Elektra prosthesis versus resection-suspension arthroplasty for thumb carpometacarpal osteoarthritis: a long-term cohort study

Abstract

The present study compares 34 patients with thumb carpometacarpal osteoarthritis (37 thumbs) treated with the Elektra® prosthesis, with 18 patients (18 thumbs) treated with resection-suspension arthroplasty, with an overall mean follow-up period of 13.3 years. Evaluation with disability of arm and shoulder scores, pain via visual analogue scale and range of motion (radial and palmar abduction, and opposition) indicated no significant difference. However, the cohort with a surviving prosthesis showed significantly better subjective grip strength ( p = 0.04). Complications occurred in 23 of the 37 thumbs in the prosthesis group compared with two in the resection-suspension arthroplasty patients. Seventeen prostheses required revision. At revision operations, we observed local signs of metallosis in 15 of 17 cases. The patients receiving resection-suspension arthroplasty were more satisfied with their treatment ( p = 0.003). Therefore, we cannot recommend the implantation of Elektra® prosthesis and we speculate that the key problem of aseptic cup loosening is a result of the metal-on-metal bearing. Level of evidence: III

Radial and palmar active range of motion measurement: reliability of six methods in healthy adults

“…Moreover, reliability testing was performed in a relatively small group of 29 young subjects with physiological anatomy of the hand. Moreover, due to our healthy study cohort, whose subjects do not suffer from any thumb CMC condition, and thus no pathological ROM impairment, we were not able to assess opposition ROM measurement methods, because all subjects would have reached 10 points in the Kapandji Score [25] or 0 centimetre distance between the thumb tip and the fifth metacarpophalangeal joint [6]. Future studies are required to validate the usefulness, applicability, and reliability of all the investigated methods for patients suffering from any condition concerning the thumb CMC joint.…”

“…In clinical practice, radial and palmar abduction measurements, [4][5][6] whose terms imply their respective movement planes (i.e. parallel and perpendicular to the palm), currently represent the most frequently applied methods for examining restrictions of ROM caused by thumb CMC conditions, e.g.…”

“…Although experimental studies have revealed the joint's precise kinematics and movement axes, these results are difficult to convert into clinical practice [1,7,8]. Historically, a wide variety of different techniques for measuring ROM have been developed and are described in the literature using terms such as 'radial abduction,' [4][5][6] 'palmar abduction,' [4][5][6] 'flexion-extension,' [9,10] 'abduction-adduction,' [9,11] or 'anteposition-retroposition' [4,11]. However, there is no clear consensus on how these terms are exactly defined; hence, there is even less consensus on the method with which they should be measured.…”

Trapeziometacarpal joint arthritis: a personal approach to its treatment

“…Thus, embarking on a randomized controlled study comparing trapeziectomy with any TMC total arthroplasty, particularly a new one, carries the risk of becoming irrelevant. This is as the joint replacement, however well it performs in the short-term, may be found to have an unacceptably high revision rate (Craik et al., 2017; Froschauer et al., 2020; Kollig et al., 2017) such that it is withdrawn from the market. Some implants appears to survive better than others (Aebischer et al., 2016), but only when a total joint replacement is shown to have acceptably low long-term failure rates (ideally at 10 years) when inserted by the majority of hand surgeons, will the time be right for such a comparative trial.…”

Autologous Fat Transplantation for Thumb Carpometacarpal Joint Osteoarthritis (Liparthroplasty): A Case Series with Two Years of Follow-UP

“…In addition to corticosteroids, injection-based treatment using hyaluronic acid, saline placebo, and dextrose were compared in a recent meta-analysis which concluded that there was no clear evidence whether any injected substance was superior to others or that one of them was better than another conservative treatment option [ 4 ]. As a further consequence, if non-operative treatment fails, a wide range of different surgical methods are available, for example, denervation, partial or total trapeziectomy, resections-suspension arthroplasty with use of various adjacent tendons, arthrodesis, and total arthroplasty with a huge number of various prosthesis types [ 5 , 6 , 7 ].…”