Abstract
Background: Osteoarthritis of the first trapeziometacarpal (TMC) joint is a disabling disease which reduces the function of the thumb and the hand. Replacement arthroplasty offers good range of joint motion and also maintains thumb length thus improving tip pinch grip.
Aims: This study reviews the results of TMCJ arthroplasty using a cemented metal-on-polyethylene implant (Sr TMC, Avanta®).
Methods and Results: Between 2001–2005 seventy two (n = 72) TMCJ cemented Arthroplasties were performed by a single surgeon. Patients were followed in the clinics for up to seven years (median follow up 36 months, range 24–84). Patients were reviewed clinically and radiologically by two independent assessors. For outcome, Sollerman and Quick-DASH (Disabilies of the Arm, Shoulder and Hand Score) scores were used. A Jamar dynamometer was used to assess the grip and pinch strengths. Thirty six patients (46 joints, n = 46), were seen at final follow up. There were 13 male and 23 female patients. Ten patients had bilateral TMCJ replaced.
Six patients were revised to trapeziectomy and ligament reconstruction with tendon interposition. Four for aseptic loosening and two for dislocation. With revision as end point the survival rate at median follow up of 36 months was 89%. At final follow up mean Quick DASH score was 29.2 and mean Sollerman Score was 77.1. Radiological review of the surviving joints showed subsidence of trapezial component in 4 joints. However these patients had good hand function and grip strength and therefore declined revision surgery. We found that the radiological findings did not correlate with clinical findings. 83% patients were satisfied with the outcome of their treatment.
Conclusion: Early results of Sr-TMC (Avanta) joint replacement are encouraging. We recommend the use of this prosthesis for osteoarthritis of the trapeziometacarpal joint.
Correspondence should be addressed to: EFORT Central Office, Technoparkstrasse 1, CH – 8005 Zürich, Switzerland. Email: office@efort.org
