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Windhofer CM, Neureiter J, Schauer J, Zimmermann G, Hirnsperger C. Trapeziectomy versus Maïa Prosthesis in Trapeziometacarpal Osteoarthritis. J Wrist Surg 2024; 13:142-150. [PMID: 38505211 PMCID: PMC10948241 DOI: 10.1055/s-0043-1770793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 05/29/2023] [Indexed: 03/21/2024]
Abstract
Background Osteoarthritis at the base of the thumb is the most frequent osteoarthritis of the hand. Trapeziectomy in a broad variety of surgical methods have been proposed to achieve pain reduction and improvement of thumb function. A well-known disadvantage is the long recovery time. Arthroplasty of the thumb carpometacarpal joint is a competing new method for this indication with different revision and complication rates reported. Purposes The aim of this study is to assess whether there are significant differences in outcome during the first 12 months and time return to work after either, implant of a Maïa joint prosthesis, or trapeziectomy with tendon interposition after Weilby. Patients and Methods This clinical follow-up study compares the efficacy of total basal joint replacement using the Maïa prosthesis with tendon interposition arthroplasty in 59 thumbs. Clinical, functional, and radiological results at preoperative, 3-, 6-, and 12-month postoperative are presented. Results We found a significant shorter return to work in the prosthesis group with 4.5 compared with 8.6 weeks. In addition to a significant difference in pain reduction with a better Mayo wrist score in the Maïa group after 3 months. The scores are closer after 6 months and nearly match after 12 months. Measurement of the pinch grip showed a parallel course. A radiological loosening of the cup in two patients was detected after 12 months. Conclusion Implantation of Maïa prosthesis enables a significant shorter recovery but is associated with the risk of loosening and higher costs. Level of Evidence Level IV, case-control study.
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Affiliation(s)
- Christian M. Windhofer
- Department Traumatology, AUVA Trauma Center Salzburg, Salzburg, Austria
- Ludwig-Boltzmann-Institute for Experimental and Clinical Traumatology in AUVA Trauma Research Center, Wien, Austria
| | - Johann Neureiter
- Department Traumatology, AUVA Trauma Center Salzburg, Salzburg, Austria
| | - Josef Schauer
- Department Traumatology, AUVA Trauma Center Salzburg, Salzburg, Austria
| | - Georg Zimmermann
- Team Biostatistics and Big Medical Data, IDA Lab Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria
- Research and Innovation Management, Paracelsus Medical University, Salzburg, Austria
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Mangan F, Spece H, Weiss APC, Ladd AL, Stockmans F, Kurtz SM. A review of wear debris in thumb base joint implants. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:251-269. [PMID: 37439887 DOI: 10.1007/s00590-023-03622-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 06/17/2023] [Indexed: 07/14/2023]
Abstract
AIM Polymers and metals, such as polyethylene (PE) and cobalt chrome (CoCr), are common materials used in thumb-based joint implants, also known as CMC (Carpometacarpal) arthroplasty. The purpose of this review was to investigate the reported failure modes related to wear debris from these type of materials in CMC implants. The impact of wear debris on clinical outcomes of CMC implants was also examined. Potential adverse wear conditions and inflammatory particle characteristics were also considered. METHOD A literature search was performed using PRISMA guidelines and 55 studies were reviewed including 49 cohort studies and 6 case studies. Of the 55 studies, 38/55 (69%) focused on metal-on-polyethylene devices, followed by metal-on-metal (35%), and metal-on-bone (4%). RESULTS The summarized data was used to determine the frequency of failure modes potentially related to wear debris from metals and/or polymers. The most commonly reported incidents potentially relating to debris were implant loosening (7.1%), osteolysis (1.2%) and metallosis (0.6%). Interestingly the reported mechanisms behind osteolysis and loosening greatly varied. Inflammatory reactions, while rare, were generally attributed to metallic debris from metal-on-metal devices. Mechanisms of adverse wear conditions included implant malpositioning, over-tensioning, high loading for active patients, third-body debris, and polyethylene wear-through. No specific examination of debris particle characterization was found, pointing to a gap in the literature. CONCLUSION This review underscores the types of failure modes associated with wear debris in CMC implants. It was found that failure rates and adverse wear conditions of CMC implants of any design are low and the exact relationship between wear debris and implant incidences, such as osteolysis and loosening remains uncertain. The authors note that further research and specific characterization is required to understand the relationship between debris and implant failure.
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Affiliation(s)
| | - Hannah Spece
- Drexel University, Philadelphia, PA, USA
- Gyroid, LLC, Haddonfield, NJ, USA
| | | | | | | | - Steven M Kurtz
- Drexel University, Philadelphia, PA, USA
- Gyroid, LLC, Haddonfield, NJ, USA
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Chiche L, Chammas PE, Vial D'Allais P, Lazerges C, Coulet B, Chammas M. Long-term survival analysis of 191 MAÏA® prostheses for trapeziometacarpal arthritis. J Hand Surg Eur Vol 2023; 48:101-107. [PMID: 36329561 DOI: 10.1177/17531934221136442] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Surgery for trapeziometacarpal osteoarthritis after failure of medical treatment remains controversial. The aim of this study was to determine the long-term results of the MAÏA® trapeziometacarpal prosthesis (Lépine, Genay, France). This was a retrospective clinical and radiographic study of 191 MAÏA® trapeziometacarpal prostheses implanted between 2001 and 2016 from a single centre. The survival rate of the implants at the final follow-up of 12 years (range 17 days to 140 months) was 88%. Median pain score was 1/10. The median Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score was 20. The rate of major complications was 9% (5% dislocations and 4% loosening) with all dislocations needing revision surgery. The risk of prosthetic dislocation was highest during the first 3 years, most often related to malposition of the trapezium implant. The MAÏA trapeziometacarpal prosthesis represents a long-term solution for surgical treatment of thumb rhizarthrosis. Level of evidence: IV.
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Affiliation(s)
- Leo Chiche
- Service de chirurgie de la main et du membre supérieur, CHU Lapeyronie, Montpellier, France
| | | | - Paul Vial D'Allais
- Service de chirurgie de la main et du membre supérieur, CHU Lapeyronie, Montpellier, France
| | - Cyril Lazerges
- Service de chirurgie de la main et du membre supérieur, CHU Lapeyronie, Montpellier, France
| | - Bertrand Coulet
- Service de chirurgie de la main et du membre supérieur, CHU Lapeyronie, Montpellier, France
| | - Michel Chammas
- Service de chirurgie de la main et du membre supérieur, CHU Lapeyronie, Montpellier, France
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4
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Newton A, Talwalkar S. Arthroplasty in thumb trapeziometacarpal (CMC joint) osteoarthritis: An alternative to excision arthroplasty. J Orthop 2023; 35:134-139. [PMID: 36471695 PMCID: PMC9719001 DOI: 10.1016/j.jor.2022.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 11/15/2022] [Accepted: 11/18/2022] [Indexed: 11/27/2022] Open
Abstract
Trapeziectomy for base of thumb arthritis is well established, but base of thumb arthroplasty offers potential advantages. The review covers the development of arthroplasty for the thumb from interposition arthroplasty to total joint replacement. It discusses contemporary prosthesis designs and results, including trapezial component geometry, bearing surfaces, and dual mobility.
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5
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McGinley BM, Siracuse BL, Gottschalk MB, Wagner ER. Treatment of First Carpometacarpal Osteoarthritis with Arthroscopy: A Systematic Review. J Wrist Surg 2022; 11:509-520. [PMID: 36504539 PMCID: PMC9731745 DOI: 10.1055/s-0042-1744493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 02/04/2022] [Indexed: 12/15/2022]
Abstract
Background First carpometacarpal (CMC) osteoarthritis or trapeziometacarpal osteoarthritis is a common debilitating hand condition. No one surgical technique has demonstrated superiority in managing this disease. Purpose This study performed a systematic review of arthroscopic techniques for treating first CMC arthritis to assess the effectiveness of different arthroscopic techniques. Methods Grip strength, pinch strength, visual analog scale, the Disability of Arm, Shoulder, and Hand (DASH) score, range of motion (ROM), and complications were recorded. Two subgroup analyses were performed, comparing outcomes of (1) trapeziectomy of any type versus debridement alone and (2) trapeziectomy alone versus interposition versus suspension techniques. Results Preoperative and postoperative scores significantly improved for DASH scores and pain at rest and with activity with variable improvements in ROM. Complications occurred in 13% of cases in publications that reported complications. When comparing studies that utilized techniques with any type of trapeziectomy to debridement alone, only the trapeziectomy subgroup showed significant improvements in pain. When comparing trapeziectomy alone to interposition and suspension techniques, mean DASH scores and pain levels significantly improved in interposition and suspension subgroups. Conclusions The existing literature describes a predominantly female population with Eaton-Littler stage II and III disease. In the subgroup analysis, arthroscopic techniques involving a trapeziectomy seem to be more effective at lowering pain scores compared to techniques involving debridement alone. Likewise, interposition and suspension techniques may show improved outcomes compared to techniques involving trapeziectomy alone. Level of evidence This is a Level III study.
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Affiliation(s)
- Beau M McGinley
- Department of Orthopaedic Surgery, Emory University, Atlanta, Georgia
| | | | | | - Eric R Wagner
- Department of Orthopaedic Surgery, Emory University, Atlanta, Georgia
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Buffet A, Lucot-Royer L, Marine P, Menu G, De Bie A, Obert L, Loisel F. ISIS trapeziometacarpal arthroplasty: What are the outcomes in male patients? HAND SURGERY & REHABILITATION 2022; 41:463-469. [DOI: 10.1016/j.hansur.2022.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 04/27/2022] [Accepted: 04/30/2022] [Indexed: 11/16/2022]
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Abstract
Thumb carpometacarpal implant arthroplasty aims to preserve thumb length and motion and to provide pain relief and functional recovery after a short postoperative time. For several decades, implant arthroplasty has been performed with total trapeziometacarpal joint prosthesis using the concept of "ball-and-socket" joint. More recently, pyrocarbon implants used as hemiarthroplasty or interposition arthroplasty have been proposed. Whatever the type of arthroplasty used, the surgical technique must be precise and may require a learning curve. Implant arthroplasty has proven that in the medium and long-term, it may be considered as a valid and reliable alternative to trapeziectomy.
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Affiliation(s)
- Philippe Bellemère
- Institut de la Main Nantes-Atlantique, Santé Atlantique, avenue Claude Bernard, Saint-Herblain, 44800 France.
| | - Bruno Lussiez
- IM2S, Clinique de Chirurgie orthopédique et traumatologique de Monaco, 11 avenue d'Ostende 98000, Monaco
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8
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Lussiez B, Falaise C, Ledoux P. Dual mobility trapeziometacarpal prosthesis: a prospective study of 107 cases with a follow-up of more than 3 years. J Hand Surg Eur Vol 2021; 46:961-967. [PMID: 34162273 DOI: 10.1177/17531934211024500] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We report the results of a prospective study using a dual mobility trapeziometacarpal prosthesis (Touch®) in 107 patients with a minimum follow-up of 3 years. One-hundred and two patients (95%) were very satisfied or satisfied with the functional outcomes and the mean pain intensity in visual analogue scale decreased from 7.4 to 0.8 (p < 0.001). Thumb opposition (Kapandji score) index increased from an average of 8.0 to 9.4, while the mean QuickDASH score improved from 38 preoperatively to 20 at follow-up (p < 0.01). Key-pinch strength improved from 3.5 kg (range 0.5-9.5) to 5.5 kg (range 3.0-11.5). There was a 4.6% rate of complications, including cup loosening and wear of polyethylene, which required revision, but no cases of prosthetic dislocation were seen. Applying the dual mobility principle to trapeziometacarpal arthroplasty may significatively improve the stability of these prostheses. Radiolucent zones around the components of the prostheses are not systematic predictors of future loosening.Level of evidence: IV.
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9
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Long-Term Results of Joint Arthroplasty with Total Prosthesis for Trapeziometacarpal Osteoarthritis in Patients over 65 Years of Age. Geriatrics (Basel) 2021; 6:geriatrics6030065. [PMID: 34209613 PMCID: PMC8293220 DOI: 10.3390/geriatrics6030065] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 06/17/2021] [Accepted: 06/19/2021] [Indexed: 11/16/2022] Open
Abstract
Trapeziometacarpal osteoarthritis (TMCOA) is a highly prevalent disease in the older population. Many different types of surgical treatments are possible, depending on the degree of joint involvement, the personal and professional circumstances of the patient and the preferences of the orthopedic surgeon. This paper evaluated the clinical and radiological results of consecutive cohorts of patients over 65 years old treated with total joint arthroplasties (TJA) of the ball and socket type (B&S) for TMCOA, with a minimum of 10 years follow-up. The survival rate (Kaplan–Meier) of the functional prostheses at 10 years was 92.2% (95% CI (89.1%, 96.1%). These functional arthroplasty patients, after 10 years of follow-up, showed little or no pain, good function and good key pinch, without radiological alterations. TJAs of the B&S type are a long lasting, effective and reliable alternative to surgical treatment of TMCOA in patients over 65 years of age, when they are performed with the patient selection criteria and surgical technique described throughout this study.
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Abstract
For thumb carpometacarpal osteoarthritis, trapeziectomy provides generally good results with reduction of pain and restoration of thumb mobility, but shortening of the thumb may at least in theory lead to reduction in grip and pinch strength. Furthermore, instability of the base of the first metacarpal and contact with the scaphoid may occur regardless of the several described techniques with ligament reconstruction and tendon interposition. Thus, for years alternatives to trapeziectomy have been explored and reported with disputable success. Often the road from idea to implantation in patients seems to have been short, and high complication rates and failure of new implant designs have been fairly common. This has led to the general impression that the implants do not provide sufficient benefits compared with simple trapeziectomy. More recent uncemented total joint replacement designs have shown rapid rehabilitation, reduction of pain, restoration of grip strength and movement, and much improved long-term implant survival. These factors may make total joint replacement a realistic alternative to trapeziectomy. Still, patient selection has to be improved, as the benefits may be small in the low activity elderly patient.
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Affiliation(s)
- Torben Bæk Hansen
- University Clinic for Hand, Hip and Knee Surgery, Holstebro Hospital, Holstebro, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
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11
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Copeland A, Gallo L, Weber C, Moltaji S, Gallo M, Murphy J, Axelrod D, Thoma A. Reporting Outcomes and Outcome Measures in Thumb Carpometacarpal Joint Osteoarthritis: A Systematic Review. J Hand Surg Am 2021; 46:65.e1-65.e11. [PMID: 32819777 DOI: 10.1016/j.jhsa.2020.05.024] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 04/20/2020] [Accepted: 05/27/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE In the thumb carpometacarpal (CMC) joint osteoarthritis (OA) literature, there is substantial heterogeneity in outcome and outcome measure reporting. This could be rectified by a standardized core outcome set (COS). This study aimed to identify a comprehensive list of outcomes and outcome measures for thumb CMC joint OA, which represents the first step in developing a COS. METHODS A computerized search of MEDLINE, EMBASE, Cochrane, and CINAHL was performed to identify randomized controlled trials, as well as observational studies involving at least 50 participants aged greater than 18 years undergoing surgery for thumb CMC joint OA. Reported outcomes and outcome measures were extracted from these trials and summarized. RESULTS This search yielded 3,498 unique articles, 97 of which were used for analysis. A total of 33 unique outcomes and 25 unique outcome measures were identified. The most frequently used outcomes were complications (78), postoperative pain (73), radiologic outcomes (64), and grip strength (63). Within each reported outcome, there was substantial variation in how the outcome was measured. Of the 25 unique outcome measures, 10 were validated. Of the remaining 15, 12 were created ad hoc by the author. The Disabilities of the Arm, Shoulder, and Hand questionnaire was the most commonly reported outcome measure (34%). CONCLUSIONS There is a lack of consensus on critical outcomes after surgery for thumb CMC joint OA. A standardized COS created by stakeholder consensus would improve the consistency and therefore the quality of future research. CLINICAL RELEVANCE This systematic review of outcomes represents the first step in developing a core outcome set for thumb CMC joint OA.
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Affiliation(s)
- Andrea Copeland
- Division of Plastic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Lucas Gallo
- Division of Plastic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Christina Weber
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Syena Moltaji
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Matteo Gallo
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Jessica Murphy
- Division of Plastic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Daniel Axelrod
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Achilleas Thoma
- Division of Plastic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.
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12
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Hooper RC, Nasser JS, Huetteman HE, Mack SJ, Chung KC. Postoperative follow-up time and justification in prospective hand surgery research: a systematic review. J Hand Surg Eur Vol 2020; 45:899-903. [PMID: 32539576 DOI: 10.1177/1753193420931478] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We systematically reviewed prospective studies for five hand procedures to analyse postoperative follow-up time, clinical or radiographic plateau, and whether the authors provide justification for times used. Demographic data, outcomes and mean follow-up were analysed. A total of 188 articles met our inclusion criteria. The mean postoperative follow-up time among these studies were carpal tunnel release, 21 months (range 1.5-111); cubital tunnel release, 27 months (2.5-46); open reduction and internal fixation for the distal radius fracture, 24 months (3-120); thumb carpometacarpal joint arthroplasty, 64 months (8.5-228); and flexor tendon repair, 25 months (3-59). Authors provided justification for follow-up intervals in 10% of these reports. We conclude that most prospective clinical studies in hand surgery do not properly justify follow-up length. Clinically unnecessary follow-up is costly without much benefit. In prospective research, we believe justified postoperative follow-up is essential, based on expected time to detect clinical plateau, capture complications and determine the need for secondary surgery.Level of evidence: III.
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Affiliation(s)
- Rachel C Hooper
- Section of Plastic Surgery, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Jacob S Nasser
- George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Helen E Huetteman
- Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Shale J Mack
- Section of Plastic Surgery, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Kevin C Chung
- Section of Plastic Surgery, University of Michigan Medical School, Ann Arbor, MI, USA
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13
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Remy S, Detrembleur C, Libouton X, Bonnelance M, Barbier O. Trapeziometacarpal prosthesis: an updated systematic review. HAND SURGERY & REHABILITATION 2020; 39:492-501. [PMID: 32860986 DOI: 10.1016/j.hansur.2020.08.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 07/29/2020] [Accepted: 08/04/2020] [Indexed: 12/23/2022]
Abstract
The trapeziometacarpal prosthesis is mostly used in Europe to treat osteoarthritis of the basal joint of the thumb. Its supposed benefits are that it restores the length of the thumb, improves strength, function and mobility while reducing recovery time compared to other surgical treatments. However, previous reviews of the literature could not confirm these assumptions. This article provides an updated systematic review to help answer to these questions through a methodical statistical analysis and to quantify the two main complications, namely failure and deep infection. To achieve these aims, a selection of articles including implant case series was done in the Medline database based on specific criteria. Data about pain, function, strength, infection, and failure were compiled and a statistical analysis was performed. Results show a fast recovery in terms of pain and function but the positive effect on strength seems limited. The failure rate represented by the revision rate is high and the deep infection rate is fairly low. Randomized controlled studies are needed to obtain reliable data to compare the prosthesis to other surgical treatments.
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Affiliation(s)
- S Remy
- Cliniques Universitaires Saint-Luc, Service d'Orthopédie et de Traumatologie de l'Appareil Locomoteur, Avenue Hippocrate 10, 1200 Brussels, Belgium.
| | - C Detrembleur
- Université Catholique de Louvain, Secteur des Sciences de la Santé, Institut de Recherche Expérimentale et Clinique, Neuro Musculo Skeletal Lab (NMSK), Avenue Mounier 53, 1200 Brussels, Belgium
| | - X Libouton
- Cliniques Universitaires Saint-Luc, Service d'Orthopédie et de Traumatologie de l'Appareil Locomoteur, Avenue Hippocrate 10, 1200 Brussels, Belgium; Université Catholique de Louvain, Secteur des Sciences de la Santé, Institut de Recherche Expérimentale et Clinique, Neuro Musculo Skeletal Lab (NMSK), Avenue Mounier 53, 1200 Brussels, Belgium
| | - M Bonnelance
- Cliniques Universitaires Saint-Luc, Service d'Orthopédie et de Traumatologie de l'Appareil Locomoteur, Avenue Hippocrate 10, 1200 Brussels, Belgium
| | - Olivier Barbier
- Cliniques Universitaires Saint-Luc, Service d'Orthopédie et de Traumatologie de l'Appareil Locomoteur, Avenue Hippocrate 10, 1200 Brussels, Belgium; Université Catholique de Louvain, Secteur des Sciences de la Santé, Institut de Recherche Expérimentale et Clinique, Neuro Musculo Skeletal Lab (NMSK), Avenue Mounier 53, 1200 Brussels, Belgium
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14
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Dumartinet-Gibaud R, Bigorre N, Raimbeau G, Jeudy J, Saint Cast Y. Arpe total joint arthroplasty for trapeziometacarpal osteoarthritis: 80 thumbs in 63 patients with a minimum of 10 years follow-up. J Hand Surg Eur Vol 2020; 45:465-469. [PMID: 32157942 DOI: 10.1177/1753193420909198] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
In this retrospective study, we report a series of 80 Arpe prostheses for trapeziometacarpal osteoarthritis in 63 patients. Twenty-seven prostheses (20 patients) were lost to follow-up. Twenty-one were revised, eight of them during the first year after operation. The calculated cumulated implant survival rate was 85% at 10 years but could be lower due to the lack of information on the patients lost to follow-up. The number of complications due to technical errors was high; but after we had done 30 cases, the number of early revisions decreased markedly. At follow-up, 23 of 32 thumbs were totally free of pain, and the patients were satisfied with 31 thumbs. We conclude that the implant survival declines progressively in the long run, with a survival rate of 80% after 15 years of follow-up and a further decline thereafter. We also found that this surgery was difficult to master. We advise selecting this implant for thumb trapeziometacarpal osteoarthritis with caution. Level of evidence: IV.
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15
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Martin-Ferrero M, Simón-Pérez C, Coco-Martín MB, Vega-Castrillo A, Aguado-Hernández H, Mayo-Iscar A. Trapeziometacarpal total joint arthroplasty for osteoarthritis: 199 patients with a minimum of 10 years follow-up. J Hand Surg Eur Vol 2020; 45:443-451. [PMID: 31495260 DOI: 10.1177/1753193419871660] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We report outcomes of 228 consecutive patients with total joint arthroplasty using the Arpe® prosthesis, among which 216 trapeziometacarpal joints in 199 patients had a minimum of 10 years follow-up. The cumulative survival rate of the 216 implants at 10 years using the Kaplan-Meyer method was 93%. Two hundred joints were functional and painless. We found good integration and positioning of the components in 184 (93%) of the joints. Sixteen prostheses failed. We conclude that this implant has acceptable long-term survival rate and restores good hand function. We also report our methods to improve implant survival and to decrease the risk of component malpositioning, and failure rate. Level of evidence: II.
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Affiliation(s)
- Miguel Martin-Ferrero
- Orthopaedic Surgery Service of the Clinical Hospital University of Valladolid, Valladolid, Spain
| | - Clarisa Simón-Pérez
- Orthopaedic Surgery Service of the Clinical Hospital University of Valladolid, Valladolid, Spain
| | - Maria B Coco-Martín
- Research Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Aureliio Vega-Castrillo
- Orthopaedic Surgery Service of the Clinical Hospital University of Valladolid, Valladolid, Spain
| | - Héctor Aguado-Hernández
- Orthopaedic Surgery Service of the Clinical Hospital University of Valladolid, Valladolid, Spain
| | - Agustín Mayo-Iscar
- IMUVA & Department of Statistics and OR, University of Valladolid, Valladolid, Spain
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Abstract
There are a number of possible assessments of functional outcomes for thumb carpometacarpal joint arthritis. The most important and easiest to measure is pain, but it is not the only material outcome. Functional scores for measuring the outcome of the treatment of thumb carpometacarpal joint arthritis have been recommended for some time, but are still not widely used even in published studies. It is also unclear which functional scores are the most valuable. Easily used scores, such as the Disabilities of the Arm Shoulder and Hand questionnaire, are freely available, but may not be sensitive enough to assess outcomes especially of thumb carpometacarpal joint arthroplasty. The optimal functional outcome measurement would be weighted for the individual patient. A minimum dataset needs to be defined in order to compare studies and derive meaningful data.
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Ganhewa AD, Wu R, Chae MP, Tobin V, Miller GS, Smith JA, Rozen WM, Hunter-Smith DJ. Failure Rates of Base of Thumb Arthritis Surgery: A Systematic Review. J Hand Surg Am 2019; 44:728-741.e10. [PMID: 31262534 DOI: 10.1016/j.jhsa.2019.05.003] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 02/27/2019] [Accepted: 05/01/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of the current review was to estimate failure rates of trapeziometacarpal (TMC) implants and compare against failure rates of nonimplant techniques for surgical treatment of TMC joint (basal thumb joint) arthritis. METHODS A systematic review was conducted to identify articles reporting on thumb implant arthroplasty and on nonimplant arthroplasty techniques for treatment of base of thumb arthritis in the English literature. The collected data were combined to calculate failure rates per 100 procedure-years. Failure was defined by the requirement for a secondary salvage procedure. The failure rates between different implant and nonimplant arthroplasty groups were compared directly and implants with higher than anticipated failure rates were identified. RESULTS One hundred twenty-five articles on implant arthroplasty and 33 articles on the outcome of nonimplant surgical arthroplasty of the TMC joint were included. The implant arthroplasty failure rates per 100 procedure-years were total joint replacement (2.4), hemiarthroplasty (2.5), interposition with partial trapezial resection (4.5), interposition with complete trapezial resection (1.7), and interposition with no trapezial resection (4.5). The nonimplant arthroplasty failure rates per 100 procedure-years were: trapeziectomy (0.49), joint fusion (0.52), and trapeziectomy with ligament reconstruction ± tendon interposition (0.23). CONCLUSIONS Several implant designs (arthroplasties) had high rates of failure due to aseptic loosening, dislocation, and persisting pain. Furthermore, some implants had higher than anticipated failure rates than other implants within each class. Overall, the failure rates of nonimplant techniques were lower than those of implant arthroplasty. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Aparna D Ganhewa
- Department of Plastic, Reconstructive and Hand Surgery, Peninsula Health, Frankston
| | - Rui Wu
- Department of Plastic, Reconstructive and Hand Surgery, Peninsula Health, Frankston
| | - Michael P Chae
- Department of Plastic, Reconstructive and Hand Surgery, Peninsula Health, Frankston; Peninsula Clinical School, Central Clinical School, Monash University, The Alfred Centre, Melbourne; Department of Surgery, School of Clinical Sciences, Monash Medical Centre, Clayton, Victoria, Australia
| | - Vicky Tobin
- Department of Plastic, Reconstructive and Hand Surgery, Peninsula Health, Frankston
| | - George S Miller
- Department of Plastic, Reconstructive and Hand Surgery, Peninsula Health, Frankston
| | - Julian A Smith
- Department of Surgery, School of Clinical Sciences, Monash Medical Centre, Clayton, Victoria, Australia
| | - Warren M Rozen
- Department of Plastic, Reconstructive and Hand Surgery, Peninsula Health, Frankston; Peninsula Clinical School, Central Clinical School, Monash University, The Alfred Centre, Melbourne; Department of Surgery, School of Clinical Sciences, Monash Medical Centre, Clayton, Victoria, Australia
| | - David J Hunter-Smith
- Department of Plastic, Reconstructive and Hand Surgery, Peninsula Health, Frankston; Peninsula Clinical School, Central Clinical School, Monash University, The Alfred Centre, Melbourne; Department of Surgery, School of Clinical Sciences, Monash Medical Centre, Clayton, Victoria, Australia.
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Andrzejewski A, Ledoux P. Maïa ® trapeziometacarpal joint arthroplasty: Survival and clinical outcomes at 5 years' follow-up. HAND SURGERY & REHABILITATION 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] [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.
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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
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19
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Smeraglia F, Mariconda M, Balato G, Di Donato SL, Criscuolo G, Maffulli N. Dubious space for Artelon joint resurfacing for basal thumb (trapeziometacarpal joint) osteoarthritis. A systematic review. Br Med Bull 2018; 126:79-84. [PMID: 29659726 DOI: 10.1093/bmb/ldy012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 03/16/2018] [Indexed: 11/15/2022]
Abstract
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.
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Affiliation(s)
- Francesco Smeraglia
- Department of Orthopaedic Surgery, 'Federico II' University of Naples, Italy
| | - Massimo Mariconda
- Department of Orthopaedic Surgery, 'Federico II' University of Naples, Italy
| | - Giovanni Balato
- Department of Orthopaedic Surgery, 'Federico II' University of Naples, Italy
| | | | - Giovanni Criscuolo
- Department of Clinical Orthopaedics, Ospedale San Giovanni e Ruggi d'Aragona, Salerno, Italy
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Baronissi, Salerno, Italy.,Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentirstry, Mile End Hospital, 275 Bancroft Road, London, England
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21
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Srnec JJ, Wagner ER, Rizzo M. Implant Arthroplasty for Proximal Interphalangeal, Metacarpophalangeal, and Trapeziometacarpal Joint Degeneration. J Hand Surg Am 2017; 42:817-825. [PMID: 28869061 DOI: 10.1016/j.jhsa.2017.07.030] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Accepted: 07/25/2017] [Indexed: 02/02/2023]
Abstract
Arthritis of the hand can result from inflammatory arthritis, osteoarthritis (OA), or be posttraumatic and can cause pain and debilitation. Arthroplasty serves as 1 surgical option in the surgical management of arthritis and aims to create a pain-free joint with preservation of motion. Although implant arthroplasty of the proximal interphalangeal (PIP), metacarpophalangeal (MCP), and trapeziometacarpal (TMC) joints predictably produce pain relief and high satisfaction, it has historically suffered from high rates of complications. The hinged silicone prosthesis was 1 of the early implants and, in many cases, remains the gold standard. However, problems with deformity correction, implant fracture, and synovitis remain. Implants made of alternative materials such as metal-plastic and pyrocarbon have evolved; however, survivorship and reoperation rates remain a concern. This review details the evolution and current options available for small joint implant arthroplasty involving the MCP, PIP, and TMC joints.
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Affiliation(s)
- Jason J Srnec
- Department of Orthopedic Surgery, Division of Hand Surgery, Mayo Clinic, Rochester, MN
| | - Eric R Wagner
- Department of Orthopedic Surgery, Division of Hand Surgery, Mayo Clinic, Rochester, MN
| | - Marco Rizzo
- Department of Orthopedic Surgery, Division of Hand Surgery, Mayo Clinic, Rochester, MN.
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22
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[Replacement of the thumb carpometacarpal joint : Current importance of endoprosthetics for operative treatment of rhizarthrosis]. Unfallchirurg 2017; 119:1007-1014. [PMID: 27738705 DOI: 10.1007/s00113-016-0252-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The role of joint replacement in the treatment of osteoarthritis of the thumb carpometacarpal joint is a subject of considerable controversy in the current literature. In German-speaking countries this technique is used much less frequently than resection procedures. Aseptic loosening of the prosthesis is believed to be the major cause of the high failure rates reported for cemented and uncemented types of implants. In this study the different implant designs were evaluated on the basis of the results reported in the international literature. There are only a few studies that cover relatively long follow-up periods and provide convincing results for thumb carpometacarpal joint prostheses in terms of implant survival and function. Aseptic loosening is reported to be the major cause with failure rates of 50 % or more. Although a Norwegian study reported high 5 and 10-year survival rates for various thumb carpometacarpal joint prostheses according to the Norwegian arthroplasty registry, it did not recommend the widespread use of thumb carpometacarpal joint replacement at the present time. In our opinion, joint replacement may be considered as a possible treatment option for advanced osteoarthritis of the thumb carpometacarpal joint but it should not always be recommended because long-term results are inconsistent and similar functional outcomes have been reported for alternative surgical techniques, such as resection arthroplasty.
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23
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Wajon A, Vinycomb T, Carr E, Edmunds I, Ada L. WITHDRAWN: Surgery for thumb (trapeziometacarpal joint) osteoarthritis. Cochrane Database Syst Rev 2017; 4:CD004631. [PMID: 28368089 PMCID: PMC6478278 DOI: 10.1002/14651858.cd004631.pub5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Surgery is used to treat persistent pain and dysfunction at the base of the thumb when conservative management, such as splinting, or medical management, such as oral analgesics, is no longer adequate in reducing disability and pain. This is an update of a Cochrane Review first published in 2005. OBJECTIVES To assess the effects of different surgical techniques for trapeziometacarpal (thumb) osteoarthritis. SEARCH METHODS We searched the following sources up to 08 August 2013: CENTRAL (The Cochrane Library 2013, Issue 8), MEDLINE (1950 to August 2013), EMBASE (1974 to August 2013), CINAHL (1982 to August 2013), Clinicaltrials.gov (to August 2013) and World Health Organization (WHO) Clinical Trials Portal (to August 2013). SELECTION CRITERIA Randomised controlled trials (RCTs) or quasi-RCTs where the intervention was surgery for people with thumb osteoarthritis. Outcomes were pain, physical function, quality of life, patient global assessment, adverse events, treatment failure or trapeziometacarpal joint imaging. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by the Cochrane Collaboration. Two review authors independently screened and included studies according to the inclusion criteria, assessed the risk of bias and extracted data, including adverse events. MAIN RESULTS We included 11 studies with 670 participants. Seven surgical procedures were identified (trapeziectomy with ligament reconstruction and tendon interposition (LRTI), trapeziectomy, trapeziectomy with ligament reconstruction, trapeziectomy with interpositional arthroplasty (IA), Artelon joint resurfacing, arthrodesis and Swanson joint replacement). We did not find any studies that compared surgery with sham surgery or surgery with non-surgical interventions.Most included studies had an unclear risk of most biases which raises doubt about the results. No procedure demonstrated any superiority over another in terms of pain, physical function, quality of life, patient global assessment, adverse events, treatment failure (re-operation) or trapeziometacarpal joint imaging. One study demonstrated a difference in adverse events (mild-moderate swelling) between Artelon joint replacement and trapeziectomy with tendon interposition. However, the quality of evidence was very low due to a high risk of bias and imprecision of results.Low quality evidence suggests trapeziectomy with LRTI may not provide additional benefits or result in more adverse events over trapeziectomy alone. Mean pain (three studies, 162 participants) was 26 mm on a 0 to 100 mm VAS (0 is no pain) for trapeziectomy alone, trapeziectomy with LRTI reduced pain by a mean of 2.8 mm (95% confidence interval (CI) -9.8 to 4.2) or an absolute reduction of 3% (-10% to 4%). Mean physical function (three studies, 211 participants) was 31.1 points on a 0 to 100 point scale (0 is best physical function, or no disability) with trapeziectomy alone, trapeziectomy with LRTI resulted in sightly lower function scores (standardised mean difference 0.1, 95% CI -0.30 to 0.32), an equivalent to a worsening of 0.2 points (95% CI -5.8 to 6.1) on a 0 to 100 point scale (absolute decrease in function 0.03% (-0.83% to 0.88%)). Low quality evidence from four studies (328 participants) indicates that the mean number of adverse events was 10 per 100 participants for trapeziectomy alone, and 19 events per 100 participants for trapeziectomy with LRTI (RR 1.89, 95% CI 0.96 to 3.73) or an absolute risk increase of 9% (95% CI 0% to 28%). Low quality evidence from one study (42 participants) indicates that the mean scapho-metacarpal distance was 2.3 mm for the trapeziectomy alone group, trapeziectomy with LRTI resulted in a mean of 0.1 mm less distance (95% CI -0.81 to 0.61). None of the included trials reported global assessment, quality of life, and revision or re-operation rates.Low-quality evidence from two small studies (51 participants) indicated that trapeziectomy with LRTI may not improve function or slow joint degeneration, or produce additional adverse events over trapeziectomy and ligament reconstruction.We are uncertain of the benefits or harms of other surgical techniques due to the mostly low quality evidence from single studies and the low reporting rates of key outcomes. There was insufficient evidence to assess if trapeziectomy with LRTI had additional benefit over arthrodesis or trapeziectomy with IA. There was also insufficient evidence to assess if trapeziectomy with IA had any additional benefit over the Artelon joint implant, the Swanson joint replacement or trapeziectomy alone. AUTHORS' CONCLUSIONS We did not identify any studies that compared surgery to sham surgery or to non-operative treatments. We were unable to demonstrate that any technique confers a benefit over another technique in terms of pain and physical function. Furthermore, the included studies were not of high enough quality to provide conclusive evidence that the compared techniques provided equivalent outcomes.
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Affiliation(s)
- Anne Wajon
- Macquarie University ClinicMacquarie Hand Therapy2 Technology PlaceMacquarie UniversityNew South WalesAustralia2109
| | - Toby Vinycomb
- Monash UniversityDepartment of Surgery (MMC)MelbourneAustralia
| | - Emma Carr
- Pacific Hand Therapy Services812 Pittwater RoadDee WhyNew South WalesAustralia2099
| | - Ian Edmunds
- Hornsby Hand Centre2/49 Palmerston RdHornsbyNew South WalesAustralia2077
| | - Louise Ada
- University of SydneySchool of PhysiotherapyCumberland CampusPO Box 170LidcombeNew South WalesAustralia1825
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Knak J, Hansen TB. Trapeziectomy or revision into a cemented polyethylene cup in failed trapeziometacarpal total joint arthroplasty. J Plast Surg Hand Surg 2016; 50:286-90. [DOI: 10.3109/2000656x.2016.1162796] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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25
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Martínez-Martínez F, García-Hortelano S, García-Paños J, Moreno-Fernández J, Martín-Ferrero M. Comparative clinical study of 2 surgical techniques for trapeziometacarpal osteoarthritis. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.recote.2015.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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26
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Martínez-Martínez F, García-Hortelano S, García-Paños JP, Moreno-Fernández JM, Martín-Ferrero MÁ. [Comparative clinical study of 2 surgical techniques for trapeziometacarpal osteoarthritis]. Rev Esp Cir Ortop Traumatol (Engl Ed) 2015; 60:59-66. [PMID: 26149634 DOI: 10.1016/j.recot.2015.05.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2014] [Revised: 05/18/2015] [Accepted: 05/20/2015] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE In trapeziometacarpal osteoarthritis (or rhizarthrosis), there is great controversy over the surgical technique to choose: simple trapeziectomy, resection-interposition arthroplasty, interposition arthroplasty suspension-or arthroplasty with implant or prosthesis. These latter 2 are the most used without consensus in the literature on the technique to choose and without sufficient comparative studies. The objective is to compare the 2 techniques most used today: suspension-interposition arthroplasty and arthroplasty with prosthesis. MATERIAL AND METHOD A prospective study was conducted on 15 patients diagnosed with grade 2-3 rhizarthrosis treated with interposition arthroplasty-suspension (group 1) and 15 with prosthesis (group 2) showing clinical outcomes, advantages and disadvantages of each. The study variables were the visual analogue scale (VAS), the DASH questionnaire, the grip strength, the strength of end to end and end-lateral clamp, the joint balance adduction-abduction and preemption-retropositioning, and the opposition. The 2 groups are from 2 different hospitals operated on by a hand surgeon from the Hand Unit. The follow-up time for all patients included in the study was 12 months. RESULTS The VAS, DASH and grip strength at 12 months did not show significant differences. As regards the strength of end to end and end-lateral clamp, group 2 showed the highest values in all follow-up periods with statistically significant differences. CONCLUSIONS Patient selection and surgical experience is essential, given the satisfactory results of both techniques. Arthroplasty prosthesis is reserved for grades 2 and 3, middle-aged patients, good trapezium architecture, and experienced surgeons.
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Affiliation(s)
| | | | - J P García-Paños
- Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España
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27
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Huang K, Hollevoet N, Giddins G. Thumb carpometacarpal joint total arthroplasty: a systematic review. J Hand Surg Eur Vol 2015; 40:338-50. [PMID: 25600851 DOI: 10.1177/1753193414563243] [Citation(s) in RCA: 89] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Accepted: 11/14/2014] [Indexed: 02/03/2023]
Abstract
Thumb carpometacarpal joint total arthroplasty has been undertaken for many years. The proponents believe the short-term outcomes are better than trapeziectomy and its variants, but the longer term complications are often higher. This systematic review of all peer reviewed articles on thumb carpometacarpal joint total arthroplasty for osteoarthritis shows that there are reports of many implants. Some are no longer available. The reported outcomes are very variable: for some there are good long-term outcomes to beyond 10 years ; for others there are unacceptably high early rates of failure. Overall the published evidence does not show that total arthroplasty is better than trapeziectomy and its variants yet there is a higher complication rate and significant extra cost of using an implant. Future research needs to compare total arthroplasty with trapeziectomy to assess short term results where the arthroplasties may be better, long-term outcomes and the healthcare and personal costs so that surgeons and patients can make fully informed choices about the treatment of symptomatic thumb carpometacarpal joint osteoarthritis.
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Affiliation(s)
- K Huang
- Tongde Hospital of Zhejiang Province, Zhejiang, People's Republic of China
| | | | - G Giddins
- Royal United Hospital Bath, Bath, UK
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Smeraglia F, Soldati A, Orabona G, Ivone A, Balato G, Pacelli M. Trapeziometacarpal arthrodesis: is bone union necessary for a good outcome? J Hand Surg Eur Vol 2015; 40:356-61. [PMID: 25524055 DOI: 10.1177/1753193414564095] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Accepted: 11/21/2014] [Indexed: 02/03/2023]
Abstract
We present a retrospective study of 107 cases of thumb carpometacarpl joint arthrodesis. The aim of our study was to analyse our population and to compare the outcomes of patients who obtained bone union with the patients who did not. There were no statistical differences in most of the clinical outcomes (DASH score, visual analogue scale, Kapandji test, grip, and key pinch) between the two groups of patients; there were fewer cases of scaphotrapeziotrapezoid arthritis in the group that did not obtain bone union. We conclude that the bone union is not necessary for a good outcome. Level IV of evidence.
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Affiliation(s)
- F Smeraglia
- Department of Orthopaedic Surgery, "Federico II" University, Naples, Italy
| | - A Soldati
- Department of Orthopaedic Surgery, "Federico II" University, Naples, Italy
| | - G Orabona
- Department of Orthopaedic Surgery, "Federico II" University, Naples, Italy
| | - A Ivone
- Department of Orthopaedic Surgery, "Federico II" University, Naples, Italy
| | - G Balato
- Department of Orthopaedic Surgery, "Federico II" University, Naples, Italy
| | - M Pacelli
- Department of Orthopaedic Surgery, "Federico II" University, Naples, Italy
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29
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Berger AJ, Meals RA. Management of osteoarthrosis of the thumb joints. J Hand Surg Am 2015; 40:843-50. [PMID: 25754790 DOI: 10.1016/j.jhsa.2014.11.026] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 11/17/2014] [Accepted: 11/19/2014] [Indexed: 02/02/2023]
Abstract
We present current concepts and evidence to optimize diagnosis and management of osteoarthritis in the thumb joints. Numerous options and controversies exist for surgical treatment of carpometacarpal joint arthritis. Fewer options exist for metacarpophalangeal joint arthritis. Surgical treatment for interphalangeal arthritis is mainly arthrodesis.
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Affiliation(s)
- Aaron J Berger
- Division of Plastic Surgery, Florida International University College of Medicine & Miami Children's Hospital, Miami, FL
| | - Roy A Meals
- Department of Orthopedic Surgery, University of California at Los Angeles, Los Angeles, CA.
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30
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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] [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.
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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
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Abstract
BACKGROUND Surgery is used to treat persistent pain and dysfunction at the base of the thumb when conservative management, such as splinting, or medical management, such as oral analgesics, is no longer adequate in reducing disability and pain. This is an update of a Cochrane Review first published in 2005. OBJECTIVES To assess the effects of different surgical techniques for trapeziometacarpal (thumb) osteoarthritis. SEARCH METHODS We searched the following sources up to 08 August 2013: CENTRAL (The Cochrane Library 2013, Issue 8), MEDLINE (1950 to August 2013), EMBASE (1974 to August 2013), CINAHL (1982 to August 2013), Clinicaltrials.gov (to August 2013) and World Health Organization (WHO) Clinical Trials Portal (to August 2013). SELECTION CRITERIA Randomised controlled trials (RCTs) or quasi-RCTs where the intervention was surgery for people with thumb osteoarthritis. Outcomes were pain, physical function, quality of life, patient global assessment, adverse events, treatment failure or trapeziometacarpal joint imaging. We excluded trials that compared non-surgical interventions with surgery. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by the Cochrane Collaboration. Two review authors independently screened and included studies according to the inclusion criteria, assessed the risk of bias and extracted data, including adverse events. MAIN RESULTS We included 11 studies with 670 participants. Seven surgical procedures were identified (trapeziectomy with ligament reconstruction and tendon interposition (LRTI), trapeziectomy, trapeziectomy with ligament reconstruction, trapeziectomy with interpositional arthroplasty (IA), Artelon joint resurfacing, arthrodesis and Swanson joint replacement).Most included studies had an unclear risk of most biases which raises doubt about the results. No procedure demonstrated any superiority over another in terms of pain, physical function, quality of life, patient global assessment, adverse events, treatment failure (re-operation) or trapeziometacarpal joint imaging. One study demonstrated a difference in adverse events (mild-moderate swelling) between Artelon joint replacement and trapeziectomy with tendon interposition. However, the quality of evidence was very low due to a high risk of bias and imprecision of results.Low quality evidence suggests trapeziectomy with LRTI may not provide additional benefits or result in more adverse events over trapeziectomy alone. Mean pain (three studies, 162 participants) was 26 mm on a 0 to 100 mm VAS (0 is no pain) for trapeziectomy alone, trapeziectomy with LRTI reduced pain by a mean of 2.8 mm (95% confidence interval (CI) -9.8 to 4.2) or an absolute reduction of 3% (-10% to 4%). Mean physical function (three studies, 211 participants) was 31.1 points on a 0 to 100 point scale (0 is best physical function, or no disability) with trapeziectomy alone, trapeziectomy with LRTI resulted in sightly lower function scores (standardised mean difference 0.1, 95% CI -0.30 to 0.32), an equivalent to a worsening of 0.2 points (95% CI -5.8 to 6.1) on a 0 to 100 point scale (absolute decrease in function 0.03% (-0.83% to 0.88%)). Low quality evidence from four studies (328 participants) indicates that the mean number of adverse events was 10 per 100 participants for trapeziectomy alone, and 19 events per 100 participants for trapeziectomy with LRTI (RR 1.89, 95% CI 0.96 to 3.73) or an absolute risk increase of 9% (95% CI 0% to 28%). Low quality evidence from one study (42 participants) indicates that the mean scapho-metacarpal distance was 2.3 mm for the trapeziectomy alone group, trapeziectomy with LRTI resulted in a mean of 0.1 mm less distance (95% CI -0.81 to 0.61). None of the included trials reported global assessment, quality of life, and revision or re-operation rates.Low-quality evidence from two small studies (51 participants) indicated that trapeziectomy with LRTI may not improve function or slow joint degeneration, or produce additional adverse events over trapeziectomy and ligament reconstruction.We are uncertain of the benefits or harms of other surgical techniques due to the mostly low quality evidence from single studies and the low reporting rates of key outcomes. There was insufficient evidence to assess if trapeziectomy with LRTI had additional benefit over arthrodesis or trapeziectomy with IA. There was also insufficient evidence to assess if trapeziectomy with IA had any additional benefit over the Artelon joint implant, the Swanson joint replacement or trapeziectomy alone.We did not find any studies that compared any other combination of the other techniques mentioned above or any other techniques including a sham procedure. AUTHORS' CONCLUSIONS We did not identify any studies that compared surgery to sham surgery and we excluded studies that compared surgery to non-operative treatments. We were unable to demonstrate that any technique confers a benefit over another technique in terms of pain and physical function. Furthermore, the included studies were not of high enough quality to provide conclusive evidence that the compared techniques provided equivalent outcomes.
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Affiliation(s)
- Anne Wajon
- Macquarie Hand Therapy, Macquarie University Clinic, 2 Technology Place, Macquarie University, New South Wales, Australia, 2109.
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Papalia R, Tecame A, Torre G, D'Adamio S, Maffulli N, Denaro V. Small joints replacement for hand osteoarthritis: a systematic review. Br Med Bull 2015; 116:55-68. [PMID: 25990961 DOI: 10.1093/bmb/ldv024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/06/2015] [Indexed: 11/14/2022]
Abstract
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.
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Affiliation(s)
- Rocco Papalia
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy
| | - Andrea Tecame
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy
| | - Gugliemo Torre
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy
| | - Stefano D'Adamio
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy
| | - Nicola Maffulli
- Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospital, London E1 4DG, UK Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Salerno, Italy
| | - Vincenzo Denaro
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy
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Martin-Ferrero M. Ten-year long-term results of total joint arthroplasties with ARPE® implant in the treatment of trapeziometacarpal osteoarthritis. J Hand Surg Eur Vol 2014; 39:826-32. [PMID: 24334554 DOI: 10.1177/1753193413516244] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Between May 1999 and April 2002 a total of 69 consecutive thumb carpometacarpal joint arthoplasties were performed in a total of 64 patients for carpometacarpal joint osteoarthritis using the cementless hydroxyapatite (HA)-coated unconstrained ARPE implant. Clinical, functional and radiological results at 10-year follow-up are presented. Survival analysis was performed using the Kaplan-Meier method. Of the 64 patients, four were lost to follow-up, 60 implants (92.3%) were functional and five (7.7%) were not (two dislocated, two were removed and one with aseptic loosening). Survival estimate for functional implants over 10 years was 93.9% (95% confidence interval 82.3-97.9). The radiographs were satisfactory in 82.4%. There was subsidence of the cup in 15.8%. Thumb carpometacarpal joint arthroplasty with the ARPE implant offers a reliable treatment alternative in patients with Eaton grade III or IV thumb carpometacarpal joint arthritis in the presence of good bone stock.
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Mariconda M, Russo S, Smeraglia F, Busco G. Partial trapeziectomy and pyrocarbon interpositional arthroplasty for trapeziometacarpal joint osteoarthritis: results after minimum 2 years of follow-up. J Hand Surg Eur Vol 2014; 39:604-10. [PMID: 24509425 DOI: 10.1177/1753193413519384] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
A prospective study was undertaken to assess the outcomes of a series of patients treated using pyrocarbon implant arthroplasty after partial trapeziectomy for trapeziometacarpal joint osteoarthritis. We analysed the results of this procedure in 27 trapeziometacarpal joints of 25 patients. The mean follow-up interval was 34 months (range 26-52). The study showed that pyrocarbon interpositional arthroplasty provided excellent pain relief and high patient satisfaction. Overall function, according to disabilities of the arm, shoulder and hand (DASH) score, improved from 48 points preoperatively to 14 points at the last follow-up assessment. Key pinch strength recorded in the operated hands was comparable with the results obtained in the contralateral hand and in healthy individuals from the same population. No further operations were performed in the study group. Partial trapeziectomy with pyrocarbon arthroplasty may prove to be a successful option for the treatment of trapeziometacarpal joint osteoarthritis. Further long-term comparative studies are warranted.
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Affiliation(s)
- M Mariconda
- Department of Orthopaedic Surgery, "Federico II" University, Naples, Italy
| | - S Russo
- Department of Orthopaedic Surgery, "Federico II" University, Naples, Italy
| | - F Smeraglia
- Department of Orthopaedic Surgery, "Federico II" University, Naples, Italy
| | - G Busco
- Department of Orthopaedic Surgery, "Federico II" University, Naples, Italy
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Vandenberghe L, Degreef I, Didden K, Fiews S, De Smet L. Long term outcome of trapeziectomy with ligament reconstruction/tendon interposition versus thumb basal joint prosthesis. J Hand Surg Eur Vol 2013; 38:839-43. [PMID: 23221185 DOI: 10.1177/1753193412469010] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Several surgical techniques to treat thumb basal joint arthritis have been described. In this study we compared the results of a cemented thumb basal joint with trapeziectomy with a ligament reconstruction and tendon interposition. A questionnaire was sent to all 519 patients, 322 (with 382 procedures) responded. No significant differences were found when comparing impairment, pain, patient satisfaction and disability. Given the fact that the superiority of a prosthesis cannot be proven and the cost of the implant is greater, we recommend the trapeziectomy with ligament reconstruction and tendon interposition as opposed to arthroplasty as the first choice in the treatment of basal joint osteoarthritis of the thumb.
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Affiliation(s)
- L Vandenberghe
- Department of Orthopaedics, Hand Unit, University Hospitals Leuven, Pellenberg, Belgium
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Rubino M, Civani A, Pagani D, Sansone V. Trapeziometacarpal narrow pseudarthrosis: a new surgical technique to treat thumb carpometacarpal joint arthritis. J Hand Surg Eur Vol 2013; 38:844-50. [PMID: 23221183 DOI: 10.1177/1753193412469127] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We describe a technique that arose from the observation of the clinical outcome of failed arthrodeses of the thumb carpometacarpal joint. In these cases a pseudoarthrosis developed which, surprisingly, rarely lead to a poor clinical outcome. Thus we developed a simple technique which deliberately caused the formation of a narrow pseudoarthrosis in the carpometacarpal joint. We present a retrospective review of 248 consecutive patients treated for Eaton stages II and III osteoarthritis. We observed a statistically significant improvement in mean appositional and oppositional pinch strength, mean DASH score (63.8 pre-operatively to 10.5 at final follow-up), and the mean pain score (8.3 to 0.2). We conclude that trapeziometacarpal limited excision arthroplasty is a simple and reliable alternative to existing surgical techniques for treating Stage II or III thumb carpometacarpal joint arthritis.
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Affiliation(s)
- M Rubino
- Orthopaedic Department, Università degli Studi di Milano, Instituto Ortopedico Galeazzi IRCCS, Milano, Italy
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de Raedt S, Stilling M, van de Giessen M, Streekstra GJ, Vos FM, Hansen TB. A three-dimensional analysis of osteoarthritic changes in the thumb carpometacarpal joint. J Hand Surg Eur Vol 2013; 38:851-9. [PMID: 23134777 DOI: 10.1177/1753193412466764] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The purpose of this study is to gain a better understanding of the changes due to osteoarthritis (OA) occurring in the thumb carpometacarpal (CMC) joint by comparing quantitative geometrical measurements in computed tomography scans of healthy and pathological joints in various stages of OA. The measurements were (1) the subluxation of the metacarpal on the trapezium, (2) distance from the scaphoid centre to the metacarpal base, and (3) distance from the metacarpal base to the articulating surface of the trapezium. The three-dimensional position of three characteristic points on the metacarpal, trapezium, and scaphoid were detected in each of the 90 wrists we scanned. The distances between the points were compared by statistical analysis. With high accuracy, we have been able to confirm and quantify that subluxation occurs in the dorso-radial direction. A significant difference in trapezium height and joint space width was found between the OA and control groups. The results indicate how to restore the centre of rotation in surgical treatment of OA with total joint arthroplasty, but the clinical relevance of these findings has to be tested in further clinical studies.
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Affiliation(s)
- S de Raedt
- Quantitative Imaging Group, Delft University of Technology, The Netherlands, Orthopaedic Research Unit, Regional Hospital Holstebro, Denmark and Orthopedic Research Department, Aarhus University Hospital, Denmark
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Goubau JF, Goorens CK, Van Hoonacker P, Berghs B, Kerckhove D, Scheerlinck T. Clinical and radiological outcomes of the Ivory arthroplasty for trapeziometacarpal joint osteoarthritis with a minimum of 5 years of follow-up: a prospective single-centre cohort study. J Hand Surg Eur Vol 2013; 38:866-74. [PMID: 23677958 DOI: 10.1177/1753193413488494] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We present the results of a 5 year prospective follow-up study on the functional outcome after total replacement of the trapeziometacarpal joint with the Ivory prosthesis (Memometal, Stryker Corporate, Kalamazoo, Michigan, USA) in 22 patients. The female to male ratio was 21:1 and the mean age was 66 (range 54-78) years. The mean follow-up period was 67 (range 60-77) months after operation. Patient satisfaction was high. The mobility of the operated thumb was restored to a range of motion comparable to the contralateral thumb. Key pinch and grip strength improved by 13% and 31%, respectively. Overall function, according to Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score, improved by 59%. Pain decreased by 85% according to the numerical rating scale. Radiological evaluation revealed no loosening of the implant after 5 years except in one patient who required revision due to polythene wear with secondary joint instability. Another patient had asymptomatic polythene wear that required no revision but remains in follow-up. The 5 year overall survival of the prosthesis was 95%. These medium-term results suggest that the Ivory arthroplasty is a reliable option for treating advanced trapeziometacarpal arthritis, because it appears to give a very good functional outcome and has the potential for long-term survival rates.
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Affiliation(s)
- J F Goubau
- Department of Orthopaedics and Traumatology - Upper Limb Unit, AZ Sint-Jan AV Brugge-Oostende, Campus Brugge, Brugge, Belgium
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Giddins G. Editorial. Hand surgery research. J Hand Surg Eur Vol 2013; 38:235-6. [PMID: 23440046 DOI: 10.1177/1753193413477054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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