A Promising Thumb Basal Joint Hemiarthroplasty for Treatment of Trapeziometacarpal Osteoarthritis

Abstract

BackgroundTrapeziometacarpal joint osteoarthritis is a painful, disabling condition that primarily affects women who are postmenopausal. Arthroplasty has been performed to treat this condition; however, subluxation has been a problem with all previous implants. We report the results of hemiarthroplasty using a prosthesis designed to address the problems associated with previous implants.Questions/purposesWe wished to (1) determine if this prosthesis results in pain relief and functional improvement and preserves the appearance of the thumb, (2) assess the prosthetic reconstruction during followup, (3) assess complications that occur with the use of this prosthesis, and (4) determine the survivorship of this prosthesis.MethodsWe performed 159 basal joint hemiarthroplasties (138 patients) to treat osteoarthritis of the trapeziometacarpal joint. The mean age of the patients was 63 years, 78% were women, and all had Eaton-Littler Stage II or III changes. Only the damaged articular surfaces of the metacarpal and trapezium were excised; no tendon grafts or transfers were performed. Seven patients (seven thumbs) were lost to followup and seven (nine thumbs) died, leaving 124 patients (143 thumbs) for review. Clinical and radiographic assessments were made preoperatively, 12 weeks postoperatively, and annually thereafter. Minimum followup was 35 months (mean, 72.1 months; range, 35–120 months).ResultsAt latest followup, pain relief occurred in 135 thumbs, function improved in 138 thumbs, 139 thumbs were excellent or good in overall assessment, and 142 thumbs had good or excellent cosmetic appearance. The mean tip pinch improved from 4.9 kg preoperatively to 6.44 kg postoperatively. Mean postoperative Buck-Gramcko score was 49 (excellent); overall Kaplan-Meier analysis with revision as the end point showed 94% implant survivorship at a mean followup of 72.1 months.ConclusionsOur results are superior to those of other implants and support continued use of this implant. Studies with longer followup are required to confirm these results.Level of EvidenceLevel IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

De Quervain Tenosynovitis Following Trapeziometacarpal Ball-and-Socket Joint Replacement

“…All these reports used a dorsoradial incision between EPB and APL. [36][37][38][39][40][41][42] The only study using a posterolateral approach for implantation of a ball and socket prosthesis and reporting de Quervain in the first year following implantation was that of Ulrich-Vinther et al 26 The unique mobility of the thumb contributes to the syndrome. 43 An awkward wrist position is also generally accepted as a condition related to de Quervain disease.…”

A Systematic Review of Postoperative Hand Therapy Management of Basal Joint Arthritis

“…Time for return to full unrestricted activity was only mentioned in five of the 19 studies (Table 5) [6,12,14,16,19]. The range for time to return to full activity was 5 to 12 weeks in these studies.…”

“…Postoperative thumb exercise protocols were quite variable across the studies identified (Table 4). Some patients simply were shown exercises after the immobilization was discontinued [2,5,8,12,13,15,19]. Patients in other studies were referred to a therapist after the period of immobilization [1,3,4,7,9,24].…”

Osteoarthritis and prosthetic joints in the hand

“…[113][114][115][116] However, an independent study by Perez-Ubeda et al reported 70% failure in 20 implants followed for between 24 and 45 months, with loosening in 55% and ankylosis in 15%. 122 Interposition arthroplasty at the base of the thumb with pyrocarbon implants has been studied using a number of forms including spheres, ellipsoids and tori or 'doughnuts' that are inserted by reaming the trapezium to create a cup. 118 Good outcomes were also reported at a mean of 59 months with only one patient complaining of minimal pain, and one revision for post-traumatic loosening.…”