High frequency failure of the Moje thumb carpometacarpal joint arthroplasty

Abstract

Arthroplasty is one of several options for treating symptomatic osteoarthritis of the thumb carpometacarpal joint. There are various hemi- and total arthroplasties available on the market. We report our experience of treating 12 patients with the Moje Acamo CMC1 prosthesis. We reviewed all the patients at a mean of 50 months postoperatively. All patients presented with loosening, migration or tilting of one or both implant components. Nine patients were symptomatic enough to warrant revision surgery with removal of the implant leaving a pseudarthrosis. At the last follow-up, five patients (42%) had already received revision surgery. All patients still possessing an implant showed progressive signs of implant loosening, although some of them had no symptoms. In order to assess their overall disadvantage compared with patients treated by primary trapeziectomy, the outcomes of these two groups were compared (matched pairs). The outcomes after revision surgery were comparable with those of primary trapeziectomy. We no longer use the Moje Acamo CMC1 implant and recommend that patients who have received this implant should be monitored carefully both clinically and radiologically.

Editorial

“…Following failed Moje CMC joint arthroplasties, excision of the implant gives results comparable to a primary trapezectomy (Kazsap et al, 2012). Nonetheless, the reported failure rates of the CMC joint arthroplasties are vastly greater than the "unacceptable" failure rates of some metal-on-metal hip replacements, and yet they continue to be implanted.…”

“…Previously, Hanson and Vainorius (2008) reported a failure rate of eight out of nine implants at 1 year, primarily due to failure of implant fixation to bone. In this issue, Kazsap et al (2012) also report a similarly high rate of failure, specifically with 75% of implants requiring or being recommended revision surgery.…”

Surgical Treatment of Trapeziometacarpal Joint Arthritis: A Historical Perspective

“…While initial results seemed favorable, longer-term studies of some initially successful implants have shown an increasing incidence of prosthetic failure requiring revision [1,21]. The dearth of reports of new prosthetic designs in the more recent literature would seem to reflect a shift away from this approach while, during the same period, there continue to be reports introducing new modifications of resection arthroplasty [19,36].…”

“…There continue to be advocates for prosthetic arthroplasty using various designs [6,30,31,38], with reports of good clinical results including, for one design, a 5-year survival rate of 95% [10]. Most current reports are from European surgeons [21,22,31], a consequence of the difficulty in obtaining FDA approval for many of the newer biomaterials and designs. A prosthetic implant may be a reasonable salvage procedure when a resection arthroplasty procedure fails.…”

Osteoarthritis and prosthetic joints in the hand

“…[91][92][93][94] When combined with an STT arthrodesis for treatment of pantrapezial osteoarthritis, loosening was observed in most cases. [96][97][98][99][100][101][102] As with other joints in the hand, the initial experience of 1st CMC joint arthroplasty was with silicone implants. 94 Cemented implant designs appear more successful for basal thumb arthritis than uncemented equivalents, with high rates of early loosening observed with the Ledoux, Moje and Elektra uncemented ball and socket designs although, as with the cemented arthroplasties, this does not always lead to revision or have a detrimental effect on the outcome.…”