Thumb carpometacarpal osteoarthritis: trapeziectomy versus pyrocarbon interposition implant (Pi2) arthroplasty

Abstract

We retrospectively compared the short-term outcomes of 18 thumbs that had a trapeziectomy and 18 that had a pyrocarbon interposition implant (Pi2) arthroplasty in 33 patients. We measured the Disability of the Arm, Shoulder, and Hand (DASH) and Short Form 36 (SF-36) scores at a mean of 20 months. Pain severity was assessed using a visual analogue scale (VAS), and level of patient satisfaction was assessed using a 5-point scale. The mean DASH scores at follow up were 27 for those that had a trapeziectomy and 35 for those that had a Pi2 arthroplasty (p = 0.001). There was no difference in the VAS for pain, SF-36 scores, or other parameters assessed. Six out of 18 (33%) thumbs in the Pi2 group had multiple operations, usually for dislocation or subluxation of the implant. The early results of Pi2 arthroplasty show a high complication rate compared with trapeziectomy and no identifiable benefit.

Erfahrungen mit dem Mini TightRope® bei schmerzhafter Proximalisierung des 1. Mittelhandstrahls nach Trapezektomie bei Rhizarthrose

“…Dies steht im Wiederspruch zu den Ergebnissen von Luria und Mitarbeitern, die im Rahmen einer biomechanischen Analyse die Trapezektomie mit der SuspensionsInterpositionsarthroplastik und der Implantation einer SwansonProthese verglichen und Vorteile für die Prothese gegenüber den anderen Verfahren, insbesondere durch die ausbleibende Proximalisierung sahen [26]. Im eigenen Patientengut beobachteten wir in 12 %, Maru und Mitarbeiter in 33 % eine SpacerLuxation nach Trapezektomie mit Implantation eines Pyrocarbonspacer [27][28][29]. Da wir bei bereits proximalisiertem ersten Strahl ein zusätzlich erhöhtes Risiko für eine Spacerluxation sahen, haben wir uns gegen den Pyrocarbonspacer als Trapeziumersatz zur Wiederherstellung der Höhe zwischen dem distalen Skaphoidpol und der Basis des ersten Mittelhandknochens im Rahmen der Revision entschieden.…”

Osteoarthritis and prosthetic joints in the hand

“…33,34 Arthroscopic debridement with interposition or distraction arthroplasty have been reported to produce good short-term outcomes. CMC fusion can reliably relieve pain, and has the advantage of maintaining pinch strength but at the cost of higher risk of complications, stiffness of the thumb and the potential for degenerative changes in adjacent joints.…”

“…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. 34 The use of other materials has been no more successful. A pyrocarbon resurfacing hemiarthroplasty prosthesis for the base of the first metacarpal has been developed (Ascension Orthopedics, Austin, TX, USA) ( Figure 61.8).…”

Partial trapeziectomy and interposition of fascia lata allograft in the operative treatment of thumb base osteoarthritis

“…Interposition can be performed with various materials; autograft or allograft tendon, gore-tex (expanded polytetrafluoroethylene), marlex (polypropylene), permacol (porcine dermal collagen xenograft), Artelon degradable spacer, Swanson silicone implant, pyrocarbon implant, Dacron or Arex (absorbable L-polylactic acid anchov) [10][11][12][13][14][15][16][17][18].…”