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

We performed a cadaver study using 18 fresh-frozen adult forearms and hands to compare the tendon loads required to generate progressively greater key pinch (0.5 kg to 2 kg) after three different surgical procedures to treat trapeziometacarpal osteoarthritis: isolated trapeziectomy, trapeziectomy followed by ligament reconstruction with tendon interposition and total joint arthroplasty using a Touch® implant. Thumb pinch was simulated by loading the main actuator tendons involved in the key pinch. Six specimens were randomly assigned to each of the three surgical procedure groups. Measurements were made before and after the joint surgery. Specimens that underwent trapeziectomy with or without ligament reconstruction with tendon interposition required significantly higher tendon loads than those with the implant to achieve the same pinch force. There was no significant difference between the isolated trapeziectomy and ligament reconstruction groups. Using the implant resulted in similar median tendon loads compared with those of the intact sample. Total joint arthroplasty with a Touch® prosthesis may yield a superior biomechanical profile in which the tendon loads needed to achieve a certain key pinch force are lower and better distributed between the actuator muscles compared with trapeziectomy with or without ligament reconstruction.

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Partial trapeziectomy and pyrocarbon interpositional arthroplasty for trapeziometacarpal osteoarthritis: minimum 8-year follow-up

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193420906805 ◽

2020 ◽

Vol 45 (5) ◽

pp. 472-476 ◽

Cited By ~ 4

Author(s):

Francesco Smeraglia ◽

Sergi Barrera-Ochoa ◽

Gerardo Mendez-Sanchez ◽

Morena A. Basso ◽

Giovanni Balato ◽

...

Keyword(s):

Young Patients ◽

Hand Surgery ◽

Dash Score ◽

Level Of Evidence ◽

Interpositional Arthroplasty ◽

Trapeziometacarpal Osteoarthritis ◽

Select Group ◽

Trapeziometacarpal Joint Osteoarthritis ◽

Surgical Treatments

We undertook a retrospective study to evaluate minimal 8-year outcomes of 46 trapeziometacarpal joints (46 patients) treated with pyrocarbon implant arthroplasty after partial trapeziectomy for trapeziometacarpal joint osteoarthritis in two different hand surgery units. The mean follow-up interval was 9.5 years (average 113 months with a range 97–144 months). The study showed that pyrocarbon interpositional arthroplasty provided pain relief and high patient satisfaction. All patients experienced a reduction in the DASH score, with an average change of 30 points. The visual analogue scale score, the Kapandji score, and key pinch also showed remarkable improvement. The PyroDisk implant exhibited good longevity, with good implant survival. A review of the literature revealed that the functional outcomes after implant surgery are not superior to more common techniques, such as trapeziectomy with or without ligamentoplasty. Therefore, this is a reliable surgery but may not have added benefits over simpler surgical treatments. This implant could have a role, perhaps in a select group of young patients, as a time-procuring procedure. Level of evidence: IV

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Long-Term Results of Joint Arthroplasty with Total Prosthesis for Trapeziometacarpal Osteoarthritis in Patients over 65 Years of Age

Geriatrics ◽

10.3390/geriatrics6030065 ◽

2021 ◽

Vol 6 (3) ◽

pp. 65

Author(s):

Miguel Angel Martin-Ferrero ◽

Jose Maria Trigueros-Larrea ◽

Elsa Martin-de la Cal ◽

Begoña Coco-Martin ◽

Clarisa Simon-Perez

Keyword(s):

Long Term Results ◽

Joint Involvement ◽

Kaplan Meier ◽

Trapeziometacarpal Osteoarthritis ◽

Prevalent Disease ◽

Patient Selection Criteria ◽

Clinical And Radiological Results ◽

Surgical Treatments ◽

Joint Arthroplasties

Trapeziometacarpal osteoarthritis (TMCOA) is a highly prevalent disease in the older population. Many different types of surgical treatments are possible, depending on the degree of joint involvement, the personal and professional circumstances of the patient and the preferences of the orthopedic surgeon. This paper evaluated the clinical and radiological results of consecutive cohorts of patients over 65 years old treated with total joint arthroplasties (TJA) of the ball and socket type (B&S) for TMCOA, with a minimum of 10 years follow-up. The survival rate (Kaplan–Meier) of the functional prostheses at 10 years was 92.2% (95% CI (89.1%, 96.1%). These functional arthroplasty patients, after 10 years of follow-up, showed little or no pain, good function and good key pinch, without radiological alterations. TJAs of the B&S type are a long lasting, effective and reliable alternative to surgical treatment of TMCOA in patients over 65 years of age, when they are performed with the patient selection criteria and surgical technique described throughout this study.

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Recent Medical and Surgical Treatments for Parkinson's Disease

Perspectives on Gerontology ◽

10.1044/gero4.1.9 ◽

1999 ◽

Vol 4 (1) ◽

pp. 9-12

Author(s):

Philip M. Green

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Surgical Treatments

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Pediatric Benign Vocal Fold Lesions: A Team Approach

Perspectives on Voice and Voice Disorders ◽

10.1044/vvd19.3.105 ◽

2009 ◽

Vol 19 (3) ◽

pp. 105-112 ◽

Cited By ~ 3

Author(s):

Geralyn Harvey Woodnorth ◽

Roger C. Nuss

Keyword(s):

Vocal Fold ◽

Evaluation Process ◽

Team Approach ◽

Speech Language Pathologist ◽

Benign Vocal Fold Lesions ◽

Different Types ◽

Team Evaluation ◽

Surgical Treatments ◽

Review Current ◽

Vocal Fold Nodules

Abstract Many children with dysphonia present with benign vocal fold lesions, including bilateral vocal fold nodules, cysts, vocal fold varices, and scarring. Evaluation and treatment of these children are best undertaken in a thoughtful and coordinated manner involving both the speech-language pathologist and the otolaryngologist. The goals of this article are (a) to describe the team evaluation process based on a “whole system” approach; (b) to discuss etiological factors and diagnosis; and (c) to review current medical, behavioral, and surgical treatments for children with different types of dysphonia.

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Severe Drooling and Treatment With Botulinum Toxin

Perspectives on Swallowing and Swallowing Disorders (Dysphagia) ◽

10.1044/sasd21.1.15 ◽

2012 ◽

Vol 21 (1) ◽

pp. 15-21

Author(s):

Merete Bakke ◽

Allan Bardow ◽

Eigild Møller

Keyword(s):

Botulinum Toxin ◽

Side Effects ◽

Health Risk ◽

Flow Rate ◽

Clinical Evidence ◽

Acetylcholine Release ◽

Psychosocial Problems ◽

Rate Reduction ◽

Local Inhibition ◽

Surgical Treatments

Severe drooling is associated with discomfort and psychosocial problems and may constitute a health risk. A variety of different surgical and non-surgical treatments have been used to diminish drooling, some of them with little or uncertain effect and others more effective but irreversible or with side effects. Based on clinical evidence, injection with botulinum toxin (BTX) into the parotid and submandibular glands is a useful treatment option, because it is local, reversible, and with few side effects, although it has to be repeated. The mechanism of BTX is a local inhibition of acetylcholine release, which diminishes receptor-coupled secretion and results in a flow rate reduction of 25–50% for 2–7 months.

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