Abstract
Total trapeziometacarpal joint arthroplasty often fails leading to secondary trapeziectomy. In this study we reviewed five patients with radiological early signs of implant loosening already 12 months after trapeziometacarpal joint replacement with the MOJE Acamo uncemented joint prosthesis to investigate whether the patients developed progressing symptoms. The observation time was eight years. One patient was not able to participate. DASH-scores and X-rays were obtained and clinical examinations done. We found radiologically progressing migration of both implants in all patients after eight years. All patients however reported normal to slightly reduced daily level of function and no to little pain in their hand. Also clinical examination showed satisfying results. It seems that satisfying results can be obtained despite radiological evidence of implant loosening and migration justifying a more conservative approach to revision surgery with the MOJE Acamo prosthesis. A possible explanation of the clinical results is the very large ball-and-socket design of the implant, which seems to retain joint stability and prevent painful luxation of the trapeziometacarpal joint.
Highlights
Total joint arthroplasty has been used for more than 40 years [1] in Trapeziometacarpal (TMC) joint osteoarthritis replacing the TMC joint with a small ball-and-socket joint
Compared to trapeziectomy total joint arthroplasty may result in faster rehabilitation and better grip strength after one year [2], but high loosening rates of TMC total joint arthroplasty components have been reported both in cemented and cementless implants [3,4,5,6,7,8,9,10,11,12]
After 8 years there was visible migration of both implants (Figure 3) in all patients participating in the follow-up, all four patients reported normal to slightly reduced daily level of function (Quick DASH score of 2,3, 4,5, 12,5 and 22,7) with no to little pain in their hand (VAS 0 to 4 on a scale from 0 to 10)
Summary
Total joint arthroplasty has been used for more than 40 years [1] in Trapeziometacarpal (TMC) joint osteoarthritis replacing the TMC joint with a small ball-and-socket joint. Compared to trapeziectomy total joint arthroplasty may result in faster rehabilitation and better grip strength after one year [2], but high loosening rates of TMC total joint arthroplasty components have been reported both in cemented and cementless implants [3,4,5,6,7,8,9,10,11,12]. The fixation of uncemented implants relies on press-fit fixation until secondary bony fixation of the implant is obtained, and early implant failure within the first year after surgery may be the result of failure of either the primary or the secondary fixation. In this study we reviewed five patients with known early migration of TMC joint implants
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