Joint replacement for trapeziometacarpal osteoarthritis: implants and outcomes

Abstract

For thumb carpometacarpal osteoarthritis, trapeziectomy provides generally good results with reduction of pain and restoration of thumb mobility, but shortening of the thumb may at least in theory lead to reduction in grip and pinch strength. Furthermore, instability of the base of the first metacarpal and contact with the scaphoid may occur regardless of the several described techniques with ligament reconstruction and tendon interposition. Thus, for years alternatives to trapeziectomy have been explored and reported with disputable success. Often the road from idea to implantation in patients seems to have been short, and high complication rates and failure of new implant designs have been fairly common. This has led to the general impression that the implants do not provide sufficient benefits compared with simple trapeziectomy. More recent uncemented total joint replacement designs have shown rapid rehabilitation, reduction of pain, restoration of grip strength and movement, and much improved long-term implant survival. These factors may make total joint replacement a realistic alternative to trapeziectomy. Still, patient selection has to be improved, as the benefits may be small in the low activity elderly patient.

Pyrocardan Implant Arthroplasty for Carpometacarpal Osteoarthritis of the Thumb: A Comparative Study with a Historical Control Group

“…Earlier designs of a total joint replacement have been discouraging with metal-on-metal pseudotumor formation, metal and polyethylene wear, and dislocation of the prosthesis. [17][18][19][20] Nevertheless, the new dual-mobility designs seem promising with good function and low long-term revision rates. 21 In 2020, very promising short-term results were published with the Moovis prosthesis in 200 cases with acceptable revision rates (Dremstrup et al, 2021).…”

Trapezial dysplasia and concomitant disorders around the thumb can influence the outcome after total carpometacarpal joint replacement: Report of two cases, short review of literature, and update to the Arpe™ prosthesis

“…Compared to trapeziectomy as unchanged the most widely performed procedure worldwide, the rationale behind total CMCJ I replacement is that this procedure obtains normal length of the thumb associated with normal muscle forces resulting in a higher carpometacarpal and metacarpaophalangeal joint stability, no occurrence of painful impingement between the base of the first metacarpal bone and the scaphoid and/or trapezoid bone, and normal tendon loads in order to achieve a certain key pinch force [47][48][49][50][51]. Noted that total CMCJ I replacement is not generally to be considered as contraindication for patients with high claims in occupational work and leisure [52,53].…”

Carpometacarpal osteoarthritis of the thumb associated with uncommon concomitant hypoproteinemia mimicking irreversible carpal tunnel syndrome: Case report

“…When decreased, forces of the donor muscle-tendon unit should be preserved [11]. The problem of trapeziectomy is that this procedure does not obtain normal length of the thumb potentially leading to a painful impingement between the base of the first metacarpal and scaphoid or trapezoid bone (Figure 4A) associated with non-physiological muscle and tendon forces often resulting in a decreased stability in the adjacent metacarpaophalangeal joint, impaired grip strength and key pinch forces as compared to a total CMCJ I replacement [15][16][17][18][19][20]. Therefore, the CMCJ I arthrodesis was the only option of choice in order to improve the functionality of the entire affected hand with our patient.…”

“…A 57-year-old underweighted female (body height 1.55 m) presented with right advanced stage of symptomatic CMCJ I OA for many years (Figure 1A). She reported about loss of her body weight within the last 10 years from 60 kg (body mass index 25) to 43 kg (body mass index 17,9). The cause for the underweight was unknown by the patient, and she has ruled out a malnutrition.…”