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.

Introduction and Aims: While successful long-term results have been shown for ligament reconstruction–tendon interposition arthroplasty for treatment of thumb basal joint osteoarthritis, the need for invasive ligament reconstruction has not been established. In this study we describe long-term results utilising the technique of tendon interposition arthroplasty with dynamic tendon transfer and capsulorrhaphy. Method: Twenty-four thumbs (21 patients) were evaluated at an average of 7.1 years (1.8–19.5 years) post-procedure. Capsulorrhaphy was performed utilising APL tendon slips where tissue was insufficient. The APB origin was advanced via tendon transfer (FCR to APB), providing a stabilising abductor moment. Subjective assessment was performed using Visual Analogue Scores (VAS), Disabilities of Arm, Shoulder, Hand (DASH) scores, and patient satisfaction scales. Objective assessment included post-operative range of motion (ROM), grip/pinch strength, and radiographs for interposition arthroplasty height. Results: Twenty of 21 patients (95%) were satisfied and described results as either good or excellent. Twenty of 21 patients (95%) would undergo surgery again. Mean VAS was 8.7 at rest and 10.2 with activity (0, no pain; 100, maximum pain). Mean DASH score was 16.9 (range from 0, no difficulty performing daily tasks to 100, unable to perform daily tasks). ROM, grip, lateral and tip pinch strengths were comparable with those of the contralateral thumb. AP radiographs showed preservation in 12 of 12 patients (100%). Fourteen of 21 patients received the procedure on their dominant hand. Conclusion: Treatment of basal joint osteoarthritis with our technique provided stable and functional reconstructions, resulting in excellent pain relief. Results were comparable to, or better than, those previously cited in the literature for alternative procedures. These results suggest that dogma requiring static ligament reconstruction or suspension may need to be re-evaluated

Purpose of the study: Basal joint osteoarthritis remains one of the most invalidating degenerative diseases of the upper limb. Most patients are women and the main symptom is pain. Several surgical approaches can be used: total trapeziectomy with or without a ligament reconstruction for intermetacarpal stabilization associated or not with tendon interposition (possibly with a synthetic insert); cemented or non-cemented trapezio-metacarpal prosthesis and arthrodesis. The purpose of this work was to report our experience with the modified Eaton-Littler technique and determine the current contribution of total trapeziectomy – ligament reconstruction – tendon interposition. Material and methods: We report a series of 26 patients who underwent surgery between 1994 and 2002 for trapezium resection associated with intercarpal ligamentoplasty and «anchovy» interposition using a flexor carpi radialis hemi-tendon. The series involved 21 patients, 16 women and 5 men, with invalidating basal joint osteoarthritis unresponsive to medical treatment. The Dell classification was stage II and III. Mean age was 58.6 years. Five patients underwent surgery on both wrists. One patient had had a prior operation on one side and a Swanson implant on the other. The mean follow-up was 66.1 months (range 25–131 months). Results: For these 22 cases, outcome at last follow-up was satisfactory with complete resolution of pain, excellent joint mobility with a mean Kapandji score of 9.5/10 (range 8–10). Half of the wrists exhibited deficient pinch and grasp force. Mean postoperative force was 20 kg (range 8–28 kg). Radiographically, scaphometacarpal collapse was nearly complete in all cases. For four cases, outcome was considered poor because of nearly constant pain with reduced mobility and a mean Kapandji score of 5/10. Three patients developed a reflux dystrophy: one of these patients achieved a final satisfactory result. There had been no revisions at last follow-up. Discussion: All the proposed techniques appear to give good results in terms of pain relief. Trapiezectomy with ligamentoplasty appears to provide good results at mean six months follow-up, results which are reliable and sustained over time. Trapezio-metacarpal prostheses give good immediate results in selected patients but the rate of failure at mid-term remains high, mainly due to loosening. Second generation cemented prostheses are promising. Trapezial implants have specific complications. Trapeiometacarpal arthrodesis gives good stability of the thumb column and is particularly indicated for young active patients with less consideration on the esthetic aspect of their hand, keeping in mind the significant rate of nonunions. Conclusion: Despite the significant progress achieved with trapeziometacarpal prosthetic arthroplaasty, we still believe that complete resection of the trapezium with ligament reconstruction associated with tendon interposition remains the gold standard in terms of patient satisfaction and reliable results for the surgical treatment of basal joint osteoarthritis

Aims

The aim of this study was to compare robotic arm-assisted bi-unicompartmental knee arthroplasty (bi-UKA) with conventional mechanically aligned total knee arthroplasty (TKA) in order to determine the changes in the anatomy of the knee and alignment of the lower limb following surgery.

Introduction and Objectives: Thumb arthritis, also called basal joint arthritis, or carpometacarpal (CMC) arthritis is a frequent pathological condition for which there are a great variety of surgical treatments. One of the most used is resection-suspension arthroplasty using the tendon of the Flexor Carpi Radialis (FCR), whole or only a hemitendon. Up to now, the clinical repercussion that sacrificing this tendon may cause has not been studied. Our aim was to compare the repercussion this has on the force and mobility of the hand, with a preserved FCR, both when the hemitendon is used and when the complete tendon is used. Materials and Methods: We analyzed the force, mobility, clinical and radiological result in a total of 32 cases of thumb arthritis operated by simple trapezectomy, trapezectomy + plasty with FCR hemitendon and trapezectomy + plasty with complete FCR tendon. A special device has been designed to quantify the force of flexion of the wrist in these patients. Results: Thumb mobility, and grasp strength were more limited in patients in which simple trapezectomy was performed, and no differences were seen between the use of hemitendon or complete FCR. There was no greater loss of wrist flexion force with the use of complete FCR, in comparison with the other techniques. Discussion and Conclusions: The use of complete FCR does not have any greater clinical repercussions than the use of FCR hemitendon

Instability of the thumb trapeziometacarpal joint is a major factor in the cause of degenerative disease. Surgically stabilized joint should be subject to less shear forces and hence, will be less likely to develop degenerative changes. The results of volar ligament reconstruction were assessed in 12 patients (8 men- 4 women). The average age at surgery was 35 years. All thumbs were radiographic stage I. All had failed conservative treatment with splinting and anti-inflammatory medication. Operativelly a strip of Flexor Carpi Radialis tendon was used for ligament reconstruction according to the technique described by Eaton, Glickel and Littler. The follow-up period averaged 7 years. At final follow-up 8 thumbs were stage I, 3 were stage II, and one was stage III. Ten patients were at least 90 % satisfied with the results of the surgery and only two had symptomatic thumb basal joint

Background. Osteoarthritis of basal joint of the thumb represents one of the commonest degenerative diseases of the hand and wrist region. Depending on the severity of clinical symptoms surgical treatment is often recommended. Resection arthroplasty of the CMC joint with tendon interposition can be regarded as the gold standard. The aim of our study is to compare the Burton Pellegrini technique with a new modified technique of resection arthroplasty with interposition of local capsule tissue. Materials and Methods. We retrospectively evaluated 2 groups of patients. Two Consultant Surgeons took part in the study, one for each group, with each consultant performing trapeziectomies using only one of the techiniques for all his patients. The first group underwent trapeziectomy and local capsule interposition. It consists of 26 patients with a female/male ratio of 20/6, an average age of 64 years (range 53–88), an average follow up of 3.15 years (range 9–1) and a left/right ratio of 16/10. The second group underwent a standard Burton Pellegrini including flexor tendon interposition. It consists of 13 patients with a female/male ratio of 5/8, an average age of 68 years (range 58–85), an average follow up of 4.46 years (range 9–1) and a left/right ratio of 5/8. The outcomes were compared using the Michigan Hand Outcomes Questionnaire. A 2-tailed independent samples t-test was used for the statistical analysis of our data. Results. We found that there is significant difference between the two procedures only on the ability of working in present, t = 2.153 and p = 0.038. However, there is no significant difference between the other parameters we examined: overall hand function, t = 0.237 and p = 0.814; activities of daily living using the operated hand, t = 0.194 and p = 0.847; activities of daily living using both hands, t = 0.184 and p = 0.855; overall activities of daily living, t = 0.204 and p = 0.839; pain, t = 0.123 and p = 0.903; aesthetics, t = 1.063 and p = 0.295; satisfaction, t = 0.628 and p = 0.534; total score, t = 0.509 and p = 0.613. Furthermore, the overall score for the two procedures suggests that there is no significant difference between them. Conclusions. The new modified procedure is simpler and quicker than the traditional operation and avoids the morbidity of tendon harvesting. The overall outcome score for the two operations is equal, suggesting that there is no advantage to the more complex procedure. We have shown a difference between the two procedures in post op working ability, being better in the group with local capsule interposition

Introduction: Osteoarthritis of the thumb basal joint is a very common and disabling condition that frequently affects middle-aged women, sometimes bilaterally. The purpose of this work is to present the methodology of the preoperative and postoperative assessment carried out in 52 patients who underwent a trapeziometacarpal joint replacement procedure (Roseland prosthesis). Material and Methods: Total joint arthoplasty of the trapeziometacarpal joint was performed on 52 thumbs in 44 patients (15 dominants hands) to treat osteoarthritis (Eaton-Littler stages II and III) between 1995 and 2007. 18 patients were missed for follow-up purposes. Average age of 59,4 years. The Roseland trapeziometacarpal joint prosthesis was used in this study. We analyzed the ROM for abduction-adduction, flexo-extension of the trapeziometacarpal joint and the opposition of the thumb by the modified Kapandji test. We also measured radiographic distance of the TMC space in preoperative radiographies and compared it with the postoperative ones. Finally, strength was quantified for the lateral, tip-to-tip, and tridigital pinch in the treated hands. Pain was measured with VAS and the DASH questionnaire was completed by all the patients. The average follow-up period was of 5,3 years (range, 1,1–12,1 years). Results: At the final follow-up visit we obtained the following Results: for thumb abduction average 66°, thumb opposition to the base of the smaller finger was present in 58%, and thumb flexo-extension average 59°. The average tip-to-tip pinch strength was 2,7, for the lateral pinch 3,6 and for the tridigital pinch was 3,7. We observed that in 36% of the radiographies the TMC space was the same pre and postoperative. Average VAS and DASH scores were of 1,6 and 26,3 respectively. Five patients (10%) needed a revision surgery (2 for infection and 3 for aseptic loosening of the prosthesis). Conclusions: Most of the protocols evaluating surgical outcomes on the trapeziometarcarpal joint don’t allow a functional analysis of ROM and strength of this joint. That’s why we developed the idea of designing a new methodology, that we currently use in our centre, to analyze the functional outcome of the surgery on the trapeziometacarpal joint. We specially recommend the measurement of the tridigital pinch strength, as is the most representative feature of the hand function

Introduction: Osteoarthritis of thumb CMC joint is a common pathology. Several non-prosthetic surgical options exist. There is abundant literature both in favour of and against combining trapeziectomy with ligament reconstruction and/or tendon interposition (LRTI). This study provides qualitative and quantitative outcomes assessment of a single surgeon series of consecutively operated 65 patients with trapezio-metacarpal joint arthritis using Trapeziectomy with LRTI. Methods: 50 female and 15 male patients at an average age of 63 at the time of surgery were followed up for a mean of 3 years, 4 months. Radial half of flexor carpi radialis is dissected using a Carroll tendon retriever and passed through a transosseous hole in the thumb metacarpal base to exit on its dorsum. Patients were put in a full below elbow cast for a period of 4 weeks following which hand therapy was instituted. Patients were evaluated using quick DASH score and objective data like thumb opposition, radiographic scaphometacarpal mobility and gap, pinch and grasp strength. All operations were carried out by senior author. Results: Good to excellent results were obtained in 59 cases with satisfactory opposition. Pinch strength was 4.3 Kg being 1 to 2 Kg less than reference range. Scoring with quick DASH did not decrease with the longevity of follow up. No complications were encountered. No correlation was found between variables like age, sex, dominance, occupation, primary diagnosis, reduced space on follow up radiographs, severity of arthritic changes and final outcome. Discussion: Present study is one of the largest consecutive single surgeon series reported recently. All efforts were made to eliminate confounding factors like multi surgeons, modifications of technique, different patient populations etc. The study supports the concept of interposition arthroplasty in the treatment of basal joint arthritis of thumb provided strict attention to the details of surgical technique is observed

Aims. Several national studies have shown that the rates of joint replacement are rising and this increase may be greater than that expected by population ageing. The aim of this study was to assess local rates of joint replacement at a district general hospital (DGH) and to investigate whether there had been a change in pre-operative functional status of patients over the study period to account for any change in rates of arthroplasty. Methods. This was a DGH based local joint registry programme with independent functional assessment and follow up. All patients undergoing primary total hip replacement (THR) and total knee replacement(TKR) between 1 January 2000 and 31 December 2009 were eligible. Only after being listed for surgery were patients assessed with WOMAC and Oxford Hip or Oxford Knee scores. Catchment population data was obtained from the Office of National Statistics. Results. 5373 joint replacements were performed over the ten year period, 89% had preoperative scoring available. There was an 80% increase in numbers of THR performed and 95% increase in number of TKR performed between 2000 and 2009. This was a significant increase when compared to the local population aged between 60 and 80 years, the size of which increased just 28% over the same period. The average age of the patients remained static over the study period and there was no clinically significant change in any of the pre-operative functional scores. Conclusions. Whilst the incidence of joint replacement increased over the study period, this was not associated with a change in patients' ages or preoperative functional status. Our results suggest that the increases seen are not due to a change in functional threshold for surgery. This is of particular relevance during this time of austerity when funding for orthopaedic surgery may be threatened

Objectives

Little is known about tissue changes underlying bone marrow lesions (BMLs) in non-weight-bearing joints with osteoarthritis (OA). Our aim was to characterize BMLs in OA of the hand using dynamic histomorphometry. We therefore quantified bone turnover and angiogenesis in subchondral bone at the base of the thumb, and compared the findings with control bone from hip OA.

The February 2015 Wrist & Hand Roundup360 looks at: Toes, feet, hands and transfers… FCR Tendonitis after Trapeziectomy and suspension, Motion sparing surgery for SLAC/SNAC wrists under the spotlight, Instability following distal radius fractures, Bilateral wrist arthrodesis a good idea?, Sodium Hyaluronate improves hand recovery following flexor tendon repair, Ultrasound treatments for de Quervain’s, Strategies for treating metacarpal neck fractures.

The June 2012 Wrist & Hand Roundup³⁶⁰ looks at; radial osteotomy and advanced Kienböck's disease; fixing the Bennett fracture; PEEK plates and four-corner arthrodesis,;carpal tunnel release and haemodialysis; degloved digits and the reverse radial forearm flap; occupational hand injuries; trapeziometacarpal osteoarthritis; fixing the fractured metacarpal neck and pyrocarbon implants for the destroyed PIPJ.