Management of hyperextension of the metacarpophalangeal joint in association with trapeziometacarpal joint osteoarthritis

2011 ◽  
Vol 36 (4) ◽  
pp. 280-284 ◽  
Author(s):  
R. J. Poulter ◽  
T. R. C. Davis
Keyword(s):  
Clinical Outcome ◽  
Kirschner Wire ◽  
Metacarpophalangeal Joint ◽  
Sesamoid Bone ◽  
Bone Anchor ◽  
Trapeziometacarpal Joint ◽  
Trapeziometacarpal Osteoarthritis ◽  
Trapeziometacarpal Joint Osteoarthritis

This study investigates the management of metacarpophalangeal joint (MCP) hyperextension in patients undergoing trapeziectomy for thumb base osteoarthritis. A total of 297 thumbs with painful trapeziometacarpal osteoarthritis were assessed on pain and thumb key and tip pinch preoperatively and at 1 year. Before surgery 101 had no MCP hyperextension, 168 had hyperextension ≤30° and 28 had hyperextension ≥35°. Of these 157 hyperextension deformities ≤30° and eight ≥35° were not treated. The others were treated by temporary insertion of a Kirschner wire (n = 9), MCP fusion (n = 6), sesamoid bone tethering to the MC head (n = 5) and palmar capsulodesis using a bone anchor (n = 11). Untreated MCP hyperextension deformities <30° did not influence the outcome of trapeziectomy. MCP hyperextension deformities ≥35° can be improved by capsulodesis or MCP fusion but this may not improve the clinical outcome.

Six year outcome excision of the trapezium for trapeziometacarpal joint osteoarthritis: is it improved by ligament reconstruction and temporary Kirschner wire insertion?

2011 ◽  
Vol 37 (3) ◽  
pp. 211-219 ◽  
Author(s):  
H. Salem ◽  
T. R. C. Davis
Keyword(s):  
Ligament Reconstruction ◽  
Kirschner Wire ◽  
Pinch Strength ◽  
Trapeziometacarpal Joint ◽  
Treatment Groups ◽  
Trapeziometacarpal Joint Osteoarthritis ◽  
Evaluation Measure ◽  
Objective Outcome ◽  
Better Than

This randomized prospective study compared the treatment of trapeziometacarpal joint osteoarthritis with a) trapeziectomy with no ligament reconstruction, no soft tissue interposition and no temporary Kirschner wire stabilization (Group T); b) trapeziectomy with flexor carpi radialis ligament reconstruction and interposition and temporary K-wire stabilization (Group T+LRTI). We followed 99 patients with 114 thumbs (59 T and 55 T+LRTI) for a mean of 6.2 (range, 4.2–8.1) years. There were no significant differences between the two treatments in any subjective or objective outcome measure at 6 year follow-up. Eighty-two percent of the thumbs were painless or only ached after use. The DASH (Group T mean, 31; 95% CI, 26–42: Group T+LRTI mean 30; 95% CI, 22–35) and Patient Evaluation Measure (Group T mean, 35; 95% CI, 29–41: Group T+LRTI mean 34; 95% CI, 27–39) scores were significantly better than preoperatively. Thumb key pinch strength did not differ significantly between the two treatment groups (Group T mean 3.7 kg: 95% CI, 3.3–4.2: Group T+LRTI mean 4.1 kg, 95% CI, 3.7–4.7) and was not significantly different from the preoperative key pinch strength. This study does not provide evidence to support the use of LRTI and temporary K-wire stabilization after trapeziectomy.

Trapeziectomy for Trapeziometacarpal Joint Osteoarthritis: Is Ligament Reconstruction and Temporary Stabilisation of the Pseudarthrosis with a Kirschner Wire Important?

2009 ◽  
Vol 34 (3) ◽  
pp. 312-321 ◽  
Author(s):  
T. R. C. DAVIS ◽  
A. PACE
Keyword(s):  
Ligament Reconstruction ◽  
Kirschner Wire ◽  
The Other ◽  
Patient Evaluation ◽  
Trapeziometacarpal Joint ◽  
Outcome Scores ◽  
Trapeziometacarpal Joint Osteoarthritis ◽  
Evaluation Measure ◽  
Improved Function ◽  
Tendon Interposition

This randomised prospective study compared two operations for trapeziometacarpal joint osteoarthritis: trapeziectomy with Flexor carpi radialis ligament reconstruction, tendon interposition and Kirschner wire insertion followed by splintage for 6 weeks (T+LRTI) and excision of the trapezium with no Kirschner wire and immobilisation of the thumb in a soft bandage for only 3 weeks (T). Sixty-seven thumbs with trapeziectomy (T) and 61 with trapeziectomy and ligament reconstruction and tendon interposition (T+LRTI) were assessed preoperatively and at 3-months and 1-year after surgery. Forty-seven percent and 73% of patients reported no pain or only aching after use at 3-months and 1-year respectively and the DASH and Patient Evaluation Measure (PEM) outcome scores reduced postoperatively indicating improved function. However the pain, DASH and PEM scores, and also key and tip thumb pinch and all the other clinical outcome measures, did not differ significantly between the two groups at either 3-months or 1-year after surgery.

Ivory arthroplasty for trapeziometacarpal osteoarthritis: 10-year follow-up

2018 ◽  
Vol 44 (2) ◽  
pp. 138-145 ◽  
Author(s):  
Gino Vissers ◽  
Chul Ki Goorens ◽  
Bert Vanmierlo ◽  
Francis Bonte ◽  
Koen Mermuys ◽  
...  
Keyword(s):  
Long Term Results ◽  
Trapeziometacarpal Joint ◽  
Level Of Evidence ◽  
Visual Analogue Pain ◽  
Trapeziometacarpal Osteoarthritis ◽  
Trapeziometacarpal Joint Osteoarthritis ◽  
Preoperative Status ◽  
The Mean

This prospective study investigates long-term functional outcome after total trapeziometacarpal joint replacement with the Ivory arthroplasty for trapeziometacarpal joint osteoarthritis. Clinical outcome, overall function, pain, and radiologic outcome after a minimum of 10 years were evaluated for 26 Ivory arthroplasty in 24 patients. Two patients had bilateral arthroplasties. The female to male ratio was 22:2, and the mean age was 71 years (range 57–83). The mean follow-up period was 130 months (range 120–142). Overall functioning as defined by the QuickDASH score and visual analogue pain score improved by 50% and 81%, respectively, when compared with the preoperative status. However, these outcomes deteriorated beyond 5 years after surgery. Long-term results suggest the Ivory arthroplasty to be a reliable treatment for trapeziometacarpal osteoarthritis since it improves overall function and reduces pain up to 10 years postoperatively. However, revision within 10 years after surgery was needed in four of 26 cases. Level of evidence: II

scholarly journals The benefit of radiologically-guided steroid injections for trapeziometacarpal osteoarthritis

2010 ◽  
Vol 92 (8) ◽  
pp. 680-684 ◽  
Author(s):  
MG Swindells ◽  
AJ Logan ◽  
DJ Armstrong ◽  
P Chan ◽  
FD Burke ◽  
...  
Keyword(s):  
Observational Study ◽  
Local Anaesthetic ◽  
Common Condition ◽  
Trapeziometacarpal Joint ◽  
Steroid Injections ◽  
Analgesic Effects ◽  
Trapeziometacarpal Osteoarthritis ◽  
Significant Disability

INTRODUCTION Osteoarthritis of the trapeziometacarpal joint (TMJ) is a common condition causing significant disability. Conservative treatments include intra-articular steroid injections. PATIENTS AND METHODS This clinical, observational study prospectively reviewed the longevity of benefit of steroid injections into the TMJ. Eighty-three patients were recruited with a median age of 62 years and injected with steroid and local anaesthetic under radioscopic guidance. They were followed up until the analgesic effects ceased with a questionnaire including visual analogue scores. RESULTS Two-thirds of patients were improved at 2 months, with nearly half having a 3-month improvement. One in six patients had a 6-month benefit, with some patients still improved 2 years after injection. Previously injected patients had a reduced duration of benefit compared to their previous injection. Severity of osteoarthritis did not affect the injection efficacy. CONCLUSIONS Based on this study, we recommend steroid injections in all degrees of TMJ osteoarthritis.

Cadaveric Study of Locked Thumb Metacarpophalangeal Joint Caused by Entrapment of Radial Sesamoid Bone

2011 ◽  
Vol 15 (1) ◽  
pp. 2-4 ◽  
Author(s):  
Sze-Chung Cheng ◽  
Yen Chi-Hung ◽  
Wong Wing-Cheung ◽  
Ho Pak-Cheong ◽  
Tse Wing-Lim ◽  
...  
Keyword(s):  
Metacarpophalangeal Joint ◽  
Cadaveric Study ◽  
Sesamoid Bone ◽  
Thumb Metacarpophalangeal Joint

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

2020 ◽  
Vol 45 (5) ◽  
pp. 472-476 ◽  
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

Bilateral Osteoarthritis of the Trapeziometacarpal Joint Treated by Bilateral Tendon Interposition Arthroplasty

1997 ◽  
Vol 22 (1) ◽  
pp. 96-99 ◽  
Author(s):  
A. DAMEN ◽  
B. VAN DER LEI ◽  
P. H. ROBINSON
Keyword(s):  
Long Term Results ◽  
Interposition Arthroplasty ◽  
Trapeziometacarpal Joint ◽  
Flexor Carpi Radialis ◽  
Trapeziometacarpal Osteoarthritis ◽  
Tendon Interposition

Twenty-four flexor carpi radialis (FCR) tendon interposition arthroplasties of the trapezium for bilateral trapeziometacarpal osteoarthritis were reviewed. Pain was reduced in all cases. Function was improved in all right hands and in 92% of the left hands. FCR tendon interposition arthroplasty for bilateral trapeziometacarpal osteoarthritis yields satisfactory long-term results on both sides.

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