Outcome of uncemented trapeziometacarpal prosthesis for treatment of thumb carpometacarpal joint arthritis

Manish Chug, Nicole Williams, David Benn, Stephen Brindley, Manish Chug, Nicole Williams, David Benn, Stephen Brindley

Abstract

Background: Osteoarthritis of the trapeziometacarpal joint of thumb occurs frequently and can be very disabling. Numerous surgical techniques including trapeziectomy with or without tendon interposition arthrodesis and partial or total joint arthroplasty with cemented and noncemented prosthesis have been described for the treatment of trapeziometacarpal joint osteoarthritis. Initial problems of osteolysis and implant loosening have been substantially reduced with improvement in implant design. The aim of this study is to demonstrate that trapeziometacarpal osteoarthritis of the thumb can be effectively treated with uncemented total joint replacement prosthesis.

Materials and methods: We retrospectively collected data for 16 trapeziometacarpal joint replacements in 14 patients. One patient was excluded as they required revision with trapeziectomy and ligament reconstruction following fracture of Trapezium. The trapeziometacarpal joint prosthesis was used in all cases and all operations were carried out by one surgeon. Clinical outcome was determined by a pre and postoperative patient rated wrist evaluation (PRWE) and Michigan Hand Questionnaire Score. Range of motion, grip, tip pinch and key pinch strength were measured and compared with the unoperated hand. Radiological assessment was carried out by plain radiographs for preoperative staging of arthritis and postoperative radiographs at latest followup for evaluation of osteolysis and implant loosening. Average followup period was 26 months.

Results: There was an improvement in hand function and pain level based on PRWE and Mischigan Hand outcome Questionnaire Score. One patient had intraoperative fracture of Trapezium and subsequent radiographs at 14 months followup showed loosening of the trapezial component due to nonunion of the fracture and complete disintegration of the trapezium. There were no cases of dislocation or implant loosening for the remaining 15 CMC joints at the latest followup.

Conclusion: The use of uncemented prosthesis in treatment of Questionnaire Score. Range of motion joint osteoarthritis gives excellent short term results in improving hand function in terms of strength and stability and achieving pain relief.

Keywords: Carpometacarpal joint; Osteoarthritis; carpal bones; implant design; metacarpal bone; osteoarthritis; thumb; trapeziometacarpal joint; uncemented trapeziometacarpal prosthesis.

Conflict of interest statement

Conflict of Interest: None

Figures

Figure 1
Figure 1
Clinical photograph showing (a) trapeziometacarpal prosthesis unconstrained metal on metal joint prosthesis consists of a titanium stem inserted into the first metacarpal, a chrome–cobalt steel cup shaped like a truncated cone on the outside and comprising a hydroxyapatite-coated deep thread which screws into the trapezium, a chrome–cobalt steel head on a neck of variable length (b) The Elektra follows ball and socket joint design
Figure 2
Figure 2
(a) Preoperative radiograph of Thumb anteroposterior and oblique views showing carpometacarpal joint for grading of osteoarthritis (b) Postoperative radiographs (anteroposterior and oblique views) for evaluation of osteolysis and loosening showing implant in situ.

References

    1. Kuczynski K. Carpometacarpal joint of the human thumb. J Anat. 1974;118:119–26.
    1. Koff MF, Zhao KD, Mierisch CM, Chen MY, An KN, Cooney WP., 3rd Joint kinematics after thumb carpometacarpal joint reconstruction: An in vitro comparison of various constructs. J Hand Surg Am. 2007;32:688–96.
    1. Taylor EJ, Desari K, D’Arcy JC, Bonnici AV. A comparison of fusion, trapeziectomy and silastic replacement for the treatment of osteoarthritis of the trapeziometacarpal joint. J Hand Surg Br. 2005;30:45–9.
    1. Eaton RG, Lane LB, Littler JW, Keyser JJ. Ligament reconstruction for the painful thumb carpometacarpal joint: A long term assessment. J Hand Surg Am. 1984;9:692–99.
    1. Roberts RA, Jabaley ME, Nick TG. Results following trapeziometacarpal arthroplasty of the thumb. J Hand Ther. 2001;14:202–7.
    1. Kriegs-Au G, Petje G, Fojtl E, Ganger R, Zachs I. Ligament reconstruction with or without tendon interposition to treat primary thumb carpometacarpal osteoarthritis. Surgical technique. J Bone Joint Surg Am. 2005;87:78–85.
    1. Sirotakova M, Figus A, Elliot D. A new abductor pollicis longus suspension arthroplasty. J Hand Surg Am. 2007;32:12–22.
    1. Budoff JE, Gordon L. Long term results of tendon shortening trapeziometacarpal arthroplasty. Clin Orthop Relat Res. 2002;405:199–206.
    1. Lanzetta M, Foucher G. A comparison of different surgical techniques in treating degenerative arthrosis of the carpometacarpal joint of the thumb. A retrospective study of 98 cases. J Hand Surg Br. 1995;20:105–10.
    1. Tomaino MM. Treatment of Eaton stage I trapeziometacarpal disease with thumb metacarpal extension osteotomy. J Hand Surg Am. 2000;25:1100–6.
    1. Lussiez B, Canovas F, Lenoble E, Allieu Y, Iselin F, Saffar P. Swanson's trapezius implants. Results of a multicenter study. Ann Chir Main Memb Super. 1990;9:198–202.
    1. Minami A, Iwasaki N, Kutsumi K, Suenaga N, Yasuda K. A long term followup of silicone-rubber interposition arthroplasty for osteoarthritis of the thumb carpometacarpal joint. Hand Surg. 2005;10:77–82.
    1. de la Caffiniere JY, Aucouturier P. Trapezio-metacarpal arthroplasty by total prosthesis. Hand. 1979;11:41–6.
    1. Ulrich-Vinther M, Puggaard H, Lange B. Prospective 1-year followup study comparing joint prosthesis with tendon interposition arthroplasty in treatment of trapeziometacarpal osteoarthritis. J Hand Surg Am. 2008;33:1369–77.
    1. Regnard PJ. Electra trapezio metacarpal prosthesis: Results of the first 100 cases. J Hand Surg Br. 2006;31:621–8.
    1. Wachtl SW, Guggenheim PR, Sennwald GR. Cemented and noncemented replacements of the trapeziometacarpal joint. J Bone Joint Surg Br. 1998;80:121–5.
    1. Hansen TB, Vainorius D. High loosening rate of the Moje Acamo prosthesis for treating osteoarthritis of the trapeziometacarpal joint. J Hand Surg Eur Vol. 2008;33:571–4.
    1. Lemoine S, Wavreille G, Alnot JY, Fontaine C, Chantelot C groupe GUEPAR. Second generation GUEPAR total arthroplasty of the thumb basal joint: 50 months followup in 84 cases. Orthop Traumatol Surg Res. 2009;95:63–9.
    1. Ferrari B, Steffee AD. Trapeziometacarpal total joint replacement using the Steffee prosthesis. J Bone Joint Surg Am. 1986;68:1177–84.
    1. Eaton RG, Littler JW. Ligament reconstruction for the painful thumb carpometacarpal joint. J Bone Joint Surg Am. 1973;55:1655–66.
    1. Kapandji AI. Clinical evaluation of the thumb's opposition. Journal of Hand Therapy. 1992;5:102–6.
    1. Hansen TB, Snerum L. Elektra trapeziometacarpal prosthesis for treatment of osteoarthrosis of the basal joint of the thumb. Scand J Plast Reconstr Surg Hand Surg. 2008;42:316–9.
    1. Hernández-Cortés P, Pajares-López M, Robles-Molina MJ, Gómez-Sánchez R, Toledo-Romero MA, De Torres-Urrea J. Two-year outcomes of Elektra prosthesis for trapeziometacarpal osteoarthritis: A longitudinal cohort study. J Hand Surg Eur Vol. 2012;37:130–7.
    1. Klahn A, Nygaard M, Gvozdenovic R, Boeckstyns ME. Elektra prosthesis for trapeziometacarpal osteoarthritis: A followup of 39 consecutive cases. J Hand Surg Eur Vol. 2012;37:605–9.
    1. De Smet L, Sioen W, Spaepen D, Van Ransbeeck H. Total joint arthroplasty for osteoarthritis of the thumb basal joint. Acta Orthop Belg. 2004;70:19–24.
    1. Badia A, Sambandam SN. Total joint arthroplasty in the treatment of advanced stages of thumb carpometacarpal joint osteoarthritis. J Hand Surg Am. 2006;31:1605–14.
    1. Hansen TB, Larsen K, Bjergelund L, Stilling M. Trapeziometacarpal joint implants can be evaluated by roentgen stereophotogrammetric analysis. J Hand Surg Eur Vol. 2010;35:480–5.
    1. Hansen TB, Meier M, Møller MC, Larsen K, Stilling M. Primary cup fixation with different designs of trapeziometacarpal total joint trapezium components: A radiostereometric analysis in a pig bone model. J Hand Surg Eur Vol. 2011;36:285–90.
    1. Hansen TB, Stilling M. Equally good fixation of cemented and uncemented cups in total trapeziometacarpal joint prostheses. Acta Orthop. 2013;84:98–105.

Source: PubMed

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