Aims. Osteoarthritis (OA) affecting the thumb carpometacarpal joint (CMCJ) is a common painful condition. In this study, we aimed to explore clinicians’ approach to management with a particular focus on the role of specific interventions that will inform the design of future clinical trials. Methods. We interviewed a purposive sample of 24 clinicians, consisting of 12 surgeons and 12 therapists (four occupational therapists and eight physiotherapists) who managed patients with CMCJ OA. This is a qualitative study using semi-structured, online interviews. Interviews were audio-recorded, transcribed verbatim, and analyzed using thematic analysis. Results. A total of 14 themes were developed, six of which were developed relating to the clinical management of CMCJ OA: 1) A flexible ‘ladder’ approach starting with conservative treatment first; 2) The malleable role of steroid injection; 3) Surgery as an invasive and risky last resort; 4) A shared and collaborative approach; 5) Treating the whole person; and 6) Severity of life impact influences treatment. The remaining eight themes were developed relating to clinical trial barriers and facilitators: 1) We need to embrace uncertainty; 2) You are not losing out by taking part; 3) It is difficult to be neutral about certain treatments; 4) Difficult to recruit to ‘no treatment’ ; 5) Difficult to recruit to a trial comparing no surgery to surgery; 6) Patients are keen to participate in research; 7) Burden on staff and participants; and 8) A enthusiasm for a variety of potential trial arms. Conclusion. Our findings contribute to a better understanding of how clinicians manage thumb CMCJ OA in their practice settings. Our study also provides useful insights informing the design of randomized clinical trials involving steroid injections and surgery in people with thumb CMCJ OA. Cite this article: Bone Jt Open 2022;3(4):321–331

Introduction. Despite the rising popularity of 1st carpometacarpal joint (CMCJ) arthrodesis as one of the surgical options for basilar thumb arthritis, the available literature on this is poor. This study aims to investigate post-operative pinch and grip strength following 1st CMCJ arthrodesis, at a minimum of 1 year follow-up. Complication rates, range of motion and patient reported scores were also evaluated. Methods. A retrospective cohort (2012–2020) was used, which included patients who had arthrodesis performed by the Hands surgeons at Counties Manukau DHB. In a 15 minute visit, we took the measurements using our standard dynamometer and pinch gauge, and collected three questionnaires [QuickDASH, PRWHE, PEM]. For analysis, we compared our results to the preoperative measures, contralateral hand, and to a previous study on a similar cohort looking at thumb strength following trapeziectomy. Results. 42 arthrodesis were performed, and 24 were available for follow-up. The average follow-up time was 77 months and the average age was 51 years old. Overall, we found a statistically significant improvement in thumb strength following surgery. Mean preoperative grip strength was 21.4kg and 32.5kg postoperatively (= +11kg). Preoperative pinch strength was 5.5kg and 7kg postoperatively (= +1.5kg). These results were significantly higher compared to the trapeziectomy cohort. We also found an improvement in 1st CMCJ ROM post-operatively. 7 complications were reported (29.1%). 4 were metalware-related and 3 were non-union. QuickDASH score significantly improved from a median of 42.95 to 12.5 while PRWHE from 67.5 to 14.5. Overall patient satisfaction was 87.4%. Conclusion. 1st CMCJ arthrodesis leads to an improvement in thumb function, pain and range of movement and results in high patient satisfaction, and therefore should be recommended for younger patients who need a pain-free and strong thumb

Introduction. There are conflicting reports about the efficacy of injection to the thumb carpometacarpal joint (CMCJ) for osteoarthritis (OA). The accuracy of joint injection without radiological control is unclear. We investigated the accuracy of blind injection and recorded their immediate and short term efficacy. Materials/Methods. We injected 25 consecutive patients between March 2010-January 2011. The CMCJ was palpated, manually distracted and a 23 gauze needle introduced blindly. Image intensifier was then used to visualize and redirect needle if necessary. Radio-opaque dye was injected to confirm intra-articular placement. We recorded patient demographics, number of attempts required for correct needle placement, pre and 10 minutes post-injection visual analogue scale (VAS) pain score, and Nelson Score (NS)before and six weeks after injection. NS is a validated thumb CMCJ specific patient administered questionnaire. Results. Mean age was 60 (range 46–90). M:F ratio was 23:2. CMC J OA ranged from grade 2–4.1. st. attempt was successful in 6 cases. Mean attempts required for accurate injection was 3 (range 0–4). Mean pain pre- injection VAS was 7 (range 4–10), 10 minutes following injection 0.5 (range 0–4) and at 6 weeks 5 (range 3–10). Mean pre-operative NS was 29.6 (range 14–65) and at 6 weeks 32.4 (range 14–55). The difference was not statistically significant (paired t test, p=0.24). Conclusion. Our results suggest that blind injection of thumb CMCJ may not be accurate. Accuracy can be improved by X-ray guided injection. The procedure afforded excellent immediate pain relief but was not effective over six weeks follow up

The purpose of the study was to evaluate the outcome of de la Caffinière prosthesis in the management of rheumatic destruction of the first carpometacarpal joint. By the end of 1998 the procedure was performed on 49 patients, 20 on the right hand and 29 on the left. All patients were addressed with a letter query and patient records and radiographs were assessed. Subjective contentment was measured with visual analog scale (VAS) and a questionnaire. Thirty six of the patients had seropositive rheumatoid arthritis, 8 juvenile chronic arthritis and 5 other rheumatic variants. The mean follow-up was 8.6 (0.5–17) years. Subjective contentment was either excellent of good in 88% of the patients, and 75% were painfree. Survival analysis with reoperation or significant loosening as end point was performed. Two cups loosened and one prosthesis was constantly dislocated, and these three were revised with tendon interposition technique. The survival rate was 96% (95% CI 84 to 99) at 5 years, and 92% (95% CI 77 to 97) at ten years. Fairly good 10-year survival and encouraging subjective results have lead us to plan and start a clinical out-patient follow-up study to collect additional objective data on implant survival and function. Preliminary results of the new study yield superior range of motion compared to tendon interposition arthroplasty, which is the golden standard in our institute at the moment. However, we promote caution and emphasize the importance of patient selection since two additional revisions in our latter study may reveal a subgroup which is more prone to implant failure

Purpose of the study: To our knowledge, only qualitative data is available concerning the tension placed on the first carpometacarpal ligaments as a function of joint motion. The three articles published in the literature have provided discordant data. We conducted a quantitative study. Material and methods:. Digitalized computed tomographies of the carpometacarpal joints magnified threefold were fed to a Stratasys® machine which created a rapid «polystyrene shock» prototype of the first and second metacarpals as well as the trapezium and the trapezoid. After a preliminary study of the behavior observed with various materials, rubber with known consistency was used to simulate the different ligaments. The first metacarpal was submitted to six movements in defined directions starting from the neutral position (in accordance with Pieron, 1973). Ligament lengthening observed for each movement from the resting position of the first metacarpal was used to define the direction producing the greatest lengthening. This lengthening was measured directly with a graduated ruler under 2.5 x optical magnification. Results: The anterior oblique ligament was under tension in the positions close to extension (positions L and D). The posterior oblique ligament was under tension in the position of ulnar finger opposition and in volar abduction (positions K and F). The inter-osseous ligament was under ension in volar abduction, opposition and flexion (positions F, K, J). A complex behavior was observed, best described by two portions, medial and lateral. Discussion: This preliminary study on a model system depended on the interpretation of the ligament and joint surface anatomy. The method of creating joint motion described by Pieron enables comparison between two studies but does not correspond to the physiological position. Conclusion: For a small-sized joint, magnification of the bony pieces and use of optical magnification facilitates apprehension of ligament lengthening during joint motion. This method can be used to better assess maximal range of motion according to ligament deformations observed in relation to joint solicitation

Introduction. The first carpometacarpal (CMC) joint is the second most common joint of the hand affected by degenerative osteoarthritis (OA). 1. Laxity of ligamentous stabilizers that attach the first metacarpal bone (MC1) and the trapezium bone (TZ), notably the volar anterior oblique ligament (AOL), has been associated with cartilage wear, joint space narrowing, osteophyte formation, and dorsal-radial CMC subluxation. 2. In addition, the proximal-volar end of the MC1 has a bony prominence known as the palmar lip (PL) that adds conformity to this double-saddle joint, and is thought to be a supplemental dorsal stabilizer. Currently, no study has looked at the changes to the 3D shape and relative positions of these structures with OA. Methods. CT scans of patients with clinically diagnosed CMC OA (n=11, mean age 73 [60–97], 8 females) and CT scans of ‘normal’ patients with no documented history of CMC OA (n=11, mean age 37 [20–51], 6 females) were obtained with the hand in a prone position. 3D reconstructions of the MC1 and TZ bones were created, and each assigned a coordinate system. 3. The long axis of the MC1 and the proximal-distal axis of the TZ were established, and the location where they intersected the CMC articular surface was defined as their articular center points, X and O, respectively (Figure 1). Using the TZ as a fixed reference, we calculated the relative position of X in the dorsal-ventral and radial-ulnar directions. A two sample t-test was performed to compare the normal and OA groups. In addition, the distal position of the PL relative to X was recorded. Results. The dorsal position of the MC1 relative to the TZ was significantly greater (p=0.002) in the OA group compared with the normal group, with mean dorsal positions of 7.1 and 3.2mm, respectively (Figure 2). The distal position of the PL relative to X was also significantly greater (p=0.001) in the OA group when compared with the normal group, with mean positions of 5.8 and 1.9mm, respectively (Figure 3). Discussion. Dorsal migration of the MC1 in the OA group would suggest a compromised AOL, known to be elongated or absent intraoperatively. Without a sufficient AOL, the PL was positioned more distally in the OA group, as the load on the PL during extension activities could possibly exceed cartilage strength resulting in subchondral bone remodeling and further joint degeneration. We did not observe radial migration of the MC1 bone possibly due to the presence of bony osteophytes that can reduce abduction-adduction function in OA patients. 4. The relationship discovered between OA and changes to bone morphology and relative bone positions of the CMC joint may provide further insight into the natural progression of this disease

Aims: Prevalence and risk factors of osteoarthritis in the carpometacarpal joint of the thumb have been amply explored in previous studies. However, no study has focused on CMC OA as a predictor of disability and mortality. We investigated CMC OA for its associations with risk factors, disability and with life expectancy in a extensive health survey. Methods: In 1978–80, a representative population sample of 8,000 Finns aged 30 or over were invited to participate in a comprehensive health examination; 90% complied. Hand radiographs were taken from 3,595 subjects and the clinical status was completed for 3,434 subjects. By the end of 1994, 897 subjects with hand radiographs had died. Results: The age adjusted prevalence rate of CMC OA of Kellgren’s grade 2 to 4 was 7% for men and 15% for women. Adjusted for alleged risk determinants, body mass index was directly proportional to the prevalence of CMC OA in both sexes, OR =1.29 (95% confidence interval 1.15–1.43) per each increase of 5 kg/m2 in body mass index. Smoking seemed to carry a protection against CMC OA in men but not in women. No significant association was found between history of workload and CMC OA. Restricted mobility, tenderness and swelling were frequently found in the presence of radiological CMC OA, but no significant increase occurred in the prevalence of disability. In men CMC OA of Kellgren’s grade 3 to 4 significantly predicted total mortality (adjusted relative risk 1.32, 95% confidence interval 1.03–1.69). Conclusion: In line with previous studies, body mass index strongly determines the prevalence of CMC OA. CMC OA is highly prevalent, but its impact on disability in the general population is scanty

Many different surgical procedures have been used to alleviate the pain of first carpometacarpal joint osteoarthritis. The most common procedure involves removal of the trapezium with, or without, suspension of the base of the first metacarpal. This operation may also include a soft tissue interposition. A novel technique using the whole of FCR as a soft tissue arthroplasty after trapezectomy is described. Fifty-two trapezectomies with suspension arthroplasty using the whole of FCR were performed on 48 patients by one surgeon over a six year period. Average follow-up was 1.8 years. Grip and pinch strengths were measured and compared with the contralateral hand and with pre-operative measurements. A Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire was completed. Of 48 patients, 42 responded to the follow-up request (87.5%) for a total of 43 operations. There were 32 females and 10 males with an average age of 54 years. There was no significant difference between the pre and post-operative pinch and grip strengths (pinch pre-op 5.4 kilogram, post-op 4.9 kilogram; grip pre-op 24 kilogram, post-op 21 kilogram). The average DASH sc ore was 41.8 (range 35–60.8), which is comparable to the other trapezectomy studies. When the patients were asked whether they would undergo the surgery again, 95% answered “yes”. Our results using this novel technique demonstrated a DASH score comparable to other techniques using half of the FCR tendon, or no soft tissue interposition at all. Interestingly a significant fall in pinch strength (noted in other trapezectomy studies) was not a finding in this study

Background

The current treatment options available for Trapezio-metacarpal arthritis are injection, splint and ultimately surgery. The injections are predominantly done by General practitioners and no data is available to specialist.

Thumb carpometacarpal joint (CMCJ) arthritis is a common and debilitating condition. The mainstay of surgical management is Trapeziectomy. Concerns about possible functional implications of collapse of the metacarpal into the arthroplasty space as well as the potential for scaphometacarpal led to the development of techniques to try and prevent this. The purpose of this study was to investigate if there were any significant differences in the long-term outcomes of patients who participated in a randomized trial of trapeziectomy alone compared with trapeziectomy with ligament reconstruction and tendon interposition (LRTI). Sixty-five patients participated in our original trial, the 1 year findings of which were published in 2007. These patients were invited for a follow-up visit at a mean of 17 years (range 15–20) postoperatively. Twenty-eight patients attended, who had 34 operations, 14 trapeziectomy alone and 20 with LRTI. Patients were asked to complete a visual analogue scale (VAS) for satisfaction with the outcome of their procedure, rated on a scale from 0 (most dissatisfied) to 100 (most satisfied). They also completed the short version of the Disabilities of the Arm, Shoulder and Hand Score (QuickDASH) at their appointment. They underwent a functional assessment with a hand therapist and had a radiograph of the thumb. There were no statistically significant differences between the two groups in terms of satisfaction with surgery or functional outcomes, with most measurements showing minimal or no differences in means between the two groups. There was no difference in the space between the metacarpal and scaphoid on radiograph. Radial abduction was the only parameter that was significantly greater in the patients with simple trapeziectomy (median 79°) compared with trapeziectomy with LRTI (median 71°) (p = 0.04). Even at 17 years there is no significant benefit of LRTI over trapeziectomy alone for thumb carpometacarpal joint osteoarthritis

Our aim was to ascertain if K-wire configuration had any influence on the infection and complication rate for base of 4th and 5th metacarpal fractures. We hypothesised that in individuals whose wires crossed the 4th and 5th carpometacarpal joint (CMCJ), the rate of complications and infection would be higher. Data was retrospectively analysed from a single centre. 106 consecutive patients with a base of 5th (with or without an associated 4th metacarpal fracture) were analysed between October 2016 and May 2021. Patients were split into two groups for comparison; those who did not have K-wires crossing the CMCJ's and those in whose fixation had wires crossing the joints. Confounding factors were accounted for and Statistical analysis was performed using SPSS version 20 software. Of 106 patients, 60 (56.6%) patients did have K-wires crossing the CMCJ. Wire size ranged from 1.2-2.0 with 65 individuals (65.7%) having size 1.6 wires inserted. The majority of patients, 66 (62.9%) underwent fixation with two wires (range 1-4). The majority of infected cases (88.9%) were in patients who had k-wires crossing the CMCJ, this trended towards clinical significance (p=0.09). Infection was associated with delay to theatre (p=0.002) and longer operative time (p=0.002). In patients with a base of 4th and 5th metacarpal fractures, we have demonstrated an increased risk of post-operative infection with a K-wire configuration that crosses the CMCJ. Biomechanical studies would be of use in determining the exact amount of movement across the CMCJ, with the different K-wire configuration in common use, and this will be part of a follow-up study

Our aim was to explore factors associated with early post operative infection for surgically managed base of 4th/5th metacarpal fractures. We hypothesised that K-wires crossing the 4th and 5th carpometacarpal joint (CMCJ) would be associated with an increased risk of post-operative infection. Data from consecutive patients requiring surgical fixation for a base of 4th/5th metacarpal fracture from October 2016 to May 2021 were collected. Patient demographics, time to surgery, length of surgery, operator experience, use of tourniquet, intra-operative antibiotics, number and thickness of K-wire used, as well as whether or not the K-wires crossed CMCJ joints were recorded. Factors associated with post operative infection were assessed using Chi Squared test and univariable logistic regression using R studio. Of 107 patients, 10 (9.3%) suffered post operative infection. Time to surgery (p 0.006) and length of operation (p=0.005) were higher in those experiencing infection. There was a trend towards higher risk of infection seen in those who had K-wires crossed (p=0.06). On univariable analysis, patients who had wires crossed were >7 times more likely to experience infection than those who didn't (OR 7.79 (95% CI, 1.39 - 146.0, p=0.056). Age, smoking, K-wire size, number of K-wires used, intraoperative antibiotics, tourniquet use and operator experience were not associated with infection. In patients with a base of 4th/5th metacarpal fractures requiring surgical fixation, we find an increased risk of post-operative infection associated with K-wires crossing the CMCJ, which has implications for surgical technique. Larger prospective studies would be useful in further delineating these findings

The October 2015 Wrist & Hand Roundup360 looks at: Base of thumb arthritis – steroids not a waste of time; De Quervain’s tenosynovitis and steroids; Use your therapy time wisely!; Excision osteotomy for the carpometacarpal joint?; CORDLESS at five years?; Arthroscopy again of no benefit?; Distal radius stirring up trouble again!; Scaphoid arthroscopy under the spotlight

Used routinely in maxillofacial reconstructive surgery, the chondrocostal graft is also applied to hand surgery in traumatic or pathologic indications. The purpose of this overview was to analyze at long-term follow-up the radiological and histological evolution of this autograft, in hand and wrist surgery. We extrapolated this autograft technique to the elbow by using perichondrium. Since 1992, 148 patients have undergone chondrocostal autograft: 116 osteoarthritis of the thumb carpometacarpal joint, 18 radioscaphoid arthritis, 6 articular malunions of the distal radius, 4 kienbock's disease, and 4 traumatic loss of cartilage of the proximal interphalangeal (PIP) joint. Perichondrium autografts were used in 3 patients with elbow osteoarthritis. Magnetic Resonance Imaging (MRI) was performed in 19 patients with a mean follow-up of 68 months (4–159). Histological studies were performed on: i) perioperative chondrocostal grafts (n=3), ii) chondrocostal grafts explanted between 2 and 48 months after surgery (n=10), and iii) perioperative perichondrium grafts (n=2). Whatever the indication, the reconstruction by a chondrocostal/ostochondrocostal or perichondrium graft yielded satisfactory clinical results at long-term follow-up. The main question was the viability of the graft. -. For rib cartilage grafting: The radiological study indicated the non-wear of the graft and a certain degree of ossification. The MRI and histology confirmed a very small degree of osseous metaplasia and graft viability. The biopsies showed neo-vascularization of the cartilage that had undergone morphological, constitutional and architectural changes. Comparison of these structural modifications with perioperative chondrocostal graft histology is in progress. -. For perichondrium grafting: The first cases gave satisfactory clinical results but must be confirmed on a larger number of patients. Histological results highlighted a tissue composed of one fibrous layer and one cartilage-like layer, a common composition of supporting tissue. Despite the strong mechanical strain in the hand and wrist, chondrocostal graft is a biological arthroplasty that is trustworthy and secure over the long term, although it can cause infrequent complications inherent to this type of surgery. Despite the inevitable histological modification, the cartilage remains alive and is of satisfactory quality at long term follow-up and fulfills the requirements for interposition and reconstruction of an articular surface. The perichondrium graft constitutes a new arsenal to cure cartilage resurfacing. The importance of perichondrium for the survival of the grafted cartilage, as previously reported, as well as its role in resurfacing, is being investigated

The comparison between surgical outcomes of trapeziectomy versus trapeziectomy with ligament reconstruction (LRTI) is well documented in the literature. We could not find any literature comparing these two procedures from a ‘patient-based outcome scoring’ perspective. The Patient Outcomes Of Surgery (POS) hand/arm questionnaire was used in order to assess the outcomes of 33 patients (23 Trapeziectomy and 10 LRTI). All surgery was carried out by the same hand surgeon. A telephone questionnaire was performed on each patient. The mean time post surgery was 15 months (range 1 to 27) and 20 months (range 7 to 30) for the Trapeziectomy and LRTI group respectively. There was statistically significant improvement in both groups for symptoms, physical activities and psychological functioning/cosmetic appearance. The Trapeziectomy alone group scored higher in all groups though this did not show statistical significance. There were statistically significant higher rates of complications in the LRTI group. LRTI surgery increased the tourniquet time by 28 minutes on average. Patient overall satisfaction was higher (85/100) in the trapeziectomy alone group than that of the LRTI group (75/100). Both trapeziectomy and trapeziectomy with LRTI offer a reliably way of treating arthritis of the carpometacarpal joint. In our study, Trapeziectomy alone resulted in better overall patient satisfaction with lower complication rates and reduced operating time

Wrist arthrodesis is a common surgical procedure that provides a high level of functional outcome and pain relief among patients.[1] Upon partial arthrodesis, the wrist experiences changes in load transmission that are influenced by the type of arthrodesis performed. Measuring the load through the wrist joint is difficult, however, combined with computational models [2], it is possible to obtain data regarding the load mechanics of the wrist joint. Although successful fusion rates among patients have been reported, it remains unclear what the biomechanical consequences are. The aim of the study is to quantify pre and post operative load transmission through a cadaveric wrist which has undergone simulated arthrodesis of the radiolunate(RL) joint. An embalmed human wrist was dissected dorsally exposing distal radius, radiocarpal and carpometacarpal joints, and dorsal ligaments. The radioscaphoid(RS) ligament was sacrificed to accommodate insertion of a PPSEN-09375 force sensitive resistor (FSR) into the RS joint. The FSR was calibrated prior to measuring the contact force on the RS joint. The wrist was aligned in the neutral position in cardboard piping, and secured proximally and distally with Dental Plaster (OthoBock Healthcare Plc, Surrey, UK). The midsection of piping was windowed to permit placement of the FSR in the RS joint, and fixation of the RL joint using 2 Kirschner wires. The window was completed circumferentially and the specimen was placed in the Instron where a graduated axial compression was applied at 20 N/min. The results showed that when the radiolunate joint is fused, and a total axial load of 100N is applied, the load transmitted through the RS joint was approx 65N. i.e. 65% of the force. This is greater than the 56% measured experimentally by Blevens et al (1989) in an unfused specimen[3]. We plan to repeat our measurements and compare to an untreated cadaveric wrist

The carpometacarpal joint of the thumb is one of the most common locations of degenerative arthritis. Surgical options include trapezio-metacarpal fusion, replacement or resection arthroplasty with or without interposition. We report the medium term results of a Modified Thompson's suspensionplasty. The radial half of the APL tendon was looped around the FCR tendon to create the suspension. The remainder of the tendon is then used for interposition. We carried out a retrospective review of 50 patients (67 hands) who underwent this procedure from January 1999 to December 2005. There were 41 female (52 hands) and 9 male (15 hands). The average age at the time of surgery was 62 years (range 41 years – 79 years). The average follow up was 5.33 years (1-9 yrs). 22 patients also had a concurrent second procedure to the same thumb and a further three had a third procedure. The average PRWHE score was 25 (0 – 80) and the average DASH score was 40 (24 – 100). There were eight complications which included four persistent radial sided wrist pain. Two of these underwent tenotomy of FCR, whilst two responded to conservative measures. Two patients had symptoms related to scapho-trapezoid arthritis, which responded to an injection. One patient had superficial infection which settled with oral antibiotics, whilst another patient had early chronic regional pain syndrome. Overall the satisfaction rate was 90% with 48 patients (96%) willing to undergo the same procedure again. We conclude that the modified Thompson's suspensionplasty gives excellent medium term results

Treating 10 consecutive patients requiring wrist arthrodesis, we assessed the effectiveness of a titanium plate specifically designed by Hill Hastings for wrist arthrodesis. It appeared to call for little or no postoperative casting and to promise an early return to functionality. We secured the plate to the third metacarpal and the radius and used autologous bone graft taken from their iliac crest. Length of time immobilisation, time to union, overall functional results and patient satisfaction were recorded. In all 10 patients clinical and radiological union occurred in 8 to 12 weeks. Four patients had no postoperative immobilisation and six had a Litecast. Correctly applied, the pre-contured plate produced a consistently satisfactory position of fusion. One patient had a small area of wound skin necrosis in a pre-existing transverse scar over the dorsum of the wrist, but this healed. The carpometacarpal joint is included in this fusion, which requires a longer longitudinal incision than some other wrist fusion techniques. However, patient satisfaction was high

The Mathys. ¯. finger joint replacement system offers a novel fixation method into the proximal and distal medullary canals and a semi-constrained articulation. This comprises a separable, form-fit joint with a distal/proximal play of 0.7 mm, a lateral excursion of 10°, and rotation of up to 6°. This has theoretical advantages of increased radio-ulnar stability, preventing ulnar drift in patients with rheumatoid disease, and enhanced osseointegration offering implant longevity. In our unit, however, high failure rates were noted, prompting a review of cases to quantify our suspicions. Case notes of all patients who underwent finger joint replacement using the Mathys. ¯. implant between 1999 and 2005 were retrieved. Twenty-two devices were implanted by a single surgeon during this period. Four were in finger proximal interphalangeal joints, 17 in finger metacarpophalangeal joints and one in a thumb carpometacarpal joint (CMCJ). Indications for joint replacement included sixteen for rheumatoid arthritis (RA) and five for post-traumatic joint problems. The only thumb CMCJ was replaced for primary osteoarthritis. Patients were reviewed regularly and implant performance assessed critically along with survival of the implant to revision, infection or death of the patient. Mean follow up was 30 months. Sixteen implants failed including the only thumb CMCJ. Modes of failure were rotation (11), poor range of motion (two), infection (two) and dislocation (the CMCJ). Similar ball and socket designs for uncemented thumb CMCJ replacement, such as the Ledoux prosthesis, have previously shown poor survival and have been withdrawn from the market. Of the finger implants in RA patients (n=16), 12 implants failed of which ten were due to rotation. Time to failure ranged from two to 48 months (mean 15 months). The authors do not recommend the use of this implant, especially in cases of rheumatoid arthritis

Purpose: Trapezium excision and arthroplasty combined with ligament reconstruction as a treatment for first carpometacarpal joint arthritis is known to be associated with synovitis, prosthesis subluxation /dislocation and proximal migration of the metacarpal. To determine the effectiveness of our technique we used the objective and subjective outcome scores to assess the long term results. Methods: Ten patients (11 thumbs) underwent trapezium arthroplasty and ligament reconstruction procedure for grade III/ IV Eaton and Glickel arthritis. The FCR tendon was harvested split into half from proximal to its insertion site. The insertion site was left intact, the split tendon was passed through the first metacarpal base, passed along the radial side of the implant, through scaphoid and back to the 1st metacarpal as an entrapment technique. 7 female and 3 male patients with mean age of 53.9 comprised our series. Off the 10 patients 60% had surgery on their dominant hands. Results: All the patients had excellent results at a mean follow up of 33.5 months. The mean score (Buck-Gramco) for the tip pinch, grip strength and subjective score for pain, function and dexterity was comparable to the contra-lateral side. The mean tarpezial space ratio calculated from plain x-rays at the follow up was 0.37cm (p< 0.01)|There was evidence of synovitis, prosthesis subluxation or shortening of the thumb. Conclusions: This new method of securing the prosthesis does offer excellent results with good patient satisfaction