Revision rates of trapeziometacarpal total joint arthroplasty in relation to occupational hand force requirements

A review of wear debris in thumb base joint implants

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.

Low complication rate and high implant survival at 2 years after Touch® trapeziometacarpal joint arthroplasty

We analysed complications, revision surgeries, and patient-reported and clinical outcomes 2 years after trapeziometacarpal joint implant arthroplasty using the Touch® prosthesis. Of 130 operated patients with trapeziometacarpal joint osteoarthritis, four had to be revised owing to implant dislocation, loosening or impingement, leading to an estimated 2-year survival rate of 96% (95% confidence interval: 90 to 99). Of 101 patients available for the 2-year follow-up, complications occurred in 17, with the most frequent being de Quervain stenosing vaginosis (n = 6) and trigger thumb (n = 5). Pain at rest decreased significantly from a median value of 5 (interquartile range [IQR]: 4 to 7) before surgery to 0 (IQR: 0 to 1) at 2 years. Key pinch strength increased significantly from 4.5 kg (IQR: 3.0 to 6.5) to 7.0 kg (IQR: 6.0 to 8.0). We recommend surgery with the Touch® prosthesis as the standard procedure for patients with isolated trapeziometacarpal joint osteoarthritis because of the high survival rate and promising outcomes at 2 years.Level of evidence: IV.

Return to Work After Surgery For Trapeziometacarpal Joint Osteoarthritis in Relation to Occupational Hand Force Requirements

PURPOSE

This study evaluated the hypothesis that higher occupational hand force requirements are related to slower return to work (RTW) after surgery for trapeziometacarpal joint osteoarthritis.

METHODS

Patients treated surgically for trapeziometacarpal joint osteoarthritis from 2001 to 2017 were identified in the Danish National Patient Register. Sustainable RTW (sRTW) was defined as the first period of 4 consecutive weeks without health-related public transfer payments, according to the Danish National Register on Public Transfer Payments. Occupational codes from the Danish Employment Classification Module were linked to a hand-arm job exposure matrix to obtain occupational hand force requirements for each patient. Cox regression models were used to analyze time until sRTW in relation to hand force requirements with adjustment for age, sex, type of surgery, preoperative sick leave, and calendar year of surgery.

RESULTS

The study included 2,090 patients. Within 104 weeks, 91% sustainably returned to work. The percentage of individuals in the subgroups that did not RTW was 8% of low-force- and medium-force-exposed patients and 14% of high-force-exposed patients. Medium and high occupational hand force requirements were associated with slower sRTW. The adjusted hazard ratio for sRTW was 0.84 (95% confidence interval, 0.74-0.95) for medium and 0.59 (95% confidence interval, 0.50-0.68) for high compared with low hand force requirements. Among patients who returned to work, patients with medium and high hand force requirements had median periods until sRTW of 16 and 18 weeks, respectively, compared with 10 weeks among patients with low hand force requirements.

CONCLUSIONS

The prognosis regarding RTW after surgery for trapeziometacarpal joint osteoarthritis is generally good, but patients with higher occupational hand force requirements can expect slower RTW.

TYPE OF STUDY/LEVEL OF EVIDENCE

Prognostic II.

Long-term survival analysis of 191 MAÏA® prostheses for trapeziometacarpal arthritis

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.