Use of the De La Caffinière Prosthesis in Rheumatoid Trapeziometacarpal Destruction

Abstract

This study evaluated the outcome of the de la Caffinière prosthesis in patients with an inflammatory arthropathy affecting the trapeziometacarpal joint. The procedure was performed in 57 thumbs for rheumatoid arthritis (41 cases), juvenile chronic arthritis (ten cases), psoriatic arthritis (four cases) and other inflammatory joint diseases (two cases). Survival analysis with a revision procedure or radiographic implant failure as end points was performed. Five loosened cups and two permanently dislocated prostheses underwent revision surgery. These were managed with a bone graft and tendon interposition technique. Radiographic follow-up yielded four additional implant failures (two loosened cups, one loosened metacarpal stem and one permanent dislocation). The implant survival rate based on revision operation was 87% (95% CI 73-94) at 10 years, and the total radiographic and implant failure rate based on radiographic findings was 15% (95% CI 7-29) at 10 years.

Analysis of methodological deficiencies of studies reporting surgical outcome following cemented total-joint arthroplasty of trapezio-metacarpal joint of the thumb

“…Outcome variables like pain were not reported in four studies [3,4,7,13]. Four of the studies used visual analogue scores (VAS) [5,9,14,17] and seven used some form of grading system for the pain. Assessment of functional capabilities was documented in only five studies [9,10,12,14,17].…”

“…Four of the studies used visual analogue scores (VAS) [5,9,14,17] and seven used some form of grading system for the pain. Assessment of functional capabilities was documented in only five studies [9,10,12,14,17]. Patient satisfaction was not documented in 11 studies, good/excellent/fair/poor grading was used in two studies [13,14] and VAS was used in the remaining two studies [5,9].…”

“…Assessment of functional capabilities was documented in only five studies [9,10,12,14,17]. Patient satisfaction was not documented in 11 studies, good/excellent/fair/poor grading was used in two studies [13,14] and VAS was used in the remaining two studies [5,9]. There was great variability in the reporting of mobility after cemented total-joint arthroplasty of the thumb.…”

“…Only patients with inflammatory arthritis were included in one study [14] and only four studies were exclusively on osteoarthritis patients [9,12,13,17]. Radiography was the only investigation used to establish the diagnosis in all studies.…”

“…Only one article was considered to adequately describe the postoperative rehabilitation by both observers [4]. Rehabilitation protocol was fairly well described in six articles [2,3,9,10,12,14]. The mean methodology score for this component was 3.6.…”