Time to return to work after total trapeziometacarpal prosthesis

Five-to-8-year prospective follow-up of 61 Touch® trapeziometacarpal prostheses

OBJECTIVE

The purpose of this study was to evaluate the clinical and radiologic outcomes of the first patients who received a dual-mobility trapeziometacarpal prosthesis in our centre, for first carpometacarpal joint osteoarthritis, with a minimum 5-year follow-up.

PATIENTS AND METHODS

Fifty-seven patients received a total trapeziometacarpal ball-and-socket arthroplasty with the Touch® prosthesis for severe arthritis and one for significant laxity. Four patients underwent bilateral surgery. One was lost of follow-up and three died during the study. Function was assessed before surgery and at one, 3, 5 and 10-years follow-up visits. Visual analog scale for pain, active thumb range of motion, including Kapandji's score, key-pinch grip strength and patients' satisfaction outcomes were recorded by an independent observer. Standardized radiographs were obtained to assess osteolysis, loosening, and subsidence.

RESULTS

Patients were followed for an average of 6.5 years (5-8.8). Pain decreased from 7.3 to 0.4, range of motion increased, and key grip strength improved from 67% to 102% of the contralateral side. Metacarpophalangeal hyperextension was present in 26 thumbs (46%) before surgery (5 severe, more than 30°), and in 19 thumbs (33%) at follow-up. Z-deformity was reported in 13 cases (23%) preoperatively and in 2 cases (4%) postoperatively. At maximum follow-up, radiographs showed minor osteolysis in 4 cases (7%) around the trapezium component and in 7 cases (12%) around the metacarpal component. One revision (2%) was required for cup loosening 7 years after surgery. All patients were satisfied or very satisfied with the treatment.

CONCLUSIONS

This prospective study of 61 Touch® dual mobility prostheses confirms that this implant is a safe and effective treatment option for trapeziometacarpal osteoarthritis in the short and medium term. Continued follow-up is necessary to assess the long-term outcomes of this arthroplasty.

LEVEL OF EVIDENCE

II.

Time to return to work after dual-mobility trapeziometacarpal prosthesis. A retrospective study of 179 patients

Treatment of trapeziometacarpal joint osteoarthritis with a dual-mobility prosthesis offered a quick convalescence and return to work (median 51 days) in patients ranging between 40 and 67 years of age. No significant difference was found between office workers and labourers.

Trapeziometacarpal total joint arthroplasty, with or without supervised hand rehabilitation: A quasi-experimental trial

Introduction

Aim of this study was to determine whether postoperative supervised rehabilitation improves functional outcomes after trapeziometacarpal (TMC) total joint arthroplasty (TJA), compared to education alone.

Method

A quasi-experimental before-after trial included 31 women (≥40 years) per group diagnosed with trapeziometacarpal osteoarthritis who underwent TJA. A cohort (n = 31) who was given education alone was compared to a cohort (n = 31) who were subjected to supervised rehabilitation. Primary outcome was the difference in hand function 3 months postoperatively, measured by the Michigan Hand Outcomes Questionnaire (MHOQ). Other outcomes were the MHOQ subscale scores, the active range of motion, strength, time to return to work, satisfaction and complications.

Results

Patients in the education group had a significantly higher median delta MHOQ score when compared to the rehabilitation group at 3 months; 28.5 (20.5-31.3) versus 15.8 (1.9-21.1), (p = <0.01) and at 12 months 36.6 (26.8 - 47.2) versus 27.4 (14.5 - 33.0), (p = 0.01). Only the secondary outcomes the MHOQ subscales hand function, ADL and satisfaction revealed significant differences in favor of the education group. The education method reduced the median number of hand therapy sessions with eight visits.

Conclusion

The present study does not show a significant or clinically relevant benefit from supervised rehabilitation in terms of functional outcomes following TJA compared to education alone. Based on this, it seems safe to leave patients unsupervised in their recovery following TJA and to suffice with just education, however further exploration of effectiveness and safety of this intervention is recommend in larger trials.

Total Arthroplasty Versus Trapeziectomy With Ligamentoplasty for Trapeziometacarpal Osteoarthritis: 5-year Outcomes

BACKGROUND

Trapeziometacarpal (TMC) osteoarthritis is the most prevalent osteoarthritis of the upper limb. It is one of the most disabling conditions. Currently, the most suitable surgical technique is debated. Trapeziectomy with ligamentoplasty continues to be the gold standard; however, results for function, esthetics, and quality of life have not been optimal. For this reason, surgeons have continued to refine and develop various surgical techniques, among which total arthroplasty is increasingly emerging as a major alternative, but it has not yet demonstrated superiority and its durability is still in doubt.

QUESTIONS/PURPOSES

At a minimum follow-up time of 5 years, do patients with total basilar thumb arthroplasty, compared with patients with trapeziectomy and ligament reconstruction, have (1) better pain as measured by a VAS scale, (2) lower disability as measured by the DASH, and (3) better tip pinch strength and functional range?

METHODS

This was a prospective study conducted in a specialized hand surgery unit within a tertiary-level referral hospital located in an urban area, with 54 patients diagnosed with TMC osteoarthritis administratively assigned to two different surgeons. Between February 2018 and June 2018, we treated 54 patients for TMC osteoarthritis. Of those, we considered as potentially eligible patients who met the following inclusion criteria: TMC osteoarthritis classified as Eaton-Littler Type III or IV, good bone quality, persistent pain lasting for > 6 months, and failure to respond to conservative treatment. The study was designed as a parallel group study in which patients treated by one surgeon were treated with total arthroplasty and patients treated by the other study surgeon were treated with trapeziectomy with ligamentoplasty. Patients were administratively assigned to their groups, and the surgeons were comparably experienced and performed similar surgical volumes. A total of 27 patients were treated with total arthroplasty, and 27 patients were treated with trapeziectomy with ligamentoplasty. One patient in the total arthroplasty group was lost to follow-up after the intervention for personal reasons unrelated to the study or the disorder. For this reason, that patient was excluded from the study. Finally, among the 26 patients who underwent arthroplasty at the end of the follow-up period, 96% (25) were women, and the mean ± SD age was 59 ± 8 years. Four percent (1) of patients were lost to follow-up before 5 years. Of the 27 patients who received ligament reconstruction and tendon interposition, 96% (26) were women with a mean ± SD age of 59 ± 7 years. A total of 0% (0) were lost to follow-up before 5 years. This left 96% (26) of patients in the total arthroplasty group and 100% (27) in the tendon interposition arthroplasty group, respectively. The mean ± SD follow-up time for all patients was 78 ± 4 months. The mean follow-up time for patients who received total arthroplasty was 78 ± 4 months, and it was 77 ± 3 months for those who received trapeziectomy with ligamentoplasty. The minimum follow-up period for inclusion was 5 years (60 months). Patients in the two treatment groups did not differ in terms of age, sex, dominant hand surgery, functional work requirement, concomitant disorder, radiographic characteristics, and Eaton-Littler stage, but a higher percentage of patients in the total arthroplasty group had carpal tunnel syndrome at the time of presentation (58% [15 of 26] versus 30% [8 of 27]; p = 0.04). Pain was assessed using a VAS ranging from 0 (pain free) to 10 (maximum pain), with a clinically significant change defined as 0.7 to 0.9. Functionality was evaluated using the DASH questionnaire, with a minimum clinically important difference (MCID) of 10.83. Secondary outcomes included mobility, measured through radial abduction and retropulsion of the thumb using a goniometer, and thumb opposition assessed by the Kapandji index, which scores opposition on a scale of 0 to 10. Grip strength was measured with a pinch gauge, averaging three measurements, with an MCID of 0.33 kg.

RESULTS

At 5 years, patients who had total arthroplasty had less pain compared to patients with trapeziectomy with ligament reconstruction (VAS 1.3 ± 0.7 versus 3.0 ± 0.9, mean difference 1.7 [95% confidence interval (CI) 1.3 to 2.1]; p < 0.001). Patients who had total arthroplasty had lower scores for upper extremity disability at 5 years (DASH 11 ± 9 versus 28 ± 12, mean difference -17 [95% CI -22 to -12]; p < 0.001). There was no clinically important difference between the groups in terms of tip pinch strength as measured in kg (3.7 ± 0.6 versus 3.2 ± 0.6, mean difference 0.4 [95% CI 0.1 to 0.8]; p = 0.01). Regarding mobility, we found differences between the total arthroplasty group and the trapeziectomy with ligamentoplasty group at 5 years of follow-up (Kapandji score 9.9 ± 0.4 versus 8.5 ± 0.6, mean difference 1.4 [95% CI 1.0 to 1.8]; p < 0.001).

CONCLUSION

In light of these findings, surgeons should consider total arthroplasty as a first-line therapeutic option for patients with advanced TMC arthritis, especially those with significant pain and persistent functional limitations. While both treatments offer benefits, total arthroplasty provides superior pain relief and greater improvement in functional disability. Future studies should focus on the long-term durability of total arthroplasty compared to trapeziectomy with ligamentoplasty, with follow-up visits extending beyond 10 to 20 years to assess implant longevity and potential late complications.Level of Evidence Level II, therapeutic study.

Functional outcome of trapeziometacarpal prostheses in pan-trapezial osteoarthritis

Trapeziometacarpal osteoarthritis is frequently associated with scaphotrapeziotrapezoid osteoarthritis. Long-term outcomes have not been reported for trapeziometacarpal protheses in patients with radiological pan-trapezial osteoarthritis that is symptomatic only in the trapeziometacarpal compartment. The primary objective of this retrospective multicenter multi-operator study was to evaluate the effectiveness of trapeziometacarpal arthroplasty for pain relief in patients with radiographic pan-trapezial osteoarthritis without symptomatic scaphotrapeziotrapezoid involvement. A total of 70 thumbs in 67 patients were evaluated by a single independent operator at a mean follow-up of 58 months. Scaphotrapeziotrapezoid osteoarthritis severity on Crosby score was stage II in 84% of patients and stage III in 16%. Mean pain score on visual analog scale decreased from 7.7 preoperatively to 1.3 at last follow-up. There were no reoperations at last follow up. These results suggest that, in patients with radiological pan-trapezial osteoarthritis without symptomatic involvement of the scaphotrapeziotrapezoid joint, a trapeziometacarpal prothesis yields good medium-term clinical outcomes. LEVEL OF EVIDENCE: III.

Pyrocardan® implant interposition in the trapeziometacarpal joint: outcomes at a minimum 10 years' follow-up

OBJECTIVE

We present long-term results for the Pyrocardan®, a pyrocarbon trapeziometacarpal interposition implant used for the treatment of osteoarthritis of the thumb.

METHODS

Between March 2009 and May 2013, 199 arthroplasties were performed in a single hand center, in 184 patients by 6 hand surgeons. 107 implants were followed up for a mean 137 months (range, 120-168 months). 82 patients (89 implants) were lost to follow-up.

RESULTS

Median age was 57 years, with 15 patients (14.2%) aged ≤50 years. At last follow-up, functional scores were significantly improved compared to preoperative data: pain rating, 0.4/10 versus 7.2/10; Patient-Rated Wrist/Hand Evaluation, 4/100 versus 61/100; Quick Disabilities of the Arm, Shoulder and Hand, 9/100 versus 54/100. Range of motion and strength were comparable to the contralateral side. Radiographic analysis showed that 82% of implants were correctly positioned. No implant dislocation was observed. There were 6 re-operations, 5 of which in the short term. Overall implant survival was 94.3%, with 44.7% loss to follow-up.

CONCLUSION

Pyrocardan® interposition arthroplasty is a valid alternative for the treatment of osteoarthritis of the thumb.

LEVEL OF EVIDENCE

IV.

Immobilization, rehabilitation and complications classification after thumb trapeziometacarpal total joint arthroplasty. A scoping review

The best way of immobilization as well as effectiveness of rehabilitation for trapeziometacarpal total joint arthroplasty is unknown. We aimed to identify and describe the available evidence, practice variation and knowledge gaps. The literature was searched without restrictions. 123 studies were included, reporting 21 types of prosthesis. Reported immobilization types were cast (23%), splint (18%), compression bandage (10%), or combinations (26%). In 19%, immobilization time and type was not reported. Supervised rehabilitation (22%), self-rehabilitation (11%), functional use (11%), or customized rehabilitation (16%) were the rehabilitation forms reported. In 28% rehabilitation type was not described. Two (2%) studies used complication classifications, but time to complication was not described in 53 (43%). Multiple evidence gaps exist; lacking studies comparing types of immobilization protocols as well as rehabilitation regimens after trapeziometacarpal total joint arthroplasty. Currently there is no scientific evidence for any postoperative regime. This means that decision-making is based on clinical experience rather than evidence, explaining the wide practice variation.

Dual Mobility Trapeziometacarpal Joint Arthroplasty: A Survey on Variations in Surgical Techniques and Patient Management

Background: Dual mobility total joint arthroplasty is gaining popularity for trapeziometacarpal joint (TMCJ) arthritis, with evolving indications, surgical technique and rehabilitation. The aim of this study was to obtain detailed insight into the variations in indications, surgical technique and rehabilitation for TMCJ arthroplasty with dual mobility implants, across a large international cohort of surgeons. The secondary aim was to analyse if there were differences in TMCJ arthroplasty between highly and less experienced surgeons. Methods: An anonymised online survey was developed and distributed to the international hand surgery community of surgeons performing TMCJ arthroplasty. Responses were summarised, and a sub-analysis comparing indications, contra-indications, surgical technique, implant placement, rehabilitation and complications between highly and less experienced surgeons was performed. Results: Of the 203 included respondents, 59 were considered highly experienced. Most respondents perform TMCJ arthroplasty under regional anaesthesia (84%), via a dorsolateral approach (78%) and with image-guidance for cup placement (84%). However, there is considerable variation in handling of scaphotrapeziotrapezoidal (STT) arthritis, cup positioning landmarks, postoperative immobilisation, first extensor compartment release and revision techniques. Highly experienced surgeons performed TMCJ arthroplasty for a larger proportion of their patients undergoing surgery for TMCJ arthritis, and a trapezium smaller than 8 mm or STT-OA was less frequently considered a contra-indication. Highly experienced surgeons preferred freehand osteotomy of the metacarpal and allowed office workers to return to work earlier. Conclusions: This survey shows that there is considerable variation in (contra)indications, surgical technique and rehabilitation amongst surgeons performing TMCJ arthroplasty, but only a few differences between highly and less experienced surgeons were identified. This data provides a reference for surgeons who want to familiarise themselves with increasingly popular procedure and may help surgeons already performing TMCJ arthroplasty to identify potential topics for future research to optimise its outcome. Level of Evidence: Level V (Therapeutic).

Comparative Analysis of Prosthetic (Touch) and Arthroplastic Surgeries for Trapeziometacarpal Arthrosis: Functional Outcomes and Patient Satisfaction With a 2-Year Follow-Up

Purpose

Trapeziometacarpal (TMC) joint prosthesis poses its own challenges for the treatment of TMC arthrosis, especially when compared with the present gold standard, arthroplasty. The aim of this study was to highlight possible outcome differences and patients' satisfaction regarding the treatment of TMC arthrosis.

Methods

We evaluated 100 patients with TMC arthrosis treated in two centers and divided into two groups: group A received TMC prosthesis (Touch), whereas group B was treated with arthroplasty, with a 2-year follow-up period.

Results

In a comparative analysis, findings revealed group A's superiority in the shortened disabilities of the arm, shoulder and hand questionnaire scores at 1 and 6 months, with significant differences: 34.6% vs 67.1% and 2% vs 9.1%, respectively (P < .0001). Although group A also showed lower the shortened disabilities of the arm, shoulder and hand questionnaire scores at 3 months, this was not statistically significant. Notably, at 1 and 2 years, group A demonstrated better scores without statistical significance. The Kapandji score differed significantly at 6 months: 9.8 vs 9.1 (P = .029). Although the visual analog scale showed generally lower values for the prosthesis group, no statistical differences emerged. Additionally, the M1/M2 ratio became significant postoperatively, favoring group A (P < .05).

Conclusions

Trapeziometacarpal prosthesis shows promise for TMC arthrosis, enhancing function, thumb length, and patient recovery, warranting further research and x-ray guidance.

Type of study/level of evidence

Therapeutic III.