Arthroplastie par prothèse trapézo-métacarpienne Moovis – une étude fonctionnelle rétrospective de 19 cas

Abstract

Since the first descriptions of thumb carpometacarpal (CMC) joint arthritis treatment, various prosthesis had been described. The use of dual mobility is a concept recently introduced for carpometacarpal arthroplasty and inspired by hip arthroplasty experience. The aim of this study was to report the early functional results of a patient cohort treated with a dual mobility prosthesis (MOOVIS®). Nineteen non-anatomic stem prosthesis were implanted between March 2014 and October 2016 by the same senior surgeon with the same technique for severe trapezio-metacarpal arthritis. Functional results were evaluated thanks to Quick Disabilities of the Arm, Shoulder and Hand Questionnaire (QuickDASH), Michigan Hand Outcomes Questionnaire (MHQ) and a satisfaction questionnaire. Clinical results were appraised by Kapandji score and power handling. The average time of follow-up was 20 months. One complication appeared after surgery–a trapezial fracture. No dislocation was observed at early and middle follow-up. Mean preoperative pain was 8 (DS 2.06) on visual analogic scale versus postoperatively 1 (DS 1.3). Kapandji anteposition score was 10 (DS 0.55) and retroposition 1 (DS 1.3). There was no significate difference between operated hand and contralateral hand concerning grip strength, key pinch, tip pinch with respectively, P = 0.86, P = 0.39, P = 0.85. Mean Quick DASH was 15 (DS 14.8) and MHQ was 53 (DS 39.73). We found significate pain decreasing after surgery, improvement of mobility with a Kapandji score almost normal, and a power grip equal to contralateral side and sometimes better than contralateral arthritic side. DASH score showed a low incapacity level after surgery and MHQ score confirmed encouraging results concerning function, aesthetic, pain and satisfaction. Range of motion and power handling were similar to other studies. No dislocation was observed in the early and middle follow-up. Longer follow-up is needed to conclude than dual-mobility concept have resolved the problem of implant dislocation. Dual mobility arthroplasty for treatment of the thumb CMC joint osteoarthritis had proved, in this short series, to be a satisfactory solution for patients with good functional results and absence of early and middle term dislocations.