Arthroplasties dans le traitement des rhizarthroses

Abstract

Introduction Patients with basal joint disease can usually adapt to their functional impairment to a significant degree, so pain becomes the primary impetus for seeking treatment. Patients with continued pain and dysfunction are potential candidates for surgery. We present a review of arthroplasty surgery for thumb basal joint arthritis with a pirocarbon interposition arthroplasty (Pirodiscy) versus total joint arthroplasty (Arpey and Roselandy). Material and methods A retrospective, cross-sectional and analytical study was conducted with patients submitted to basal joint arthroplasty with pirocarbon interposition arthroplasty versus total joint arthroplasty between 2001 and 2012, with a minimum of follow-up of 3,5 years. Three types of arthroplasties were used: Pirodiscy versus Arpey and Roselandy. The indication for surgery was pain and dysfunction (stage II or III of Eaton classification). All patients were evaluated for characterization of pain using a visual analogue scale, DASH score palmar and digital pinch strength using a dynamometer and the Kapandji score. Results There were made 115 arthroplasties and 102 were included in the study (corresponding to 97 patients). They were all females, mean age of 59.6 years (45–79), predominance of the left hand (55%) and the main indication was primary osteoarthritis (85%) and 15% of cases associated with arthritis rheumatoid. The mean follow up was 10.8 years (3,5–15 years). The visual analog scale showed a residual pain with a mean VAS of 1.71 associated with a low degree of disability in daily activities (mean DASH 23.7). The postoperative Kapandji was 8.67 (corresponding to 89% of the contralateral mobility). Mean palmar pinch strength was 14.2 kg/cm 2 (15% less than the contralateral hand) and a mean digital clamp force of 4.36 (10% less of the contralateral). Eighty-eight percent of the patients report being satisfied or very satisfied, and 80.5% of patients stated that would repeat surgery. We note 11 complications (11.5%). Discussion In our study, we had a high survival rate in the two groups with