Complications Related to Metal-on-Metal Articulation in Trapeziometacarpal Joint Total Joint Arthroplasty.

Christina Frølich,Torben Hansen

doi:10.3390/jfb6020318

Christina Frølich, Torben Hansen

Open Access

https://doi.org/10.3390/jfb6020318

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Abstract

Adverse reactions to metal-on-metal (MoM) prostheses are well known from total hip joint resurfacing arthroplasty with elevated serum chrome or cobalt, pain and pseudo tumor formation. It may, however, also be seen after total joint replacement of the trapeziometacarpal joint using MoM articulation, and we present two cases of failure of MoM prostheses due to elevated metal-serum levels in one case and pseudo tumor formation in another case. Furthermore, we suggest a diagnostic algorithm for joint pain after MoM trapeziometacarpal joint replacement based on published experiences from MoM hip prostheses and adverse reactions to metal.

Highlights

The trapeziometacarpal joint is a common site for osteoarthritis, especially in females in their fifth to seventh decade of life, and typically presents with pain, loss of function and reduced pinch and gripJ
A 53-years old female was treated with an Elektra MoM cementless trapeziometacarpal prosthesis (Small Bone Innovations Inc., Les Bruyères, France) for osteoarthritis in her right trapeziometacarpal joint
A wide range of serum metal ion levels has been reported, and some have reported a correlation with pseudo tumor formation [14,18,19], others have found no correlation between pseudo tumor formation and serum metal ion levels [6,20,21,22]

Summary

Introduction

The trapeziometacarpal joint is a common site for osteoarthritis, especially in females in their fifth to seventh decade of life, and typically presents with pain, loss of function and reduced pinch and gripJ. A range of treatment options exists both non-operatives, e.g., splints and medication, and operatives, e.g., trapeziectomy with or without ligament reconstruction and tendon interposition, arthrodesis and total joint prosthesis [1]. No one operative treatment seems to be superior to all others in the treatment of osteoarthritis of the trapeziometacarpal joint, and the choice of treatment is primarily dependent on the surgeon’s preference, the patient’s age and the severity of the symptoms [1]. Total joint prosthesis may have some advantages. Total MoM joint prosthesis has shown good short-term results with faster rehabilitation, better strength and less pain than trapeziectomy [5], and in longer follow up has shown continued good results regarding strength, pain relief and mobility [4]

Results

Discussion

Conclusion