Treatment Of Trapeziometacarpal Osteoarthritis Research Articles

Erfahrungen mit Endoprothetik am Daumensattelgelenk

The complex kinematics of the saddle joint has been achallenge in the development of trapeziometacarpal prostheses. The introduction of the dual-mobility design increases the range of motion and limits strains on the cup fixation. Therefore, rates of loosening and dislocation have been markedly reduced. Furthermore, several studies showed asimilar relief of pain, range of movement and grip strength compared to the results of resection arthroplasty. The preservation of the length of the first ray as well as the more stable and functional joint can be favourable in younger and active patients. Further investigation is needed to determine whether or not those higher demands affect long-term survivorship. The high grade of patient satisfaction, the shorter recovery time and the safe surgical technique motivates considering the implantation of atotal endoprosthesis with adual-mobility cup as an attractive alternative to resection arthroplasty in the operative treatment for trapeziometacarpal osteoarthritis.

Trapeziometacarpal osteoarthritis - a stepwise therapeutic approach.

Osteoarthritis of the trapeziometarcarpal joint, also called rhizarthrosis, is a common finding in the second half of life. It has a higher prevalence in females and is of growing importance in ageing societies. A variety of conservative and surgical treatment options are known, including conservative treatment up to joint replacement. Without treatment, rhizarthrosis can lead to disabling pain and loss of hand function. The goal of this overview of treatment options is to present a stepwise approach that can be initiated by any physician. Treatment of trapeziometacarpal osteoarthritis should be started early with conservative measures such as splinting and physical therapy, which can be supplemented by oral and topical analgesics and local infiltrations subsequently. If all of these interventions do not provide sufficient relief, referral to a hand surgeon should be considered. Surgical strategies vary from arthroscopic debridement over trapeziectomy, with or without tendon interposition and ligament reconstruction, to interposition implants and total joint replacements. The planned intervention should be based on clinical and subjective functional limitations and associated degenerative changes, as well as the patient’s expectations and needs. The goal of this paper is to develop a treatment algorithm, leading to higher levels of patient functionality and satisfaction. Below we discuss the current literature and point out key treatment options used in our department. &nbsp.

Trapeziectomy and Suture-Button Suspensionplasty for Basilar Thumb Arthritis: Is It Enough to Prevent First Ray Subsidence?

Introduction Trapeziectomy and suture-button suspensionplasty (SBS) are a novel option to treat end-stage trapeziometacarpal (TMC) osteoarthritis. Our purpose is to evaluate our outcomes with this technique and in this setting, with a minimum of 18 months of follow-up.Materials and Methods Twenty-eight patients were included, operated between 2016 and 2018. We recorded demographic data, preoperative Eaton stage, follow-up and operative times. The patients completed the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire and tip pinch, key pinch, and grip strength were measured. First metacarpal subsidence was calculated, and postoperative complications were documented.Results The average follow-up was 34 months. The mean QuickDASH was 32 at the final follow-up. The average strength results were 20 kg for grip, 3.6 kg for tip pinch, and 4.2 kg for key pinch. The rate of first ray subsidence was 10.7%. We encountered three complications: a hardware intolerance, a second metacarpal fracture, and a suture rupture. There was one reoperation to remove an implant.Conclusion Trapeziectomy and SBS functional results are similar to other techniques, with less subsidence of the first ray and allowing for early mobilization and fast recovery. This procedure is a safe and promising option in the treatment of TMC osteoarthritis, with good medium-term outcomes.

The Effect of Surgical Treatments for Trapeziometacarpal Osteoarthritis on Wrist Biomechanics: A Cadaver Study

PurposeStudies have shown the effects of surgical treatments for trapeziometacarpal osteoarthritis on thumb biomechanics; however, the biomechanical effects on the wrist have not been reported. This study aimed to quantify alterations in wrist muscle forces following trapeziectomy with or without ligament reconstruction and replacement.MethodsA validated physiological wrist simulator replicated cyclic wrist motions in cadaveric specimens by applying tensile loads to 6 muscles. Muscle forces required to move the intact wrist were compared with those required after performing trapeziectomy, suture suspension arthroplasty, prosthetic replacement, and ligament reconstruction with tendon interposition (LRTI).ResultsTrapeziectomy required higher abductor pollicis longus forces in flexion and higher flexor carpi radialis forces coupled with lower extensor carpi ulnaris forces in radial deviation. Of the 3 surgical reconstructions tested post-trapeziectomy, wrist muscle forces following LRTI were closest to those observed in the intact case throughout the range of all simulated motions.ConclusionsThis study shows that wrist biomechanics were significantly altered following trapeziectomy, and of the reconstructions tested, LRTI most closely resembled the intact biomechanics in this cadaveric model.Clinical relevanceTrapeziectomy, as a standalone procedure in the treatment of trapeziometacarpal osteoarthritis, may result in the formation of a potentially unfilled trapezial gap, leading to higher wrist muscle forces. This biomechanical alteration could be associated with clinically important outcomes, such as pain and/or joint instability.

Five year long term results of total joint arthroplasties in the treatment of trapeziometacarpal osteoarthritis.

Introduction: Trapeziometacarpal (TMC) osteoarthritis is a common disease. Patients with advanced disease who have failed conservative treatment have different surgical options, including total joint prosthesis. The aim of this study was to investigate the long-term outcome and complications of trapeziometacarpal (TMC) total arthroplasty. Materials and Methods: One hundred and forty-seven patients with TMC osteoarthritis were surgically treated with TMC arthroplasty, and one hundred and thirty-seven patients were seen for follow-up (102 women and 35 men). At follow -up patients were asked to complete a visual linearanalogue scale (VAS) for satisfaction with the result of the operation and persisting pain from the thumb, the Spanish validated Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire was used to evaluate function of the affected hand.(9) The radiological examination consisted of posterior-anterior and oblique radiographs. In preoperative radiographs Eaton-Little was used, and in postoperative radiographs were assessed with regard to implant loosening and alignment. Results: The subjective outcome was satisfactory in 126 cases (92 %), 14 (12 %) patients would undergo the same procedure in the other hand. The DASH questionnaireswere 19.55 (range 5.6-33,5) on average, and EVA was 1 on average. The mean key pinch strength was 5.8 Kg at 5 years follow-up. The most frequent postoperative complication was De Quervain tenosynovitis (21%), other complications were: Cup loosening (3.6%), traumatic dislocation (3,6%). The prosthesis was removed in nine cases (7%). There were four intraoperative complications. The survival rate for ARPE prosthesis was 92,7% at 60,5 months. TMC total arthroplasty offers a reliable treatment alternative in patients with thumb carpometacarpal joint osteoarthrosis which conservatives’ treatment had failed. Conclusions: The TMC joint prosthesis is an option for patients with TCM osteoarthritis, provides satisfactory outcomes and has a low failure rate.(www.actabiomedica.it)

Slip abductor pollicis longus suspension tendinoplasty for management of trapezio-metacarpal joint osteoarthritis.

Trapezio-metacarpal (TM) joint arthritis is a common cause of pain and functional disability of the hand. The ideal surgical procedure for TM joint osteoarthritis is still controversial. The aim of the current study is to assess the outcome of complete trapezial excision and abductor pollicis longus tendon interposition arthroplasty in the treatment of TM osteoarthritis. Twenty patients (16 women and 4 men) were prospectively enrolled in the current study with average age of 51.5 years (36-64). All patients had complete trapezial excision and abductor pollicis longus tendon interposition arthroplasty with minimum follow-up of 24 months. At final follow-up there was significant improvement as regard pain, range of motion, and functional assessment scores. Pre-operative visual analogue scale (VAS) for pain improved from 6.2 (±1.54) to 1.1 (±0.97), and the average Quick DASH Score improved from 47.6 (±8.81) points pre-operatively to 13.6 (±5.46) points post-operatively. The mean pre-operative Buck-Gramcko score system improved from 21 (±6.2) points to 41.5 (±7). The average post-operative satisfaction score was 9.1(±2.1), with all the patients somewhat satisfied and recommending operation to other patients. The total trapeziectomy tendinoplasty with suspension and interposition using the abductor pollicis longus is a reliable procedure for the treatment of TMJ osteoarthritis, providing satisfactory functional results.

Ten-year long-term results of total joint arthroplasties with ARPE® implant in the treatment of trapeziometacarpal osteoarthritis

Between May 1999 and April 2002 a total of 69 consecutive thumb carpometacarpal joint arthoplasties were performed in a total of 64 patients for carpometacarpal joint osteoarthritis using the cementless hydroxyapatite (HA)-coated unconstrained ARPE implant. Clinical, functional and radiological results at 10-year follow-up are presented. Survival analysis was performed using the Kaplan-Meier method. Of the 64 patients, four were lost to follow-up, 60 implants (92.3%) were functional and five (7.7%) were not (two dislocated, two were removed and one with aseptic loosening). Survival estimate for functional implants over 10 years was 93.9% (95% confidence interval 82.3-97.9). The radiographs were satisfactory in 82.4%. There was subsidence of the cup in 15.8%. Thumb carpometacarpal joint arthroplasty with the ARPE implant offers a reliable treatment alternative in patients with Eaton grade III or IV thumb carpometacarpal joint arthritis in the presence of good bone stock.

The Role of Arthroscopy in Trapeziometacarpal Arthritis

Trapeziometacarpal (TM) arthroscopy should be viewed as a useful minimally invasive adjunctive technique rather than the operation itself since it allows one to visualize the joint surface under high-power magnification with minimal disruption of the important ligamentous complex. Relatively few articles describe the arthroscopic treatment of TM osteoarthritis (OA) and the arthroscopic anatomy of the TM joint. There is lingering confusion as to whether soft tissue interposition and K-wire fixation of the joint are needed and whether the outcomes of arthroscopic procedures compare to the more standard open techniques for TM arthroplasty. This paper describes (1) the arthroscopic ligamentous anatomy of the TM joint, (2) the portal anatomy and methodology behind TM arthroscopy, and (3) the arthroscopic treatment for TM OA, including the current clinical indications for TM arthroscopy and the expected outcomes from the literature. A MEDLINE(®) search was used to retrieve papers using the search terms trapeziometacarpal, carpometacarpal, portal anatomy, arthroscopy portals, arthroscopy, arthroscopic, resection arthroplasty, and arthroscopic resection arthroplasty. Eighteen citations satisfied the search terms and were summarized. Careful wound spread technique is needed to prevent iatrogenic injury to the surrounding superficial radial nerve branches. Traction is essential to prevent chondral injury. Fluoroscopy should be used to help locate portals as necessary. Cadaver training is desirable before embarking on a clinical case. Questions regarding the use of temporary K-wire fixation or thermal shrinkage or the need for a natural or synthetic interposition substance cannot be answered at this time. Longitudinal prospective studies are needed to answer these lingering questions. An intimate knowledge of the portal and arthroscopic anatomy is needed to perform TM arthroscopy. Minimally invasive techniques for resection arthroplasty in TM OA with and without soft tissue interposition can yield good outcomes in the treatment of TM OA.

Treatment of trapeziometacarpal osteoarthritis by partial trapeziectomy and costal cartilage autograft. A review of 100 cases

PurposeTrapeziectomy remains the surgery of choice in the treatment of trapeziometacarpal osteoarthritis. Some authors consider the collapse of the trapezial space responsible for a loss of strength and intracarpal deformities. We report our experience of partial trapeziectomy with chondrocostal autograft as an interposition material. MethodsThe study included100 thumbs in 82 patients with a mean age of 64.6 years (47–82). Mean follow-up was 68 months (4–159). Partial trapeziectomy was carried out through a dorsal approach. The graft was harvested through a direct approach of the 9th rib. ResultsOur results were similar to those obtained with alternative techniques, except for strength where the gain is improved. No intracarpal deformities were seen. There was no sign of graft wear; the length of the thumb ray is preserved. The results are stable over time, and the morbidity of the costal donor site is negligible. The interposition of a hardwearing biological material and its association with partial trapeziectomy enable to restore the thumb stability and strength.

Commentary on ?Dynamic suspension-sling arthroplasty with intermetacarpal ligament reconstruction for the treatment of trapeziometacarpal osteoarthritis? by Scheker LR, Boland MR

The technique of ligament suspension after trapeziectomy described in this paper by Scheker and Boland represents considerable sophistication of the original concept of “ligament reconstruction—tendon interposition” (LRTI) described by Burton and Pellegrini [1]. The elaboration of the routing of the tendon slip of FCR is ingenious, and has the purpose of providing more direct ligamentous control of the metacarpal base to prevent both dorsal subluxation and proximal migration of the metacarpal, and a cushion between the first and second metacarpal bases. There is no doubt that the procedure is technically more demanding. After more than 200 operations it is not surprising that a master-surgeon such as Dr Scheker makes the operation appear simple, but any surgeon planning to embark on this procedure in preference to more simple versions of the operation should be prepared for some difficulty in matching Dr Scheker’s expertise, and his results. It would certainly be advisable for a less experienced surgeon to observe the operation in the hands of an experienced exponent. Dr Scheker’s results, taken together with the large size of the series, are impressive, and compare well with those reported by Tomaino et al. [2] in a small series, although the latter noted some fall in power over 9 years compared to 6, and there is some confusion in their paper about the preoperative and postoperative key pinch measurements which make direct comparison difficult. The opposite approach to Dr Scheker’s is to simplify rather than elaborate the reconstruction, and Davis et al. [3] have shown no difference between their results with or without LRTI. Long-term results are not yet available. The results in terms of pain relief are not obviously different from Scheker and Boland’s, although the methods of evaluation are not easily comparable. Davis et al. showed much less improvement in strength, so the precise method of soft tissue reconstruction may be the important factor. In particular, Davis et al. question the importance of preventing proximal migration of the metacarpal, and there may be grounds to speculate on the ability of a ligament reconstruction, however strong to start with, to prevent gradual migration over the long term. All series of trapeziectomy will have a small proportion of disappointing results, and for some the reason may be amenable to prevention; persistent scaphotrapezoid arthritis can be anticipated by joint excision, and first metacarpal adduction deformity avoided by maintaining control of a hypermobile first MP joint, either with a temporary k-wire during the period of splintage, or by MP fusion. Any surgeon who feels that he or she can master Scheker and Boland’s technique can be confident that the results will be among the best achievable, but those planning to change from a method that works for them should be aware of the increased complexity and technical demands of this operation.

Commentary on ?Dynamic suspension-sling arthroplasty with intermetacarpal ligament reconstruction for the treatment of trapeziometacarpal osteoarthritis? by Scheker LR, Boland MR

Commentary on ?Dynamic suspension-sling arthroplasty with intermetacarpal ligament reconstruction for the treatment of trapeziometacarpal osteoarthritis? by Scheker LR, Boland MR

Silicone spacer or tendon spacer for trapezium resection arthroplasty—Comparison of results

A comparison study was done for 25 consecutive trapeziectomies in 21 women with silicone replacements and 25 consecutive trapeziectomies in 24 women without silicone replacements who were reviewed from 1 to 9 years postoperatively. The patients, who ranged from 35 to 75 years of age, were housewives and clerical workers. All had trapeziometacarpal osteoarthritis. Among the patients with silicone replacement of the trapezium, 90% reported pain relief; mean thumb abduction was 42.5 degrees, pronation was 37.5 degrees, and pinch strength averaged 5 kg. Among the patients without silicone replacement after trapeziectomy, 95% reported pain relief; mean thumb abduction was 46.8 degrees, pronation was 41.4 degrees, and pinch strength averaged 4.6 kg. For those patients with only one hand operated upon, pinch strength in that hand averaged 85% that of the opposite hand in patients with silicone trapezial replacement and 82% for those without silicone trapezial replacement. In this patient population, trapeziectomies with or without silicone replacement as treatment for trapeziometacarpal osteoarthritis appear to give similar results.