Upload
others
View
2
Download
0
Embed Size (px)
Citation preview
Seediscussions,stats,andauthorprofilesforthispublicationat:https://www.researchgate.net/publication/6654426
TotalJointArthroplastyintheTreatmentofAdvancedStagesofThumbCarpometacarpalJointOsteoarthritis
ArticleinTheJournalOfHandSurgery·January2007
ImpactFactor:1.67·DOI:10.1016/j.jhsa.2006.08.008·Source:PubMed
CITATIONS
65
READS
155
2authors:
AlejandroBadia
BadiaHandtoShoulderCenter,Miami,FL…
47PUBLICATIONS608CITATIONS
SEEPROFILE
SenthilNathanSambandam
31PUBLICATIONS187CITATIONS
SEEPROFILE
Allin-textreferencesunderlinedinbluearelinkedtopublicationsonResearchGate,
lettingyouaccessandreadthemimmediately.
Availablefrom:AlejandroBadia
Retrievedon:20May2016
63646566676869707172737475767778798081828384858687888990919293949596
1234567891011121314151617181920212223242526272829303132333435363738394041424344454647484950515253545556575859606162
TipptoIbica
4313
AQ: 1
AQ: 3
AQ: 4
ARTICLE IN PRESS
RECTE
D PRO
OF
Total Joint Arthroplasty in the Treatmentof Advanced Stages of Thumb
Carpometacarpal Joint OsteoarthritisAlejandro Badia, MD, S.N. Sambandam, MS
From the Miami Hand Center, Miami, FL.
Purpose: Osteoarthritis of the thumb basal joint is a very common and disabling conditionthat frequently affects middle-aged women. Many different surgical techniques have beenproposed for extensive degenerative arthritis of the first carpometacarpal (CMC) joint. Jointreplacement has been an effective treatment of this condition. The purpose of this article isto present the outcome of a total cemented trapeziometacarpal implant in the treatment ofmore advanced stages of this disease.Methods: Total joint arthroplasty of the trapeziometacarpal joint was performed on 26thumbs in 25 patients to treat advanced osteoarthritis (Eaton and Littler stages III and IV)between 1998 and 2003. Indications for surgery after failure of conservative treatment weresevere pain, loss of pinch strength, and diminished thumb motion that limited activities ofdaily living. A trapeziometacarpal joint prosthesis was the implant used in this series. Theaverage follow-up time was 59 months.Results: At the final follow-up evaluation, thumb abduction averaged 60° and thumb oppo-sition to the base of the small finger was present. The average pinch strength was 5.5 kg (85%of nonaffected side). One patient had posttraumatic loosening, which was revised withsatisfactory results. Radiographic studies at the final follow-up evaluations did not show signsof atraumatic implant loosening. One patient complained of minimal pain, and the remaining24 patients were pain free.Conclusions: In our series, total joint arthroplasty of the thumb CMC joint has proven to beefficacious with improved motion, strength, and pain relief. We currently recommend thistechnique for the treatment of stage III and early stage IV osteoarthritis of the CMC joint inolder patients with low activity demands. (J Hand Surg 2006;xx:xxx. Copyright © 2006 by theAmerican Society for Surgery of the Hand.)Type of study/level of evidence: Therapeutic, Level IV.Key words: Carpometacarpal, cemented arthroplasty, osteoarthritis, thumb
R 979899
100101102103104105106107108109110111
stttrdoplrl
UNCO
he trapeziometacarpal joint has an exclusiveanatomic design that allows arcs of motion in3 different planes (abduction–adduction, flex-
on–extension, axial rotation) to place the thumb in areaxial position to resist axial loads.1 These variableositions of load may explain why it is common forhis joint to develop osteoarthritis (OA) even whenther small joints in the vicinity remain uninvolved.2
t has been shown that there is a strong correlationetween basal joint laxity (specifically volar ligamentnstability) and the evolution of early degenerativehanges. These alterations lead to pain, weakness,
nd adduction deformity.3 mRestoration of thumb function with a painfree,table, and mobile joint with preserved strength arehe main goals of treatment of painful arthritis of thehumb.2 Many surgical methods have been proposedo achieve these goals. Procedures such as ligamenteconstruction,4–12 ligament reconstruction and ten-on interposition,7,8,13–20 tendon interposition with-ut ligament reconstruction,7,14,21–31 and simple tra-ezial excision7,8,32–35 all are associated with someoss of thumb length and hence pinch strength. Theole of metacarpal osteotomy is not clearly estab-ished.6,36–41 Arthrodesis is associated with loss of
112113114115116117118119120121122123124
obility and a transfer of reaction forces to the
The Journal of Hand Surgery 1.e1
T
63646566676869707172737475767778798081828384858687888990919293949596979899
100101102103104105106107108109110111
1234567891011121314151617181920212223242526272829303132333435363738394041424344454647484950515253545556575859606162
npat
Ctpopsb
kTwivjolhmJEwcwtfl
tis2lTpdnpitco(
MTjw
tpniwpfpt
asDC(Rtssstpowtwild
DTwria
1.e2 The Journal of Hand Surgery / Vol. xx No. x Month 2006
AQ: 5
AQ: 6
AQ: 7
AQ: 8
T1
AQ: 9
AQ: 10
AQ: 11
AQ: 12
ARTICLE IN PRESS
UNCORREC
eighboring joints.29,42–48 Silicone implant arthro-lasty was proposed as an alternative but is associ-ted with instability, silicone wear, synovitis, pros-hesis fracture, and prosthesis subluxation.35,49–64
Total joint arthroplasty was first described by de laaffiniere and Aucouturier.65 This procedure applies
he concept of total hip replacement to creating aermanent swivel within the base of the thumb thatbviates the need for ligament reconstruction, re-laces the joint surface with a mechanical bearingurface for frictionless movement, and provides sta-ility for strong pinch and grasp.66
Various implant designs are available on the mar-et for total joint arthroplasty of the thumb.36,65–85
he de la Caffiniere implant is the mostidely used and most extensively studied
mplant65,69,70,73–76,78,80 – 83 Appendix 1 can beiewed at the Journal’s Web site, http://www.handsurg.org). De la Caffiniere first reported hiswn experience with this implant in 197965 andater in 1991.75 GUEPAR is another implant thatas been reported in the French67,85,86 and Ger-an84 literature (Appendix 2 can be viewed at the
ournal’s Web site, http://www.jhandsurg.org).ven though surgeons in different parts of theorld continue to use other implants (Appendix 3
an be viewed at the Journal’s Web site, http://ww.jhandsurg.org), the indications and long-
erm outcomes of those implants are not reportedrequently and hence are not adequately estab-ished.
The Braun-Cutter prosthesis (SBI/Avanta Or-hopaedics, San Diego, CA) is a commonly usedmplant for total joint arthroplasty.36,71,72 In histudy71 in 1982, Braun reported his experience in2 patients with 29 involved thumbs. Three yearsater, he reported his experience with 50 patients.36
hese are the only 2 reports regarding the Braunrosthesis, both from its designer. The implantesign, cementing techniques, and surgical tech-iques, however, have changed considerably in theast 20 years. Therefore, the purpose of this articles to report our experience with the Braun-Cutterrapeziometacarpal joint prosthesis and its out-ome in the treatment of stage III and select casesf stage IV OA of the thumb carpometacarpalCMC) joint.
aterials and Methodsotal joint arthroplasty of the trapeziometacarpal
oint was performed on 26 thumbs in 25 patients (24
omen, 1 man) to treat advanced basal joint OA of hED P
ROO
F
he thumb between 1998 and 2003 (Table 1). Allatients were initially treated conservatively withonsteroidal anti-inflammatory medications, splint-ng, and steroid injections for a minimum of 6 to 12eeks. Surgical treatment was considered in thoseatients for whom the conservative treatment hadailed and who continued to have severe pain, loss ofinch strength, and lack of thumb motion that limitedheir activities of daily living.
Before surgery, we measured pain using a visualnalog scale, movement using a goniometer, griptrength using a dynamometer (Jamar Digital Handynamometer; Therapeutic Equipment Corp.,lifton, NJ), and pinch strength using a pinch gauge
Preston pinch gauge; JA Preston, New York, NY).adiographic assessment was performed according
o the Eaton-Littler method. Patients with Eatontage III trapeziometacarpal arthritis87 and selectedtage IV patients with clinically painless mildcaphotrapezial joint involvement were included inhis study. Patients with clinically painful scaphotra-ezial joints and those who had advanced radiologicsteoarthritic changes in the scaphotrapezial jointere excluded from having total joint arthroplasty of
he thumb CMC joint. We also excluded patientsho were younger than 60 years old or whose jobs
nvolved strenuous manual work, because we be-ieved that more active patients are not good candi-ates for implant arthroplasty.
emographicshe average patient age was 71 years; there were 24omen and 1 man. There was 1 bilateral case. The
ight thumb was involved in 17 patients and the leftn 9. The dominant hand was involved in 22 casesnd the nondominant in 4. None of the patients had
Table 1. Patient Demographics
Characteristic Value
Number of patients 25Number of thumbs 26Average age, y 71M:F ratio 24:1Dominant:nondominant hand
ratio 22:3Average duration of symptoms, y 3Average follow-up period, mo 46Average surgery time, min 45Preoperative pain (no. of patients)
At rest 20During strain 25
112113114115116117118119120121122123124
ad previous thumb surgery. Most patients com-
T
63646566676869707172737475767778798081828384858687888990919293949596979899
100101102103104105106107108109110111
1234567891011121314151617181920212223242526272829303132333435363738394041424344454647484950515253545556575859606162
p(lhr1iopozstw
eA
almcZ5vguw
STtcibsFstotwtsutrtptutiscttibt(bbmmipci
Fypcp
Badia and Sambandam / Total Joint Arthroplasty of Thumb CMC Joint 1.e3
AQ: 13
AQ: 14
AQ: 15
F1
AQ: 16
AQ: 17
AQ: 18
AQ: 19
AQ: 20
F2
F3
ARTICLE IN PRESS
UNCORREC
lained of diffuse pain about the thumb basal jointvisual analog scale score, 8–9/10) and decreasedateral pinch strength and grip strength. One patientad severe loss of the first web space. Patients expe-ienced symptoms an average of 3 years (range,–4 y) before surgery. Positive physical findingsncluded a grind test in all patients. Consistent pre-perative radiographic findings were dorsal metacar-al subluxation, the presence of prominent marginalsteophytes on the ulnar border of the distal trape-ium, joint space narrowing, cystic changes, andclerotic bone (Fig. 1). No patients had severe flat-ening or loss of trapezial height of the trapezium,hich would preclude the use of a CMC implant.Based on radiographic staging, 21 thumbs showed
vidence of Eaton stage III OA and 5 of stage IV OA.
igure 1. Radiographic study from the left thumb of a 67-ear-old woman showing complete loss of trapeziometacar-al joint space, subluxation, osteophytes, and subchondralysts. Total cemented arthroplasty was performed in thisatient.
dditional procedures performed at the time of CMC c
ED P
ROO
F
rthroplasty included endoscopic carpal tunnel re-ease (8 patients), volar capsulodesis of the firstetacarpophalangeal joint (4 patients), first extensor
ompartment release (6 patients), and first web space-plasty (1 patient). The average follow-up time was9 months (range, 26–68 mo). During the follow-upisits, pain (visual analog scale), motion, pinch andrip strengths, and x-ray appearances of the individ-al patients were personally evaluated. No patientas lost to follow-up study.
urgical Techniquehe Braun-Cutter trapeziometacarpal joint pros-
hesis was implanted in this series by using a boneement technique. A 3-cm, longitudinal, lazy-Sncision is performed over the dorsal aspect of thease of the thumb. Branches of the superficialensory radial nerve are identified and protected.urther dissection is performed between the exten-or pollicis longus and extensor pollicis brevisendons isolating and protecting the dorsal branchf the radial artery. The dorsal capsule of therapeziometacarpal joint is opened longitudinallyith a proximal-based flap. The periosteum and
he dorsal capsule are reflected proximally as aingle flap to be repaired later. A sagittal saw issed to remove the proximal 6- to 8-mm base ofhe thumb metacarpal. The adductor pollicis iseleased if required to allow abduction of thehumb metacarpal away from the palm. At thisoint, longitudinal traction and flexion are appliedo better expose the trapezial surface. A rongeur issed to remove the marginal osteophytes and flat-en the joint surface of the trapezium. With imag-ng, the center of the trapezium is identified with amall burr. The center hole is then enlarged toreate a deep channel within the trapezium wherehe polyethylene cup will be cemented. For thehumb metacarpal, a guide is used to open thentramedullary canal, which is broached with aurr to allow for an ample cement mantle. Therapezial cup is first cemented in the trapeziumFig. 2) with care taken to impact the cementeneath the subcortical bone. Once the cup haseen inserted and the cement cured, the thumbetacarpal component is inserted with bone ce-ent (Fig. 3). Because this stem is collarless, it is
mportant to maintain adequate neck length (torevent subsidence) until the bone cement hasured. Care is taken so that the stem neck does notmpinge on the edge of the trapezium. Once the
112113114115116117118119120121122123124
omponents are implanted and the cement has
T
63646566676869707172737475767778798081828384858687888990919293949596979899
100101102103104105106107108109110111
1234567891011121314151617181920212223242526272829303132333435363738394041424344454647484950515253545556575859606162
homtpDim
wsosacta(
CFf
bp(oqweapaettoG
RPtaoe
Ft
F
1.e4 The Journal of Hand Surgery / Vol. xx No. x Month 2006
F4
AQ: 21
F5
AQ: 22
AQ: 31
ARTICLE IN PRESS
UNCORRECardened, the stem is pressed into place in the cup
n the trapezium. Stability and circumferentialotion are assessed to ensure no impingement on
he implant (Fig.4). The proximal-based capsule–eriosteum flap is closed with absorbable suture.uring the procedure, intraoperative fluoroscopy
s performed to check proper alignment and place-ent of the prosthesis (Fig.5).We close the skin and the subcutaneous tissue
ith a resorbable suture and apply a well-paddedhort-arm thumb spica splint with the thumb inpposition for 1 week, after which rehabilitation istarted. An orthoplast thumb-based spica splint ispplied for further protection when thumb exer-ises are not performed. Patients rapidly regainhumb–to– base of small finger opposition with anctive and gentle active assisted range-of-motionROM) protocol.
linical Assessmentollow-up assessments of the patients were per-
igure 2. First, the polyethylene cup is cemented in therapezium.
ormed by an independent examiner who had not i
ED P
ROO
F
een involved in either the surgical procedure oratient care. A VAS was used to assess the pain level0, absence of pain to 10, severe pain). The frequencyf pain was also registered (never, occasional, fre-uent, constant). The grip strength was determinedith a dynamometer (Jamar Digital Hand Dynamom-
ter) and lateral pinch strength was determined withpinchmeter (Preston pinchmeter). Complete inter-
halangeal and metacarpophalangeal joint ROMsnd radial abduction were recorded with a goniom-ter. The ability to oppose the thumb to the base ofhe small finger was recorded as the distance from thehumb distal pulp to the fifth metacarpal head. Anbjective assessment was performed with the Buck-ramcko score.88,89
adiologic Evaluationosteroanterior and lateral radiographs were ob-
ained at the final follow-up evaluations to evalu-te cup migration, stem subsidence, zones of oste-lysis, and joint subluxation as defined by Wachtlt al.83,90
igure 3. Cementing and placement of the metacarpal stem
112113114115116117118119120121122123124
n the medullary canal are performed.
T
63646566676869707172737475767778798081828384858687888990919293949596979899
100101102103104105106107108109110111
1234567891011121314151617181920212223242526272829303132333435363738394041424344454647484950515253545556575859606162
RCP2apl
Sktasc
M(4caqe
lr
Lfiiovfs
Ssfcttchslpp
Oc
Fi
F
Badia and Sambandam / Total Joint Arthroplasty of Thumb CMC Joint 1.e5
F6
AQ: 23
ARTICLE IN PRESS
UNCORRECesults
linical Assessmentain relief. Complete pain relief was achieved in4 patients (96%). Mild pain was present in 1 patientfter traumatic injury to the hand. A revision of therosthesis was required for secondary loosening be-ieved to be caused by the injury.
trength. The preoperative pinch strength was 6.0g in the noninvolved side and 3.5 kg in the affectedhumb (61% of the contralateral side). The postoper-tive pinch strength was 6.5 kg in the noninvolvedide and 5.5 kg in the affected one (85% of theontralateral side).
obility. The final thumb radial abduction was 60°range, 50°–65°). Palmar abduction was more than0° in all patients, and all patients were able toomfortably hold large objects between the thumbnd index finger. Flexion and extension were notuantified but were satisfactory at the final follow-up
igure 4. Reduction of both components is followed by test-ng for stability and impingement of the prosthesis.
xamination. The final ROM of the metacarpopha- c
ED P
ROO
F
angeal joint was 5°–40°, and thumb oppositioneached the base of the small finger in all cases.
oosening analysis. Radiographic studies at thenal follow-up evaluation showed no evidence of
mplant loosening, cup migration, stem subsidence,r subluxation in either the anteroposterior or lateraliews of the thumb (Fig. 6). This was also the caseor the 1 patient in the series who had revisionurgery performed.
urvival analysis. There was only 1 revision (96%urvival) in our series, performed in a woman whoell after the primary replacement and dislocated theomponents. Closed reduction was obtained, and ahumb spica splint was used. Even though the pa-ient’s ROM continued improving she had mild dis-omfort, and 3 years after the original procedure shead revision surgery using the same type of prosthe-is for posttraumatic loosening. At the final fol-ow-up examination (5 years), she did not have anyain and radiographic findings were the same as foratients who did not have revision surgery.
bjective assessment. We used the Buck-Gram-ko score in this study to objectively assess the
igure 5. Fluoroscopic views are obtained to assess proper
112113114115116117118119120121122123124
ementing and correct implant positioning.
T
63646566676869707172737475767778798081828384858687888990919293949596979899
100101102103104105106107108109110111
1234567891011121314151617181920212223242526272829303132333435363738394041424344454647484950515253545556575859606162
o((Wesr
DRvarrtCiaspo9
oibsleipgsttd
fCpi
upGitclpetpaiadrOrdWrIalpedFisrp
Fn
1.e6 The Journal of Hand Surgery / Vol. xx No. x Month 2006
AQ: 24
ARTICLE IN PRESS
UNCORRECutcome. The mean total in our series was 53 points
range, 47–54), constituting an excellent outcomeAppendices 4, 5) can be viewed at the Journal’s
eb site, http://www.jhandsurg.org). There were 24xcellent results, and the patient who required revi-ion of her joint had good result (47 points ) after theevision surgery.
iscussionestoration of thumb function ideally should pro-ide pain-free, stable motion at the basal joint withdequate strength and proper balance of the entireay. In this study, we reported good to excellentesults after total joint cemented arthroplasty withhe Braun-Cutter implant) for the treatment ofMC OA in select patients. Twenty-four patients
n our series had an excellent outcome, and 1 hadgood outcome based on the Buck-Gramcko
core. Complete pain relief was achieved in 24atients (96%), and the average strength was 85%f that on the unaffected side. Implant survival was
igure 6. Radiographic study at the final follow-up exami-ation with no signs of implant loosening.
6% in our study. The only complication seen in a
ED P
ROO
F
ur series was an implant dislocation due to trauman 1 patient that later required revision surgeryecause of pain and posttraumatic loosening. Nopontaneous loosening was found. Fracture or dis-ocations of the prosthesis and posttraumatic loos-ning have been reported by few other researchersn the past. In 1985 Braun36 reported 2 cases ofosttraumatic loosening that required revision sur-ery. Complications such as asymptomatic orymptomatic loosening,36,65,66,69,70,71,82,83 hetero-ropic ossification,36,66,71 cement extrusion withendon and nerve injury,36 or reflex sympatheticystrophy36 were not seen in our series.Various surgical procedures have been described
or stage III and early stage IV OA of the thumbMC joint. The literature specifically regarding tra-eziometacarpal total joint arthroplasty is rather lim-ted, and the indications are not clearly delineated.
The de la Caffiniere implant is the most widelysed and most extensively studied im-lant65,69,70,73–76,78,80 – 83,91 (Appendix 3). TheUEPAR is another implant that has been reported
n the French67,85,86 and German84 literature. Evenhough surgeons in different parts of the worldontinue to use other implants, the indications andong-term outcomes of those implants are not re-orted frequently and hence are not adequatelystablished. In 1979, de la Caffiniere and Aucou-urier65 reported their experience with a total CMCrosthesis with 34 thumbs in 29 patients with anverage follow-up period of 2 years. That seriesncluded patients with both OA and rheumatoidrthritis of the thumb. There were 5 cases of ra-iographic loosening, but the functional resultsemained adequate and these were not revised.ther researchers have reported similarly good
esults with the de la Caffiniere prosthesis (Appen-ix 1). The only exception was the report byachtl33 in 1998. He reported his extensive expe-
ience in 84 patients with 88 thumbs involved.mplants required revision surgery in 10 cases withn overall survival rate of 66%, and asymptomaticoosening was detected in 52%. The reasons for hisoor results were not clearly evident, but the av-rage age of patients in his series was 61 years. Heid not report the activity levels of his patients.urther, he mentioned revision surgery for loosen-
ng but failed to mention whether his patients wereymptomatic or not. Recently, De Smet et al76
eported their experience with the de la Caffiniererosthesis with 43 thumbs in 40 patients with an
112113114115116117118119120121122123124
verage of 26 months of follow-up evaluation.
T
63646566676869707172737475767778798081828384858687888990919293949596979899
100101102103104105106107108109110111
1234567891011121314151617181920212223242526272829303132333435363738394041424344454647484950515253545556575859606162
TlcpTsp1crvbho
tmaEtvupcagntmictpIWdpea
ojtcsao
vfpp
annpcpcigmcacalammwoArpap
pwjicnrr
bwvcbnsbactrdttp
Badia and Sambandam / Total Joint Arthroplasty of Thumb CMC Joint 1.e7
AQ: 25
AQ: 26
ARTICLE IN PRESS
UNCORREC
here was no revision surgery in that series, butucent zones appeared in 44% (most of them oc-urring in patients younger than 60 years old);rogression to clinical loosening was not reported.he Braun prosthesis has been less extensivelytudied. Braun reported his initial experience in 22atients in 198271 and later in 50 patients in985.36 In the initial report he had to revise 3ases, and later in the larger series 4 implantsequired revision surgery. Braun believed that re-ision is possible in the context of implant failureecause of the well-preserved bone stock. Thereave been no reports by unbiased surgeons on theutcomes with use of this particular implant.We believe that the appropriate selection of pa-
ients for this procedure is an important factor deter-ining the outcome. Trapeziometacarpal total joint
rthroplasty is most commonly indicated for lateaton-Littler stage II and stage III OA. It is important
o determine if scaphotrapezial-trapezoidal joint in-olvement will influence the decision of whether tose an implant, which obviously requires trapezialreservation. North and Eaton92 found that 47% ofadavers had scaphotrapezial joint arthritic changeslong with trapeziometacarpal joint arthritis and sug-ested that routine complete trapezial excision wasot necessary. Several researchers68,81 included pa-ients with moderate scaphotrapezial joint involve-ent in their arthroplasty series and concluded that
nvolvement of the scaphotrapezial joint is not aontraindication for total joint implant arthroplasty ofhe thumb trapeziometacarpal joint. Our clinical ex-erience has also suggested that certain early stageV cases are amenable to this method of treatment.
e clinically assessed the scaphotrapezial-trapezoi-al joint by direct palpation of the joint dorsally. Aainful scaphotrapezial-trapezoidal joint was consid-red a contraindication to this procedure, as weredvanced radiographic changes in this joint.
Few reports78,84 have highlighted the importancef trapezial height for good surgical outcome in totaloint arthroplasty. With this in mind, we excludedhose patients with advanced radiographic OAhanges of the scaphotrapezial joint with a wedge-haped trapezium. We believe this factor might havelso contributed to the favorable outcome achieved inur series.Accurate implant design plays a vital part in de-
eloping a dependable and successful system. Dif-erent implant designs have been developed in theast. The Braun-Cutter design (SBI/Avanta Ortho-
aedics) consists of a metallic metacarpal component hED P
ROO
F
rticulated with a polyethylene cup trapezial compo-ent. The form and length of the metacarpal compo-ent of the Braun-Cutter prosthesis allows for centrallacement at an appropriate depth in the medullaryanal. Subsidence of this titanium metacarpal com-onent is prevented by 3 transverse troughs strategi-ally located on the stem of the implant. The conicalmplant shape and porous coated surface provides aood cement–prosthesis interface. The ultra-high–olecular-weight polyethylene of the trapezium
omponent has a cylindric outer shape that resembleschampagne cork and permits pressurization of the
ement and proper positioning. Once implanted, therticulated components lie at the normal anatomicevel of the trapeziometacarpal joint, which promotesppropriate muscle balance in the thumb. Further-ore, the relation between the neck diameter of theetacarpal component and the open surface and cupalls allows for unrestrained rotation and nearly 90°f motion in any direction without impingement.part from implant design, other possible factors
esponsible for good outcome are appropriate com-onent alignment, proper cementing techniques, andddressing the hyperextension of the thumb metacar-ophalangeal joint and metacarpal adduction.66
In our series, we revised the implant in only 1atient. The reason for revision in this caseas posttraumatic loosening with a painful
oint. This is in contrast to previous stud-es36,65,66,68,69,70,71,73,76,77,81– 83 in which the mostommon indication for revision was symptomaticontraumatic loosening. The sole patient who hadevision surgery in our series had a satisfactoryesult.
Total joint arthroplasty has been shown to giveetter or comparable functional results comparedith other surgical procedures performed for ad-anced trapeziometacarpal joint OA. Apart from theomparable functional results, another importantenefit it offers to patients is rapid recovery and theeed for minimal rehabilitation. The constrained de-ign principle obviates the need for prolonged immo-ilization, because soft-tissue and capsular healingre not critical for implant function. This key elementannot be overemphasized, because most of our pa-ients were elderly patients who lived alone andequired rapid recovery to continue living indepen-ently. Many had physical difficulty getting to theherapy sites. We believe this particular aspect con-ributed to the high level of satisfaction seen in ouratient group. All patients, including the one who
112113114115116117118119120121122123124
ad revision surgery, were happy with the outcome
T
63646566676869707172737475767778798081828384858687888990919293949596979899
100101102103104105106107108109110111
1234567891011121314151617181920212223242526272829303132333435363738394041424344454647484950515253545556575859606162
ap
tttplsiti
RA
aa
ES
R
1
1
1
1
1
1
1
1
1
1
2
2
2
2
2
2
2
2
2
1.e8 The Journal of Hand Surgery / Vol. xx No. x Month 2006
AQ: 2
AQ: 27
ARTICLE IN PRESS
UNCORREC
nd indicated they would have the same procedureerformed the other thumb if the need arose.We recognize that there are some shortcomings to
his study: The study is a prospective, noncompara-ive study without any control group. Furthermore,his study was performed on a selected subset ofatients who were over 60 years of age and wereow-demand patients and who had stage III or earlytage IV OA of the thumb basal joint. We believe thiss the group of patients who would most benefit fromhis procedure while maximizing success with anmplant.
eceived for publication August 30, 2004; accepted in revised formugust 9, 2006.The Journal of Hand Surgery / Vol. 31A No. 9 November 2006No benefits in any form have been received or will be received fromcommercial party related directly or indirectly to the subject of this
rticle.Corresponding author: Alejandro Badia, MD, FACS, Hand, Upper
xtremity and Microsurgery, Miami Hand Center, 8905 SW 87th Ave,te 100, Miami, FL 33176;e-mail: [email protected] © 2006 by the American Society for Surgery of the Hand0363-5023/06/xx0x-0001$32.00/0doi:10.1016/j.jhsa.2006.08.008
eferences1. Kuczynski K. Carpometacarpal joint of the human thumb. J
Anat 1974;118:119–126.2. Barron OA, Glickel SZ, Eaton RG. Basal joint arthritis of the
thumb. J Am Acad Orthop Surg 2000;8:314–323.3. Pelligrini VD Jr. Osteoarthritis of the trapeziometacarpal
joint: the pathophysiology of articular cartilage degenera-tion. II. Articular wear patterns in the osteoarthritic joint.J Hand Surg 1991;16A:975–982.
4. Eaton RG, Lane LB, Littler JW, Keyser JJ. Ligament recon-struction for the painful thumb carpometacarpal joint: along-term assessment. J Hand Surg 1984;9A:692–699.
5. Freedman DM, Eaton RG, Glickel SZ. Long-term results ofvolar ligament reconstruction for symptomatic basal jointlaxity. J Hand Surg 2000;25A:297–304.
6. Tomaino MM. Treatment of Eaton stage I trapeziometacar-pal disease. Ligament reconstruction or thumb metacarpalextension osteotomy? Hand Clin 2001;17:197–205.
7. Davis TR, Brady O, Barton NJ, Lunn PG, Burke FD. Tra-peziectomy alone with tendon interposition or with ligamentreconstruction? J Hand Surg 1997;22B:689–694.
8. Davis TR, Brady O, Dias JJ. Excision of the trapezium forosteoarthritis of the trapeziometacarpal joint: a study of thebenefit of ligament reconstruction or tendon interposition.J Hand Surg 2004;29A:1069–1077.
9. Diao E. Trapezio-metacarpal arthritis. Trapezium excisionand ligament reconstruction not including the LRTI arthro-plasty. Hand Clin 2001;17:223–236.
0. Gerwin M, Griffith A, Weiland AJ, Hotchkiss RN, McCor-mack RR. Ligament reconstruction basal joint arthroplastywithout tendon interposition. Clin Orthop 1997;342:42–45.
1. Nylen S, Johnson A, Rosenquist AM. Trapeziectomy and
ligament reconstruction for osteoarthrosis of the base of theED P
ROO
F
thumb. A prospective study of 100 operations. J Hand Surg1993;18B:616–619.
2. Rayan GM ,Young BT. Ligament reconstruction arthro-plasty for trapeziometacarpal arthrosis. J Hand Surg 1997;22A:1067–1076.
3. Burton RI, Pellegrini VD Jr. Surgical management of basaljoint arthritis of the thumb. Part II. Ligament reconstructionwith tendon interposition arthroplasty. J Hand Surg 1986;11A:324–332.
4. De Smet L, Sioen W, Spaepen D, van Ransbeeck H. Treat-ment of basal joint arthritis of the thumb: trapeziectomy withor without tendon interposition/ligament reconstruction.Hand Surg 2004;9:5–9.
5. De Smet L, Vanfleteren L, Sioen W, Spaepen D, van Rans-beeck H. Ligament reconstruction/tendon interposition ar-throplasty for thumb basal joint osteoarthritis: preliminaryresults of a prospective outcome study. Acta Orthop Belg2002;68:20–23.
6. Lins RE, Gelberman RH, Mckoewn L, Katz JN, KadiyalaRK. Basal joint arthritis: trapeziectomy with ligament recon-struction and tendon interposition arthroplasty. J Hand Surg1996;21A:202–209.
7. Liu Y, Chang MC. Ligament reconstruction and tendoninterpositional arthroplasty for degenerative arthritis of thethumb trapeziometacarpal joint. Zhonghua Yi Xue Za Zhi(Taipei) 1999;62:795–800.
8. Tomaino MM. Ligament reconstruction tendon interpositionarthroplasty for basal joint arthritis. Rationale, current tech-nique, and clinical outcome. Hand Clin 2001;17:207–221.
9. Tomaino MM, King J. Ligament reconstruction tendon in-terposition arthroplasty for basal joint arthritis: simplifyingflexor carpi radialis tendon passage through the thumb meta-carpal. Am J Orthop 2000;29:49–50.
0. Tomaino MM, Pellegrini VD Jr, Burton RI. Arthroplasty ofthe basal joint of the thumb. Long-term follow-up afterligament reconstruction with tendon interposition. J BoneJoint Surg 1995;77A:346–355.
1. Barron OA, Eaton RG. Save the trapezium: double interpo-sition arthroplasty for the treatment of stage IV disease of thebasal joint. J Hand Surg 1998;23A:196–204.
2. Dell PC, Muniz RB. Interposition arthroplasty of the trape-ziometacarpal joint for osteoarthritis. Clin Orthop 1987;220:27–34.
3. Eaton RG, Glickel SZ, Littler JW. Tendon interpositionarthroplasty for degenerative arthritis of the trapeziometa-carpal joint of the thumb. J Hand Surg 1985;10A:645–654.
4. Froimson AI. Tendon interposition arthroplasty of carpo-metacarpal joint of the thumb. Hand Clin 1987;3:489–505.
5. Imaeda T, Cooney WP, Niebur GL, Linscheid RL, An KN.Kinematics of the trapeziometacarpal joint: a biomechanicalanalysis comparing tendon interposition arthroplasty andtotal joint arthroplasty. J Hand Surg 1996;21A:544–553.
6. Kleven T, Russwurm H, Finsen V. Tendon interpositionarthroplasty for basal joint arthrosis. 38 thumbs followed for4 years. Acta Orthop Scand 1996;67:575–577.
7. Menon J. Partial trapeziectomy and interpositional arthro-plasty for trapeziometacarpal osteoarthritis of the thumb.J Hand Surg 1995;20B:700–706.
8. Menon J, Schoene HR, Hohl JC. Trapeziometacarpal arthri-tis—results of tendon interpositional arthroplasty. J Hand
112113114115116117118119120121122123124
Surg 1981;6A:442–446.
T
63646566676869707172737475767778798081828384858687888990919293949596979899
100101102103104105106107108109110111
1234567891011121314151617181920212223242526272829303132333435363738394041424344454647484950515253545556575859606162
2
3
3
3
3
3
3
3
3
3
3
4
4
4
4
4
4
4
4
4
4
5
5
5
5
5
5
5
5
5
5
6
6
6
6
6
6
6
6
Badia and Sambandam / Total Joint Arthroplasty of Thumb CMC Joint 1.e9
AQ: 28
AQ: 29
ARTICLE IN PRESS
UNCORREC
9. Mureau MA, Rademaker RP, Verhaar JA, Hovius SE. Ten-don interposition arthroplasty versus arthrodesis for thetreatment of trapeziometacarpal arthritis: a retrospectivecomparative follow-up study. J Hand Surg 2001;26A:869–876.
0. Nylen S, Juhlin LJ, Lugnegard H. Weilby tendon interposi-tion arthroplasty for osteoarthritis of the trapezial joints.J Hand Surg 1987;12B:68–72.
1. Weilby A. Tendon interposition arthroplasty of the firstcarpo-metacarpal joint. J Hand Surg 1988;13B:421–425.
2. Gibbons CE, Gosal HS, Choudri AH, Magnussen PA. Tra-peziectomy for basal thumb joint osteoarthritis: 3- to 19-yearfollow-up. Int Orthop 1999;23:216–218.
3. Varley GW, Calvey J, Hunter JB, Barton NJ, Davis TR.Excision of the trapezium for osteoarthritis at the base of thethumb. J Bone Joint Surg 1994;76B:964–968.
4. Amadio PC. A comparison of fusion, trapeziectomy, andSilastic replacement for the treatment of osteoarthritis of thetrapeziometacarpal joint. J Hand Surg 2005;30B:331–332.
5. Taylor EJ, Desari K, D’Arcy JC, Bonnici AV. A comparisonof fusion, trapeziectomy and Silastic replacement for thetreatment of osteoarthritis of the trapeziometacarpal joint.J Hand Surg 2005;30B:45–49.
6. Braun RM. Total joint arthroplasty at the carpometacarpaljoint of the thumb. Clin Orthop 1985;195:161–167.
7. Hobby JL, Lyall HA, Meggitt BF. First metacarpal osteot-omy for trapeziometacarpal osteoarthritis. J Bone Joint Surg1998;80B:508–512.
8. Holmberg J, Lundborg G. Osteotomy of the first metacarpalfor osteoarthrosis of the basal joints of the thumb. Scand JPlast Reconstr Surg Hand Surg 1996;30:67–70.
9. Molitor PJ, Emery PJ, Meggitt BF. First metacarpal osteot-omy for carpo-metacarpal osteoarthritis. J Hand Surg 1991;16B:424–427.
0. Tomaino MM. Treatment of Eaton stage I trapeziometacar-pal disease with thumb metacarpal extension osteotomy.J Hand Surg 2000;25A:1100–1106.
1. Wilson JN, Bossley CJ. Osteotomy in the treatment of os-teoarthritis of the first carpometacarpal joint. J Bone JointSurg 1983;65B:179–181.
2. Amadio PC, De Silva SP. Comparison of the results oftrapeziometacarpal arthrodesis and arthroplasty in men withosteoarthritis of the trapeziometacarpal joint. Ann Chir MainMemb Super 1990;9:358–363.
3. Bamberger HB, Stern PJ, Kiefhaber TR, McDonough JJ,Cantor RM. Trapeziometacarpal joint arthrodesis: a func-tional evaluation. J Hand Surg 1992;17A:605–611.
4. Carroll RE. Arthrodesis of the carpometacarpal joint of thethumb. A review of patients with a long postoperative pe-riod. Clin Orthop 1987;220:106–110.
5. Damen A, Dijsktra T, van der Lei B, den Dunnen WF,Robinson PH. Long-term results of arthrodesis of the car-pometacarpal joint of the thumb. Scand J Plast ReconstrSurg Hand Surg 2001;35:407–413.
6. Hartigan BJ, Stern PJ, Kiefhaber TR. Thumb carpometacar-pal osteoarthritis: arthrodesis compared with ligament recon-struction and tendon interposition. J Bone Joint Surg 2001;83A:1470–1478.
7. Lisanti M, Rosati M, Spagnolli G, Luppichini G. Trapezi-ometacarpal joint arthrodesis for osteoarthritis. Results of
power staple fixation. J Hand Surg 1997;22B:576–579.ED P
ROO
F
8. Peng YP, Low CK, Looi KP. Comparison of first carpometa-carpal joint arthrodesis with contralateral excision arthro-plasty in a patient with bilateral saddle joint arthritis: a casereport. Ann Acad Med Singapore 1999;28:451–454.
9. Amadio PC, Millender LH, Smith RJ. Silicone spacer or ten-don spacer for trapezium resection arthroplasty—comparisonof results. J Hand Surg 1982;7:237–244.
0. Braun RM. Stabilization of Silastic implant arthroplasty atthe trapezometacarpal joint. Clin Orthop 1976;121:263–270.
1. Eiken O, Necking LE. Silicone rubber implants for arthrosisof the scaphotrapezial trapezoidal joint. Scand J Plast Re-constr Surg 1983;17:253–255.
2. Freeman GR, Honner R. Silastic long term replacement ofthe trapezium. J Hand Surg 1992;17B:458–462.
3. Hay EL, Bomberg BC, Burke C, Misenheimer C. Results ofsilicone trapezial implant arthroplasty. J Arthroplasty 1988;3:215–223.
4. Hofammann DY, Ferlic DC, Clayton ML. Arthroplasty ofthe basal joint of the thumb using a silicone prosthesis—long-term follow-up. J Bone Joint Surg 1987;69A:993–997.
5. Lehmann O, Herren DB, Simmen BR. Comparison of ten-don suspension-interposition and silicon spacers in the treat-ment of degenerative osteoarthritis of the base of the thumb.Ann Chir Main Memb Super 1998;17:25–30.
6. Lovell ME, Nuttall D, Trail IA, Stilwell J, Stanley JK. Apatient-reported comparison of trapeziectomy with SwansonSilastic implant or sling ligament reconstruction. J HandSurg 1999;24B:453–455.
7. Niebauer JJ, Shaw JL, Doren WW. Silicone-Dacron hingeprosthesis. Design, evaluation, and application. Ann RheumDis 1969;28(suppl):56–58.
8. Ruffin RA, Rayan GM. Treatment of trapeziometacarpalarthritis with Silastic and metallic implant arthroplasty.Hand Clin 2001;17:245–253.
9. Swanson AB. Finger joint replacement by silicone rubberimplants and the concept of implant fixation by encapsula-tion. Ann Rheum Dis 1969;28(suppl):47–55.
0. Swanson AB. Disabling arthritis at the base of the thumb:treatment by resection of the trapezium and flexible (sili-cone) implant arthroplasty. J Bone Joint Surg 1972;54A:456–471.
1. Swanson AB, Swanson dee doot G, Watermeier JJ. Trape-zium implant arthroplasty. Long-term evaluation of 150cases. J Hand Surg 1981;6:125–141.
2. Tagil M, Kopylov P. Swanson versus APL arthroplasty inthe treatment of osteoarthritis of the trapeziometacarpaljoint: a prospective and randomized study in 26 patients.J Hand Surg 2002;27B:452–456.
3. Weilby A, Sondorf J. Results following removal of siliconetrapezium metacarpal implants. J Hand Surg 1978;3:154–156.
4. Wood VE. Unusual complication of a silicone implant ar-throplasty at the base of the thumb. J Hand Surg 1984;9B:67–68.
5. de la Caffiniere JY, Aucouturier P. Trapezio-metacarpalarthroplasty by total prosthesis. Hand 1979;11:41–46.
6. Cooney WP, Linscheid RP, Askew LJ. Total arthroplasty ofthe thumb trapeziometacarpal joint. Clin Orthop 1987;220:35–45.
7. Alnot JY, Beal D, Oberlin C, Salon A, Guepar. GUEPAR
112113114115116117118119120121122123124total trapeziometacarpal prosthesis in the treatment of arthri-
T
63646566676869707172737475767778798081828384858687888990919293
1234567891011121314151617181920212223242526272829303132333435363738394041424344454647484950515253545556575859606162
6
6
7
7
7
7
7
7
7
7
7
7
8
8
8
8
8
8
8
8
8
8
9
9
9
1.e10 The Journal of Hand Surgery / Vol. xx No. x Month 2006
AQ: 30
ARTICLE IN PRESS
C
tis of the thumb-36 case reports. Ann Chir Main MembSuper 1993;12:93–104.
8. Alnot JY, Saint Laurent Y. Total trapeziometacarpal arthro-plasty. Report on seventeen cases of degenerative arthritis ofthe trapeziometacarpal joint. Ann Chir Main 1985;4:11–21.
9. August AC, Coupland RM, Sandifer JP. Short term reviewof the de la Caffiniere trapeziometacarpal arthroplasty.J Hand Surg 1984;9B:185–188.
0. Boeckstyns ME, Sinding A, Elholm KT, Rechnagel K. Re-placement of the trapeziometacarpal joint with a cemented(Caffiniere) prosthesis. J Hand Surg 1989;14A:83–89.
1. Braun RM. Total joint replacement at the base of the thumb-preliminary report. J Hand Surg 1982;7A:245–251.
2. Braun RM, Feldman CW. Total joint replacement at the baseof the thumb. Semin Arthroplasty 1991;2:120–129.
3. Chakrabarti AJ, Robinson AH, Gallagher P. de la Caffinierethumb carpometacarpal replacements—93 cases at 6 to 16years follow-up. J Hand Surg 1997;22B:695–698.
4. de la Caffiniere JY. Longevity factors in total trapezometa-carpal prostheses. Chir Main 2001;20:63–67.
5. de la Caffiniere JY. Long-term results of the total trapezio-metacarpal prosthesis in osteoarthritis of the thumb. RevChir Orthop Reparatrice Appar Mot 1991;77:312–321.
6. De Smet L, Sione W, Spaepen D, van Ransbeeck H. Totaljoint arthroplasty for osteoarthritis of the thumb basal joint.Acta Orthop Belg 2004;70:19–24.
7. Ferrari B, Steffee AD. Trapeziometacarpal total joint re-placement using the Steffee prosthesis. J Bone Joint Surg1986;68A:1177–1184.
8. Guggenheim-Gloor PR, Wachtl SW, Sennwald GR. Pros-thetic replacement of the first carpometacarpal joint with acemented ball and socket prosthesis (de la Caffiniere). Hand-chir Mikrochir Plast Chir 2000;32:134–137.
9. Linscheid RL, Dobyns JH. Total joint arthroplasty. Thehand. Mayo Clin Proc 1979;54:516–526.
0. Nicholas RM, Calderwood JW. de la Caffiniere arthroplastyfor basal thumb joint osteoarthritis. J Bone Joint Surg 1992;74B:309–312.
UNCORRE1. Sondergaard L, Konradsen L, Rechnagel K. Long-term fol-
ED P
ROO
F
low-up of the cemented Caffiniere prosthesis fortrapezio-metacarpal arthroplasty. J Hand Surg 1991;16B:428–430.
2. van Cappelle HG, Elzenga P, van Horn JR. Long-termresults and loosening analysis of de la Caffiniere replace-ments of the trapeziometacarpal joint. J Hand Surg 1999;24A:476–482.
3. Wachtl SW, Guggenheim PR, Sennwald GR. Cemented andnon-cemented replacements of the trapeziometacarpal joint.J Bone Joint Surg 1998;80B:121–125.
4. Masmejean E, Alnot JY, Beccari R. Surgical replacement ofthe thumb saddle joint with the GUEPAR prosthesis. Ortho-pade 2003;82:798–802.
5. Masmejean E, Alnot JY, Chantelot C, Beccari R. Gueparanatomical trapeziometacarpal prosthesis. Chir Main 2003;22:30–36.
6. Alnot JY, Muller GP. A retrospective review of 115 cases ofsurgically-treated trapeziometacarpal osteoarthritis. RevRhum Engl Ed 1998;65:95–108.
7. Eaton RG, Glickel SZ. Trapeziometacarpal osteoarthritis-staging as a rationale for treatment. Hand Clin 1987;3:455–471.
8. Buck-Gramcko D, Dietrich FE, Gogge S. Evaluation criteriain follow-up studies of flexor tendon therapy. Handchirurgie1976;8:65–69.
9. Kriegs-Au G, Petje G, Fojtl E, Ganger R, Zachs I. Ligamentreconstruction with or without tendon interposition to treatprimary thumb carpometacarpal osteoarthritis. Surgical tech-nique. J Bone Joint Surg 2005;87A(suppl 1):78–85.
0. Wachtl SW, Guggenheim PR, Sennwald GR. Radiologicalcourse of cemented and uncemented trapeziometacarpalprostheses. Ann Chir Main Memb Super 1997;16:222–228.
1. de la Caffiniere JY, Mazas F, Achach PC. The stage ofarticular destruction in the rheumatoid hand. Rev Chir Or-thop Reparatrice Appar Mot 1975;61:61–74.
2. North ER, Eaton RG. Degenerative joint disease of thetrapezium: a comparative radiographic and anatomic study.
949596979899
100101102103104105106107108109110111112113114115116117118119120121122123124
J Hand Surg 1983;8:160–166. 32-37
UNCORRECTED PROOF
63646566676869707172737475767778798081828384858687888990919293949596979899
100101102103104105106107108109110111112113114115116117118119120121122123124
1234567891011121314151617181920212223242526272829303132333435363738394041424344454647484950515253545556575859606162
Appendix 1. Total Cemented Joint Arthroplasty of the Thumb: Outcome Studies in the English Literature
Study YearNo. of
Pts/JointsAge,
ySTJ
InvolvedSide,
D/NDGender,
M/F ImplantFollow-Up
Period
Outcome Revision, n(Implant
Survival, %)
Complications, n
RelevantConclusionsE G F P ASL SL Other
de la Caffiniere andAucouturier 65
1979 29/34 59 Yes NM NM DLC 24 mo — 20 — 4 4 5 NM — —
Braun71 1982 22/29 NM NM NM NM Braun 1–7 y — 22 — — 3 3 NM 1 septiclooseningHO,6 CE, 1
Revision possiblebecause of intactbone stock
August et al69 1984 20/21 57 NM 2.5:1 1:3 DLC 15 mo NM 5 (76) 9 5 — —Braun36 1985 50/0 NM NM NM NM Braun 6 mo–10 y — 26 — — 4 1 4 (2
PT)— —
Alnot and SaintLaurent68
1985 15/17 56 Yes NM NM DLC 1–10 y;avg, 3 y
— 13 — — 3 NM NM — Repeat surgeryalways possible.Pantrapezialdisease not acontraindication
Ferrari and Steffee77 1986 38/45 61 NM 21/29 7/31 Steffee 2–6 y NM 3 11 5 1 septicloosening
Loosening not tendsto increase withtime. Salvageprocedurepossible in theevent of failure
Cooney et al66 1987 57/63 62 NM 39/23 6/56 Mayo 4–6 y 21 28 6 7 12(81) 20 12 1 septicloosening HO,36%
Careful prostheticalignment,cementingtechniquesrequired
Boeckstyns et al70 1989 28/31 62 NM 8/12 3/25 DLC 13–77 mo NM 4 3 4 — —Sondergaard et al81 1991 20/22 60 NM 18/7 3/20 DLC 9 y NM 3(82) 3 3 — Accelerated
tendency of latefailure not seen
Nicholas andCalderwood80
1992 20/20 57.2 NM NM 4/13 DLC 10 y — — — 3 NM 1 NM 1 Dis 1 TC Radiologic lucencydoes not affectfunction
Chakrabarti et al73 1997 71/93 57 NM NM 9/62 DLC 6–16 y NM 11(89) 13 9 1 Dis 1 CE Implant failed inmen younger than65 y
Wachtl et al83 1998 84/88 61 Yes NM NM DLC 63 mo NM 10 (66.4) 52% NM — Pantrapezial diseasenot acontraindication.Revision givessatisfactory result.Most revisionsoccur within 2 y
van Cappelle et al82 1999 63/77 62 NM 38/39 11/60 DLC 2–16 y;avg, 8.5y
NM 16(72) 13 14 — Cemented prosthesishas better survival
De Smet et al76 2004 40/43 54 NM 22/21 3/37 DLC NM 1 14 10 — Loosening related toyoung age
ASL, asymptomatic loosening; avg, average; CE, cement extrusion; D, dominant; Dis, dislocation; DLC, de la Caffiniere; E, excellent; F, fair; G, good; HO, heterotopic ossification; ND,nondominant; NM, no mention; P, poor; PT, posttraumatic; pts, patients; SL, symptomatic loosening; STJ, scaphotrapezial joint; TC, trapezial collapse.
Badia
andSam
bandam/
TotalJoint
Arthroplasty
ofThum
bC
MC
Joint1.e11
ARTICLE IN PRESS
TED P
R
63646566676869707172737475767778798081828384858687888990919293949596979899
100101102103104105106107108109110111
1234567891011121314151617181920212223242526272829303132333435363738394041424344454647484950515253545556575859606162
rapezial.
1.e12 The Journal of Hand Surgery / Vol. xx No. x Month 2006
AQ: 38
AQ: 39
AQ: 40
AQ: 41
AQ42-43
AQ: 44
AQ: 45
ARTICLE IN PRESS
UNCORREC
Appendix 2. Total Cemented Joint Arthroplasty of
Study Year
No. ofPatients/
JointsST JointInvolved
de la Caffiniere75
1991 NM/13 YesAlnot et al67
1993 32/36 YesAlnot and
Muller86
1998 NM/90 NMde la Caffiniere74
2001 NM/13 YesGuggenheim-
Gloor et al78
2000 NM/43 NMMasmejan et al84
2003 NM/51 NMMasmejan et al85
2003 60/64 Yes
avg, average; DLC, de la Caffiniere; NM, no mention; ST, scaphot
Appendix 3. Various Implant Designs Available on
Design ManufacturerMetacComp
Lewis79 Howmedica PolyethylMayo66 Depuy Polyethylde la Caffiniere65,74–76,91
FrancobalCobalt ch
stemBraun-Cutter prosthesis Avanta Orthopedics
(now SBI) TitaniumBraun36,71 Zimmer Metallic sGUEPAR67,84,85 GUEPAR Group Metallic sSteffe77 Laure Prosthetics Metallic s
OO
F
the Thumb: Outcome Studies in Non-English Literature
ImplantUsed
Follow-UpPeriod Conclusions
DLC 12 yLong-term result seems to be good
despite high level of loosening
GUEPAR1–9 y(avg,
3.5 y) Trapezial height is a significant factor
GUEPAR 5.75 y
Trapezial height �7 mm, young age,and dominant hand are adversefactors affecting outcome
DLC 12–17 y
Dominant hand in heavy workers is acontraindication. Involvement of STjoint is not a contraindication.Trapezial height is a significantfactor.
DLC 63 mo
This procedure is reserved for elderlypatients not involved in strenuousexercise
GUEPAR 27 moRadiologic loosening does not affect
clinical outcome
GUEPAR 29 mo
Revision and salvage procedurepossible in the event of failure.Trapezial height is a significantfactor affecting outcome
the Market
arpalonent
TrapezialComponent
Collar inthe Stem
Horizontal Groovesin the Stem
FixationTechnique
ene cup Metallic ball NA NA Cementene cup Metallic ball NA NA Cementromium
Polyethylene cup Yes No Cement
Polyethylene cup No Yes Cementtem Polyethylene cup No Yes Cementtem Polyethylene cup Yes No Cementtem Polyethylene cup Yes No Cement
112113114115116117118119120121122123124
NA, not available.
6364656667686970717273747576777879
1234567891011121314151617181920212223242526272829303132333435363738394041424344454647484950515253545556575859606162
Badia and Sambandam / Total Joint Arthroplasty of Thumb CMC Joint 1.e13
AQ: 46
ARTICLE IN PRESS
Appendix 4. Objective Outcome Based on Buck-Gramcko Score at Final Follow-Up Evaluation
Measurement No. of Points Thumbs
Palmar abduction, °�40 6 2630–39 420–29 2�20 0
Radial abduction, °�40 6 2630–39 420–29 2�20 0
Tip pinch compared withcontralateral side, %�100 6�80 4 2660–79 2
UNCORREC
T8081828384858687888990919293949596
�60 0
ED P
ROO
F
Appendix 5. Subjective Outcome Based onBuck-Gramcko Score at Final Follow-UpEvaluation
Characteristic No. of Points Patients
Pain frequencyNever 6 24Occasional 4 1Frequent 2Constant 0
StrengthImproved 6 25Same 3Worse 0
Daily functionNo difficulty 6 25Mild difficulty 4Moderate difficulty 2Severe difficulty 0
DexterityImproved 6 25Same 3Worse 0
AppearanceExcellent 6 24Good 3 1Acceptable 2Poor 0
Would you have surgery again?Yes 4 25No 0 0
Overall assessmentExcellent 6 24Good 4 1Fair 2Poor 0
Grade of total scoreExcellent 49–56 24Good 40–48 1Fair 28–39Poor 28
979899
100101102103104105106107108109110111112113114115116117118119120121122123124
Mean total score, points 53