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Herren DB. Basal thumb arthritis surgery: complications and its management. J Hand Surg Eur Vol 2024; 49:188-200. [PMID: 38315137 DOI: 10.1177/17531934231197787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
The management of complications after surgery for basal thumb arthritis is sometimes challenging, and there are no clear recommendations on how to evaluate and manage patients with residual symptoms. The aim of the present article was to review the most common complications after surgery for basal thumb arthritis, with an emphasis on resection arthroplasty, joint replacement and joint fusion. In addition, possible management strategies for the different types of complications will be highlighted.
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Affiliation(s)
- Daniel B Herren
- Schulthess Klinik, Department of Hand Surgery, Zurich, Switzerland
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Vanmierlo B, Buitenweg J, Vanmierlo T, Van Royen K, Bonte F, Goubau J. Ivory Arthroplasty for Trapeziometacarpal Joint Arthritis in Men: Analysis of Clinical Outcome and Implant Survival. Hand (N Y) 2022; 17:440-446. [PMID: 32697106 PMCID: PMC9112725 DOI: 10.1177/1558944720930297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Trapeziometacarpal arthroplasties are designed to restore an adequate level of mobility, stability, and grip strength. In this article, pain and functional and radiographic outcome of Ivory arthroplasty in male patients are investigated. Methods: Between 2005 and 2012, the Ivory arthroplasty was inserted in 21 male patients with degenerative trapeziometacarpal osteoarthritis, of which 14 patients were found eligible for inclusion. Mobility, grip strength, patient self-assessment (pain; Quick Disabilities of the Arm, Shoulder, and Hand [QuickDASH]), and radiographic outcome were measured. Twenty-two female patients who received an Ivory arthroplasty between 2005 and 2007 were included and underwent the same evaluation. Age at primary surgery, survival rate of the implant, and clinical outcome were compared between the 2 groups. Results: In both groups, QuickDASH score and mean pain sensation improved significantly. The improvement in mobility obtained significance in the female group. In the male group, 7 arthroplasties failed (mean follow-up of 65 months). In the female group, 3 of the 24 arthroplasties failed (mean follow-up of 123 months). Kaplan-Meier survival analysis demonstrated a significant lower implant survival in the male group. Conclusions: Decrease in muscle mass and decline in grip strength that postmenopausal women tend to experience might explain the significant difference in implant survival between sexes. In 4 of the 7 failed arthroplasties in the male group, no surgical revision was required. Trapeziometacarpal arthroplasty, even after radiographic failure, still served as a spacer, avoiding collapse of the thumb base. Nevertheless, the failure rate of the Ivory arthroplasty in male patients is high, and an alternative treatment should be considered.
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Affiliation(s)
- Bert Vanmierlo
- AZ Sint-Jan AV Brugge-Oostende, Belgium
- Bert Vanmierlo, Department of Orthopaedics and Traumatology, Upper Limb Unit, AZ Sint-Jan AV Brugge-Oostende, Campus Brugge, Ruddershove 10, B-8000 Brugge, Belgium. Emails: ,
| | | | - Tim Vanmierlo
- Hasselt University, Belgium
- Maastricht University, The Netherlands
| | - Kjell Van Royen
- AZ Sint-Jan AV Brugge-Oostende, Belgium
- University Hospital of Brussels, Belgium
| | | | - Jean Goubau
- AZ Sint-Jan AV Brugge-Oostende, Belgium
- University Hospital of Brussels, Belgium
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[Hemitrapeziectomy of the carpometacarpal joint of the thumb]. DER ORTHOPADE 2021; 51:23-28. [PMID: 34928419 DOI: 10.1007/s00132-021-04193-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/15/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Hemiresection arthoplasty or partial trapeziectomy of the carpometacarpal joint of the thumb is a surgical option in stages 1-3 according to Eaton-Littler classification. Preservation of the intact scaphotrapeziotrapezoidal (STT) joint and maintenance of the length of the thumb is the advantage of this technique. TECHNIQUE Technically, partial trapeziectomy is only slightly more complex compared to trapeziectomy with or without suspension. An interposition of autologous or allogeneic material is recommended; suspension arthroplasty is also possible in almost all common variants. Despite these theoretical advantages, this technique has not proven advantageous in practice, neither in terms of function nor in terms of time, compared to other techniques. The great advantage of partial trapeziectomy, however, is the wide range of options for revision surgery in the case of persistent complaints. RESULTS The risk of proximalization of the thumb due to an inadequate interposition is generally minor and is usually caused by implant sintering. This can easily be compensated for by implanting a larger graft. Persistent instabilities are the most common cause of persistence of symptoms and can usually be remedied by autologous or allogeneic suspension arthroplasty. In addition, the entire range of endoprosthetics is also possible with a previous spare resection of the trapezium and the possibility of a complete trapeziectomy remains in any case. The obvious theoretical advantages of arthroscopic hemitrapeziectomy need to be confirmed in practice in future.
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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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Abstract
The thumb carpometacarpal joint (CMCJ1) is born to have good freedom of motion. However, the excellent mobility at this joint also predisposes attenuation of capsuloligamentous structures, joint incongruity, instability, and osteoarthritis. The prevalence of radiographic CMCJ1 arthritis is high. There is no single ideal surgery for all stages of CMCJ1 arthritis, and for all kinds of patients. The arthroscopic approach seems to provide a better alternative with rewarding preliminary results. It includes arthroscopic synovectomy/debridement/thermal shrinkage, arthroscopic partial trapeziectomy and suture button suspensionplasty, and arthroscopic CMCJ1 excision/suture button suspensionplasty/K-wire fixation.
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Affiliation(s)
- Clara Wing-Yee Wong
- Division of Hand and Microsurgery, Department of Orthopaedic and Traumatology, Prince of Wales Hospital, Chinese University of Hong Kong, 16/F, The Club Lusitano, 16 Ice House Street, Central, Hong Kong SAR.
| | - Pak-Cheong Ho
- Division of Hand and Microsurgery, Department of Orthopaedic and Traumatology, Prince of Wales Hospital, Chinese University of Hong Kong, 5F, Lui Che Woo Clinical Sciences Building, 30-32 Ngan Shing Street, Shatin, NT, Hong Kong SAR
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Abstract
LEARNING OBJECTIVES After studying this article, the participant should be able to: 1. Assess the patient's history, clinical examination, and radiographic findings to diagnose and stage basilar joint arthritis. 2. Recall the cause and epidemiology of the condition. 3. Formulate a management plan including nonoperative management, and evaluate the candidacy for surgical treatment. 4. Understand the rationale for the various surgical options available (including rehabilitation), their potential complications, and the evidence related to outcomes. SUMMARY This article has been prepared to accompany practice-based assessment with ongoing surgical education for the Maintenance of Certification for the American Board of Plastic Surgery. It is designed for clinicians to analyze and structure their care of a patient with arthritis of the trapeziometacarpal joint.
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Abstract
In patients with carpometacarpal osteoarthritis of the thumb, treatment strategies should be based on functional impairment and pain. Although X‑ray imaging is an integral component of the diagnostics, it is of subordinate importance for the therapy algorithm. Conservative therapy is always the first step in the chain of treatment. The efficacy of non-operative treatment, including intermittent immobilization using splinting and the application of technical assist devices in the daily routine has been proven to achieve pain relief. The intra-articular injection of hyaluronic acid or glucocorticoids is still under debate as some good experiences in routine clinical applications are contrasted by the lack of effectiveness in randomized studies. The indications for operative treatment are fulfilled by persisting pain after exhausting all the options for conservative therapy. In this case isolated trapeziectomy is the method of choice. Suspension (interpositioning) arthroplasty is not associated with improved clinical results. More recent procedures which aim to avoid proximalization by tendon interposition, have not yet shown better clinical outcome compared to trapeziectomy alone.
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Rubino M, Cavagnaro L, Sansone V. A new surgical technique for the treatment of scaphotrapezial arthritis associated with trapeziometacarpal arthritis: the narrow pseudoarthrosis. J Hand Surg Eur Vol 2016; 41:710-8. [PMID: 26453601 DOI: 10.1177/1753193415609656] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 08/24/2015] [Indexed: 02/03/2023]
Abstract
UNLABELLED We describe a technique for treating Eaton stage IV osteoarthritis of the first ray, which is a development of our previously published technique for treating trapeziometacarpal arthritis. This simple technique is based on a limited resection arthroplasty of the first trapeziometacarpal and the scaphotrapezial joints, with the aim of inducing the formation of a narrow pseudoarthrosis at both sites. A total of 26 consecutive patients were treated for Eaton stage IV arthritis at a mean follow-up of 4.7 years (range 3.2-6.6). There were statistically significant improvements in all clinical parameters: mean appositional and oppositional pinch strength, mean DASH score (65 points pre-operatively to 8.7 points at final follow-up), and in mean visual analogue scale score (8.6 to 0.2 points). Although a larger cohort and a longer follow-up will be necessary to evaluate this new technique fully, these results encourage us to believe that the limited excision arthroplasty of the trapeziometacarpal and scaphotrapezial joints is a viable alternative to the existing surgical treatments for stage IV thumb arthritis. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- M Rubino
- Istituto Ortopedico Galeazzi IRCCS, Milano, Italy
| | - L Cavagnaro
- Clinica Ortopedica dell'Università degli Studi di Genova, Genova, Italy
| | - V Sansone
- Orthopaedic Department of the Università degli Studi di Milano, Istituto Ortopedico Galeazzi IRCCS, Milano, Italy
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Gay AM, Cerlier A, Iniesta A, Legré R. Surgery for trapeziometacarpal osteoarthritis. HAND SURGERY & REHABILITATION 2016; 35:238-249. [DOI: 10.1016/j.hansur.2016.06.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 05/09/2016] [Accepted: 06/05/2016] [Indexed: 11/24/2022]
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Raven EEJ, Kerkhoffs GMMJ, Sansone V. Re: Rubino M, Cavagnaro L and Sansone V. A new surgical technique for the treatment of scaphotrapezial arthritis associated with trapeziometacarpal arthritis: the narrow pseudoarthrosis. J Hand Surg Eur. 2016, 41: 710-718. J Hand Surg Eur Vol 2016; 41:780-1. [PMID: 27539832 DOI: 10.1177/1753193415620106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
| | - G M M J Kerkhoffs
- Academic Medical Center, Amsterdam, Gelre Hospital, Apeldoorn, The Netherlands
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Mattila S, Waris E. Unfavourable short-term outcomes of a poly-L/D-lactide scaffold for thumb trapeziometacarpal arthroplasty. J Hand Surg Eur Vol 2016; 41:328-34. [PMID: 26319289 DOI: 10.1177/1753193415601952] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2015] [Accepted: 07/13/2015] [Indexed: 02/03/2023]
Abstract
The bioabsorbable poly-L-D-lactide joint scaffold arthroplasty is a recent attempt in the reconstruction of small joints in rheumatoid patients. In this study, we analysed the 1-year clinical, functional and radiologic results of partial trapeziectomy with the poly-L-D-lactide (96/4) joint scaffold in 23 patients with isolated trapeziometacarpal osteoarthritis. The results showed that the procedure provided pain relief and improvement in overall function according to the Quick Disabilities of the Arm, Shoulder and Hand score in most patients. However, radiographs demonstrated a high frequency of osteolysis around the implant. Seven patients developed clinically manifested foreign-body reactions 6 months to 1 year after surgery. The reason for the unexpected tissue reactions may relate to excessive mechanical cyclic loading of the implant. The outcomes of this implant in our patients have not been sufficiently beneficial and we have discontinued use of this implant in isolated trapeziometacarpal osteoarthritis.
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Affiliation(s)
- S Mattila
- Department of Hand Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - E Waris
- Department of Hand Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Lansinger YC, Lehman TP. Nonunion Following Trapeziometacarpal Arthrodesis With Plate and Screw Fixation. J Hand Surg Am 2015; 40:2310-4. [PMID: 26440742 DOI: 10.1016/j.jhsa.2015.03.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Revised: 03/19/2015] [Accepted: 03/25/2015] [Indexed: 02/02/2023]
Affiliation(s)
- Yuri C Lansinger
- Department of Orthopedic Surgery and Rehabilitation, The University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Thomas P Lehman
- Department of Orthopedic Surgery and Rehabilitation, The University of Oklahoma Health Sciences Center, Oklahoma City, OK.
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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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Herren D. Commentary on Singh et al. Nonunion after trapeziometacarpal arthrodesis: comparison between K-wire and internal fixation and Smeraglia et al. Trapeziometacarpal arthrodesis: is bone union necessary for a good outcome? J Hand Surg Eur Vol 2015; 40:362-3. [PMID: 25852013 DOI: 10.1177/1753193414563654] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- D Herren
- Hand Surgery Department, Schulthess Klinik, Zurich, Switzerland
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Kodama N, Takemura Y, Imai S, Matsusue Y. New option for surgical treatment of the trapeziometacarpal osteoarthritis: a case report. CASE REPORTS IN PLASTIC SURGERY AND HAND SURGERY 2015; 2:47-9. [PMID: 27252969 PMCID: PMC4793790 DOI: 10.3109/23320885.2015.1029483] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Revised: 01/27/2015] [Accepted: 03/10/2015] [Indexed: 11/13/2022]
Abstract
We present the case of a 71-year-old, left-handed woman with left thumb carpometacarpal (CMC) joint arthritis. The patient had no pain and could use the hand actively in daily life with a new option of surgical treatment, a vascularized pedicled third CMC joint transfer to the thumb CMC joint.
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Affiliation(s)
- Narihito Kodama
- Department of Orthopaedic Surgery, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Yoshinori Takemura
- Department of Orthopaedic Surgery, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Shinji Imai
- Department of Orthopaedic Surgery, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Yoshitaka Matsusue
- Department of Orthopaedic Surgery, Shiga University of Medical Science, Otsu, Shiga, Japan
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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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