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Lirola-Palmero S, Salva-Coll G, Yáñez-Juan AM, Sánchez-Iriso E. Cost-effectiveness and cost-utility of the ball-and-socket trapeziometacarpal prosthesis compared to trapeziectomy and ligament reconstruction: study protocol for a randomized controlled clinical trial. Trials 2024; 25:220. [PMID: 38532422 PMCID: PMC10967180 DOI: 10.1186/s13063-024-08057-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 03/13/2024] [Indexed: 03/28/2024] Open
Abstract
BACKGROUND Trapeziometacarpal (TMC) osteoarthritis (OA) is a common cause of pain and weakness during thumb pinch leading to disability. There is no consensus about the best surgical treatment in unresponsive cases. The treatment is associated with costs and the recovery may take up to 1 year after surgery depending on the procedure. No randomized controlled trials have been conducted comparing ball and socket TMC prosthesis to trapeziectomy with ligament reconstruction. METHODS A randomized, blinded, parallel-group superiority clinical trial comparing trapeziectomy with abductor pollicis longus (APL) arthroplasty and prosthetic replacement with Maïa® prosthesis. Patients, 18 years old and older, with a clinical diagnosis of unilateral or bilateral TMC OA who fulfill the trial's eligibility criteria will be invited to participate. The diagnosis will be made by experienced hand surgeons based on symptoms, clinical history, physical examination, and complementary imaging tests. A total of 106 patients who provide informed consent will be randomly assigned to treatment with APL arthroplasty and prosthetic replacement with Maïa® prosthesis. The participants will complete different questionnaires including EuroQuol 5D-5L (EQ-5D-5L), the Quick DASH, and the Patient Rated Wrist Evaluation (PRWE) at baseline, at 6 weeks, and 3, 6, 12, 24, 36, 48, and 60 months after surgical treatment. The participants will undergo physical examination, range of motion assessment, and strength measure every appointment. The trial's primary outcome variable is the change in the visual analog scale (VAS) from baseline to 12 months. A long-term follow-up analysis will be performed every year for 5 years to assess chronic changes and prosthesis survival rate. The costs will be calculated from the provider's and society perspective using direct and indirect medical costs. DISCUSSION This is the first randomized study that investigates the effectiveness and cost-utility of trapeziectomy and ligament reconstruction arthroplasty and Maïa prosthesis. We expect the findings from this trial to lead to new insights into the surgical approach to TMC OA. TRIAL REGISTRATION ClinicalTrials.gov NCT04562753. Registered on June 15, 2020.
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Affiliation(s)
- Serafín Lirola-Palmero
- Departmen of Hand Surgery and Microsurgery, Hospital Universitari Son Espases, Ctra. Valldemosa 79, Palma de Mallorca, 07120, Spain.
| | - Guillem Salva-Coll
- Departmen of Hand Surgery and Microsurgery, Hospital Universitari Son Espases, Ctra. Valldemosa 79, Palma de Mallorca, 07120, Spain
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Van Geel P, Decramer A, Top A, Muermans S, Ryckaert T, Vanmierlo B. Thumb Arthroplasty as Reliable Long-term Solution for Trapeziometacarpal Osteoarthritis: A Minimum of 15 Years of Follow-up. Hand (N Y) 2024:15589447241233367. [PMID: 38389259 DOI: 10.1177/15589447241233367] [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] [Indexed: 02/24/2024]
Abstract
BACKGROUND In patients with symptomatic trapeziometacarpal (TMC) joint arthritis resistant to conservative treatment, surgical treatment can be advised. One of the many surgical treatment options is TMC arthroplasty. The Arpe prosthesis is one example of these TMC arthroplasties. METHODS This retrospective study evaluated patients who underwent TMC arthroplasty with the Arpe prosthesis after a minimum of 15 years of follow-up. Clinical, radiologic, and qualitative outcomes were assessed for 43 Arpe arthroplasties in 41 patients, of whom 2 had bilateral arthroplasties. The female to male ratio was 39:4. The mean follow-up time was 197 months (range = 180-225). RESULTS The cumulative survival rate after a mean of 16.5 years was 84%. Seven failures (16%) were registered, of which 5 during the first 3 years after primary surgery. All patients were successfully converted to a trapeziectomy. Quick Disabilities of the Arm, Shoulder and Hand score improved with 44.9 points and visual analogue pain score with 97% and 91% at rest and during exercise, respectively. CONCLUSIONS This series demonstrates that thumb arthroplasty is a reliable long-term solution for thumb base arthritis, with significant pain reduction and functional improvement, even after 15 years of follow-up.
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Affiliation(s)
- Pieter Van Geel
- Department of Orthopaedic Surgery, AZ Delta, Roeselare, Belgium
| | - Arne Decramer
- Department of Orthopaedic Surgery, AZ Delta, Roeselare, Belgium
| | - Alexander Top
- Department of Orthopaedic Surgery, AZ Delta, Roeselare, Belgium
| | - Stijn Muermans
- Department of Orthopaedic Surgery, AZ Delta, Roeselare, Belgium
| | | | - Bert Vanmierlo
- Department of Orthopaedic Surgery, AZ Delta, Roeselare, Belgium
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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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Pichard R, Jehanno P, Dukan R. One-year follow-up of failed first carpometacarpal joint arthrodesis treated by Touch® prosthesis. HAND SURGERY & REHABILITATION 2023; 42:555-556. [PMID: 37567414 DOI: 10.1016/j.hansur.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 08/05/2023] [Indexed: 08/13/2023]
Affiliation(s)
- Rémy Pichard
- Hand, Upper Limb and Peripheral Nerve Surgery, Georges-Pompidou European Hospital (HEGP), Paris, France.
| | - Pascal Jehanno
- Hand, Upper Limb and Peripheral Nerve Surgery, Georges-Pompidou European Hospital (HEGP), Paris, France
| | - Ruben Dukan
- Hand, Upper Limb and Peripheral Nerve Surgery, Georges-Pompidou European Hospital (HEGP), Paris, France
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de Villeneuve Bargemon JB, Lupon E, Soudé G, Jaloux C, Levet P, Levadoux M. Targeted partial arthroscopic trapeziectomy with temporary distraction: a retrospective study with 5-year follow-up. J Hand Surg Eur Vol 2023; 48:1062-1067. [PMID: 37751486 DOI: 10.1177/17531934231191246] [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: 09/28/2023]
Abstract
Targeted partial arthroscopic trapeziectomy with temporary distraction is a minimally invasive treatment for trapeziometacarpal osteoarthritis. We performed a retrospective single centre study from March 2011 to May 2022 and included patients with at least 5 years of follow-up. A failure was defined as a patient requiring a second procedure. Of the 28 patients with at least 5 years of follow-up, 23 were reviewed. Five of the 23 patients underwent revision surgery with a 5-year survival rate of 78%. There was a significant improvement in pain and the Quick Disabilities of the Arm, Shoulder and Hand (Q-DASH) score. There were three postoperative complications, one with complex regional pain syndrome, and two with hyperesthesia in the distribution of the sensory branch of the radial nerve. Targeted partial arthroscopic trapeziectomy with temporary distraction is a feasible temporary solution for early stage trapeziometacarpal joint osteoarthritis. However, there remains a 20% risk of failure.Level of evidence: IV.
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Affiliation(s)
- Jean-Baptiste de Villeneuve Bargemon
- Hand Surgery and Limb Reconstructive Surgery Department, Timone Adult Hospital, Aix Marseille University, Marseille, France
- Hand, Wrist and Elbow Surgery, Saint Roch Private Hospital, Toulon, Toulon, France
| | - Elise Lupon
- University Institute of Locomotor and Sport (IULS), Pasteur Hospital, Nice
| | - Guillaume Soudé
- Orthopedic Surgery Department, Hôpital Nord, Assistance Publique - Hôpitaux de Marseille, Marseille, France
| | - Charlotte Jaloux
- Hand Surgery and Limb Reconstructive Surgery Department, Timone Adult Hospital, Aix Marseille University, Marseille, France
| | - Paul Levet
- Hand Surgery and Limb Reconstructive Surgery Department, Timone Adult Hospital, Aix Marseille University, Marseille, France
| | - Michel Levadoux
- Hand, Wrist and Elbow Surgery, Saint Roch Private Hospital, Toulon, Toulon, France
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Ling K, Fassler R, Burgan J, Komatsu DE, Wang ED. Readmission and Reoperation Following Carpometacarpal Arthroplasty. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2023; 5:661-666. [PMID: 37790819 PMCID: PMC10543817 DOI: 10.1016/j.jhsg.2023.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 06/21/2023] [Indexed: 10/05/2023] Open
Abstract
Purpose Carpometacarpal (CMC) arthroplasty is an effective surgical treatment for osteoarthritis of the CMC joint. Risk factors for readmission and reoperation have been studied for other joint arthroplasty procedures but have not yet been studied for CMC arthroplasty. The purpose of this study was to identify patient demographics and comorbidities associated with 30-day readmission and 30-day reoperation after CMC arthroplasty. Methods The American College of Surgeons National Surgical Quality Improvement Program database was queried for all records of patients who underwent CMC arthroplasty between 2015 and 2020. Variables collected in this study included patient demographics, comorbidities, surgical characteristics, and 30-day postsurgical complication data. Multivariate logistic regression was used to identify independent associations between patient characteristics and readmission and reoperation after CMC arthroplasty. Results In total, 6,432 records were included in this study: 34 (0.5%) were readmitted within 30 days, and 27 (0.4%) underwent reoperation within 30 days. Compared with the non-readmission cohort, the readmission cohort was significantly associated with higher rates of age ≥ 75 years (P = .003), body mass index (BMI) ≥ 40 kg/m2 (P = .005), American Society of Anesthesiologists classification (ASA) ≥ 3; P < .001), insulin-dependent diabetes (P = .016), and chronic obstructive pulmonary disease (COPD; P = .009). Compared with the non-reoperation cohort, the reoperation cohort was significantly associated with higher rates of age ≥ 75 years (P = .003), BMI ≥ 40 kg/m2 (P = .005), ASA ≥ 3 (P < .001), insulin-dependent diabetes (p = .016), and COPD (P = .009). Conclusion The clinically significant predictors for 30-day readmission and 30-reoperation after CMC arthroplasty were age ≥ 75 years, BMI ≥ 40 kg/m2, ASA ≥ 3, insulin-dependent diabetes, and COPD. Of these risk factors, age and BMI were identified as independent predictors for 30-day readmission. A better understanding of presurgical risk factors for postsurgical complications may help surgeons with risk stratification and optimization of outcomes. Type of study/level of evidence Prognostic III.
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Affiliation(s)
- Kenny Ling
- Department of Orthopaedics, Stony Brook University, Stony Brook, NY
| | - Richelle Fassler
- Renaissance School of Medicine at Stony Brook University, Stony Brook, NY
| | - Jane Burgan
- Renaissance School of Medicine at Stony Brook University, Stony Brook, NY
| | - David E. Komatsu
- Department of Orthopaedics, Stony Brook University, Stony Brook, NY
| | - Edward D. Wang
- Renaissance School of Medicine at Stony Brook University, Stony Brook, NY
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Tang JB. CORR Insights®: Dorsal Subluxation of the First Metacarpal During Thumb Flexion is an Indicator of Carpometacarpal Osteoarthritis Progression. Clin Orthop Relat Res 2023; 481:1238-1239. [PMID: 36892532 PMCID: PMC10194642 DOI: 10.1097/corr.0000000000002618] [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] [Received: 01/22/2023] [Accepted: 02/08/2023] [Indexed: 03/10/2023]
Affiliation(s)
- Jin Bo Tang
- Professor of Hand Surgery, Affiliated Hospital of Nantong University, Nantong, Jiangsu, P. R. China
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8
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Massarella M, Poggi DS, Piccirilli E. Trapeziometacarpal Joint Arthroplasty, a Salvage Technique for Failed Open Reduction Internal Fixation of the First Metacarpal. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2023; 5:246-249. [PMID: 36974289 PMCID: PMC10039295 DOI: 10.1016/j.jhsg.2022.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 12/21/2022] [Indexed: 02/10/2023] Open
Abstract
This report describes the case of a 61-year-old man reporting a painful subluxation and instability of the first metacarpal of the right hand after surgery for a multifragment fracture-subluxation of the thumb base. The fracture (considered irreducible) had been previously treated with K-wire stabilization of the trapeziometacarpal joint and subsequent removal of the K-wires at another clinical center. We advocate the use of trapeziometacarpal arthroplasty after the failure of open reduction internal fixation of the previous articular fracture, with successful results at follow-up.
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Affiliation(s)
- Massimo Massarella
- Orthopaedic and Trauma Surgery, Villa Stuart Sport Clinic, Rome, Italy
- Corresponding author: Massimo Massarella, MD, Villa Stuart Sport Clinic, Via Trionfale, 5952 - 00136 Rome, Italy.
| | | | - Eleonora Piccirilli
- Policlinico Tor Vergata, Department of Orthopaedics and Traumatology, Rome, Italy
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9
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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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10
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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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11
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Myncke I, Vanhees M, Verstreken F. Our Treatment Strategy for CMC-1 Osteoarthritis. HANDCHIR MIKROCHIR P 2022; 54:244-252. [PMID: 35649427 DOI: 10.1055/a-1808-7096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Osteoarthritis of the carpometacarpal joint of the thumb ( CMC-1) is a common problem and many patients will seek medical attention and may eventually need surgical treatment. As no treatment option has shown consistent superiority, a variety of surgical procedures have been proposed. In this review paper we present our algorithm for the approach of symptomatic CMC-1 osteoarthritis, supported by scientific evidence and our personal experience. It is primarily based on patient demands, status of CMC-1 disease and associated problems around the thumb. The selection of a successful surgical treatment plan with restoration of a pain free and fully functional thumb is the goal. We'll outline the pro's and con's of the surgical procedures and although trapeziectomy has long been the gold standard, the advent of reliable total joint arthroplasties with good short and long-term outcome reports has changed our treatment protocol completely.
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12
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Duerinckx J, Verstreken F. Total joint replacement for osteoarthritis of the carpometacarpal joint of the thumb: why and how? EFORT Open Rev 2022; 7:349-355. [PMID: 35638603 PMCID: PMC9257729 DOI: 10.1530/eor-22-0027] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Total joint replacement has certain advantages over other surgical treatment methods for osteoarthritis of the thumb carpometacarpal joint, including restoration of thumb length and alignment, good cosmetical result, fast recovery of hand function and prevention of iatrogenic complications at neighbouring joints. Disadvantages include the technical difficulty to perform this surgery and a possible higher complication rate. A meticulous surgical technique is mandatory. Combined with a cementless and modular ball-in-socket implant with a metal-on-polyethylene friction couple, a 10-year survival rate higher than 90% can be expected. Revision surgery is possible with implant exchange or conversion to trapeziectomy.
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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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14
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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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Sánchez-Crespo M, de la Red-Gallego M, Ayala-Gutiérrez H, Couceiro-Otero J, Rodríguez-Fernández J, del Canto-Alvarez F. Initial survival of the Isis® total trapeziometacarpal prosthesis with conical trunk threaded cups. Rev Esp Cir Ortop Traumatol (Engl Ed) 2021. [DOI: 10.1016/j.recote.2021.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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17
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Athlani L, Motte D, Bergere M, Mottet J, Beaulieu JY, Moissenet F. Assessment of trapezial prosthetic cup migration: A biomechanical study. HAND SURGERY & REHABILITATION 2021; 40:754-759. [PMID: 34391955 DOI: 10.1016/j.hansur.2021.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 08/01/2021] [Accepted: 08/06/2021] [Indexed: 11/29/2022]
Abstract
We performed a biomechanical study using 60 Sawbones® rigid foam blocks of two simulated densities (osteoporotic, n = 30 and non-osteoporotic, n = 30) and 10 cadaveric trapezium bones from fresh-frozen, unembalmed adult cadaver hands to assess the trapezial prosthetic cup migration with progressively greater compression loads (10-40 kg). Two cups from the Touch® prosthesis were compared: 9-mm conical cup and 9-mm spherical cup. Uniaxial compression tests were carried out using an MTS Criterion® Series 40 Electromechanical Testing System. Cup migration was measured in millimeters (mm) at 10, 20, and 40 kg of compression load. Median cup migration values were similar in the cadaveric trapezium bones and Sawbones® non-osteoporotic blocks, and higher in the Sawbones® osteoporotic blocks. In the cadaveric trapezium bones and the Sawbones® non-osteoporotic blocks, migration values were less than or equal to 0.1 mm for 10 and 20 kg loads; it was 0.2 mm for 40 kg load. In the Sawbones® osteoporotic blocks, migration values were less than or equal to 0.3 mm for 10 and 20 kg loads; it was 0.4-0.5 mm for 40 kg load. There was no significant difference between the two cup shapes in both cadaveric trapezium bones and Sawbones® non-osteoporotic blocks. In Sawbones® osteoporotic blocks, the largest difference between the two cup shapes was 0.1 mm for loads up to 40 kg, which corresponded to our measurement accuracy. Our findings indicate that the trapezial component of total trapeziometacarpal joint arthroplasty undergoes very weak migration for axial compression loads up to 40 kg, presumably below the threshold of clinical relevance. The cup shape did not have an obvious influence; however, low bone mineral density may result in greater cup migration.
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Affiliation(s)
- L Athlani
- Department of Hand Surgery, Division of Orthopedics and Trauma Surgery, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, CH-1211 Geneva 14, Switzerland; Department of Anatomy, Faculty of Medicine, University of Geneva, Rue Michel-Servet 1, 1206 Geneva, Switzerland.
| | - D Motte
- KeriMedical SA, Route des Acacias 45A, 1227 Geneva, Switzerland.
| | - M Bergere
- KeriMedical SA, Route des Acacias 45A, 1227 Geneva, Switzerland.
| | - J Mottet
- KeriMedical SA, Route des Acacias 45A, 1227 Geneva, Switzerland.
| | - J-Y Beaulieu
- Department of Hand Surgery, Division of Orthopedics and Trauma Surgery, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, CH-1211 Geneva 14, Switzerland; Department of Anatomy, Faculty of Medicine, University of Geneva, Rue Michel-Servet 1, 1206 Geneva, Switzerland.
| | - F Moissenet
- Department of Anatomy, Faculty of Medicine, University of Geneva, Rue Michel-Servet 1, 1206 Geneva, Switzerland; Biomechanics Laboratory (B-LAB), Division of Orthopedics and Trauma Surgery, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, CH-1211 Geneva 14, Switzerland.
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18
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Lane JC, Craig R, Rees JL, Gardiner M, Mikhail MM, Riley N, Prieto-Alhambra D, Furniss D. Low rates of serious complications and further procedures following surgery for base of thumb osteoarthritis: analysis of a national cohort of 43 076 surgeries. BMJ Open 2021; 11:e045614. [PMID: 34233971 PMCID: PMC8264901 DOI: 10.1136/bmjopen-2020-045614] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To determine the incidence of further procedures and serious adverse events (SAEs) requiring admission to hospital following elective surgery for base of thumb osteoarthritis (BTOA), and the patient factors associated with these outcomes. DESIGN Population based cohort study. SETTING National Health Service using the national Hospital Episode Statistics data set linked to mortality records over a 19-year period (01 April 1998-31 March 2017). PARTICIPANTS 43 076 primary surgeries were followed longitudinally in secondary care until death or migration on 37 329 patients over 18 years of age. MAIN OUTCOME MEASURES Incidence of further thumb base procedures (including revision surgery or intra-articular steroid injection) at any time postoperatively, and local wound complications and systemic events (myocardial infarction, stroke, respiratory tract infection, venous thromboembolic events, urinary tract infection or renal failure) within 30 and 90 days. To identify patient factors associated with outcome, Fine and Gray model regression analysis was used to adjust for the competing risk of mortality in addition to age, overall comorbidity and socioeconomic status. RESULTS Over the 19 years, there was an increasing trend in surgeries undertaken. The rate of further thumb base procedures after any surgery was 1.39%; the lowest rates after simple trapeziectomy (1.12%), the highest rates after arthroplasty (3.84%) and arthrodesis (3.5%). When matched for age, comorbidity and socioeconomic status, those undergoing arthroplasty and arthrodesis were 2.5 times more likely to undergo a further procedure (subHR 2.51 (95% CI 1.81 to 3.48) and 2.55 (1.91 to 3.40)) than those undergoing simple trapeziectomy. Overall complication rates following surgery were 0.22% for serious local complications and 0.58% for systemic events within 90 days of surgery. CONCLUSIONS The number of patients proceeding to BTOA surgery has increased over the last 19 years, with a low rate of further thumb base procedures and SAEs after surgery overall registered. Arthrodesis and arthroplasty had a significantly higher revision rate. TRIAL REGISTRATION NUMBER NCT03573765.
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Affiliation(s)
- Jennifer Ce Lane
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University, Oxford, UK
| | - Richard Craig
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University, Oxford, UK
| | - Jonathan L Rees
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University, Oxford, UK
| | - Matthew Gardiner
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University, Oxford, UK
- Department of Plastic Surgery, Wexham Park Hospital, Slough, UK
| | - Mark M Mikhail
- Department of Plastic Surgery, Oxford University Hospitals NHS Foundation Trust, Nuffield Orthopaedic Centre, Oxford, UK
| | - Nicholas Riley
- Department of Hand Surgery, Oxford University Hospitals NHS Foundation Trust, Nuffield Orthopaedic Centre, Oxford, UK
| | - Daniel Prieto-Alhambra
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University, Oxford, UK
| | - Dominic Furniss
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University, Oxford, UK
- Department of Plastic Surgery, Oxford University Hospitals NHS Foundation Trust, Nuffield Orthopaedic Centre, Oxford, UK
- Department of Hand Surgery, Oxford University Hospitals NHS Foundation Trust, Nuffield Orthopaedic Centre, Oxford, UK
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19
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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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20
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Sánchez-Crespo MR, de la Red-Gallego MA, Ayala-Gutiérrez H, Couceiro-Otero J, Rodríguez-Fernández J, Del Canto-Alvarez FJ. Initial survival of the Isis® total trapeziometacarpal prosthesis with conical trunk threaded cups. Rev Esp Cir Ortop Traumatol (Engl Ed) 2021; 65:S1888-4415(21)00081-3. [PMID: 34148810 DOI: 10.1016/j.recot.2021.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 01/20/2021] [Accepted: 02/10/2021] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The treatment of trapeziometacarpal osteoarthritis through the implantation of total trapeziometacarpal prostheses is in continuous expansion. The Isis® prosthesis is a trunk-conical threaded anchorage prosthesis. Our objective was to assess the functional results and survival of this implant for at least one year of follow-up. MATERIAL AND METHOD Prospective study on 53 Isis® prosthesis, implanted from april 2014 to january 2019. The Van Cappelle functional test, pain, strength, mobility, return to previous activity, radiological variables and placement of the trapezial component were evaluated. The surgical technique was performed with a guide wirefocused on the trapezius and control of the scopia. Observed complications were recorded and statistical analysis was performed. RESULTS Fifty-one implants (49 patients) were reviewed. Mean follow-up was 2.1 years (1-5.7). Van Cappelle's test, pain, mobility, and grip and clamp strength improved significantly, as did the distance between the metacarpal head and the trapezius base; 96% of the patients returned in less than 6 months to their activities. Minor complications, 3 De Quervain's tendinopathy and 2 intra-operative metacarpal and 2 trapezium fractures were recorded, and one carpal tunnel syndrome. There was no dislocation, mobilization, or implant infection. CONCLUSIONS The functional results of the Isis® prosthesis are excellent in the short term, far exceeding the first year of 100% of survival. The complications that arose were minor and few. The anchorage and placement of the trapezial component guided by scopia seem to be crucial for the good result.
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Affiliation(s)
- M R Sánchez-Crespo
- Servicio de Cirugía Ortopédica y Traumatología, Unidad de Mano y Muñeca, Hospital Universitario Marqués de Valdecilla, Santander, España; Universidad de Cantabria, Santander, España.
| | - M A de la Red-Gallego
- Servicio de Cirugía Ortopédica y Traumatología, Unidad de Mano y Muñeca, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - H Ayala-Gutiérrez
- Servicio de Cirugía Ortopédica y Traumatología, Unidad de Mano y Muñeca, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - J Couceiro-Otero
- Servicio de Cirugía Ortopédica y Traumatología, Unidad de Mano y Muñeca, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - J Rodríguez-Fernández
- Servicio de Cirugía Ortopédica y Traumatología, Unidad de Mano y Muñeca, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - F J Del Canto-Alvarez
- Servicio de Cirugía Ortopédica y Traumatología, Unidad de Mano y Muñeca, Hospital Universitario Marqués de Valdecilla, Santander, España; Universidad de Cantabria, Santander, España
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21
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Borgers A, Verstreken A, Vanhees M, Verstreken F. Primary endoprosthetic replacement of the arthritic CMC-1 joint. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2021; 33:228-244. [PMID: 34003322 DOI: 10.1007/s00064-021-00713-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 11/23/2020] [Accepted: 12/10/2020] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Osteoarthritis of the carpometacarpal (CMC)-1 joint is a common condition that can cause significant pain and functional problems. When nonoperative management fails, surgery may be indicated. Resection of the trapezium, often combined with soft tissue stabilization, is still considered the gold standard. But recovery time is often prolonged and a significant number of patients remain unsatisfied in the long term. Knowing that total endoprosthetic joint replacement is one of the most successful achievements of orthopedic surgery, many attempts have been made to produce a replacement for the CMC‑1 joint that provides a better outcome than trapeziectomy. INDICATIONS Eaton-Glickel stage 2-3 CMC‑1 osteoarthritis. CONTRAINDICATIONS Symptomatic pan-trapezial osteoarthritis (Eaton-Glickel stage 4), infection, young manual worker, poor bone quality or insufficient trapezium size. SURGICAL TECHNIQUE A dorsoradial approach to the CMC‑1 joint is used. Minimal resection of the trapezial and metacarpal articular surfaces, including osteophytes and loose bodies. Reaming of the trapezium and broaching of the metacarpal stem with dedicated instruments. Implantation of the endoprosthetic components. Selection of the correct neck length to ensure a stable joint. Closure of the capsule and skin. POSTOPERATIVE MANAGEMENT Immobilization of thumb for 2 weeks in a splint. Followed by a removable thumb CMC brace for 4 weeks, starting with gentle mobilization exercises. No forceful gripping or pinching the first 6 weeks. RESULTS A specific design-the uncemented, ball in socket, metal on polyethylene total joint replacement-has stood the test of time and successful long-term clinical and radiographic outcome results have been published. Recent comparative trials have shown better pinch strength, better pain relief and faster functional recovery, when compared to trapeziectomy with ligament reconstruction and tendon interposition. The incidence of complications such as dislocation, polyethylene wear and cup loosening is acceptable.
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Affiliation(s)
- Anton Borgers
- Orthopedic Department, AZ Turnhout Hospital, Turnhout, Belgium
| | | | - Matthias Vanhees
- Orthopedic Department, Antwerp University Hospital, Edegem, Belgium.,Orthopedic Department, AZ Monica Hospital, Antwerp, Belgium
| | - Frederik Verstreken
- Orthopedic Department, Antwerp University Hospital, Edegem, Belgium. .,Orthopedic Department, AZ Monica Hospital, Antwerp, Belgium.
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22
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Athlani L, Auberson L, Motte D, Moissenet F, Beaulieu JY. Comparison of two radiographic landmarks for centering the trapezial component in total trapeziometacarpal arthroplasty. HAND SURGERY & REHABILITATION 2021; 40:609-613. [PMID: 33992819 DOI: 10.1016/j.hansur.2021.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 04/30/2021] [Accepted: 05/03/2021] [Indexed: 10/21/2022]
Abstract
We performed a retrospective review of standard anteroposterior and lateral radiographs of the thumb in 80 patients, to compare two radiographic landmarks, in terms of mediolateral bone support, for centering the trapezial component in total joint arthroplasty. On anteroposterior view, we identified the distal articular surface of the trapezium and trapezium width, and defined the two midpoints as radiographic landmarks for positioning a 9-mm trapezial cup. Mean trapezium width was significantly greater than the distal articular surface of the trapezium, and the midpoints did not match. Thus, after positioning simulated 9-mm prosthetic cups centered on each landmark, the residual radial bone distance was significantly greater using the landmark based on trapezium width. The mean value was 33% greater with this landmark, and the minimum value was 2.1 mm, compared to 0.2 mm using the landmark based on the distal articular surface. Our study thus suggested that the midpoint of the trapezium width is the more relevant radiographic landmark for centering the trapezial prosthetic cup in total joint arthroplasty, by preserving better bone stock on the radial side without depleting the ulnar side. On an intraoperative anteroposterior fluoroscopic view, this landmark could be used to check cup positioning.
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Affiliation(s)
- L Athlani
- Department of Hand Surgery, Division of Orthopedics and Trauma Surgery, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 14, Switzerland; Department of Anatomy, Faculty of Medicine, University of Geneva, Rue Michel-Servet 1, 1206 Geneva, Switzerland.
| | - L Auberson
- Department of Hand Surgery, Division of Orthopedics and Trauma Surgery, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 14, Switzerland.
| | - D Motte
- KeriMedical SA, Route des Acacias 45A, 1227 Geneva, Switzerland.
| | - F Moissenet
- Biomechanics Laboratory (B-LAB), Division of Orthopedics and Trauma Surgery, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 14, Switzerland.
| | - J-Y Beaulieu
- Department of Hand Surgery, Division of Orthopedics and Trauma Surgery, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 14, Switzerland; Department of Anatomy, Faculty of Medicine, University of Geneva, Rue Michel-Servet 1, 1206 Geneva, Switzerland.
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23
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Holme TJ, Karbowiak M, Clements J, Sharma R, Craik J, Ellahee N. Thumb CMCJ prosthetic total joint replacement: a systematic review. EFORT Open Rev 2021; 6:316-330. [PMID: 34150326 PMCID: PMC8183150 DOI: 10.1302/2058-5241.6.200152] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Thumb carpometacarpal joint (CMCJ) arthritis is a common and painful condition. Thumb CMCJ prosthetic replacement aims to restore thumb biomechanics and improve pain and function. Early reviews demonstrated a lack of high-quality studies, but more recently a significant number of higher-quality studies have been published. This review provides a concise and systematic overview of the evidence to date. A systematic review of several databases was conducted according to PRISMA guidelines. Studies evaluating the outcomes of thumb CMCJ prosthetic total joint replacement were included. Data extracted included patient-reported outcome measures (PROMs), pain scores, range of motion, strength, survival rates and complications. A total of 56 studies met all inclusion criteria and were analysed. There was one randomized controlled trial, three prospective comparative cohort studies, five retrospective comparative cohort studies, and 47 descriptive cohort studies. The reported studies included 2731 patients with 3048 thumb total CMCJ prosthetic joint replacements. Follow up ranged from 12 months to 13.1 years. In general, good results were demonstrated, with improvements in PROMs, pain scores and strength. Failure rates ranged from 2.6% to 19.9% depending upon implant studied. Comparative studies demonstrated promising results for replacement when compared to resection arthroplasty, with modest improvements in PROMs but at a cost of increased rates of complications. Studies reporting outcomes in thumb CMCJ prosthetic total joint replacement are increasing in both number and quality. Failure, in terms of loosening and dislocation, remains a concern, although in the medium-term follow up for modern implants this issue appears to be lower when compared to their predecessors. Functional outcomes also look promising compared to resection arthroplasty, but further high-quality studies utilizing a standardized resection arthroplasty technique and modern implants, together with standardized core outcome sets, will be of value.
Cite this article: EFORT Open Rev 2021;6:316-330. DOI: 10.1302/2058-5241.6.200152
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Affiliation(s)
- Thomas J Holme
- Epsom & St Helier University Hospitals NHS Trust, Trauma & Orthopaedics, Carshalton, UK
| | - Marta Karbowiak
- Royal Surrey NHS Foundation Trust, Trauma & Orthopaedics, Guildford, UK
| | - Jennifer Clements
- Epsom & St Helier University Hospitals NHS Trust, Trauma & Orthopaedics, Carshalton, UK
| | - Ritesh Sharma
- Epsom & St Helier University Hospitals NHS Trust, Trauma & Orthopaedics, Carshalton, UK
| | - Johnathan Craik
- Epsom & St Helier University Hospitals NHS Trust, Trauma & Orthopaedics, Carshalton, UK
| | - Najab Ellahee
- Epsom & St Helier University Hospitals NHS Trust, Trauma & Orthopaedics, Carshalton, UK
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24
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Tchurukdichian A, Gerenton B, Moris V, See LA, Stivala A, Guillier D. Outcomes of Double-Mobility Prosthesis in Trapeziometacarpal Joint Arthritis With a Minimal 3 Years of Follow-Up: An Advantage for Implant Stability. Hand (N Y) 2021; 16:368-374. [PMID: 31272202 PMCID: PMC8120594 DOI: 10.1177/1558944719855690] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: New generation of total trapeziometacarpal joint prosthesis using double mobility concept has been used for several years. The aim of this study was to evaluate the dislocation rate with this implant after a minimal 3 years of follow-up. Methods: From September 2013 to August 2015, 200 trapeziometacarpal prostheses were implanted in 179 patients. Clinico-radiological follow-up was performed with an average of 48.2 months (36-60 months). Survival rate and dislocation rate were analyzed. Loosening of the implants and other intercurrent events were noticed. Results: Visual analog scale, Quick-DASH, strengths and range of motion improved significantly. We report a survival rate of 97% with only 0.5% of dislocation of prosthesis at 48 months of follow-up. Intercurrent events rate were similar to the ones found in literature or other studies. Conclusions: After a minimal of 3 years of follow-up, prosthesis with double mobility seemed to bring better stability in implant for thumb prosthetic replacement.
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Affiliation(s)
- Alain Tchurukdichian
- Dijon University Hospital, France,Cliniques de Valmy et de Drevon, Dijon, France
| | | | | | | | | | - David Guillier
- Dijon University Hospital, France,David Guillier, Department of Plastic Reconstructive and Hand Surgery and Department of Oral and Maxillofacial Surgery, Dijon University Hospital, Boulevard de Lattre de Tassigny, F-21000 Dijon, France.
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25
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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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26
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Dremstrup L, Thillemann JK, Kirkeby L, Larsen LP, Hansen TB, Stilling M. Two-year results of the Moovis trapeziometacarpal joint arthroplasty with focus on early complications. J Hand Surg Eur Vol 2021; 46:131-140. [PMID: 32397782 DOI: 10.1177/1753193420921307] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
In this prospective study, we aimed to analyse the early results of 200 consecutive total trapeziometacarpal joint arthroplasties using the Moovis cup, a new generation, dual-mobility, uncemented conical cup, with special focus on early complications. At the 24-month follow-up, we found clinically relevant improvement of function and comfort. Among intraoperative complications were nine intraoperative trapezial fractures, which were treated by screw osteosynthesis; prolonged immobilization; and conversion to cemented cup fixation or primary or secondary trapeziectomy. One was left untreated as the loose cup did not cause notable symptoms. There were three implants with polyethylene wear and two with liner dislocation. We conclude that early outcomes of this new-generation implant are favourable, but its surgery is challenging and associated with important intraoperative and early postoperative complications related to the learning curve. Attentive reaming of the trapezium and careful cup impaction are crucial steps to avoid trapezial fracture and early cup failure. Level of evidence: II.
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Affiliation(s)
- Lene Dremstrup
- Department of Orthopaedics, Hospital Unit West, Holstebro, Denmark
| | - Janni Kjærgaard Thillemann
- Department of Orthopaedics, Hospital Unit West, Holstebro, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Lone Kirkeby
- Department of Orthopaedics, Hospital Unit West, Holstebro, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | | | - Torben Bæk Hansen
- Department of Orthopaedics, Hospital Unit West, Holstebro, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Maiken Stilling
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Orthopaedics, Aarhus University Hospital, Aarhus, Denmark
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27
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Duerinckx J, Goubau J. Revision surgery for the Ivory® trapeziometacarpal prosthesis: compatibility with the Touch® prosthesis allows the stem to be retained. HAND SURGERY & REHABILITATION 2020; 39:588-589. [DOI: 10.1016/j.hansur.2020.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 07/21/2020] [Accepted: 08/05/2020] [Indexed: 10/23/2022]
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28
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Gerace E, Royaux D, Gaisne E, Ardouin L, Bellemère P. Pyrocardan® implant arthroplasty for trapeziometacarpal osteoarthritis with a minimum follow-up of 5 years. HAND SURGERY & REHABILITATION 2020; 39:528-538. [DOI: 10.1016/j.hansur.2020.09.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 07/28/2020] [Accepted: 09/01/2020] [Indexed: 10/23/2022]
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29
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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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30
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Martins A, Charbonnel S, Lecomte F, Athlani L. The Moovis® implant for trapeziometacarpal osteoarthritis: results after 2 to 6 years. J Hand Surg Eur Vol 2020; 45:477-482. [PMID: 31964213 DOI: 10.1177/1753193420901435] [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 reviewed the outcomes of 46 trapeziometacarpal joint replacements with the Moovis® prosthesis in 46 patients with painful osteoarthritis. The dual mobility design of this prosthesis aims to reduce prosthetic dislocation and subsidence. At follow-up 2 to 6 years (mean 5 years) after operation, pain was reduced from 6 to 0 on a visual analogue scale from 0 to 10. The scores of the Quick Disabilities of the Arm, Shoulder and Hand questionnaire improved significantly. Thumb motion and grip and pinch strength did not differ significantly from the contralateral hand. There were no radiographical signs of implant subsidence or loosening. No implant required revision. Forty-five patients rated the result as excellent or good. We conclude the Moovis® is a reliable and effective implant at short- to mid-term follow-up. Level of evidence: IV.
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Affiliation(s)
- Antoine Martins
- Service d'Orthopédie-Traumatologie, Hôpital Gabriel Montpied, CHU Clermont Ferrand, France
| | - Sébastien Charbonnel
- Centre de chirurgie de la main, Hôpital Privé La Châtaigneraie, La Châtaigneraie, France
| | - Frédéric Lecomte
- Centre de chirurgie de la main, Hôpital Privé La Châtaigneraie, La Châtaigneraie, France
| | - Lionel Athlani
- Department of Hand Surgery, Plastic and Reconstructive Surgery, Centre chirurgical Emile Gallé, CHU Nancy, France
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Tchurukdichian A, Guillier D, Moris V, See LA, Macheboeuf Y. Results of 110 IVORY® prostheses for trapeziometacarpal osteoarthritis with a minimum follow-up of 10 years. J Hand Surg Eur Vol 2020; 45:458-464. [PMID: 31992116 DOI: 10.1177/1753193419899843] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The IVORY® prosthesis is a total trapeziometacarpal joint prosthesis used for the treatment of symptomatic trapeziometacarpal osteoarthritis. The aim of this prospective study was to evaluate its long-term outcomes with a minimum follow-up of 10 years. From 2004 to 2007, 110 trapeziometacarpal prostheses (95 patients) were implanted. The implant survival curve was constructed using the Kaplan-Meier method. Five patients were lost from follow-up and two died. Six prosthesis (5.5%) were removed after dislocation or fracture of the trapezium. The survival rate of the prosthesis was 95%. After 10 years, the mean visual analogue pain score was 0.24/10 and the key-pinch force was similar to the other hand. Dislocations occurred for eight implants (7.3%). No radiological loosening was noted. In conclusion, the long-term results with the IVORY® prosthesis are very satisfactory in terms of pain relief, function and survival. Level of evidence: II.
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Affiliation(s)
- Alain Tchurukdichian
- Service de Chirurgie Plastique, Reconstructrice et Esthétique et Chirugie de la Main, CHRU de Dijon, Dijon, France.,Chirurgie de la main, Cliniques de Valmy et de Drevon, Dijon, France
| | - David Guillier
- Service de Chirurgie Plastique, Reconstructrice et Esthétique et Chirugie de la Main, CHRU de Dijon, Dijon, France
| | - Vivien Moris
- Service de Chirurgie Plastique, Reconstructrice et Esthétique et Chirugie de la Main, CHRU de Dijon, Dijon, France
| | - Leslie-Ann See
- Service de Chirurgie Plastique, Reconstructrice et Esthétique et Chirugie de la Main, CHRU de Dijon, Dijon, France
| | - Yvan Macheboeuf
- Service de Chirurgie Plastique, Reconstructrice et Esthétique et Chirugie de la Main, CHRU de Dijon, Dijon, France
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Froschauer SM, Holzbauer M, Hager D, Schnelzer R, Kwasny O, Duscher D. Elektra prosthesis versus resection-suspension arthroplasty for thumb carpometacarpal osteoarthritis: a long-term cohort study. J Hand Surg Eur Vol 2020; 45:452-457. [PMID: 31510855 PMCID: PMC7232778 DOI: 10.1177/1753193419873230] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The present study compares 34 patients with thumb carpometacarpal osteoarthritis (37 thumbs) treated with the Elektra® prosthesis, with 18 patients (18 thumbs) treated with resection-suspension arthroplasty, with an overall mean follow-up period of 13.3 years. Evaluation with disability of arm and shoulder scores, pain via visual analogue scale and range of motion (radial and palmar abduction, and opposition) indicated no significant difference. However, the cohort with a surviving prosthesis showed significantly better subjective grip strength (p = 0.04). Complications occurred in 23 of the 37 thumbs in the prosthesis group compared with two in the resection-suspension arthroplasty patients. Seventeen prostheses required revision. At revision operations, we observed local signs of metallosis in 15 of 17 cases. The patients receiving resection-suspension arthroplasty were more satisfied with their treatment (p = 0.003). Therefore, we cannot recommend the implantation of Elektra® prosthesis and we speculate that the key problem of aseptic cup loosening is a result of the metal-on-metal bearing. Level of evidence: III.
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Affiliation(s)
- Stefan M. Froschauer
- Department for Trauma Surgery and
Sportstraumatology, Johannes Kepler University Linz, Linz, Austria,Faculty of Medicine, Johannes
Kepler University Linz, Linz, Austria,Stefan M. Froschauer, Department for
Trauma Surgery and Sportstraumatology, Johannes Kepler University
Linz, Kepler University Hospital GmbH, Altenberger Strasse 69, 4020
Linz, Austria.
| | | | | | - Richard Schnelzer
- Department for Trauma Surgery and
Sportstraumatology, Johannes Kepler University Linz, Linz, Austria
| | - Oskar Kwasny
- Department for Trauma Surgery and
Sportstraumatology, Johannes Kepler University Linz, Linz, Austria,Faculty of Medicine, Johannes
Kepler University Linz, Linz, Austria
| | - Dominik Duscher
- Department for Trauma Surgery and
Sportstraumatology, Johannes Kepler University Linz, Linz, Austria,Technical University Munich,
Department for Plastic and Hand Surgery, Munich, Germany
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33
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Boeckstyns MEH. Commentary on: 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; 45:470-471. [PMID: 32407195 DOI: 10.1177/1753193420913460] [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]
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34
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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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