Foreign-Body Reaction to the Artelon CMC Joint Spacer: Case Report

Choung, Edward; Tan, Virak

doi:10.1016/j.jhsa.2008.06.012

Cited by 41 publications

(35 citation statements)

References 12 publications

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“…In one case, the inflammation recurred and was attributed to residual microfragments, which required a second débridement [9]. That case suggests the possibility of recurrent foreign-body reactions.…”

Section: Discussionmentioning

confidence: 89%

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Delayed Foreign-body Reaction to Absorbable Implants in Metacarpal Fracture Treatment

Givissis

Stavridis

Papagelopoulos

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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Background First-generation bioabsorbable implants have been associated with a high complication rate attributable to weak mechanical properties and rapid degradation. This has led to the development of stronger devices with improved durability. However, the modern implants have raised concerns about potential late-occurring adverse reactions. Questions/purposes This retrospective study addressed the following questions: Can absorbable implants consisting of trimethylene carbonate, L-lactide, and D,L-lactide provide adequate fixation for healing of a metacarpal fracture? Will these implants obviate a second removal operation? What complications can occur in the reaction to implant breakdown? Patients and Methods Twelve unstable, displaced, metacarpal fractures were studied in 10 consecutive patients (seven men, three women; mean age, 36.4 years; range, 18-75 years). The fractures were treated with absorbable plates and screws consisting of the aforementioned copolymers and designed to resorb in 2 to 4 years. Nine patients (10 fractures) were available for clinical and radiographic followups (mean, 45.7 months; range, 34-61 months).

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Section: Discussionmentioning

confidence: 89%

“…Recently, two cases of a severe foreign-body reaction requiring implant removal were observed with a bioabsorbable spacer used for treating thumb basal arthritis [9,15]. In one case, the inflammation recurred and was attributed to residual microfragments, which required a second débridement [9].…”

Section: Discussionmentioning

confidence: 99%

Delayed Foreign-body Reaction to Absorbable Implants in Metacarpal Fracture Treatment

Givissis

Stavridis

Papagelopoulos

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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“…There were no statistically significant differences between the two groups in grip or pinch strength or thumb range of motion [9]. One anecdotal report suggested satisfactory results "in the vast majority of cases" with only two of 50 patients requiring revision surgery (the need for revision was attributed to inadequate correction of bony deformity on the distal trapezium) [2,3].…”

Section: Discussionmentioning

confidence: 99%

Complications with the Use of Artelon in Thumb CMC Joint Arthritis

Clarke

Hagberg

Kaufmann

et al. 2011

Hand (New York, N,Y.)

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Background Complications with the use of the Artelon spacer in thumb carpometacarpal (CMC) joint arthritis include inflammation, osteolysis, and persistent pain. We evaluated our short-term results and complications. Methods A retrospective review of 29 patients was performed. Pre-and postoperative radiographs, operative techniques, complications, and subsequent surgeries were analyzed. Pearson's and chi-squared testing was used to identify associations between complications and surgical technique or preoperative radiographic criteria. The average age was age 51±7.7 (34-66), average follow-up was 8 months (1-26). Results Twelve patients sustained complications. Nine patients displayed postoperative osteolysis. Four patients underwent conversion to CMC suspensionplasty due to persistent pain. The rate of revision surgery and radiographic postoperative osteolysis were not significantly associated with preoperative arthritis grade, metacarpal subluxation, or surgical techniques: fixation method, the bony surface(s) involved in the osteotomy, or spacer modifications. Conclusions Our study found a significant short-term complication rate following Artelon spacer arthroplasty of the CMC joint. This is higher than previously described.We could not identify any factors that were significantly associated with the complications. It is possible that the inherent instability of the joint or the material of the spacer is involved in implant failure. Further study is necessary to better define the indications for use and specific techniques for the use of the implant.

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“…The manuscripts that formed the major portion of the review (n = 22) include those focused on arthroscopic débridement or partial trapeziectomy with case series and adequate outcomes data (n = 11) [2,9,14,15,17,18,21,25,27,28,34]; open series that provided information regarding the interposition material or changes in the STT joint or MCP hyperextension (n = 7) [8,10,23,[31][32][33]39]; and review or techniques articles or a case study with some limited original clinical data (n = 4) [4,5,12,41].…”

Section: Search Strategy and Criteriamentioning

confidence: 99%

“…However, because of the paucity of manuscripts available for evaluation of arthroscopic interposition of this material, use of this material in open procedures without ligament stabilization were also reviewed in addition to two level V manuscripts [4,41]. Two manuscripts were case series or reports documenting inflammatory response and unsatisfactory results in terms of pain relief [8,37] resulting in revision surgery and explantation. Others [23,31,32] documented comparison studies between the Artelon 1 spacer and tendon arthroplasty.…”

Section: Manufactured Materialsmentioning

confidence: 99%

Does Arthroscopic Débridement With or Without Interposition Material Address Carpometacarpal Arthritis?

Adams

2014

Clinical Orthopaedics &Amp; Related Research

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Background Thumb carpometacarpal (CMC) joint arthritis is a common problem in clinical practice with a variety of treatment options. Arthroscopic procedures can preserve all or part of the trapezium in the setting of treatment of basilar joint arthritis, and such procedures (even without stabilization or ligament reconstruction) have high reported success rates. However, little is documented about the limitations of these procedures in terms of patient selection, the optimal type of interposition, if any, and rehabilitation. Questions/purposes A systematic review was performed to determine the influence of (1) interposition material (manufactured, biological, or none); and (2) patient-related factors (including metacarpophalangeal joint hyperextension, ligamentous laxity, and severity of arthritis) on pain, functional scores, and postoperative complications unique to each approach.Methods A systematic review of the English language literature regarding thumb basilar joint arthritis and arthroscopic partial trapeziectomy or débridement was performed. Those procedures including ligament reconstruction or stabilization were excluded. Results Biological materials and no interposition were both associated with satisfactory improvement and low rates of complications; complication rates with synthetic materials were higher. Eaton Stages I to III were treated successfully with this technique. The effect of scaphotrapeziotrapezoid (STT) changes was variably described across series. In most series, metacarpophalangeal hyperextension did not seem to have an adverse effect on outcomes, although these patients were excluded in some series. Conclusions Arthroscopic débridement with or without interposition can be used for treatment of Eaton Stages I to III CMC osteoarthritis with satisfactory outcomes. Some series suggest satisfactory outcomes in the setting of STT changes and metacarpophalangeal hyperextension.

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Foreign-Body Reaction to the Artelon CMC Joint Spacer: Case Report

Cited by 41 publications

References 12 publications

Delayed Foreign-body Reaction to Absorbable Implants in Metacarpal Fracture Treatment

Delayed Foreign-body Reaction to Absorbable Implants in Metacarpal Fracture Treatment

Complications with the Use of Artelon in Thumb CMC Joint Arthritis

Does Arthroscopic Débridement With or Without Interposition Material Address Carpometacarpal Arthritis?

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