Abstract
Long-term follow up after replacement arthroplasty has become established as a “Gold Standard”, providing information that can aid optimisation in future prosthetic design and use. In less mainstream joint replacements however, the evidence for use of prostheses, and in particular long-term outcome, is scarce.
A cohort of 71 patients (93 implants) was reviewed in 1997 having had a De la Caffinière prosthesis implanted between 1980 and 1989. The conclusions of the study included the findings that the replacement was generally well regarded by recipients, pain was improved and survivorship was comparable with data from the best hip replacements.
Ethical permission was obtained to review the same cohort ten years on (16 – 26 years post-op). Similar outcome measures were employed as in the original study but in addition formal grip strength measurements were taken, along with newer outcome scores including the DASH (Disability of arm, shoulder and hand) and EQ-5D (a European quality of life measure). Radiographs allowed assessment of radiological failure using the criteria from the original study.
We found a significant mortality rate in the interim period since the original review (27 patients, 36 implants). A further 8 implants in 8 patients had been removed and were not clinically reviewed as per patients’ wishes. However, 39 implants in 26 patients were available for follow up at a mean 19 years (SD 6.3) leaving a “lost to follow up” rate of 10 patients (10 implants). Survivorship at 26 years was 73.9% (95% CI 61.2, 86.6) with the end-point as revision. Our data also demonstrated continued patient satisfaction without pain, satisfactory power and thumb mobility.
Such information may be used to counsel future patients requiring surgery that there is a functional alternative to excision arthroplasty (trapeziectomy).
The abstracts were prepared by Mr Matt Costa and Mr Ben Ollivere. Correspondence should be addressed to Mr Costa at Clinical Sciences Research Institute, University of Warwick, Clifford Bridge Road, Coventry CV2 2DX, UK.
