Correlation between range of motion and implant fracture: a 5 year follow-up of 72 joints in 18 patients in a randomized study comparing Swanson and Avanta/Sutter MCP silicone prosthesis

Eighteen out of 18 rheumatoid patients (at one centre of a two-centre 30 patient study previously reported) with a mean age of 56 years, and 72/72 operated joints were randomized to Avanta/Sutter or Swanson MCP prostheses and followed for 5 years. Both ulnar deviation and extension lag were improved already at 6 weeks and remained improved at 5 years. The Avanta prosthesis had a better range of motion (ROM) than the Swanson. Six of nine patients with Avanta/Sutter implants had at least one implant fracture compared to 1/9 patients with the Swanson implant ( P = 0.05) but fracture did not change the outcome subjectively. The ROM at 3 months correlated with the occurrence of an implant fracture at 5 years and a greater early ROM may be related to implant fracture. At 5 years patients remained satisfied and the deformities remained corrected.

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Radial Column Excision and Four-Corner Fusion for the Treatment of Basal Thumb Arthritis and Scapholunate Advanced Collapse Wrist or Midcarpal Arthritis

Journal of Wrist Surgery ◽

10.1055/s-0037-1602587 ◽

2017 ◽

Vol 06 (04) ◽

pp. 294-300 ◽

Cited By ~ 1

Author(s):

Avanthi Mandaleson ◽

Michael Wagels ◽

Stephen Tham

Keyword(s):

Range Of Motion ◽

Grip Strength ◽

Clinical Outcomes ◽

Consecutive Series ◽

Level Of Evidence ◽

Ulnar Deviation ◽

Pinch Grip ◽

The Mean ◽

Therapeutic Study

Background The combination of trapeziometacarpal arthritis and intercarpal pattern of degenerative wrist arthritis is uncommon. Purpose To report on the clinical and radiologic results of patients who have undergone radial column excision (scaphoidectomy and trapeziectomy) (RCE) and four-corner fusion (4CF). We describe the patterns of disease that present with basal thumb and midcarpal arthritis and treatment outcomes of a single-surgeon series. Patients and Methods A consecutive series of seven patients underwent RCE and 4CF over a 2-year period, for basal thumb osteoarthritis with concurrent degenerative midcarpal wrist arthritis. Six patients were available for review. All six patients were women with a mean age of 73 years (range: 67–78; SD 4.6). Mean follow-up time was 48.2 months (34–59 months). Radiographic and clinical outcomes were recorded for all patients, to include wrist range of motion, key pinch, grip strength, and patient-rated wrist evaluation (PRWE). Results There were no failures or revision procedures. The mean range of motion was flexion of 40 degrees (range: 30–40 degrees), extension of 30 degrees (range: 20–42 degrees), radial deviation of 18 degrees (range: 10–30 degrees), and ulnar deviation of 15 degrees (range: 0–25 degrees). The mean key pinch was 4.2 kg (range: 0.5–10, SD ± 3.5) and mean grip strength was 9.4 kg (range: 0–19, SD ± 8.9). The PRWE results in four patients were within normal values. Conclusion RCE with 4CF resulted in acceptable clinical outcomes in four of six patients treated, with no failures at a mean follow-up of 48.2 months. Level of Evidence Level IV, therapeutic study.

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Promising Clinical Results of the Universal Total Wrist Prosthesis in Rheumatoid Arthritis

The Open Orthopaedics Journal ◽

10.2174/1874325001004010067 ◽

2010 ◽

Vol 4 (1) ◽

pp. 67-70 ◽

Cited By ~ 15

Author(s):

P.J.T.S. van Winterswijk ◽

P.A.G.M. Bakx

Keyword(s):

Rheumatoid Arthritis ◽

Range Of Motion ◽

Pain Score ◽

Clinical Results ◽

The Other ◽

Study Group ◽

Ulnar Deviation ◽

Radial Deviation ◽

Component Loosening

The purpose of this study was to evaluate the results of the Universal Total Wrist prosthesis.Seventeen wrist arthroplasties were performed in 15 patients using the Universal Total Wrist prosthesis. The 11 women and 4 men in the study group ranged in age from 45 to 86 years. Fourteen patients had rheumatoid arthritis and one had osteoarthritis. Follow up ranged from 20 to 74 months. Patients were evaluated for range of motion, with the Disabilities of the Arm, Shoulder, and Hand (DASH) survey and radiographically.All range of motion values improved after surgery. Average postoperative motion was 29° dorsiflexion, 38° volar flexion, 7° radial deviation and 17° ulnar deviation. The DASH scores improved with 29 %. Pain score improved in all 15 patients. One prosthesis had to be removed due to component loosening of the carpal plate. The other cases showed no radiographic signs of loosening. One patient had an early prosthetic dislocation and was treated conservatively with success.The Universal Total Wrist prosthesis provides a promising outcome in patients with rheumatoid arthritis.

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Four-Corner Arthrodesis Using the Quad Memory Staple

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193408094444 ◽

2009 ◽

Vol 34 (2) ◽

pp. 252-255 ◽

Cited By ~ 13

Author(s):

E. A. VAN AMERONGEN ◽

A. H. SCHUURMAN

Keyword(s):

Range Of Motion ◽

Compressive Property ◽

Dash Score ◽

Ulnar Deviation ◽

Non Union ◽

Radial Deviation ◽

Pin Fixation ◽

The Mean ◽

Simple Fixation

Range of motion, pain, consolidation and complications were evaluated for nine patients who underwent four-corner arthrodesis using the Quad Memory Staple (QMS) at a mean follow-up of 44 months. The mean pre-operative range of motion was 50° extension, 62° flexion, 9° radial deviation and 24° ulnar deviation. The postoperative range of motion was similar to previous studies at 32° extension, 31° flexion, 15° radial deviation and 20° ulnar deviation. The grip strength was 28 kg pre-operatively and 26 kg postoperatively. The mean pain score improved from 41 to 23 and the Disabilities of Arm, Shoulder, and Hand (DASH) score from 24 to 20. Non-union, haematoma and wound infection were not seen and eventually all four-corner fusions were consolidated. The main advantages of the QMS are its compressive property and the simple fixation technique. It gives good stability, enables early rehabilitation and avoids the risks of pin fixation methods.

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Survivorship of the Neuflex Silicone Implant in MCP Joint Replacement

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193408094437 ◽

2009 ◽

Vol 34 (1) ◽

pp. 25-28 ◽

Cited By ~ 9

Author(s):

B. MWAURA KIMANI ◽

I. A. TRAIL ◽

A. HEARNDEN ◽

R. DELANEY ◽

D. NUTTALL

Keyword(s):

Range Of Motion ◽

Joint Replacement ◽

Silicone Implant ◽

Fracture Rate ◽

End Point ◽

Kaplan Meier ◽

Swanson Implant ◽

End Stage

The Neuflex silicone metacarpophalangeal (MCP) joint replacement has previously been shown to provide improved movement, particularly flexion, when compared with the Swanson implant. In this study, we reviewed the outcome of 237 Neuflex implants in 66 patients with a follow-up of up to 7 years. Kaplan–Meier analysis using revision as the end stage revealed survival at 7 years to be 88%. If however an implant fracture, as seen radiographically, is taken as the end point, the survivorship drops to 68% at 7 years. These figures are comparable with a similar analysis for the Swanson implant. We conclude that the improved range of motion of the Neuflex implant demonstrated previously does not result in either a higher or a lower revision or implant fracture rate when compared with the Swanson implant.

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Avanta Versus Swanson Silicone Implants in the MCP Joint—A Prospective, Randomized Comparison of 30 Patients Followed for 2 Years

Journal of Hand Surgery (European Volume) ◽

10.1016/j.jhsb.2004.09.011 ◽

2005 ◽

Vol 30 (1) ◽

pp. 8-13 ◽

Cited By ~ 29

Author(s):

K. MÖLLER ◽

C. SOLLERMAN ◽

M. GEIJER ◽

P. KOPYLOV ◽

M. TÄGIL

Keyword(s):

Grip Strength ◽

Hand Function ◽

Randomized Study ◽

Metacarpophalangeal Joint ◽

Silicone Implants ◽

Subjective Outcome ◽

Ulnar Deviation ◽

Joint Arthroplasties ◽

Analogue Scales

The results of Swanson and Avanta metacarpophalangeal joint arthroplasties in rheumatoid patients were compared in a prospective, randomized study of 30 patients (120 implants). At 2-year follow-up, grip strength was measured, hand function was assessed with the Sollerman test and the subjective outcome was determined with visual analogue scores. With both implants ulnar deviation and flexion deformities decreased, and there was no difference between the groups. The increase in range of motion was 7° greater with Avanta implants than with Swanson implants. Grip strength and hand function were unaltered but the visual analogue scales showed decreased pain levels and subjective improvements in hand function, grip strength and cosmesis. Twenty-four of 30 patients were satisfied. Fracture of the silicone spacer occurred with 12 Avanta (20%) and eight Swanson implants (13%), with a higher fracture frequency in men.

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Complications Following Mucous Cyst Excision

Journal of Hand Surgery (European Volume) ◽

10.1016/s0266-7681(97)80067-8 ◽

1997 ◽

Vol 22 (2) ◽

pp. 222-225 ◽

Cited By ~ 47

Author(s):

G. R. FRITZ ◽

P. J. STERN ◽

M. DICKEY

Keyword(s):

Range Of Motion ◽

Superficial Infection ◽

Ulnar Deviation ◽

Cyst Excision ◽

Nail Deformity ◽

Mucous Cyst ◽

Potential Risks ◽

Infection Recurrence

Eighty-six mucous cysts in 79 patients were surgically excised. Follow-up was carried out at an average of 2.6 years. Fifteen digits (17%) had a residual loss of extension of 5 to 20° at the IP or DIP joints. One patient developed a superficial infection and two developed a DIP pyarthrosis, which eventually required DIP arthrodesis. Nail deformities were present in 25 of 86 digits preoperatively (29%), 15 of which resolved after surgery (60%). Four of 61 digits developed a nail deformity which was not present preoperatively (7%). Three of 86 digits (3%) developed recurrence. Other complications included persistent swelling, pain, numbness, stiffness, and radial or ulnar deviation at the DIP joint. We recommend that patients be informed preoperatively of the potential risks of decreased range of motion, persistent swelling and pain, infection, recurrence, and persistent or postoperatively acquired nail deformity.

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OUTCOMES OF FOUR-CORNER ARTHRODESIS USING THE HUBCAPTM CIRCULAR PLATE

Hand Surgery ◽

10.1142/s0218810413500263 ◽

2013 ◽

Vol 18 (02) ◽

pp. 215-220 ◽

Cited By ~ 4

Author(s):

Sameer K. Khan ◽

Syed M. Ali ◽

Andrew McKee ◽

Jonathan W. M. Jones

Keyword(s):

Range Of Motion ◽

Circular Plate ◽

Functional Outcomes ◽

Circular Plates ◽

Ulnar Deviation ◽

Non Union ◽

Flexion Extension ◽

Radiological Union

We present results of four-corner carpal arthrodesis with the Acumed® HubcapTM circular plate performed at our unit. Eight patients underwent eight procedures over five years, for scapholunate advanced collapse (five wrists) and scaphoid non-union advanced collapse (three wrists). Outcomes included range of motion, quickDASH scores, and visual analogue scores for satisfaction. At final follow-up, mean flexion-extension arc was 56°, mean radial-ulnar deviation 29° and mean quickDASH score was 23/100. Mean score for satisfaction was 7.7/10 (77%). Seven out of eight (87.5%) patients said they would have it done again, and would also recommend it to others. Radiological union was achieved in all cases. One screw broke in one arthrodesis without causing symptoms. The functional outcomes with our use of the HubcapTM are comparable to those reported in literature to date with other circular plates (e.g. Spider plate). There were no non-unions, which is the main reported complication with these plates.

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Radio-Lunate Arthrodesis for Distal Radial Intraarticular Malunion

Journal of Hand Surgery (European Volume) ◽

10.1016/s0266-7681(96)80005-2 ◽

1996 ◽

Vol 21 (1) ◽

pp. 14-20 ◽

Cited By ~ 24

Author(s):

P. SAFFAR

Keyword(s):

Range Of Motion ◽

Grip Strength ◽

High Velocity ◽

Posterior Approach ◽

Ulnar Deviation ◽

Radial Deviation ◽

Posterior Subluxation ◽

The Mean

Eleven cases of symptomatic distal radial intraarticular malunion were treated by radio-lunate arthrodesis from 1983 to 1991. The mean age was 35.3 years. There were 11 men, all manual workers. The mechanism was usually a high velocity injury. The time elapsed since injury was a mean 23 months (2–109 months). The range of motion was, on average, flexion 39°, extension 27°, radial deviation 10° and ulnar deviation 20°. Pain was present on light work and grip strength was 45% of the opposite side. The average step-off was 4.4 mm. The scapho-lunate gap was greater than 3 mm in three cases and 5 mm in one case. An ulnar translation of the carpus greater than 4 mm was present in four cases. Posterior subluxation was significant in three cases. The distal radio-ulnar joint (DRUJ) was totally destroyed in three cases, and incongruent in five. Radio-lunate arthrodesis is performed by a posterior approach. Other procedures were combined, mainly on the DRUJ. The average follow-up was 28.5 months (8–79 months). Healing was achieved in ten out of 11 cases in 45 to 90 days. Pain was absent or moderate after 4 months. The range of motion was 33° in flexion, 39° in extension, 17° in radial deviation and 29° in ulnar deviation. The average post-operative strength was 57% of the opposite side (19 kg/33). Eight patients returned to their previous work and two to lighter work.

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