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Abstract

We appreciate Dr. Diao's insightful thoughts and comments regarding our article.1Choung E.W. Tan V. Foreign-body reaction to the Artelon CMC joint spacer: case report.J Hand Surg. 2008; 33A: 1617-1620Abstract Full Text Full Text PDF Scopus (37) Google Scholar The purpose of the case was to demonstrate that a foreign-body reaction could occur after implanting an Artelon spacer. We made no comment or suggestion as to the effectiveness of the implant, especially the newer, larger sizes, in which suture anchor fixation is now recommended. As pointed out by Dr. Diao and described in the case report, our patient developed painful swelling in the region of the thumb carpometacarpal joint about 10 weeks after the index Artelon procedure. A computed tomography scan did not show a fluid collection; therefore, aspiration was not done. Despite conservative treatment of immobilization and anti-inflammatory medications, her symptoms failed to improve, and she subsequently had revision surgery more than 4 months after the index procedure. Regarding the screw positions, we agree that the metacarpal screw might have over-penetrated the far cortex. A computed tomography scan confirmed that the screw extended 1 mm beyond the cortex, but it did not penetrate into the joint. Insofar as the screws being “overtightened and penetrated through the wings of the Artelon prosthesis,” there were no signs or symptoms of instability after the index procedure, and we did not observe this phenomenon at the time of revision surgery. At revision surgery, the Artelon spacer was found to be intact, with the screws holding the wings in place; however, there was no gross evidence of incorporation of the prosthesis into the surrounding tissue. After removal of the screws, Artelon spacer, and remaining trapezium, a complete synovectomy was performed. A hematoma distraction arthroplasty2Kuhns C.A. Emerson E.T. Meals R.A. Hematoma and distraction arthroplasty for thumb basal joint osteoarthritis: a prospective, single-surgeon study including outcomes measures.J Hand Surg. 2003; 28A: 381-389Google Scholar was done at the same time. The K-wire was removed at 6 weeks. Despite the revision surgery, our patient had a second bout of painful swelling approximately 4 months after the revision surgery. Unlike Dr. Diao's case, aspiration of the sterile fluid did not provide long-term pain relief. She subsequently had a second revision surgery to remove the boggy synovium, most of which was found to be extra-articular. The gross specimen measured 4.85 × 4.25 × 0.5 cm at the pathology laboratory. We hope that these details of the case help to answer any lingering questions. It is also worth reiterating that, as clinicians, we “need to recognize that a foreign-body reaction can occur with any artificial material (including the Artelon spacer), despite reports of biocompatibility.”1Choung E.W. Tan V. Foreign-body reaction to the Artelon CMC joint spacer: case report.J Hand Surg. 2008; 33A: 1617-1620Abstract Full Text Full Text PDF Scopus (37) Google Scholar A Decision-Analysis Model to Diagnose Feigned Hand WeaknessJournal of Hand SurgeryVol. 32Issue 10PreviewMalingering is a condition in which patients exaggerate incapacity. Feigned hand weakness is one form of malingering, and it is often seen after work-related hand injuries. Malingering is prevalent in the workers’ compensation system, which devotes a large proportion of valuable resources to unwarranted claims. Feigned hand weakness must be detected early because it is relatively prevalent and expensive to society. Clinical evaluation is the first step in detecting feigned hand weakness, but it is not very specific. Full-Text PDF Foreign-Body Reaction to the Artelon CMC Joint SpacerJournal of Hand SurgeryVol. 34Issue 6PreviewIn the report by Choung and Tan1, approximately 10 weeks after Artelon CMC spacer surgery, the patient developed some swelling and pain in the region of the thumb base that had progressed over a 1-week course without any antecedent trauma. There was moderate swelling in the thenar eminence and basal joint region with minimal erythema and warmth. Radiographs were interpreted as having “a questionable area of osteolysis (Fig. 4).” Full-Text PDF