Tendon Interposition Arthroplasty Research Articles

Interposition Arthroplasty versus Dual Cup Mobility Prosthesis in Treatment of Trapeziometacarpal Joint Osteoarthritis: A Prospective Randomized Study.

Osteoarthritis (OA) of the trapeziometacarpal (TMC) joint is a common cause of pain and functional disability of the hand and is the second most frequent site in the hand of OA. This prospective randomized study analyses and compares the outcomes and global assessment of 2 different surgical techniques for rhizarthrosis treatment: trapeziectomy with tendon interposition arthroplasty and total joint replacement with Touch® (KeriMedical; Geneva, Switzerland) TMC prosthesis. The enrolled patients were randomly divided into 2 groups: group A included 71 patients (75 hands) treated with tendon interposition arthroplasty, while group B included 65 patients (72 hands) treated with total joint replacement. Clinical and radiological outcomes were collected before surgery and at 1, 3, 6, 12, and 24 months of follow-up. Although the values of all clinical tests performed during follow-up demonstrated statistically significant improvement over preoperative ones in both groups, patients treated with prosthesis showed faster improvement, especially in tests of strength and range of motion, which showed better results than patients treated with trapeziectomy and tendon interposition arthroplasty throughout the follow-up. Our study suggests that joint replacement should be preferred to interposition arthroplasty as the treatment of rhizarthrosis, choosing the latter in case of prosthetic replacement complications or scaphoid-trapezium-trapezoid OA.

Trapeziectomy versus Maïa Prosthesis in Trapeziometacarpal Osteoarthritis.

Background Osteoarthritis at the base of the thumb is the most frequent osteoarthritis of the hand. Trapeziectomy in a broad variety of surgical methods have been proposed to achieve pain reduction and improvement of thumb function. A well-known disadvantage is the long recovery time. Arthroplasty of the thumb carpometacarpal joint is a competing new method for this indication with different revision and complication rates reported. Purposes The aim of this study is to assess whether there are significant differences in outcome during the first 12 months and time return to work after either, implant of a Maïa joint prosthesis, or trapeziectomy with tendon interposition after Weilby. Patients and Methods This clinical follow-up study compares the efficacy of total basal joint replacement using the Maïa prosthesis with tendon interposition arthroplasty in 59 thumbs. Clinical, functional, and radiological results at preoperative, 3-, 6-, and 12-month postoperative are presented. Results We found a significant shorter return to work in the prosthesis group with 4.5 compared with 8.6 weeks. In addition to a significant difference in pain reduction with a better Mayo wrist score in the Maïa group after 3 months. The scores are closer after 6 months and nearly match after 12 months. Measurement of the pinch grip showed a parallel course. A radiological loosening of the cup in two patients was detected after 12 months. Conclusion Implantation of Maïa prosthesis enables a significant shorter recovery but is associated with the risk of loosening and higher costs. Level of Evidence Level IV, case-control study.

Comparison of Surgical Outcomes for Arthrodesis and Arthroplasty for Thumb Carpometacarpal Osteoarthritis in Female Workers

BackgroundBoth arthrodesis and trapeziectomy with ligament reconstruction and tendon interposition (T + LRTI) arthroplasty are reliable surgical procedures for thumb carpometacarpal (CMC) osteoarthritis. Here, we compared surgical outcomes between arthrodesis and T + LRTI for female workers aged over 40 years with thumb CMC osteoarthritis to determine an optimal procedure. Patients and MethodsFourteen thumbs of 13 patients who underwent arthrodesis with locking plates and 11 thumbs of 10 patients who underwent T + LRTI and were followed up for at least 12 months were retrospectively analyzed. For the two groups, we investigated the range of motion (ROM) of the thumb, grip strength, pinch strength, disabilities of the arm, shoulder, and hand (DASH) score, Hand20 score, and visual analog scale (VAS) scores for pain at 1-year follow-up and compared them between the two groups. In addition, we investigated surgical complications and resumption of work. ResultsBoth procedures provided similar subjective outcomes in terms of Hand20 and VAS scores; however, arthrodesis provided significantly larger ROM of the metacarpophalangeal and interphalangeal joints of the thumb, grip and pinch strength, and DASH score, whereas T + LRTI provided a significantly better palmar abduction at 1-year follow-up. There were three and four postoperative complications in the arthrodesis and T + LRTI groups, respectively. One patient in the arthrodesis group had resigned, whereas two patients in T + LRTI had changed their jobs to less physically demanding ones postoperatively. ConclusionBoth procedures satisfy female workers aged over 40 years with thumb CMC osteoarthritis. Nevertheless, arthrodesis can provide favorable outcomes that are equal to or better than T + LRTI.

Surgical treatment of carpometacarpal thumb arthritis with trapeziectomy and intra-tendon (FCR) suspension with one-loop APL: comparative cohort study

BackgroundOne of the current choices of treatment for Trapeziometacarpal (TMC) joint arthritis is trapeziectomy with ligament reconstruction and tendon interposition arthroplasty. The Ceruso’s technique consists of complete trapezial excision and abductor pollicis longus (APL) tendon suspension. The APL tendon is tied to the flexor carpi radialis (FCR) tendon with two loops, one around it and one inside, and then used as interposition tissue. The purpose of the present study was to compare two different techniques of a trapeziectomy with ligament reconstruction and tendon interposition arthroplasty using the Abductor Pollicis Longus (APL) tendon, which is only Once Looped Around (OLA) versus Once Looped Inside (OLI) the Flexor Carpi Radialis (FCR) tendon.MethodsA single-center, retrospective study (Level of evidence: III) has been conducted on sixty-seven patients older than 55 years (33 OLI, 35 OLA), assessing clinical outcomes for at least 2 years of post-surgery follow-up. The outcomes were to assess and compare surgical outcomes comparing the two groups, in terms of subjective and objective evaluation for both groups at the last follow-up (primary outcome), and at the intermediate follow-ups (three and six months). Complications were also assessed.ResultsThe authors found an improvement in pain, range of motion, and function, with equivalent results for both techniques. No subsidence was observed. FCR tendinitis was significantly reduced with OLI, as well as the need of post-operative physiotherapy.ConclusionsThe one-loop technique allows for reduced surgical exposure, providing excellent suspension and clinical outcomes. Intra FCR loop should be preferred to improve post-surgical recovery.Level of evidenceLevel III study. This is a retrospective cohort study (written according to STROBE guidelines).

Ligament Reconstruction and Interposition Arthroplasty of the Acromioclavicular Joint.

Distal clavicle excision (DCE) for acromioclavicular (AC) joint primary osteoarthritis and post-traumatic arthritis has been shown to have good to excellent outcomes. However, there are studies that report significant rates of residual AC joint pain and distal clavicle instability after open and arthroscopic techniques. We describe a surgical technique for management of AC joint primary osteoarthritis, post-traumatic arthritis, and revision DCE that involves DCE with ligament reconstruction and tendon interposition arthroplasty. It provides distal clavicle stability and can theoretically reduce residual AC joint pain secondary to acromial abutment after DCE.

Trapeziectomy with ligament reconstruction and tendon interposition arthroplasty continuously improves hand functions up to 5-year postoperatively.

Trapeziectomy with ligament reconstruction and tendon interposition (LRTI) arthroplasty is a reliable surgical procedure for the treatment of thumb carpometacarpal osteoarthritis, which provides good long-term outcomes. However, it remains unclear when the greatest benefit of this procedure can be obtained, and how long these benefits will continue. Therefore, we investigated the middle- to long-term advantages of this procedure by analysing the chronological changes in clinical outcomes by following the same patients from 1year to a median 5years after trapeziectomy with LRTI. Sixteen thumbs that completed consecutive clinical and radiographic evaluations preoperatively, 1year, 2years, 3years, and median 5years (range 4-8years) after trapeziectomy with LRTI were included in this study. We investigated grip strength, pinch strength, range of motion (ROM) of the thumb, a visual analogue scale for pain, Disabilities of Arm, Shoulder and Hand (DASH) score, Hand20 questionnaire score, trapezial space height, and trapezial space ratio at every time point. Hand strength (grip, pulp, and lateral pinch), palmar abduction, DASH score, and Hand20 questionnaire score were improved at 1year postoperatively while the radial abduction showed significant improvement at the final follow-up. Moreover, pulp pinch strength, DASH score, and Hand20 questionnaire score continued to improve significantly from 1year postoperatively to the final follow-up. Conversely, trapezial space height and ratio continuously decreased up to the final follow-up. Trapeziectomy with LRTI consecutively improved the pinch strength, ROM of the thumb, DASH score, and Hand20 questionnaire score up to 5years postoperatively. It also maintained the improvement of the other clinical outcomes up to 5years postoperatively except for radiological findings.

Artículo traducido] Modificación de la técnica de trapeciectomía de Burton-Pellegrini: análisis comparativo a medio término

IntroductionLigament reconstruction and tendon interposition (LRTI) arthroplasty is the procedure of choice of most hand surgeons in the treatment of basal joint arthritis of the thumb. Progressive and natural collapse after trapeziectomy is a common problem. Description of techniqueWe performed LRTI with flexor carpi radialis (FCR) hemitendon technique, then proceeded to block the hemitendon plasty with a bone fragment at the base of the metacarpal. This technique allows us to maintain tension and to obtain immediate stability. Patients and methodsWe conducted a single-center retrospective longitudinal observational study including 51 patients with diagnosis of symptomatic osteoarthritis of the trapeziometacarpal joint. Group A consisted of 24 thumbs treated with trapeziectomy with LRTI with FCR hemitendon using the Burton–Pellegrini technique. Group B included 27 thumbs treated using the modified technique. The postoperative height of the Scaphometacarpal (SM) space was analyzed. Clinical outcome, opposition, retroversion, patient satisfaction and surgical timing were studied. ResultsThe difference of the SM space, after applying correction factor, at one and six months postoperative is significantly less in the modified technique group (P = .033 and P = .001, respectively). The average height loss of the SM space from one to six months postoperative measurement was smaller in the study group, showing greater stability of the plasty. ConclusionsThe use of a bone fragment to block the FCR plasty improves the results at one and six months postoperatively, showing a diminished height loss of the SM space, improved thumb opposition and without prolonging surgical timing in our series.

Modification of Burton and Pellegrini trapeziectomy technique: Medium-term comparative analysis

IntroductionLigament reconstruction and tendon interposition (LRTI) arthroplasty is the procedure of choice of most hand surgeons in the treatment of basal joint arthritis of the thumb. Progressive and natural collapse after trapeziectomy is a common problem. Description of techniqueWe performed LRTI with flexor carpi radialis (FCR) hemitendon technique, then proceeded to block the hemitendon plasty with a bone fragment at the base of the metacarpal. This technique allows us to maintain tension and to obtain immediate stability. Patients and methodsWe conducted a single-center retrospective longitudinal observational study including 51 patients with diagnosis of symptomatic osteoarthritis of the trapeziometacarpal joint. Group A consisted of 24 thumbs treated with trapeziectomy with LRTI with FCR hemitendon using the Burton-Pellegrini technique. Group B included 27 thumbs treated using the modified technique. The postoperative height of the Scaphometacarpal (SM) space was analyzed. Clinical outcome, opposition, retroversion, patient satisfaction and surgical timing were studied. ResultsThe difference of the SM space, after applying correction factor, at one and six months postoperative is significantly less in the modified technique group (p=0.033 and p=0.001 respectively). The average height loss of the SM space from one to six months postoperative measurement was smaller in the study group, showing greater stability of the plasty. ConclusionsThe use of a bone fragment to block the FCR plasty improves the results at one and six months postoperatively, showing a diminished height loss of the SM space, improved thumb opposition and without prolonging surgical timing in our series.

Trapeziectomy with Abductor Pollicis Longus Tendon Interposition Arthroplasty for First Carpometacarpal Joint Osteoarthritis: A Systematic Review.

Background:The prevalence of osteoarthritis (OA) of the first carpometacarpal (CMC) joint and subsequent thumb disability is rising. Abductor pollicis longus tendon interposition arthroplasty (APLTIA) has gained popularity as a procedure to alleviate pain and restore thumb function. Methods: A systematic review was performed to assess the current reported outcomes of APLTIA. Inclusion criteria involved clinical studies with case-series as the minimal accepted level of evidence. Our primary outcome focussed on PROMs data, whilst secondary outcomes focussed on objective measures of function and complications. Papers investigating pathologies other than CMC OA or procedures other than APLTIA were excluded. Results:Twelve studies were included (485 thumbs), all of which were observational in study design. APLTIA appears to be associated with a reduction in pain and functional improvement. APLTIA was not found to complicate further surgery. Conclusion: APLTIA may be associated with improvement in short-term pain relief and functional status. Further research is required to evaluate the benefits, duration of relief and long-term outcomes of APLTIA.

Preoperative prognostic factors associated with poor early recovery after trapeziectomy with ligament reconstruction and tendon interposition arthroplasty for thumb carpometacarpal osteoarthritis

BackgroundTrapeziectomy with ligament reconstruction and tendon interposition (LRTI) is performed for treating thumb carpometacarpal osteoarthritis. However, patients occasionally experience delayed postoperative recovery. Although several prognostic factors associated with long-term outcomes have been identified, the factors associated with delayed recovery after trapeziectomy with LRTI have not been identified. HypothesisWhen we define major disability in the early postoperative period at 3 months after LRTI surgery as delayed recovery, some preoperative factors can influence with delayed recovery. Moreover, delayed recovery can influence the long-term therapeutic outcome. Patients and methodsThirty thumbs that underwent trapeziectomy with LRTI (mean follow-up period, 29.3 months) were retrospectively analyzed. Major disability was defined by both DASH and Hand20 scores≥35 after surgery, and patients were divided into groups 1 (major disability; n=9) and 2 (no major disability; n=21) according to the scores at 3 months after surgery. Preoperative data, including age, sex, preoperative symptom duration, dominant hand surgery, concurrent surgery with LRTI, previous orthopedic surgery, employment, stage of osteoarthritis, thickness of the trapezium, metacarpophalangeal hyperextension deformity, DASH score, Hand20 score, visual analogue scale (VAS) scores for pain, grip strength, pinch strength, and range of motion of the thumb were compared between groups to identify the factors indicating a poor prognosis at 3 months after surgery. We also compared the clinical outcomes at the 12-month and final follow-up. ResultsDominant hand surgery, previous orthopedic surgery, and preoperative poor DASH score were significantly more frequent in group 1, while the other factors did not show significant intergroup differences. Moreover, group 1 showed significantly poorer DASH score, grip and pinch strength, and active flexion of the thumb metacarpal joint at both the 12-month and final follow-up. This group also showed significantly poorer Hand20 and VAS scores at the final follow-up. DiscussionDominant hand surgery, previous orthopedic surgery, and preoperative poor DASH score were associated with poor recovery at 3 months after trapeziectomy with LRTI. Moreover, major disability at 3 months after surgery influenced poor clinical outcomes at the 12-month and final follow-ups. These data could be useful for counseling patients regarding the expected recovery duration and outcomes after LRTI surgery. Level of evidenceIV; retrospective therapeutic study.

Does trapeziectomy with ligament reconstruction and tendon interposition arthroplasty correct the metacarpophalangeal joint hyperextension associated with trapeziometacarpal osteoarthritis?

Trapeziometacarpal osteoarthritis sometimes results in hyperextension of the thumb metacarpophalangeal (MCP) joint, which could negatively impact outcomes following trapeziectomy with ligament reconstruction and tendon interposition (LRTI) arthroplasty. Although algorithms on performing trapeziectomy with LRTI for the management of this deformity are available, they lack clear evidence. Here, we investigate the function of the thumb MCP joint after trapeziectomy with LTRI and whether this procedure alone corrects preoperative MCP hyperextension, and also analyze clinical factors correlated with MCP hyperextension post-surgery. Twenty-eight patients who underwent trapeziectomy with LRTI and followed up for at ≥ 1year (mean, 27.2months) were retrospectively analyzed. No patient had concomitant surgery to the thumb MCP joint at the time of trapeziectomy with LRTI. Patients were divided into the < 30° (n = 19) and > 30° (n = 9) hyperextension groups as per their preoperative passive range of motion (ROM) of the MCP joint. Changes in ROM of the MCP joint post-surgery, clinical factors correlated with postoperative MCP hyperextension, and correlations between clinical outcomes and postoperative MCP extension were analyzed. In the < 30° MCP hyperextension group, active and passive extensions of the MCP joint did not significantly change after surgery, and no worsening of postoperative MCP hyperextension was observed. In the > 30° hyperextension group, passive extension of the MCP joint significantly decreased (mean, 49.6°-29.8°). Preoperative MCP hyperextension improved in seven patients, was unchanged in 1, and worsened in 1. Postoperative passive MCP extension was negatively correlated with active/passive radial abduction, MCP flexion, trapezial space height, subjective outcomes, and hand strength post-surgery. Trapeziectomy with LRTI alone could prevent postoperative thumb MCP hyperextension deformity for patients with thumb MCP extension < 30° and improve preoperative thumb MCP hyperextension. However, for patients with loss of radial abduction and MCP flexion due to the contracture, indirect correction of the MCP hyperextension was improbable.

Assessment of modified Zancolli arthroplasty for basal thumb arthritis

Background and aim The trapeziometacarpal arthritis is one of the most common joint problems affecting women after the age of 50 years. Surgery is indicated after failure of conservative treatment with continuation of pain and functional disabilities. One of the most reported and well-known surgical procedure for management of basal thumb arthritis is the ligament reconstruction and tendon interposition arthroplasty. The aim of the study was to evaluate patients who underwent modified Zancolli arthroplasty for basal thumb arthritis. Patients and methods The study included 15 patients with basal thumb arthritis (three males and 12 females). Full clinical examination and scoring of the hand was done using Quick DASH, visual analog scale, measuring range of motion, and grip strength. All patients underwent full radiological and laboratory investigations. Results Overall pain intensity was measured with a visual analog scale, which ranged from 5–10 preoperatively and ranged from 0 to 1 6 months postoperatively. Regarding the DASH score, there was improvement from a mean of 64.48±16.61 points preoperatively to a mean of 1.37±1.67 points postoperatively. The mean postoperative abduction was 75% to the normal side, opposition was 80% to the normal side, and power grip was 90% to the normal hand. Conclusion Modified Zancolli arthroplasty is an effective means of treating symptomatic patients with trapeziometacarpal arthritis who failed to improve with nonsurgical measures. This technique ensures a dynamic fixation of the apical ligament and provides better stability. The procedure is simple both technically and regarding postoperative care.

Interpositional Arthroplasty With Extensor Digitorum Brevis Tendon in Freiberg Disease.

No consensus has been reached in the treatment of Frieberg disease. Our aim was to evaluate medium- to long-term results of patients with advanced Freiberg disease managed with extensor digitorum brevis tendon interpositional arthroplasty. There were 24 patients (19 females, 5 males) managed with interpositional arthroplasty for advanced Freiberg disease between 2003 and 2015. The mean follow-up was 133.8 (range, 60-198) months. According to Smillie classification, there were 4 grade 3, 13 grade 4, and 7 grade 5 patients. Patients were evaluated preoperatively and at the final follow-up with the American Orthopaedic Foot & Ankle Society (AOFAS) score and metatarsophalangeal joint range of motion and postoperatively with visual analog scale (VAS) and subjective satisfaction evaluation. Joint space was evaluated on x-rays. Mean AOFAS score increased (53.9 to 80.3, P = .001). Eight patients had excellent, 14 had good, and 2 had fair scores. A significant increase was found in dorsiflexion (38.1° [24°-52°] vs 55.3° [34°-65°]; P = .001) and plantarflexion (19.0° [10°-28°] vs 28.6° [19°-39°]; P = .001). Narrowing of the joint space was not seen in any patient, but expansion was determined in all patients (0.39 [0.35-0.47] vs 0.44 [0.41-0.47] cm; P = .002). Of the patients, 9 were very satisfied, 12 were satisfied, 2 were moderately satisfied, and 1 was dissatisfied. The mean postoperative VAS pain score was 1.7 ± 0.9 (0-4). After a minimum 5-year follow-up, most patients with Freiberg disease managed with interpositional arthroplasty using the extensor digitorum brevis tendon had excellent to good functional results with a widening of the joint space. Level IV, retrospective case series.

Chronological changes in surgical outcomes after trapeziectomy with ligament reconstruction and tendon interposition arthroplasty for thumb carpometacarpal osteoarthritis

BackgroundDespite satisfactory mid-term and long-term outcomes of trapeziectomy with ligament reconstruction and tendon interposition (LRTI) procedures for thumb carpometacarpal osteoarthritis, there is limited literature describing detailed chronological changes in early-phase postoperative outcomes. We investigated chronological changes of subjective, objective, and radiological outcomes within 1 year post-trapeziectomy with LRTI using a longitudinal evaluation and analyzed clinical factors associated with patient-reported subjective outcomes. HypothesisSome parameters influence patient-reported subjective outcomes during the early postoperative period. Patients and methodsNineteen patients (mean age, 67.3 years) who underwent trapeziectomy with LRTI were evaluated preoperatively and at 3, 6, and 12 months postoperatively to investigate objective (grip strength, pinch strength, range of motion [ROM] of the interphalangeal [IP] joint, metacarpophalangeal [MP] joint, and carpometacarpal [CMC] joint, Kapandji score), subjective (Disabilities of the Arm, Shoulder, and Hand [DASH] score, Hand20 questionnaire score, and visual analog scale [VAS] for pain), and radiological outcomes (trapezial space height and its ratio). Factors affecting DASH and Hand20 scores were analyzed. ResultsGrip strength and pinch strength were decreased at 3-month follow-up. It required 6 months to recover preoperative strength and 12 months for significant improvement. VAS for pain, DASH, and Hand20 scores were significantly improved at 3-month follow-up, continuing to improve until 12 months. The trapezial space height and its ratio decreased approximately 50% at 3-month follow-up, with no further changes at 6 or 12 months. Both DASH and Hand20 scores were strongly correlated with VAS for pain during activity within 6 months post-surgery and moderately correlated with ROM of the thumb at 3 months post-surgery; however, they were not correlated with grip and pinch strength as well as the trapezial space height ratio within 12 months post-surgery. DiscussionTrapeziectomy with LRTI for thumb carpometacarpal osteoarthritis provided early subjective improvements in outcomes as early as 3 months post-procedure. However, more than 6 months are required to determine objective improvements in outcomes. To obtain early patient-reported satisfactory outcomes, we should focus not on improving hand and finger strength, but on treating postoperative surgical site pain and preventing thumb stiffness. Level of evidenceIV, retrospective therapeutic study.

Treatment of Severe Ulnar Instability of the MCP Joint Improves Function in LRTI Arthroplasty for Osteoarthritis of the Thumb CMC Joint.

Background Comorbidity in the metacarpophalangeal joint (MCPj) of the thumb, i.e., hyperextension or ulnar collateral instability, could affect the outcome of arthroplasty in the thumb carpometacarpal joint (CMCj). Objective In a retrospective study, we evaluated the effect of arthrodesis of the MCPj for thumbs with unstable MCPj and simultaneous ligament reconstruction tendon interposition (LRTI) arthroplasty for the CMCj in terms of strength, function, and patient satisfaction. Patients and Methods A total of 69 thumbs treated with a LRTI arthroplasty of the CMCj were included. In 14 of those cases, an arthrodesis of the MCPj was performed as well. In 12 thumbs, both procedures were done simultaneously; in one case MCPj arthrodesis followed LRTI arthroplasty, whereas one patient already had MCPj arthrodesis at time of LRTI arthroplasty. Those 14 thumbs were compared with the control group of 55 thumbs who had only undergone LRTI. At a mean follow-up of 4 to 5 years (mean 54 [10-124] months) postoperative assessments included range of motion (ROM) of the CMC, MCP, and interphalangeal (IP) joint of the thumb, as well as any instability of the MCPj. Pinch and grip strength were examined, also the visual analogue scale (VAS), patient satisfaction, QuickDASH, PRWE-Thumb, and the Kapandji's Opposition Score. Radiologically, proximalization of the first metacarpal bone was measured. Student's t -test was used to determine significance, p < 0.05 was considered significant. Results Additional arthrodesis of the MCPj provided no significant difference of function in thumbs that only had a hyperextension-instability. However, in thumbs with marked ulnar instability, stronger pinch-grip was obtained with arthrodesis, compared with only LRTI. Conclusion In patients with advanced painful thumb CMCj osteoarthritis, we recommend (simultaneous) arthrodesis of the MCPj, to allow a stable thumb grip if there is additional marked ulnar collateral ligament instability. Level of Evidence This is a Level III, retrospective comparative study.

Rolled Tendon Allograft Interposition Arthroplasty for Salvage Surgery of the Hallux Metatarsophalangeal Joint.

Hallux rigidus is a common osteoarthritic disease of the first metatarsophalangeal joint (MTPJ). Few salvage treatment options exist that preserve motion for patients who have failed an initial procedure and who are not amenable to fusion, typically patients who are active or who would like to wear high heels. Allograft tendon interpositional arthroplasty is an unconventional salvage treatment option that may preserve motion and prevent bone loss. A retrospective chart review is reported of 19 patients who failed previous procedures and refused fusion who underwent allograft tendon interpositional arthroplasty of the hallux MTPJ by a single surgeon between 2012 and 2015. Outcomes included the American Orthopaedic Foot & Ankle Society (AOFAS) hallux metatarsophalangeal-interphalangeal scale assessment as well as measurement of apparent joint space on anterior to posterior and lateral views. The cumulative average AOFAS score for all patients was 68.5 preoperatively and 74.1 postoperatively. The average AOFAS pain subscore was 24.7 preoperatively and 26.8 postoperatively (SD = 7.7 and 13.8, respectively). Radiographically, patients had an increase in apparent joint space from pre- to postoperatively, most notable on the lateral view (0.6 to 4.7 mm; SD = 0.7 and 3.2 mm). Five patients required a second operative procedure, for an overall 26% reoperation rate. One patient underwent hallux MTPJ fusion after the interpositional arthroplasty. An additional 4 patients (21%) had symptoms requiring a steroid injection, and another 3 patients (16%) were recommended to undergo a revision procedure based on their symptoms. Rolled allograft tendon interposition arthroplasty performed poorly as a salvage strategy for failed previous hallux MTPJ surgery for hallux rigidus because of a high rate of complication and minimal benefits. The senior author has abandoned the technique. Level IV, retrospective case series.

Partial Versus Total Trapeziectomy Thumb Arthroplasty: An Expertise-based Feasibility Study.

There are numerous surgical techniques for the treatment of first carpometacarpal joint osteoarthritis, however, controversy exists as to whether outcomes differ between techniques. This feasibility study aimed to determine if a large-scale, health-related quality of life and functional outcomes study comparing 2 surgical techniques, complete trapeziectomy with ligament reconstruction and tendon interposition (T + LRTI) versus partial trapeziectomy and tendon interposition (PT + TI) arthroplasty, is possible. Patients with advanced stage arthritis (Eaton stages II-IV) of the thumb were invited to undergo either T + LRTI or PT + TI at 1 of the 2 hand surgery practices. Feasibility outcomes included: (1) Process: recruitment rate; (2) Resources: eligibility rate, eligibility criteria, retention, and compliance rates (completion of health-related quality of life questionnaires, Disabilities of the Arm, Shoulder, and Hand, EuroQol-5D-3L, and SF-36, and functional measurements, grip, key pinch, and tip pinch strength, at 1-week preoperatively and 1, 3, 6, and 12 months postoperatively); (3) Management: determining the practices' commitment to the study; and (4) Scientific: calculation of the variances and treatment effect sizes (ES) of differences between procedures. Data from baseline measurements and 6-month follow-up were used for analysis. Sixty patients were screened, of which 34 (57%) were eligible for surgery. Twenty-one (81%) of the 26 ineligible patients were excluded due to previous or additional planned surgical procedures on the same hand, particularly carpal tunnel release (n = 17). Twenty patients consented; 12 in the T + LRTI and 8 in the PT + TI group. The highest completion rate for the 3 questionnaires and the functional measurements, for both groups was at 6-month time point. Compliance rates for questionnaire completion at 6-months were calculated at 50% and 75% for the T + LRTI and PT + TI group, respectively. Functional measurement completion rate was 50% and 63% for T + LRTI and PT + TI groups, respectively. Treatment ES were group dependent, with Disabilities of the Arm, Shoulder, and Hand, EuroQol-5D-3L usual activities and anxiety/depression showing a large ES in the PT + TI group; the T + LRTI group showed large ES in EQ-5D state of health today. Authors conclude that a large-scale study is feasible and dependent on: (1) increasing sample size to account for the high attrition rate; (2) liberalizing inclusion criteria to include patients with carpal tunnel syndrome; (3) allotting more time at follow-up visits to ensure completion of all measurements; and (4) increasing staff involvement (ie, develop rapport with patients and maintain stability with research assistants).

First Ray Stabilization With Mini-Tightrope in the Treatment of Trapeziometacarpal Arthritis

Objective: Trapeziometacarpal (TMC) arthritis is the most frequent indication for articular reconstruction in the upper limb. The surgical treatment is an option when conservative treatment fails, and TMC joint ligament reconstruction and tendon interposition arthroplasty has been used due to its predictable pain relief and low morbidity. However, there are complications related to this technique, such as donor site pain and tendon failure. Thus, a technique combining trapeziectomy and first ray stabilization with suture has been increasingly used. In this study, we present our results with trapeziectomy and first ray stabilization with mini-tightrope at a minimum 4-month follow-up. Materials and Methods: Seventeen patients with TMC arthritis were treated surgically with trapeziectomy and first ray stabilization with percutaneous placement of mini-tightrope between 2014 and 2015. Four patients had had previous surgical treatment with Weilby or Burton-Pellegrini techniques that failed and in these patients trapeziectomy had already been done. We selected patients who had not responded to physical therapy and who had no high force demand for daily activities. Patients had a minimum follow-up period of 4 months. In the postoperative period, we collected data related to pain using the visual analogue scale (VAS), joint mobility, grip and pinch strength and we also evaluated patients with the Quick Disability of the Arm, Shoulder and Hand (QuickDASH) score. Patient satisfaction with the procedure was also evaluated. Results: We treated 17 patients, 15 women and 2 men, with a mean age of 57 years. Postoperative mobility was good with total opponens, extension, and flexion of the first finger in all patients and mobility without limitation in their daily activities. The average postoperative grip strength was 20 vs 20.6 on the contralateral side. Pinch strength was also decreased with an average postoperative terminolateral pinch strength of 3.84 vs 4.2 on the contralateral side and terminoterminal pinch strength of 3.11 vs 3.27 on the contralateral side. The majority of patients referred a high level of satisfaction with the procedure at 2 months postoperative, with return to their previous activities. We report necessity of removal of the mini-tightrope in 2 cases, one due to pain related to the metal implant of the mini-tightrope, without pain referred to the TMC joint, and another due to conflict between the base of the first and second metacarpal bones. We report 1 case of failure, which was later, revised with good preliminary results. Conclusions: The surgical treatment for TMC arthritis has many valid options. First ray stabilization with a mini-tightrope appears to achieve good results, with pain relief, high patient satisfaction, and a quicker return to work compared with conventional suspension techniques. Few complications were reported in our sample. It appears to be a valuable solution, in order to maintain good mobility in patients with low strength requirements on their daily lives.

Pyrocarbon Interposition Arthroplasty of the Trapeziometacarpal Joint With the PyroDisk

Introduction: Pyrocarbon is a high-strength, low-friction carbon material. It is isoelastic to bone and therefore considered ideal for a hemiarthroplasty. Pyrocarbon interposition arthroplasty is an alternative to the traditional tendon interposition arthroplasty in the trapeziometacarpal joint, but follow-up series are rare. Objectives: We aimed to evaluate the short-term results and safety of pyrocarbon prosthesis in a younger population. Methods: Between February 2006 and April 2009, 25 patients (29 arthroplasties) were operated with a PyroDisk interposition arthroplasty (Ascension Orthopedics/Integra, Austin, Texas). The mean age was 61 years (range, 52-71 years). Four patients were males and 21 females. The mean follow-up time was 28 months (range, 10-44 months). The patients were evaluated subjectively using the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score as well as a visual analogue scale (VAS 0-10 cm) regarding pain at rest and at activity, and the cosmetic. Grip strength was recorded with a JAMAR dynamometer and the pinch grip strength as well as volar and radial thumb abduction noted. Results: Six prostheses were revised: 4 due to prostheses dislocation, 1 due to scapho-trapezium-trapezoid (STT) arthritis and persistent, and 1 due to persistent pain without any cause. All 6 patients were converted into abductor pollicis longus (APL) tendon interposition arthroplasty. The average pinch grip strength was 5.0 kg force (range, 1.2-9.5 kg) in the operated hands. In patients with unilateral surgery (n = 21), the pinch grip strength was 86 % of the untreated hands. The mean VAS pain at rest was 1.1 cm (SD = 2.0 cm), and 17 of 25 patients were pain free at rest. Six patients reported mild pain (VAS 1-3), and 2 patients reported VAS 7 at rest. VAS pain at activity was 4.2 cm (SD = 2.5 cm). The average DASH score was 32 (range, 0-93). Conclusion: The use of PyroDisk arthroplasty gives good range of motion and pain relief at rest, and the pinch grip after mean 28 months was close to the nonaffected side but not completely normalized. However, a large number (6/29) of the prostheses were revised, which is a major concern.

Outcome of Stainsby Forefoot Arthroplasty for Severe Rheumatoid Feet

Category: Lesser Toes Introduction/Purpose: Treatment of the severely deformed rheumatoid forefoot generally involves resection arthroplasty of the lesser toe MTP joints. This can either involve resection of the metatarsal heads or, as described by Stainsby: resection of part of the proximal phalanx and extensor tendon interposition arthroplasty. The Stainsby procedure is a well accepted technique, however despite this there is little information on the outcome of this procedure especially long term results. We present, what we believe is, the largest series with longest follow up in literature apart from original authors’ work. Methods: Retrospective review of prospectively collected data was performed of 48 rheumatoid patients with 71 feet treated with the Stainsby procedure, between March 2006 and December 2013, by a single surgeon. American Orthopaedic Foot and Ankle Score (AOFAS) was recorded at both pre- and postoperative assessment alongwith a satisfaction survey at final follow-up. 5 patients had died at final follow up. The follow-up duration was 5.4 years (range 2.2-9.8). Results: 9/48 patients were on anti TNF therapy and 26/48 were treated with Methotraxate. 57 cases (80%) had 1st Metatarsophalangeal Joint (MTPJ) fusion (Group 1) alongwith Stainsby procedure for lesser toes. There was significant improvement in mean AOFAS from 32.5 to 67.4. The difference in improvement in mean AOFAS for Group 1 (29.4 to 72.0) as compared to Group 2 with Stainsby procedure alone (34.3 to 71.0) was statistically significant. 76% had no (50%) or painfree (26%) callosities at final follow up. Three patients had significant hallux valgus deformity (one for Group 1) at final follow up. There were four cases of superficial wound infection that resolved with oral antibiotics with no further consequences. Two patients had broken retained wires in metatarsal with no consequences and one patient had non-union of 1st MTPJ fusion not requiring revision. 77% were very happy (35%) or pleased (52%) with results of operation. 93% patients would recommend the operation – 78% definitely and 15% with reservation. Conclusion: Treatment of the rheumatoid forefoot involving resection of the metatarsal heads is an established procedure, with much published literature to support its use. Stainsby procedure in an effective procedure but unfortunately not as popular probably because of lack of long term results. This study highlights the long term benefits and very good satisfaction results with Stainsby procedure with even better results if combined with 1st MTPJ fusion.