Metacarpophalangeal Joint Arthroplasty Using Flexible Hinge Toe Implant with Grommets for Boutonnière Deformity of Rheumatoid Thumb

2018 ◽  
Vol 23 (01) ◽  
pp. 66-70
Author(s):  
Tetsuya Nemoto ◽  
Hajime Ishikawa ◽  
Asami Abe ◽  
Kiyoshi Nakazono ◽  
Hiroshi Otani ◽  
...  
Keyword(s):  
Grip Strength ◽  
General Health ◽  
Treatment Options ◽  
Metacarpophalangeal Joint ◽  
Joint Arthroplasty ◽  
Pinch Strength ◽  
Flexible Hinge ◽  
Boutonniere Deformity ◽  
Swanson Implant ◽  
Boutonnière Deformity

Background: MP joint arthroplasty is one of the treatment options for the rheumatoid thumb with boutonniere deformity. The use of flexible hinge toe implant for MP joint reconstruction was introduced; however, the outcome of flexible toe implantation for the reconstruction of the MP joint has not as yet been reported in detail. Therefore, in this study, we retrospectively investigated the clinical outcome and radiological findings. Methods: We assessed 56 Swanson implant arthroplasties that used flexible hinge toe implants with grommets to address boutonnière deformity of the thumb MP joint. The minimum follow-up period was 6 months. Pain, the range of motion, grip strength, pinch strength, General health Visual analogue scale and DASH (Disabilities of Hand, Shoulder and Hand) were assessed. Results: For most of the patients, the procedure provided painless motion and stability to the thumb. In the radiological assessments, the preoperative flexion angles at the MP joint were 45° improved to 17°. The origin of arc was shifted toward the extended position and the average arc of motion was 21°, with a flexion arc from 23° to 44°. The severity of boutonniere deformity was improved in most cases. The average grip strength changed from 110 to 121 mmHg and the average side pinch power changed from 1.5 to 2.2 kgf. General health VAS improved from 40 to 29 (p = 0.019), and the DAS28-CRP decreased from 3.3 to 2.4 (p < 0.001). Infection occurred in one case, and there were no implant fractures. Conclusions: Swanson flexible hinge toe implant arthroplasty with grommets applied to the MP joint of the thumb was one of the recommended procedures for the reconstruction of boutonnière deformity of the thumb.

REVISION METACARPOPHALANGEAL JOINT REPLACEMENT 30 YEARS AFTER PRIMARY SWANSON FLEXIBLE SILICONE IMPLANT ARTHROPLASTY IN A RHEUMATOID PATIENT: A CASE REPORT

Hand Surgery ◽  
2009 ◽  
Vol 14 (01) ◽  
pp. 25-29 ◽  
Author(s):  
Katsumitsu Arai ◽  
Hajime Ishikawa ◽  
Takehiro Murai ◽  
Junichi Fujisawa ◽  
Naoto Endo
Keyword(s):  
Rheumatoid Arthritis ◽  
Case Report ◽  
Joint Replacement ◽  
Revision Surgery ◽  
Metacarpophalangeal Joint ◽  
Joint Arthroplasty ◽  
Implant Removal ◽  
Silicone Implant ◽  
Rheumatoid Patient ◽  
Swanson Implant

We report a case of a patient with rheumatoid arthritis undergoing revision surgery 30 years after primary metacarpophalangeal joint arthroplasty using a Swanson implant. Removal and replacement of the implant were successfully performed, and the patient was satisfied with the revision surgery.

The Effect of the Additional Use of Grommets in Silicone Implant Arthroplasty of the Metacarpophalangeal Joints

1999 ◽  
Vol 24 (5) ◽  
pp. 561-564 ◽  
Author(s):  
K. SCHMIDT ◽  
R. WILLBURGER ◽  
A. OSSOWSKI ◽  
R. K. MIEHLKE
Keyword(s):  
Rheumatoid Arthritis ◽  
Grip Strength ◽  
Clinical Outcomes ◽  
Metacarpophalangeal Joint ◽  
Joint Arthroplasty ◽  
Silicone Implant ◽  
Active Movement ◽  
Ulnar Deviation ◽  
Metacarpophalangeal Joints

After silicone arthroplasty of the metacarpophalangeal (MP) joint there is increasing osteolysis, subsidence and fracture of the implants in the longer postoperative term. In 44 patients with rheumatoid arthritis (54 hands) 151 arthroplasties of the metacarpophalangeal joint were assessed at a mean of 3.9 years postoperatively. In 57 arthroplasties titanium protectors (grommets) were used. There were no significant differences in the clinical outcomes with respect to swelling, correction of ulnar deviation, range of active movement and grip strength. The additional use of grommets in MP joint arthroplasty slightly reduced reactive osteolysis, protected the spacers from breakage and slightly reduced the amount of pain with only a few additional complications in the midterm follow-up.

scholarly journals Percutaneous Reconstruction of the Ulnar Collateral Ligament of the Metacarpophalangeal Joint of the Thumb: Technique and Results

2020 ◽  
Vol 48 (02) ◽  
pp. 101-108
Author(s):  
Juan Manuel Herrera ◽  
Lucas Herrera ◽  
Pablo Rotella ◽  
Raquel Cantero Téllez ◽  
Jimena Castellanos ◽  
...  
Keyword(s):  
Grip Strength ◽  
Ulnar Collateral Ligament ◽  
Metacarpophalangeal Joint ◽  
Tendon Graft ◽  
Pinch Strength ◽  
Percutaneous Technique ◽  
Dash Score ◽  
Joint Movement ◽  
Collateral Ligament ◽  
Contralateral Limb

Abstract Objectives The present study aims to describe a new percutaneous technique for the reconstruction of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb with a tendon graft, and to evaluate the functional outcomes and stability six months postoperatively. Material and methods The percutaneous ligamentoplasty technique was performed with a palmaris longus tendon graft and tenodesis screws in 6 patients with ulnar instability of the thumb (> 30° degrees of radial deviation) for more than 6 weeks. Range of motion, grip strength, and pinch strength (lateral/key pinch, tip pinch, and palmar pinch) were assessed in comparison to the contralateral limb, as well as the Quick Disabilities of the Arm, Shoulder and Hand (DASH) score. Results At 6 months, the joint movement was of 100%, the grip strength was of 94.8%, the key pinch was of 95%, the palmar pinch was of 85.7%, and the tip pinch was of 93.5% compared to the contralateral limb. The internal tilt was of 14° compared to 9° at the contralateral limb. The Quick DASH score decreased from 24.2 to 2.6 points. Conclusion We devised this versatile surgical procedure to obtain early mobility with the advantages related to the percutaneous techniques.

scholarly journals Boutonniere Deformity: A Review of Considerations before Treatment and Current Treatment Options

2020 ◽  
Vol 25 (4) ◽  
pp. 249-258
Author(s):  
Jun-Ku Lee ◽  
Choongki Kim ◽  
Soo-Hong Han
Keyword(s):  
Functional Limitations ◽  
Treatment Options ◽  
Current Treatment ◽  
Boutonniere Deformity ◽  
Appropriate Treatment ◽  
Pip Joint ◽  
Central Slip ◽  
Clear Guideline ◽  
Surgical Treatments ◽  
Boutonnière Deformity

Central slip injury is a common occurrence in hand trauma. When the base of the middle phalanx, which is the contact part of the central tendon, is weakened or damaged, extension lag or restriction would be found in the proximal interphalangeal (PIP) joint and the distal interphalangeal joint becomes hyperextended, presenting buttonhole or boutonniere deformation. Buttonhole deformation has limited cases that a hand surgeon can experience, and there is still no clear guideline for treatment, so treatment tends to depend on the knowledge and experience of the treating doctor. In this review, the factors to be considered in determining the treatment of boutonniere deformity are discussed, and nonsurgical or surgical treatment is considered. Treatment of the PIP joint in boutonniere deformity is a difficult task. Understanding the cause of the deformity, the time point and the stage of deformity, the relationship to the biomechanical changes in adjacent joints, the patient’s functional limitations, and the condition of the joint will improve treatment decisions and outcomes. Based on these considerations, an appropriate treatment should be chosen among nonsurgical or surgical treatments. Various surgical options were introduced but none of method guarantee the optimal outcome. Sufficient understanding of deformity and sufficient consultation and cooperation with the patient regarding the treatment process, outcome, and rehabilitation are necessary.

Thumb-Basal Joint Arthroplasty Outcomes and Metacarpal Subsidence: A Prospective Cohort Analysis of Trapeziectomy With Suture Button Suspensionplasty Versus Ligament Reconstruction With Tendon Interposition

Hand ◽  
2021 ◽  
pp. 155894472199422
Author(s):  
Owolabi Shonuga ◽  
Kristen Nicholson ◽  
Jack Abboudi ◽  
Gregory Gallant ◽  
Christopher Jones ◽  
...  
Keyword(s):  
Ligament Reconstruction ◽  
Demographic Data ◽  
Cohort Analysis ◽  
Joint Arthroplasty ◽  
Pinch Strength ◽  
Complication Rates ◽  
Suture Button ◽  
Basal Joint ◽  
Tendon Interposition ◽  
Cmc Joint

Background Thumb carpometacarpal (CMC) joint arthroplasty is a common procedure in the surgical management of symptomatic thumb basal joint arthritis. Following trapeziectomy, a number of suspensionplasty techniques are often used, but limited comparative evidence exists between these techniques. The central aim of this study was to prospectively compare the outcomes of 2 suspensionplasty techniques following trapeziectomy: suture button (TightRope) versus ligament reconstruction and tendon interposition (LRTI). Methods Prospective data were collected on 112 consecutive patients with Eaton stage III-IV thumb CMC arthritis who underwent open trapeziectomy and suspensionplasty. There were 53 LRTI and 59 TightRope suspensionplasty procedures. Outcomes were measured using the Quick Disabilities of the Arm, Shoulder, and Hand ( QuickDASH) questionnaire, Visual Analogue Scale (VAS) for pain, radiographic analysis, and lateral pinch strength. Patient demographic data and complications were also recorded. Results Patients undergoing TightRope suspensionplasty had significantly higher trapeziometacarpal index and thus less subsidence than the LRTI group at 2 weeks (0.22 vs 0.17 [ P < .0001]) and 3 months (0.17 vs 0.15 [ P < .05]) postoperatively. TightRope suspensionplasty also had a significantly lower QuickDASH score at 2 weeks (64.7 vs 74.6 [ P < .05]), 3 months (20.7 vs 32.5 [ P < .05]), and 1 year postoperatively (7.57 vs 21.5 [ P < .05]) compared with the LRTI group. However, there was no difference in VAS pain, lateral pinch strength, reoperation, or complications at any time point between groups. Conclusions Thumb CMC joint arthroplasty performed with a TightRope suspensionplasty versus LRTI yielded short-term improved resistance to subsidence, long-term greater improvement in clinical outcome by QuickDASH, and no difference in pain or complication rates.

A volar approach to on-top plasty for correction of radial polydactyly: a case series of 21 patients

2021 ◽  
pp. 175319342098185
Author(s):  
Xia Fang ◽  
Ping-tak Chan ◽  
Shengbo Zhou ◽  
Xinyi Dai ◽  
Ruiji Guo ◽  
...  
Keyword(s):  
Case Series ◽  
Functional Results ◽  
Metacarpophalangeal Joint ◽  
Contralateral Side ◽  
Average Score ◽  
Pinch Strength ◽  
Level Of Evidence ◽  
Volar Approach ◽  
Flexion Extension ◽  
Aesthetic Results

Correction of unequal radial polydactyly in which neither thumb duplicates possess both well-developed proximal and distal components, remains challenging. Current techniques using on-top plasty techniques require circumferential incisions, often resulting in postoperative swelling and dorsal scars. We described our experience using a volar approach to achieve better aesthetic and functional results. Twenty-one patients underwent this surgery between 2008 and 2018, with a mean follow-up of 5.1 years. The mean flexion–extension arc for the metacarpophalangeal joint was 75° and that of the interphalangeal joint was 43°. Mean percentage of key, tripod and tip pinch strength were 77%, 79% and 77%, respectively, when compared with the contralateral side. The Vancouver Scar Scale showed an average score of 1.2. We conclude from our study that the volar approach to on-top plasty is a good technique for the correction of unequal radial polydactyly, with good functional and aesthetic results. Level of evidence: IV

A custom-made neoprene thumb carpometacarpal orthosis with thermoplastic stabilization: An orthosis that promotes function and improvement in patients with the first carpometacarpal joint osteoarthritis

2013 ◽  
Vol 38 (1) ◽  
pp. 79-82 ◽  
Author(s):  
Monireh Ahmadi Bani ◽  
Mokhtar Arazpour ◽  
Stephen William Hutchins ◽  
Fereydoun Layeghi ◽  
Mahmood Bahramizadeh ◽  
...  
Keyword(s):  
Grip Strength ◽  
Clinical Relevance ◽  
Hand Function ◽  
Pinch Strength ◽  
Conservative Approach ◽  
Carpometacarpal Joint ◽  
Custom Made ◽  
First Carpometacarpal Joint ◽  
Thumb Carpometacarpal ◽  
Improved Function

Background and aim: Patients with mild to moderate first carpometacarpal joint osteoarthritis report pain, a reduction in pinch and grip strength and hand function. The purpose of this study was to analyze the effect of a custom-made neoprene thumb carpometacarpal orthosis with thermoplastic stabilization on pain, function, grip strength, and key pinch in these patients. Technique: A total of 11 volunteer patients participated in this study. All the above-mentioned parameters were evaluated at baseline and also 30, 60, and 90 days after using the splint. Discussion: A decrease in pain was observed after 30 days, and this continued to improve during treatment with the splint. After 90 days of using the splint, grip strength was improved. Function and pinch strength also increased significantly and was maintained during the study period compared to baseline. Clinical relevance A custom-made neoprene thumb carpometacarpal orthosis with thermoplastic stabilization may be a suitable conservative approach for the treatment of first carpometacarpal joint osteoarthritis.

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