Soft Tissue Interposition Arthroplasty Research Articles

Early Results in Total Replacement of the Distal Radioulnar Joint.

Pathology of the distal radioulnar joint (DRUJ) including instability and arthritis presents a challenge for hand and upper extremity surgeons. Surgical options include a Darrach procedure and similar resections, soft tissue interposition arthroplasty, and a one-bone forearm. In 2005, a prosthesis for DRUJ arthroplasty was approved for use in the United States. The authors hypothesize that DRUJ arthroplasty will lead to improved pain and range of motion (ROM) with a moderate, but manageable, complication rate. A retrospective review of 46 patients who underwent DRUJ arthroplasty by a single private group of hand surgeons was performed. Demographics, complications, postoperative visual analog scale (VAS), and postoperative ROM were obtained and analyzed. The patients were followed up for a mean of 60 weeks. The implant was used both as primary surgical treatment for DRUJ pathology and as salvage for previous failed procedures. Twenty-two percent of patients experienced complications: 15% required revision surgery. No patients were converted to another type of implant, including those who underwent revision surgery. Prominent hardware was the most common indication requiring revision. Patients achieved an improvement in supination of 17° and extension of 5°. They additionally achieved a decrease in average VAS score from 7.1 to 2.3. Distal radioulnar joint arthroplasty reduces pain and improves ROM in patients with DRUJ pathology with a 22% complication rate. This cohort demonstrates improved pain, modest improvement in ROM, but a 22% complication rate for this implant. Further long-term studies are encouraged.

Proximal Row Carpectomy With Soft Tissue Interposition: A Systematic Review of Clinical Outcomes.

Proximal row carpectomy (PRC) with soft tissue interposition arthroplasty (STIA) presents an alternative approach to addressing wrist arthritis patterns involving the capitate and/or lunate fossa, in lieu of wrist arthrodesis. This systematic review aimed to evaluate clinical outcomes and techniques associated with PRC-STIA in patients with advanced wrist arthritis. We conducted a systematic review using databases including PubMed, Embase, MEDLINE, and the Cochrane Central Register of Controlled Trials. Inclusion criteria involved articles reporting outcomes of patients who underwent PRC-STIA with at least 1 relevant outcome. The analysis encompassed 8 studies involving 106 patients (108 wrists) meeting the inclusion criteria. A majority of patients were men (69%, n = 88), with a mean age of 54.4 ± 12.7 years and an average follow-up of 4.8 ± 6.3 years. Dorsal capsule was the most commonly interposed tissue (63%, 5 out of 8 studies). Patients receiving STIA achieved comparable patient-reported outcome measures scores to those undergoing PRC alone. Postoperative pain, measured by the Visual Analog Scale, averaged 3.7 ± 0.6. The Disabilities of the Arm, Shoulder, and Hand score averaged 27.8 ± 8, while the Patient-Rated Wrist Evaluation score averaged 41.5 ± 25.9. Five complications were reported in three studies. The addition of STIA into PRC for patients with capitate and/or lunate fossa cartilage degeneration yielded outcomes akin to traditional PRC, improving wrist function, pain, and grip strength in a safe and straightforward manner. Future research should prioritize high-quality comparative studies, extended follow-up periods, and standardized core outcome measures for a more comprehensive understanding of its role in wrist arthritis treatment.

Treatment of Post-Traumatic Elbow Stiffness Using Soft Tissue Interposition Arthroplasty: A Retrospective Study in the Jordanian Population

Treatment of Post-Traumatic Elbow Stiffness Using Soft Tissue Interposition Arthroplasty: A Retrospective Study in the Jordanian Population

Humeral Head Morphology Influences Outcomes of Arthroscopic Interposition Glenoid Patch Allograft for Glenohumeral Arthritis

PurposeTo determine short- to midterm patient-reported outcomes of arthroscopic soft-tissue interposition arthroplasty using acellular dermal allograft with a minimum follow-up of 1 year and to assess outcomes in patients with and without flattening of the humeral head.MethodsPatients with a diagnosis of primary glenohumeral arthritis who underwent arthroscopic soft-tissue interposition arthroplasty with an acellular dermal allograft from July 2010 to November 2019 were retrospectively enrolled. Inclusion criteria were a primary diagnosis of glenohumeral arthritis and Outerbridge 4 full-thickness cartilage loss of ≥50% of the glenoid articular surface. Patients underwent arthroscopic debridement, microfracture, and biological arthroscopic soft-tissue interposition arthroplasty with an acellular dermal matrix. Postoperative outcomes included American Shoulder and Elbow Surgeon (ASES) score, Single Assessment Numeric Evaluation (SANE) score, Penn Shoulder Score (PSS), numeric rating scale (NRS) pain score, analgesic use, and conversion to total shoulder arthroplasty (TSA). Results were stratified according to humeral head morphology on preoperative radiographs.ResultsA total of 25 patients were included, with a mean age of 56.0 years (range 19.2 to 74.8) and a mean follow-up of 3.36 years (range 1.03 to 8.98). The mean postoperative ASES score was 64.1 (range 11.7 to 100.0), SANE score was 62% (range 5% to 100%), and PSS was 61.2 (range 10.6 to 97.9). Additionally, 56% of patients rated their shoulder function as improved or much improved, and 36% of patients converted to TSA at a mean of 2.35 years. Patients with and without humeral flattening had similar postoperative ASES scores (P = .44), SANE scores (P = .90), PSS (P = .73), and conversions to TSA (P = .83). Patients with humeral flattening were more likely to have shoulder pain at night (83.3% versus 28.6%, P = .02).ConclusionArthroscopic soft-tissue interposition arthroplasty with an acellular dermal allograft resulted in satisfactory short- to mid-term postoperative outcomes for younger patients with glenohumeral arthritis but demonstrated a TSA conversion rate of 36%. Patients with humeral head flattening also had satisfactory shoulder function but were more likely to experience shoulder pain at night.Level of EvidenceLevel IV, therapeutic case series

Allograft Tendon Interposition Arthroplasty of the Hallux Metatarsophalangeal Joint: A Technique Guide and Literature Review.

The "anchovy" interpositional arthroplasty technique can be used as a salvage option for failed hallux rigidus procedures. The operative technique utilized by the senior author is described. Careful soft-tissue handling, meticulous joint space and graft preparation, and interposition graft stabilization using a bone tunnel and suture anchors are unique aspects of this technique, which in the authors' experience have contributed to improved outcomes. Current literature regarding indications and outcomes is limited and controversial. The proposed benefits of soft-tissue interposition arthroplasty of the hallux metatarsophalangeal joint for patients with prior failed implant arthroplasty are improved pain scores and preservation of range of motion. Level of Evidence: Level V, technique guide.

Arthroscopic Partial Trapeziectomy With Soft Tissue Interposition for Symptomatic Trapeziometacarpal Arthritis: 6-Month and 5-Year Minimum Follow-Up.

To determine if arthroscopic partial trapeziectomy (APT) and soft tissue interposition arthroplasty is an effective treatment for symptomatic trapeziometacarpal arthritis. We retrospectively evaluated 30 consecutive patients with symptomatic isolated trapeziometacarpal arthritis, Eaton-Littler stages II and III. Treatment consisted of an APT with soft tissue interposition utilizing an acellular dermal matrix as the interposition material. At a minimum of 6 months and 5 years after surgery, Numeric Pain Rating Scale (NPRS), Quick Disabilities ofthe Arm, Shoulder, and Hand (QuickDASH), grip strength, oppositional and appositional pinchstrengths, arthroplasty space, and thumb range of motion (ROM) were evaluated. At 6-month minimum follow-up, 30 of 30 patients reported a significant reduction in pain; preoperative NPRS averaged 8.2 and decreased to 1.3. Average QuickDASH score was 17.5. Twenty-nine of 30 thumbs could adduct fully in the plane of the palm. Twenty-four patients were available for 5-year minimum follow-up. Average QuickDASH score measured 8.9, whereas pain (mean NPRS, 0.8), grip, and pinch strengths were not significantly different from the 6-month assessment. There was a small reduction in arthroplasty space at 5-year follow-up that did not affect clinical outcome measures. Thumb ROM did not change between the 6-month and the 5-year follow-up. Complications were rare. An APT with interposition arthroplasty utilizing an acellular dermal matrix as the interposition material is a safe and reliable procedure with satisfactory outcomes at short- and long-term follow-up. Pain, strength, QuickDASH, and ROM do not significantly change between the 6-month and the 5-year follow-up. Therapeutic IV.

Study of functional and radiological outcome of total knee arthroplasty using the knee society score

The common causes of arthritis of the knee include Osteoarthritis (OA), Rheumatoid Arthritis (RA), Juvenile Rheumatoid Arthritis, Post traumatic Arthritis or secondary Osteoarthritis and other types of inflammatory arthritis. Osteoarthritis is thought to be the most prevalent chronic joint disease. The surgical techniques have varied from soft tissue interposition arthroplasty to resection arthroplasty to surface replacement arthroplasty. In surface replacement arthroplasty different types of prosthesis were developed to address the complex knee kinematics. Total Knee Arthroplasty (TKA) is now a reliable treatment for severe arthritis. Various systems are available with specific features regarding the geometry of the components, the degree of conformity of the articulating surface and the anchoring technique. Aim: To study the clinical, functional and radiological outcome in a consecutive series of Total Knee Arthroplasty using Knee Society Score. Materials and Methods: This study was done to analyse the clinical, functional and radiological outcome of Total Knee Arthroplasty using Knee Society score using a Posterior Cruciate substituting (Indus Knee Prosthesis). A Prospective study consisting of 30 patients who consented and underwent Total Knee Arthroplasty. The follow up period was at 3 months, 6 months and 1 year. Results and Discussion: According to the Knee Society Functional Scoring system, 30 patients were assessed in this study. 16 patients (53%) had Excellent, 11 patients (37%) had Good, 2 patients (7%) had Fair and 1 patient (3%) poor results. The results were found to be comparable with other studies. Conclusion: Total Knee Arthroplasty improves the functional ability of the patient and the ability of the patient to get back to pre-disease state, which is to have a pain free mobile joint, as reflected by the improvement in the post-op Knee Clinical Score and Knee Functional Score.

Arthroscopic Partial Trapeziectomy with Soft Tissue Interposition for Symptomatic Trapeziometacarpal Arthritis (SS-50)

Arthroscopic Partial Trapeziectomy with Soft Tissue Interposition for Symptomatic Trapeziometacarpal Arthritis (SS-50)

Soft tissue interposition arthroplasty of the shoulder

Soft tissue interposition arthroplasty for treatment of shoulder arthritis is an emerging technique that has received increasing attention recently. Although currently available data are insufficient to advocate routine use of this procedure, the technique is presented as a possible option to treat shoulder arthritis. Further work is required to determine the role of soft tissue interposition arthroplasty in this setting.

A New Modification of Trapeziectomy and Soft Tissue Interposition Arthroplasty With Abductor Pollicis Longus Advancement

A new modification of trapeziectomy, soft-tissue interposition arthroplasty with a one-half slip of the flexor carpi radialis tendon and advancement of the abductor pollicis longus tendon for treatment of thumb carpometacarpal degenerative arthritis and instability is presented. This procedure facilitates tenodesis of the flexor carpi radialis slip at the first metacarpal and realigns and rebalances the thumb posture by using and advancing the abductor pollicis longus tendon. Therefore, this new modification eliminates the need for perioperative pin fixation of the first metacarpal, offers better soft tissue tenodesis of the ligament reconstruction component of the procedure, and results in improved intraoperative thumb alignment.

Titanium Basal Joint Arthroplasty: A Finite Element Analysis and Clinical Study

To define the mechanics and determine the clinical outcome of titanium implant arthroplasty in trapeziometacarpal arthritis. For the finite element analysis (FEA) a 2-dimensional FEA mesh of the titanium arthroplasty was constructed with 8-node quadrilateral elements and analyzed. Flexion-extension displacement of the metacarpal was analyzed. For the clinical study, between 1996 and 2003, 47 patients (50 thumbs) with Eaton stage 3 trapeziometacarpal arthritis were treated with titanium basal joint arthroplasty. The average follow-up period was 2 years. Disabilities of the Arm, Shoulder, and Hand questionnaire answers and grip and pinch measurements were obtained before surgery and at the final follow-up evaluation. Failure was defined strictly as the point when revision to the standard soft-tissue interposition arthroplasty became inevitable. In the FEA the titanium implant showed pistoning behavior with maximum stress concentration in the midmetacarpal shaft of 1.92 MPa. The convex sphere of the implant rotates and lifts out of the trapezial crater with a high stress concentration of 0.51 MPa at the radial and ulnar corner of the trapezium. In the clinical study treatment failed in 10 of the patients before 9 months. All were converted successfully to a standard ligament reconstruction tendon interposition. The remaining 80% of the patients showed significant improvement in Disabilities of the Arm, Shoulder, and Hand questionnaire scores albeit with continued weakness at the 2-year follow-up evaluations. The reconstructed thumbs never attained the strength of the contralateral thumbs; even in the success group residual swelling was not uncommon with any increase in activity level. Anecdotal quotations show success rates for titanium implant arthroplasty for basal joint arthritis to be as high as 97%. Our results are quite to the contrary in that high failure rates were common early in the follow-up period. Our FEA results are confirmed by the clinical study. Titanium implant arthroplasty may have a role in low-demand patients with good bone stock; however, we have stopped offering titanium hemiarthroplasty to patients at our institution.

Alternatives to Total Shoulder Arthroplasty in the Young Patient

Early arthritis of the glenohumeral joint represents a diagnostic and therapeutic challenge. Equally challenging is the presence of arthritis at any stage in the young or active patient since joint replacement may not be desirable, while nonoperative treatment may not provide sufficient pain relief. The common theme of all glenohumeral arthritides is one of progressive, irreversible osteoarticular destruction. Articular damage is usually accompanied by secondary involvement of the synovium, capsule, glenohumeral ligaments, and rotator cuff. Surgical intervention is predicated on the specific condition, stage of the disease, and condition of the periarticular tissues. The authors will discuss surgical alternatives including arthroscopic debridement, glenoidplasty, capsular release, synovectomy, corrective osteotomy, core decompression, and soft tissue interposition arthroplasty.

Soft-tissue arthroplasty for hallux rigidus.

Seven patients (seven feet) were evaluated at an average follow-up of 42 months following soft-tissue interposition arthroplasty of the hallux metatarsophalangeal (MTP) joint for severe hallux rigidus. The technique involved reaming of the base of the proximal phalanx and metatarsal head to decompress the first MTP joint and placement of a soft-tissue tendon bundle as a biologic spacer. Six of seven patients had bilateral disease, and a positive family history of hallux rigidus. At final follow-up, all seven patients rated their result as good or excellent, the level of pain was substantially reduced, and the mean AOFAS score substantially improved from 46 to 86 points. Mild metatarsalgia was noted by four patients and characterized by mild plantar callosities in these cases. The mean MTP dorsiflexion improved from 9 degrees to 34 degrees and patients demonstrated good to excellent plantarflexion strength on manual muscle testing and with toe rise. Physical examination of the involved feet demonstrated no evidence of pes planus, metatarsus primus elevatus, Achilles tendon contracture, or metatarsocuneiform joint hypermobility in any of the seven. The technique of soft-tissue interposition arthroplasty as described gave excellent pain relief and reliable function of the hallux, and is an alternative treatment to MTP arthrodesis in select cases of severe hallux rigidus.

Proximal Row Carpectomy and Soft Tissue Interposition Arthroplasty

Proximal Row Carpectomy and Soft Tissue Interposition Arthroplasty

A propos de deux cas de « siliconitesprécoces

Two cases of early silicone synovitis, 12 and 18 months after surgery for partial scaphoid implant arthroplasty (Swanson design) are reported. None of the implants had been fixed by Kirschner wire or sutured to the radius or an other carpal bone. Both implants had been immobilized for six weeks. Initially the result in both cases was good. Pain and loss of range of movement gradually increased, and a large erosive osteolytic defect of the radius was seen on the X-ray after 12 months for the first case and 18 months for the second one. Surgical revision consisted of implant removal, synovectomy with a proximal row carpectomy in the first case and a soft tissue interposition arthroplasty for the second one. The histologic examination showed a foreign body reaction with birefringent material in multinucleated giant cells. All reports about this type of silicone implant complication emphasises the role of compression forces and micro-fragmentation of the silicone. Should we continue to perform partial scaphoid implant arthroplasty from whom microparticles are creating a severe foreign body reaction?

Follow-up after Bentzon's operation : Boecksteyns M. E. H., Kjäer L., Busch P. and Holgt-Nielsen F. (1985) Soft-tissue interposition arthroplasty for scaphoid non-union. J. Hand Surg.10A, 109

Follow-up after Bentzon's operation : Boecksteyns M. E. H., Kjäer L., Busch P. and Holgt-Nielsen F. (1985) Soft-tissue interposition arthroplasty for scaphoid non-union. J. Hand Surg.10A, 109

Soft tissue interposition arthroplasty for scaphoid nonunion

Twenty-six patients with scaphoid nonunion were reexamined 22 to 39 years after Bentzon's soft tissue interposition arthroplasty was performed. All but one were satisfied, although three still had moderate pain. Mobility of the wrist was reduced by 20% to 25% and grip strength by 8%. The nonunion remained open and unstable in 16 of 25 radiologically reexamined cases. Carpal collapse, which had increased over time, was found in 15 cases, nine of which presented an unstable nonunion. Osteoarthritis had developed in five of 15 wrists with carpal collapse and in two of 10 without it. No significant osteoarthritis was found in any case earlier than 27 years after the operation. Thus, the risk of disability that is due to late degenerative changes of the wrist is small, even in the presence of carpal collapse.

Soft tissue interposition arthroplasty for osteoarthritis of the carpometacarpal joint of the thumb.

A soft tissue interposition arthroplasty for carpometacarpal osteoarthritis of the thumb is described. Thirty-seven joints in 32 patients were operated on. The results with regard to pain, strength and mobility are recorded. In 34 cases the patients reported considerable improvement after the operation and the majority of the patients could resume their usual work. Only minor complications occurred.