. This study shows the Maïa® prosthesis provides satisfactory medium-term results and has an excellent 5-year survival. However, the high complication and revision rates are still a major concern.
Collapse
Affiliation(s)
- A Andrzejewski
- Centre Hospitalier de EpiCURA Baudour, 136, rue Louis-Caty, 7334 Baudour, Belgium.
| | - P Ledoux
- Centre Hospitalier de EpiCURA Baudour, 136, rue Louis-Caty, 7334 Baudour, Belgium; Polyclinique du Parc, 48, rue Henri-Barbusse, 59880 Saint-Saulve, France
| |
Collapse
|
35
|
Lucet A, Ligeard M, Salle de Chou E, Hulet C, Malherbe M. Arthroscopic treatment of basal joint arthritis by partial trapeziectomy with ligament reconstruction: Short-term results from a prospective study of 20 patients. Hand Surg Rehabil 2019; 38:102-107. [PMID: 30661962 DOI: 10.1016/j.hansur.2018.11.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 11/14/2018] [Accepted: 11/30/2018] [Indexed: 10/27/2022]
Abstract
Partial trapeziectomy for basal joint arthritis is an alternative to total trapeziectomy that preserves the height of the thumb column. Using arthroscopy reduces the incidence of periarticular lesions and the risks of complications. The purpose of this prospective single-center study was to evaluate the results of arthroscopic partial trapeziectomy combined with suspension and interposition ligament reconstruction using half of the abductor pollicis longus tendon. Twenty patients (18 women, 2 men) with a mean age of 55 years (43-65 years) were operated using this technique between November 2013 to February 2015. Patients were evaluated clinically and radiologically at 1 month, 3 months, 6 months and 12 months after surgery. The 20 patients were reviewed after 12 months. The subjective QuickDASH score improved from the 3rd post-operative month (P = 0.0029) from 50.6 preoperatively to 30.3 after 3 months, 17.6 after 6 months and 9.6 after 12 months. Pain was reduced in the 1st month post-operative (P < 0.0001). The Kapandji Score and pinch strength improved from the 3rd month (P = 0.034). Return to work was possible for 19% of employed patients after 1 month, 44% after 3 months and 87.5% after 6 and 12 months. Eighty-eight percent of the patients were satisfied or very satisfied after 3 months and 95% after 6 and 12 months. Pain levels, range of motion and QuickDASH Score are similar to those of open partial trapeziectomy described in the literature. However, recovery seems to be faster with this arthroscopic technique. Arthroscopic treatment of basal joint arthritis, which limits capsule and ligament lesions, leads to good short- and medium-term results in terms of pain relief and thumb motion while preserving strength. LEVEL OF EVIDENCE: 4 (Prospective, non-randomized).
Collapse
Affiliation(s)
- A Lucet
- Service d'orthopédie et de traumatologie, CHU de Caen, avenue de la côte de nacre, 14000 Caen, France.
| | - M Ligeard
- Service d'orthopédie et de traumatologie, CHU de Caen, avenue de la côte de nacre, 14000 Caen, France.
| | - E Salle de Chou
- Service d'orthopédie et de traumatologie, CHU de Caen, avenue de la côte de nacre, 14000 Caen, France.
| | - C Hulet
- Service d'orthopédie et de traumatologie, CHU de Caen, avenue de la côte de nacre, 14000 Caen, France.
| | - M Malherbe
- Service d'orthopédie et de traumatologie, CHU de Caen, avenue de la côte de nacre, 14000 Caen, France.
| |
Collapse
|
36
|
Vigouroux F, Rabarin F, Jeudy J, Bigorre N, Saint Cast Y, Pechmajou L, Raimbeau G. Peritrapezial osteoarthritis: Inter- and intraobserver reliability of the Allieu classification. Hand Surg Rehabil 2017; 36:363-7. [PMID: 28822670 DOI: 10.1016/j.hansur.2017.06.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 05/24/2017] [Accepted: 06/02/2017] [Indexed: 11/21/2022]
Abstract
The Allieu classification takes into consideration the distal and proximal joints of the trapezium. Trapeziometacarpal (TMC) joint arthritis, TMC joint instability (TMI) and scapho-trapezio-trapezoid (STT) joint arthritis are considered independently, which better corresponds to the anatomical examinations. The aim of the study was to evaluate the inter- and intraobserver reliability of the Allieu classification of the peritrapezial arthritis. This was a prospective, single-center study performed from May to September 2016 with 30 cases of primary thumb osteoarthritis. Five raters scored the X-rays twice. In the Allieu classification, TMC arthritis is scored as "0" when the TMC joint is normal, "1" when the TMC joint space is <50% narrowed, "2" when the TMC joint space is >50% narrowed, "3" when the joint space is loose with advanced degenerative changes. TMI is scored as "0" for reducible subluxation, painful and unstable joint, "1" for advanced reducible subluxation, "2" for chronic subluxation <1/3 of the surface, "3" for chronic subluxation >1/3 of the surface. STT joint arthritis is scored as "0" for normal joint space, "1" for joint space narrowing <50%, "2" for important joint space narrowing and "3" for advanced degenerative changes with sclerotic subchondral bone changes. Inter- and intraobserver reliability was assessed using the weighted Cohen's kappa coefficient. Additional analyses were undertaken to determine the intraclass correlation coefficient (ICC) for the overall raters. The interobserver reliability was "moderate" to "substantial" for the TMC arthritis; "fair" to "substantial" for STT arthritis and "fair" to "substantial" for TMI. The intraobserver reliability was "moderate" to "excellent" for TMC arthritis (2 "excellent", 2 "substantial", 1 "moderate"); "fair" to "excellent" for the STT (1 "excellent", 2 "substantial", 1 "moderate", 1 "fair") and "fair" to "excellent" for the TMI (1 "excellent", 2 "substantial", 1 "moderate", 1 "fair"). The worst reliability, either for intra- or interobserver, was for TMI. The ICC for TMC arthritis was 0.67 (95%CI, 0.28-0.83); for STT it was 0.47 (95%CI, 0.15-0.66) and for TMI it was 0.30 (95%CI, 0.23-0.70), which is "fair". This study confirms a large variation in X-ray staging for peritrapezial arthritis. It shows that the Allieu classification is moderately reliable. However, the interobserver reliability was better for evaluating the TMC than the STT and worse for TMI. The classification for TMC and STT is simple to apply, based principally on the joint narrowing. The intraobserver is better than the interobserver reliability.
Collapse
|
37
|
Willekens P, Verstraete K, Hollevoet N. Foreign body reaction after trapeziectomy and Dacron interposition. Hand Surg Rehabil 2016; 35:27-33. [PMID: 27117021 DOI: 10.1016/j.hansur.2015.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 11/04/2015] [Accepted: 11/06/2015] [Indexed: 11/19/2022]
Abstract
The purpose of this study was to evaluate patients who were treated with trapeziectomy and Dacron interposition in our hospital and to describe the incidence of foreign body reactions. Between 2004 and 2010, 10 women with trapeziometacarpal osteoarthritis underwent Dacron interpositional arthroplasty. One patient had surgery in both hands. Implants were removed in two patients, 5 and 8 years postoperatively. Histological analysis confirmed the presence of a foreign body reaction with giant cells in both cases. At a mean follow-up of 9 years, seven patients with the implant still in place were available for review and clinical examination. Mean DASH score was 32 and mean VAS for pain and satisfaction was 1.6 and 8.8, respectively. Mean grip strength was 11.4kg and mean key pinch strength was 1.5kg. Recent radiographs were available in nine hands. Seven out of nine hands had radiological signs of a foreign body reaction with bone erosion. A severe reaction occurred in three patients. We no longer use the Dacron implant and recommend careful monitoring of all patients in whom this implant has been used.
Collapse
Affiliation(s)
- Philippe Willekens
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium.
| | - Koenraad Verstraete
- Department of Radiology, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium.
| | - Nadine Hollevoet
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium.
| |
Collapse
|
38
|
Semere A, Vuillerme N, Corcella D, Forli A, Moutet F. Results with the Roseland(®) HAC trapeziometacarpal prosthesis after more than 10 years. ACTA ACUST UNITED AC 2015; 34:59-66. [PMID: 25769771 DOI: 10.1016/j.main.2015.01.004] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 11/30/2014] [Accepted: 01/05/2015] [Indexed: 11/29/2022]
Abstract
The Roseland(®) hydroxyapatite-coated prosthesis is a total trapeziometacarpal joint prosthesis used for the surgical treatment of thumb basal joint arthritis. The aim of this retrospective study was to evaluate its long-term outcomes. Fifty-one patients (64 thumbs) underwent trapeziometacarpal joint replacement with this prosthesis. The mean follow-up was 12.5 years. Survival rate of the prosthesis was 91%. There was either no pain or only occasional pain in 91% of cases. The mean QuickDASH score was 27.6. Abnormal radiographic findings were present in 70% of cases. Since they were often asymptomatic, no further treatment was carried out. Complications were common (25%) and occurred early on but could often be treated without surgery. The long-term results with the Roseland(®) HAC prosthesis are satisfactory in terms of pain relief and function. However, the high complication rate is a major concern.
Collapse
Affiliation(s)
- A Semere
- Service de chirurgie de la main et des brûlés, hôpital Michallon, CHU de Grenoble, boulevard de la Chantourne, BP217, 38043 Grenoble cedex 09, France.
| | - N Vuillerme
- Laboratoire AGIM-FRE 3405 équipe AFIRM, faculté de médecine, université Joseph-Fourier, domaine de la Merci, 38706 La Tronche, France
| | - D Corcella
- Service de chirurgie de la main et des brûlés, hôpital Michallon, CHU de Grenoble, boulevard de la Chantourne, BP217, 38043 Grenoble cedex 09, France
| | - A Forli
- Service de chirurgie de la main et des brûlés, hôpital Michallon, CHU de Grenoble, boulevard de la Chantourne, BP217, 38043 Grenoble cedex 09, France
| | - F Moutet
- Service de chirurgie de la main et des brûlés, hôpital Michallon, CHU de Grenoble, boulevard de la Chantourne, BP217, 38043 Grenoble cedex 09, France
| |
Collapse
|
39
|
Taleb C, Berner S, Mantovani Ruggiero G. First metacarpal resurfacing with polyvinyl alcohol implant in osteoarthritis: preliminary study. ACTA ACUST UNITED AC 2014; 33:189-95. [PMID: 24880607 DOI: 10.1016/j.main.2014.03.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Revised: 01/27/2014] [Accepted: 03/01/2014] [Indexed: 11/16/2022]
Abstract
Osteoarthritis of first carpometacarpal (CMC) joint is a condition that is frequently encountered in hand surgery. If conservative treatment fails, several surgical procedures are available ranging from arthroscopic debridement to total joint arthroplasty. This study focuses on a new resurfacing technique for the base of the first metacarpal using a polyvinyl alcohol hydrogel implant. Our preliminary study found good clinical outcomes and no inflammatory reaction after a follow-up of 30 months. However prospective studies with a longer follow-up and more patient are needed to confirm these results.
Collapse
Affiliation(s)
- C Taleb
- Hand surgery department, Beneficência Portuguesa de Sao Paulo Hospital, Sao Paulo, Brazil; Hand surgery department, University Hospital of Strasbourg, 21075 Illkirch, France.
| | - S Berner
- Hand surgery department, Sinai Hospital of Baltimore, Maryland, USA
| | - G Mantovani Ruggiero
- Hand surgery department, Beneficência Portuguesa de Sao Paulo Hospital, Sao Paulo, Brazil
| |
Collapse
|