Modified Burton and Pellegrini procedure for trapezium excision, ligament reconstruction and interposition arthroplasty of the tendon of flexor Carpi radialis

First metacarpal extension-abduction osteotomy effect on joint remodeling and articular cartilage repair in thumb carpometacarpal osteoarthritis

BACKGROUND

The first metacarpal osteotomy is a joint-preserving surgery for thumb carpometacarpal (CMC) osteoarthritis that improves pain and function. However, its effects on joint remodeling and articular cartilage repair under physiological conditions remain unclear. This study aimed to clarify these aspects using computed tomography (CT)-based subchondral bone density analysis and arthroscopic evaluation.

METHODS

Fifteen hands of 14 patients who underwent a first metacarpal extension-abduction osteotomy for thumb CMC osteoarthritis were included. CT scans were performed preoperatively and one year postoperatively to assess changes in subchondral bone density (measured in Hounsfield units [HU]) across nine regions of the first metacarpal and trapezium articular surfaces. Arthroscopic evaluation of the articular cartilage was performed at the time of osteotomy and at implant removal one year postoperatively using the International Cartilage Repair Society (ICRS) grading scale.

RESULTS

Preoperatively, higher HU values (median [interquartile range]) were observed in the palmar regions of the first metacarpal (758 [643-803] HU) and the central regions of the trapezium (898 [867-960] HU). One year after osteotomy, these values decreased significantly in these initially high-stress regions (first metacarpal palmar regions: 433 [307-475] HU, p <.001; trapezium central regions: 571 [508-649] HU, p <.001; Wilcoxon matched-pairs signed rank test), indicating a more uniform stress distribution. Arthroscopic evaluation revealed improvements in ICRS grade in five out of nine cases on the metacarpal side and four out of nine cases on the trapezium side.

CONCLUSIONS

The first metacarpal extension-abduction osteotomy alters the abnormal stress distribution patterns in thumb CMC osteoarthritis, leading to a more uniform stress distribution across the joint. Arthroscopic findings suggest that articular cartilage repair may occur following osteotomy. These results provide new insights into the mechanisms underlying the clinical benefits of this procedure and support its use as a joint-preserving surgery for thumb CMC osteoarthritis.

Comparison of arthrodesis and arthroplasty of Chinese thumb carpometacarpal osteoarthritis

Background

The thumb carpometacarpal (CMC) osteoarthritis is very common. Multiple methods are used to treat progressive thumb CMC osteoarthritis, among which trapeziometacarpal arthrodesis and trapezial excision with ligament reconstruction and tendon interposition (LRTI) are the most common. These two surgical treatment methods have received mixed reviews in previous studies in the west patients. This retrospective study studied the effects, advantages, and disadvantages of arthrodesis and arthroplasty for treating thumb carpometacarpal osteoarthritis in Chinese patients.

Methods

Between February 2012 and September 2017, 39 Chinese patients with stage II or III thumb carpometacarpal osteoarthritis underwent surgery (trapeziometacarpal arthrodesis in 22, trapezial excision with ligament reconstruction and tendon interposition in 17). Postoperative objective and subjective evaluations were performed. The objective evaluation involved grip strength, pinch strength, thumb abduction degree (palmar and radial), and Kapandji opposition scores. The subjective evaluation involved visual analog scale (VAS) and Disabilities of the Arm, Shoulder, and Hand (DASH) scores.

Results

Intergroup differences in pinch strength, thumb abduction degrees (palmar and radial), and Kapandji opposition scores were obvious, whereas those in grip strength, VAS score, and DASH score were not.

Conclusion

In Chinese patients, both techniques relieved pain and improve grip strength. Arthrodesis displayed better pinch strength, while arthroplasty displayed better motor function. Patients were satisfied with the effects of both techniques.

Dubious space for Artelon joint resurfacing for basal thumb (trapeziometacarpal joint) osteoarthritis. A systematic review

INTRODUCTION

Trapeziometacarpal arthritis is a common and disabling condition. There is no evidence in the literature of superiority of one surgical procedure over others. Several prosthetic implants have been introduced to preserve joint mobility.

SOURCED OF DATA

We searched the on Medline (PubMed), Web of Science and Scopus databases using the combined keywords 'artelon', 'thumb', 'carpometacarpal', 'trapeziometacarpal' and 'rhizoarthrosis'; 11 studies were identified.

AREAS OF AGREEMENT

The use of Artelon implant is not recommended because of its high revision rate and worse outcomes compared to conventional techniques.

AREAS OF CONTROVERSY

Inert materials subjected to compressive and shearing forces could produce debris and subsequent inflammatory response. There is debate in the published scientific literature regarding the role of preoperative antibiotic profilaxis and post-surgery inflammatory response.

GROWING POINTS

Standard techniques such as trapeziectomy alone or combined with interposition or suspensionplasty offer effective treatment for thumb basal joint arthritis.

AREAS TIMELY FOR DEVELOPING RESEARCH

Several prosthetic implants show promising results in terms of pain relief and functional request, but there is a need of long-term randomized controlled trials to demonstrate their equivalence, and eventually superiority, compared to standard techniques.

Small joints replacement for hand osteoarthritis: a systematic review

INTRODUCTION

Small joints replacement is a valid treatment for moderate to severe osteoarthritis of the hand. Several design and materials are now available for prostethic procedures with very different clinical and functional outcomes.

SOURCES OF DATA

An online search was carried out using Medline, Cochrane and Google scholar online databases, searching for studies on small joints replacement in hand surgery.

AREAS OF AGREEMENT

Good functional and clinical outcomes can be achieved with silicone and pyrolitic carbon implants, either for trapeziometacarpal and metacarpophalangeal joints. In particular, the silicone spacer seems to be very effective for trapeziometacarpal osteoarthrosis, while the pyrolitic carbon total joint prosthesis produces excellent outcomes if used for metacarpophalangeal replacement. Major complications, such as persistent pain and implant loosening, have still a variable rate of occurrence.

AREAS OF CONTROVERSY

Heterogeneity in the methodology of the assessments in the studies reviewed and the implants and techniques involved makes it difficult to carry out a complete and effective comparative analysis of the data collected.

GROWING POINTS

Larger cohorts treated with the same implant should be investigated in better designed trials, to draw more clinically relevant conclusions from the evidences presented. Better methodology is also a goal to achieve, since the average Coleman Methodology Score measured for the articles included was 54.9 out of 100.

RESEARCH

More and better designed studies are needed to produce clear guidelines to define the better implant in terms of clinical outcomes, function and complications for trapeziometacarpal and metacarpophalangeal joints.

Surgical treatment of thumb carpometacarpal joint arthritis: a single institution experience from 1995-2005

There are numerous techniques for the surgical management of thumb carpometacarpal (CMC) joint arthritis. The four senior authors of this study employ three such techniques: trapeziectomy with hematoma distraction arthroplasty, hemitrapeziectomy with osteochondral allograft, and ligament reconstruction tendon interposition (LRTI). This study examines the three commonly utilized procedures at a single institution. This study examines the 10-year experience from 1995-2005 with a minimum 3-month follow-up. Disabilities of the arm, shoulder, and hand (DASH) scores, pre-and postoperative pinch strength, and operative time were examined. After approval from the institutional review board of our institution was obtained, all patients treated surgically by three of the senior authors were contacted via mail and phone. Each patient was asked to complete and return a DASH questionnaire. Of the 115 patients treated during that period, 60 participated in this study. Each patient's final postoperative pinch measurement was obtained from occupational therapy and clinic records. This pinch strength was compared to the preoperative pinch and contralateral pinch strength. Lastly, the total operative time for each procedure was obtained from the operative record. The only significant finding in this study was a shorter mean operative time with the trapeziectomy group (76.90 min) and osteochondral allograft group (90.45 min) when compared to the LRTI group (139.00 min; p = 0.001 and p = 0.001, respectively). We found no significant difference between groups in terms of DASH score and pinch strength. There was no difference between the techniques in terms of postoperative pinch strength and patient satisfaction measured by DASH scores. The operative times for trapeziectomy and hematoma interposition as well as the osteochondral allograft were significantly shorter than that of the LRTI. This presents further evidence that potentially, "less is more" in the treatment of thumb CMC arthritis. We used a retrospective study design to evaluate potential differences between the three surgical techniques described above, therapeutic, levels III-IV.