scholarly journals Metacarpophalangeal Arthrodesis with Resection-suspension Arthroplasty in First Carpometacarpal Osteoarthritis

2020 ◽  
Vol 48 (01) ◽  
pp. 027-030
Author(s):  
Jose A. Oteo-Maldonado ◽  
Patricia Merino-Carretero
Keyword(s):  
Functional Results ◽  
Metacarpophalangeal Joint ◽  
Wilcoxon Test ◽  
Carpometacarpal Joint ◽  
Medium Term ◽  
Hand Grip ◽  
First Carpometacarpal Joint ◽  
Quick Dash ◽  
Carpometacarpal Osteoarthritis

AbstractFirst carpometacarpal joint osteoarthritis (CMC-1) may develop first metacarpophalangeal joint hyperextension (MCP-1). We enrolled patients with CMC-1 osteoarthritis and MCP-1 hyperextension ≥40 degrees treated with resection-suspension arthroplasty and MCP-1 intramedullary arthrodesis with XMCP™ system. Minimum follow-up was five years. We evaluated: thumbinterphalangeal (IP) range ofmotion, key pinch, hand grip, Kapandji, VAS and Quick DASH. Wilcoxon test was uses for statistical analysis.Nineteen patients were reviewed. We found improvement in key pinch, hand grip, VAS and Quick DASH; statistical difference (p < 0.05) was observed in all of them except key pinch. IF thumb range of motion and Kapandji decreased.TMC arthrodesis with XMCP™ system associated with resection-suspension arthroplasty, as a treatment for CMC-1 osteoarthritis and MCP-1 hyperextension ≥40 degrees, achieves good functional results in the medium term.

Mechanical thumb pain in a systemic sclerosis patient: simple first carpometacarpal osteoarthritis?

Rheumatology ◽  
2021 ◽  
Author(s):  
Guillaume LARID ◽  
Pier-Olivier DUBOE ◽  
Jean-Denis LAREDO ◽  
Elisabeth GERVAIS
Keyword(s):  
Systemic Sclerosis ◽  
Signal Intensity ◽  
Topoisomerase I ◽  
Joint Space ◽  
Carpometacarpal Joint ◽  
Cross Sectional ◽  
First Carpometacarpal Joint ◽  
Provide Pain Relief ◽  
Long Time ◽  
Carpometacarpal Osteoarthritis

Abstract A 70-year-old female patient treated with methotrexate for diffuse cutaneous systemic sclerosis (SSc) came up with mechanical pain over the left thumb for several months. SSc was diagnosed based on a clinical picture associating puffy fingers, skin sclerosis, wrist arthralgia, pulmonary hypertension, presence of antinuclear factors and antibodies against Topoisomerase-I. Her complaint was attributed to first carpometacarpal joint osteoarthritis and treated with orthesis, which did not provide pain relief after 5 months of regular use. Hand radiograph showed first carpometacarpal arthropathy with joint space narrowing and marked sclerosis of the first proximal metacarpal (A). MRI showed an area of very low signal intensity on T1- and T2-weighted images (B) within the proximal metacarpal, distal trapezium and medial joint recess surrounded by bone marrow edema. Mild peripheral enhancement was present after gadolinium injection. CT-scan (C) showed that the low signal intensity material visible at MRI consisted of calcium. These aspects are suggestive of scleroderma arthropathy rather than common first carpometacarpal osteoarthritis. Though involvement of the first carpometacarpal joint is long time known in SSc [1], it remains exceptional when looking at cross-sectional studies [2]. Carefully analyzing imaging exams is the key point in order not to miss this rare scleroderma feature.

Benefits of Additional Procedures for Metacarpophalangeal Hyperextension on Simple Trapeziectomy in Thumb Basal Osteoarthritis: A Biomechanical Cadaver Study

2019 ◽  
Vol 24 (02) ◽  
pp. 153-160
Author(s):  
Charles E. Dumont ◽  
Arndt von Campe
Keyword(s):  
Preoperative Assessment ◽  
Force Sensor ◽  
Metacarpophalangeal Joint ◽  
Cadaver Study ◽  
Distal Phalanx ◽  
Significant Shift ◽  
Carpometacarpal Joint ◽  
Metacarpal Head ◽  
Biomechanical Investigation ◽  
First Carpometacarpal Joint

Background: Patients with advanced osteoarthritis of the first carpometacarpal joint (CMC-1) may develop hyperextension of the first metacarpophalangeal joint (MCP-1). No clear clinical benefice has been reported consecutively to the surgical treatment of the MCP-hyperextension combined to a trapeziectomy. The reason of the missing benefit may be due to changes in the thumb position impairing the thumb stability secondary to the surgical procedures. We assessed changes in the transmission of forces at the thumb’s end phalanx following a trapeziectomy combined with the surgical adjustment of the hyperextension of the MCP-1-joint in a biomechanical investigation using cadavers. Methods: The thumb muscles were loaded with nylon cables connected to a tension meter in 8 forearm cadavers. A 6-axis force sensor assessed the termino-lateral key-pinch orthogonal strength vectors at the level of the thumb distal phalanx prior to any surgery, and following a simple trapeziectomy, a trapeziectomy combined to a MCP-1-capsulodesis and the transfer of the extensor pollicis brevis over the metacarpal-1 head, or to an MCP-1-arthrodesis. Results: Combination of the trapeziectomy with the MCP-1- joint palmar capsulodesis and EPB-transfer or with a MCP-arthrodesis in neutral pronation-supination resulted in a significant shift of the thumb in pronation-abduction with respect to the preoperative assessment. The lowest shift was achieved when performing the arthrodesis in 20° supination or by overloading of the adductor pollicis. Conclusions: Combining the trapeziectomy with surgeries addressing the MCP-1-joint hyperextension induced a shift of the thumb in pronation-abduction that could impair the key-pinch stability. When considering additional procedures for MCP-1-joint hyperextension deformities, it should be recommended to fix the EPB-tendon on the radial aspect of the metacarpal head if a tendon transfer is considered, otherwise the MCP joint arthrodesis should be performed in supinated position, in order to achieve lateral key-pinch stability.

Early Results of the ARPE Arthroplasty Versus Trapeziectomy for the Treatment of Thumb Carpometacarpal Joint Osteoarthritis

2017 ◽  
Vol 22 (04) ◽  
pp. 472-478 ◽  
Author(s):  
Johnathan D. Craik ◽  
Simon Glasgow ◽  
James Andren ◽  
Mark Sims ◽  
Reza Mansouri ◽  
...  
Keyword(s):  
Treatment Options ◽  
Complication Rates ◽  
Implant Survival ◽  
Carpometacarpal Joint ◽  
Thumb Carpometacarpal Joint ◽  
Early Results ◽  
Functional Scores ◽  
Thumb Carpometacarpal ◽  
Quick Dash

Background: Thumb carpometacarpal joint arthroplasty for osteoarthritis may hold advantages over trapeziectomy by preserving range of motion, whilst providing stability and preventing thumb shortening. Methods: We compare functional and satisfaction outcomes scores, radiological shortening and complication rates between patients treated with trapeziectomy and those receiving the ARPE thumb CMCJ arthroplasty. Results: Seventy-five trapeziectomies and one hundred and ten ARPE arthroplasties were performed over the study period. Both treatments resulted in significant improvements in functional scores. When matching patients according to pre-operative function, patients receiving the ARPE arthroplasty had better post-operative function (Quick DASH: trapeziectomy = 25.1, ARPE = 16.8). More patients receiving the ARPE arthroplasty were satisfied with their treatment (trapeziectomy = 7.8/10, ARPE = 8.7/10) and would have the same treatment again (trapeziectomy = 76%, ARPE = 89%). The ARPE also resulted in less thumb shortening. However the ARPE arthroplasty is associated with a higher complication rate, with 14% of patients requiring further surgery at a mean of 2 years follow up (95% implant survival). Conclusions: Both trapeziectomy and the ARPE CMCJ arthroplasty are effective treatment options for thumb CMCJ osteoarthritis. Arthroplasty may offer potential advantages in terms of post-operative function and patient satisfaction. However the risk of complications and requirement for further surgery is greater and must be carefully considered during patient selection and pre-operative counselling.

Composite Osteocutaneous Groin Flap Combined with Neurovascular Island Flap for Thumb Reconstruction

2003 ◽  
Vol 28 (5) ◽  
pp. 399-404 ◽  
Author(s):  
F. PARMAKSIZOGLU ◽  
T. BEYZADEOGLU
Keyword(s):  
Bone Resorption ◽  
Functional Results ◽  
Metacarpophalangeal Joint ◽  
Island Flap ◽  
Bone Block ◽  
Thumb Reconstruction ◽  
Groin Flap ◽  
Three Phase ◽  
Bone Scans

Three amputated thumbs were reconstructed with a composite osteocutaneous groin flap and a neurovascular island flap. The average age at the time of surgery was 28 (range 25–35) years. The level of the amputation was distal to metacarpophalangeal joint in two cases and proximal in one case. The injury mechanism was avulsion in all cases. The postoperative follow-up periods ranged from 27 to 30 months. There were no cases of skin necrosis, bone resorption or infection. Radiographs and three-phase bone scans showed union of the iliac bone block and the stump without any resorption in all three patients. This surgical procedure is reliable and simple and the functional results are satisfying. We reserve this technique for the treatment of thumb amputations which cannot be replanted, particularly as it does not result in bone resorption.

A COMPARISON OF SILICONE REPLACEMENT AND TENDON ARTHROPLASTY FOR BASAL THUMB ARTHRITIS

Hand Surgery ◽  
1998 ◽  
Vol 03 (02) ◽  
pp. 271-276
Author(s):  
W. J. Cumming ◽  
G. A. Parker
Keyword(s):  
Elderly Patients ◽  
Joint Replacement ◽  
Retrospective Review ◽  
Carpometacarpal Joint ◽  
Replacement Arthroplasty ◽  
Significant Difference ◽  
First Carpometacarpal Joint ◽  
Joint Arthritis ◽  
Thumb Arthritis

This paper presents a retrospective review of 39 patients having 52 procedures for first carpometacarpal joint arthritis. Swanson silicone replacement arthroplasty is compared with tendon suspension arthroplasty. There were 34 silicone replacement arthroplasties with an average follow-up of 8.9 years, and 18 suspension arthroplasties with an average follow-up of 6.1 years. There was no statistically significant difference between the two groups. We continue to use silicone for first carpometacarpal joint replacement in elderly patients with low demands.

scholarly journals Functional outcome of ligament reconstruction with tendon interposition after failed first carpometacarpal joint prosthesis

2021 ◽  
Vol 87 (1) ◽  
pp. 137-142
Author(s):  
Lyne Anthonissen ◽  
Elke Van Eynde ◽  
Maarten Van Nuffel ◽  
Luc De Smet
Keyword(s):  
Functional Outcome ◽  
Grip Strength ◽  
Ligament Reconstruction ◽  
Strength Loss ◽  
Contralateral Side ◽  
Joint Prosthesis ◽  
Carpometacarpal Joint ◽  
First Carpometacarpal Joint ◽  
Quick Dash ◽  
Tendon Interposition

The purpose is to determine if ligament reconstruction with tendon interposition (LRTI) is a recommendable salvage option for failed total joint prosthesis of the first carpometacarpal joint. Twenty-two patients in our database met the in- clusion criteria for this retrospective study, with at least 6 months follow-up. Fourteen participated and were invited for a clinical examination and asked to fill out two questionnaires. They were evaluated for pain (VAS), impairment (NHS), disability (Quick DASH), opposition (Kapandji test) and grip strength (hydraulic dynamometer). Results of the questionnaires were compared to a cohort study of primary LRTI’s. Kapandji test and grip strength were compared to the contralateral side. Compared to primary LRTI’s, revision surgery showed mild deterioration of impairment and disability. The average VAS score was 2.9 out of 10. Twelve patients mentioned a sense of strength loss, which could be quantified with the dynamometer : a mean of 15.1 kg (operated thumb) versus 20.5 kg (contralateral). There was a relatively small decline of opposition with Kapandji 8.6 versus 9.9. The overall satisfaction was good for 8 patients, fair for 3 and poor for the remaining 3 (mainly based on strength loss). One patient needed a second revision. Failed first carpometacarpal joint replacement can be salvaged by ligament reconstruction with tendon interposition, providing an acceptable functional outcome in 79% of cases studied. However, compared to the functional outcome of primary LRTI’s, mild aggravation of impairment and disability should be taken into account.

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

2020 ◽  
Author(s):  
Ana Moreira Ferrão ◽  
Bruno Morais ◽  
Nuno Marques ◽  
João Nóbrega ◽  
José Monteiro ◽  
...  
Keyword(s):  
Demographic Data ◽  
Early Mobilization ◽  
Functional Results ◽  
Medium Term ◽  
Suture Button ◽  
First Ray ◽  
The Mean ◽  
End Stage ◽  
Good Medium

Abstract 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.

scholarly journals Seven-year survival analysis of the Global® CAP® (Conservative Anatomic Prosthesis) shoulder resurfacing

2017 ◽  
Vol 10 (2) ◽  
pp. 87-92
Author(s):  
Helen Ingoe ◽  
Philip Holland ◽  
Emma Tindall ◽  
Raymond Liow ◽  
James L Mcvie ◽  
...  
Keyword(s):  
Survival Analysis ◽  
Confidence Interval ◽  
Medium Term ◽  
Survival Analyses ◽  
Oxford Shoulder Score ◽  
The Mean ◽  
Shoulder Arthroplasties ◽  
Quick Dash ◽  
Shoulder Score

Background Shoulder resurfacings represent approximately one-third of shoulder arthroplasties and have the highest revision rates of any shoulder arthroplasty. We present a survival analysis of the Global CAP hemi-resurfacing implanted by multiple surgeons with up to 10 years of follow-up. Methods A life-table survival analysis of the Global CAP hemi-resurfacing was undertaken in a single site with multiple surgeons. Two survival analyses were performed; first, where failure was defined as component exchange and, second, where failure was defined as re-operation for any reason. Postoperative functional outcome was quantified using the Quick Disability Arm Hand and Shoulder Score (Quick DASH) and Oxford Shoulder Score (OSS). Results Eighty-seven Global CAPs were implanted in 75 patients. At a mean (SD) follow-up of 5.4 years (2.5 years) (range 0.9 years to 10 years), five patients had revision surgery and three patients underwent a reoperation for any reason. Survival at year 7 with component exchange as the endpoint was 80% (95% confidence interval = 93 to 65) and survival with re-operation for any reason as the end point was 62% (95% confidence interval = 82 to 50). The mean OSS and Quick DASH were 35 and 27.6, respectively. Conclusions The Global CAP has similar survivorship in the short to medium term and produces similar clinical outcomes compared to other shoulder resurfacings.

The Follow-up of Trapeziometacarpal Arthrodesis Using V-shaped Osteotomy for Osteoarthritis of The First Carpometacarpal Joint

2015 ◽  
Vol 19 (1) ◽  
pp. 18-22 ◽  
Author(s):  
Andrew Harston ◽  
Yorell Manon-Matos ◽  
Selena McGill ◽  
Rebecca Jones ◽  
Joris Duerinckx ◽  
...  
Keyword(s):  
Carpometacarpal Joint ◽  
First Carpometacarpal Joint

MEDIUM-TERM OUTCOME FOLLOWING INTRA-ARTICULAR CORTICOSTEROID INJECTION IN FIRST CMC JOINT ARTHRITIS USING FLUOROSCOPY

Hand Surgery ◽  
2009 ◽  
Vol 14 (02n03) ◽  
pp. 99-104 ◽  
Author(s):  
Wies Maarse ◽  
Adam C. Watts ◽  
Gregory I. Bain
Keyword(s):  
Pain Relief ◽  
Surgical Intervention ◽  
Corticosteroid Injection ◽  
Carpometacarpal Joint ◽  
Medium Term ◽  
Short Term ◽  
Term Outcome ◽  
Joint Arthritis ◽  
Local Corticosteroid Injection

First carpometacarpal joint osteoarthritis (1st CMCJ OA) is a common condition with variable results reported from local corticosteroid injection. This study aims to explore the medium-term outcome with respect to pain relief, patient satisfaction and the need for subsequent surgical intervention. A prospective review was performed of patients undergoing fluoroscopically guided corticosteroid injection by one surgeon, with postal questionnaires for medium-term follow-up. Forty-one patients were included. Thirty-one were female and ten male, with a mean age of 60 years. In the short term 76% of patients reported pain relief with an average duration of four weeks and 69% of the patients reported benefit from injection. After a median follow-up of 36 months 76% of patients reported continuing pain but 59% reported satisfaction with the outcome. Twenty-eight per cent of the patients had undergone surgery. Local corticosteroid injection of the CMCJ provides only short-term pain relief, but few patients go on to surgical intervention.

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