L’arthroplastie à rotule (Ivory[r]) comme traitement de l’arthrose trapezométacarpienne chez l’homme – le taux d’échec est-il plus élevé ?

Abstract

This study investigated the long term functional outcome after total replacement of the trapeziometacarpal joint with the Ivory prosthesis (Stryker Corporate, Michigan, USA) for trapeziometcarpal joint osteoarthritis in male patients. In this prospective study, range of motion, overall function, pain and radiologic outcome of the trapeziometacarpal arthroplasty were analysed in male patients after a minimum of 5 years of follow-up. The opening of the first web space and metacarpophalangeal flexion and extension were graded. Opposition and retropulsion were graded by Kapandji scores. Key pinch, precision pinch and grip strength were measured using a calibrated hydraulic pinch gauge and a calibrated hydraulic hand dynamometer. To assess overall function, the Quick Disabilities of the Arm, Shoulder and Hand score was used. Pain score was assessed with the Visual Analogue Scale. Radiologic outcome was evaluated using frontal and profile views as described by Kapandji and Eaton views with and without stress. A total of 17 Ivory arthroplasties was evaluated. Out of the 21 male patients eligible, 14 were included in the study. Three had bilateral arthroplasties. The mean age was 63 (range 52–84) years. The mean follow up period was 95 (range 62–125) months. Patient's satisfaction was high in 65 % of the patients, with 35 % of the patients not willingly to repeat surgery. We found no significant improvement in key pinch, precision pinch and grip strength after surgery, nor when comparing preoperative with postoperative strength. Considering thumb mobility, similar conclusions can be drawn. Overall function, according to the Quick Disabilities of the Arm, Shoulder and Hand score had been improved by 37 %. Pain decreased by 83 % with a mean Visual Analogue Scale score of 11/100 at a minimum of 5 years follow-up. Radiologic evaluation revealed collapse of the trapezium in 2 patients. In two other patients, a broken implant was detected. None of these patients needed surgical revision. They are followed in our outpatient clinic. Three patients had a failure of the prosthesis (overall survival of 82 %) and were converted to a trapiezectomy. Cantilever bending loads at the thumb base are larger in males than females. This might explain the high complication rate in the male subgroup. The Ivory arthroplasty for treating advanced trapeziometacarpal osteoarthritis, is associated with an high incidence of complications in the male patient. Nevertheless, there is an improvement in overall function and pain reduction and not every complication requires surgical revision.