In a pig bone model mimicking the human trapezium, we assessed the cementless fixation of trapezial cups in cancellous and cortical bone. Thirty-two saddle-shaped pig forefoot bones were prepared for cup fixation. Conical Konos cups (Beznoska, Kladno, Czech Republic) size 9 mm or 10 mm diameter were impacted. Cup migration was evaluated with repeated radiostereometry after intervals of cyclic-load tests. Migration increased for every load-interval up to 750 N and was higher with cancellous bone fixation than with cortical bone fixation. In cancellous bone, 9 mm cups migrated more than 10 mm cups. At the highest load (1050 N), the cumulative implant survival was 88% for 10 mm cups with cortical bone fixation and 13% for 9 mm cups with cancellous bone fixation. We conclude that mechanical fixation of conical Konos cups was better in cortical than in cancellous bone. Our results further suggest that the largest possible cup diameter should be used.
- MeSH
- acetabulum chirurgie MeSH
- náhrada kyčelního kloubu * MeSH
- prasata MeSH
- protézy - design MeSH
- selhání protézy MeSH
- trapézová kost * MeSH
- zvířata MeSH
- Check Tag
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Česká republika MeSH
PURPOSE OF THE STUDY Trapeziometacarpal osteoarthritis affects primarily postmenopausal middle-aged and older women. Total joint replacement is one of the surgical treatment options for symptomatic advanced degenerative changes of the carpometacarpal joint. This study aims to evaluate the short-term functional and radiological results of the Ivory ® prosthesis with the minimum followup period of three years after the surgery. MATERIAL AND METHODS Presented are the results of 48 total trapeziometacarpal joint replacements in the group of 40 patients composed of 36 women and 4 men. The age of patients ranges from 41 to 75 years (median 56 years), with the ratio between the dominant and non-dominant upper extremity 23:25. The follow-up period ranged from 36 to 63 months (median 52 months). The surgery was indicated in patients with symptomatic trapeziometacarpal arthrosis of stage II, III and early stage IV according to Eaton-Glickel once the conservative therapy had failed. In all the patients, the evaluation of the function and pain of the operated joint by DASH score, the range of motion -thumb opposition by Kapandji score were carried out at regular intervals pre- and postoperatively, the radiological evaluation of the stage of degenerative joint condition was done preoperatively, whereas the position of the implant and the lengthening of the first column of the finger were assessed postoperatively. RESULTS Subjectively, the patients were satisfied with the result of the surgery. After the joint replacement, in 65% of cases the patients reported full satisfaction with no difficulties present, in 31% of cases the patients suffered from pain during loading, in 4% of cases the patients reported also occasional pain at rest. Postoperatively, the total DASH score values decreased from the mean preoperative value of 52.79 to 10.4 points at a three-year follow-up. The average value of pain dropped from 3.46 to 1.44 points 3 years after the surgery. The average range of motion - thumb opposition by Kapandji score increased from 8.57/10 to 9.85/10 one year after the surgery. The difference between the values of average increase in length of the first column of the finger was 0.14 mm in favour of the sub-group of symptomatic cases. In the evaluated group, the need for revision was determined in 4 implants. In 1case for aseptic loosening of the cup and three times for dislocation. After 36 months, 47 of 48 implants were in situ, the overall three-year survival was achieved in 97.9%. The most frequent postoperative complication was the occurrence of De Quervain s tenosynovitis (10%). DISCUSSION Currently, most of the newer types of modular uncemented hydroxyapatite-coated total "ball and socket" joint replacements present acceptable medium-term, and in some cases even long-term, results regarding the survival. The most pressing issue continues to be the survival of implants, particularly the failure of the trapezial component and the associated risk of revision surgery. Good postoperative results can be achieved by accurate indication, carefully applied cup implant and good postoperative cooperation of patients. The complementary study did not confirm that the lengthening of the thumb causes the postoperative development of De Quervain s tenosynovitis. CONCLUSIONS The uncemented first carpometacarpal joint total replacement using the Ivory ® prosthesis brings about very good shortterm functional and radiological results, with no occurrence of early aseptic loosening of the implant. Key words:rhizarthrosis, arthroplasty, carpometacarpal joint prosthesis, uncemented.
- MeSH
- artroplastiky kloubů škodlivé účinky přístrojové vybavení metody MeSH
- dospělí MeSH
- karpometakarpální klouby diagnostické zobrazování chirurgie MeSH
- lidé středního věku MeSH
- lidé MeSH
- následné studie MeSH
- osteoartróza diagnostické zobrazování chirurgie MeSH
- pooperační komplikace MeSH
- protézy kloubů * MeSH
- rentgendiagnostika MeSH
- senioři MeSH
- spokojenost pacientů MeSH
- trapézová kost chirurgie MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- senioři MeSH
- Publikační typ
- časopisecké články MeSH
PURPOSE OF THE STUDY The aim of the study was to present the surgical technique combining the interposition and suspension arthroplasty using the TIE-IN implant as a treatment option for advanced symptomatic to final stage rhizarthrosis. MATERIAL AND METHODS Since 2015 we have performed the interposition arthroplasty combined with suspension arthroplasty using the TIE-IN implant in 12 patients, mostly indicated for stage IV rhizarthrosis. In two cases stage III rhizarthrosis with concomitant trapezium destruction was present. In two other cases the patients suffered from secondary osteoarthrosis associated with rheumatoid arthritis. Pain under loads was present in all the patients, of whom in 10 patients also the pain at rest occurred. Preoperatively, a total of 10 patients showed subluxation of the first carpometacarpal joint of 50% of the articular surface width. The ratio between the dominant and non-dominant extremity was 1:1. As a part of the evaluation, correlation was established between the preoperative findings and the postoperative results at 3 months follow-up. The examination included the assessment of pain intensity by VAS scale, the range of motion measurement - by Kapandji thumb opposition test, handgrip strength test and functional evaluation using the scoring systems - DASH score, modified DASH score for thumb, and modified Wrightington score. RESULTS No intraoperative or postoperative complications such as infection, complex regional pain syndrome, implant failure or failed surgical procedure were reported in the given group of patients. The pain at rest ceased in all 12 patients. The VAS pain intensity score improved from the preoperative average of 5.8 to 0.8 postoperatively. The range of motion in all the patients with stage IV rhizarthrosis substantially improved. The average Kapandji thumb opposition score increased from 6.9 preoperatively to 9.5 postoperatively. DISCUSSION There are multiple surgical treatment options for advanced rhizarthrosis. Apart from the combination of interposition and suspension arthroplasty referred to above, it is trapeziometacarpal (TMC) arthrodesis on the one hand and carpometacarpal joint total arthroplasty on the other hand. The arthrodesis continues to be a fairly frequently used procedure, despite the final limitation of thumb movement. It is because of this loss of fine motor function why it is not the preferred technique for treating advanced rhizarthrosis at our department. On the very contrary, the total replacement of the TMC joint is at our department as well as at many other departments the treatment of choice for advanced symptomatic rhizarthrosis since in conservative resection of the articular surfaces the biomechanics of the carpometacarpal joint of the thumb is preserved. As an outcome, this technique combines the advantages of other surgical methods by ensuring full painless range of motion and strength of the joint as opposed to other techniques, which mostly result either in a limited movement, or in a loss of grip strength. There is a whole range of resection arthroplasty techniques available. From simple trapeziectomy, which leads to the radial column collapse and ultimately to a major functional deficit, up to various interposition or suspension arthroplasty techniques with the resulting range of motion, stability and thus grip strength depending on the technique applied. CONCLUSIONS By applying the combination of the interposition and suspension arthroplasty of the carpometacarpal joint of the thumb using the TIE-IN implant we preserve the length of the thumb, its stability, and thus achieve the recovery of adequate thumb range of motion and grip strength. Our conclusions are in correlation with the results obtained at reference centres. Key words:rhizarthrosis, trapeziometacarpal prosthesis, arthroplasty, trapezium implant.
- MeSH
- artroplastiky kloubů škodlivé účinky přístrojové vybavení metody MeSH
- karpometakarpální klouby patofyziologie chirurgie MeSH
- lidé středního věku MeSH
- lidé MeSH
- měření bolesti MeSH
- osteoartróza patofyziologie chirurgie MeSH
- palec ruky chirurgie MeSH
- pooperační komplikace MeSH
- protézy kloubů * MeSH
- rozsah kloubních pohybů MeSH
- senioři MeSH
- síla ruky MeSH
- trapézová kost chirurgie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- senioři MeSH
- Publikační typ
- časopisecké články MeSH
An intraosseous ganglion cyst has been reported in nearly all of the carpal bones; it is a rare cause of chronic wrist pain. The case presented here is a rare finding of symptomatic intraosseous ganglion of the trapezium bone. The relevant literature is reviewed. Key words: ganglion cyst, trapezium bone, wrist.
- MeSH
- akutní bolest etiologie MeSH
- kostní cysty diagnostické zobrazování MeSH
- lidé MeSH
- trapézová kost diagnostické zobrazování MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
- přehledy MeSH
PURPOSE OF THE STUDY: The aim of the study was to compare results of the Burton-Pellegrini trapeziectomy with ligamentoplasty using the flexor carpi radialis tendon with those of trapeziometacarpal joint replacement in the treatment of advanced rhizarthrosis. MATERIAL AND METHODS: A group of 17 patients, 15 men and two women, underwent trapeziectomy with ligamentoplaty; in 12 of them, the dominant hand was involved. The trapeziometacarpal joint prosthesis Beznoska was implanted in 11 patients (10 men and one woman) with seven dominant and four non-dominant hands. All patients pre-operatively experienced pain during thumb movement and hand grip. They were examined before surgery and at 3, 6 and 12 months after it; the values obtained before and at 1 year after surgery were compared. The methods of evaluation included pain intensity assessed using the visual analogue scale (VAS), the Kapandji thumb opposition test and the disabilities of the arm, shoulder and hand (DASH) score (total DASH score and its thumb-targeted module). RESULTS: In the group treated by the Burton-Pellegrini procedure, the average pre- and post-operative Kapandji scores were 6.4 and 8.9, respectively. The average VAS scores were 5/10 pre-operatively and 1/10 post-operatively. The average values for the total pre- and post-operative DASH scores were 58 and 19 points, respectively. The DASH score in a thumb-targeted module assessing basal joint-loading in the thumb was 63 points before and 21 points after surgery. In the patients with total joint replacement, the average pre- and post-operative values were as follows: Kapandji score, 7.4 and 9.8; VAS score, 5/10 and 1/10; total DASH score, 56 and 7 points; thumb module DASH score, 60 and 11 points. Two serious complications were recorded, an infection in resection interposition arthroplasty and a trauma associated with total joint replacement loosening. Four patients showed transient paresthesia. DISCUSSION: Several methods for surgical treatment of rhizarthrosis are available today. Arthrodesis is still a widely used procedure although it inhibits thumb movements. Resection arthroplasty provides sufficient pain-free thumb motion, but radial shortening and a loss of grip strength are its disadvantages. Resection interposition arthroplasty results in sufficient painless motion. Tendon interposition provides enough stability for the thumb and for sufficient grip and pinch strength. The disadvantages of this method include a potential for failure of the suspensory tendon during over exercising or a weakened attachment of the autologous tendon to the bone and thus a risk of rupture. Total joint replacement respects the thumb anatomy, preserves the articular capsule and fibrous structures during conservative resection of joint surfaces and keeps the biomechanics of the basal joint of the thumb. It combines advantages of the other surgery procedures, by allowing for a painless range of motion in the joint and vital pinching and gripping abilities, while avoiding their disadvantages such as movement restriction and loss of grip strength. However, the technique may still bear any of the risks associated with foreign material implantation (dislocation, replacement failure, infection, etc.). CONCLUSIONS: The two techniques present valuable contributions to the treatment of advanced rhizarthrosis. In our patients, better outcomes are shown in trapeziometacarpal joint replacement though, in comparison with resection interposition arthroplasty, the indication criteria for this surgery are limited by factors such as the height of the trapezium bone and bone quality necessary for good osseointegration.
- MeSH
- artrodéza metody MeSH
- artroplastiky kloubů metody MeSH
- karpometakarpální klouby chirurgie MeSH
- lidé MeSH
- měření bolesti metody MeSH
- obnova funkce fyziologie MeSH
- osteoartróza chirurgie MeSH
- palec ruky chirurgie MeSH
- přenos šlachy metody MeSH
- protézy kloubů MeSH
- rozsah kloubních pohybů MeSH
- šlachy transplantace MeSH
- trapézová kost chirurgie MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- srovnávací studie MeSH
Názor na chirurgickou léčbu izolované scapho-trapezio-trapezoidní artrózy není doposud jednotný a ani etiologie vzniku izolované artrózy tohoto kloubu není dostatečně objasněna. Nejčastěji užívaná léčebná metoda u symptomatické scapho-trapezio-trapezoidní artrózy je artrodéza, která způsobuje omezení pohybu zápěstí a je zatížena komplikacemi především v podobě vzniku bolestivého pakloubu a rozvojem radioscaphoidního impingementu. Další metodou operačního řešení je resekce distálního pólu scaphoidea, která často způsobí zvýraznění midkarpální malpozice mezi proximální a distální karpální řadou a v některých případech dochází k progresivním změnám charakteru midkarpální destrukce kloubu. Popsaný případ upozorňuje na stav, kdy izolovaná scapho-trapezio-trapezoidní artróza není ve své podstatě primární, ale je sekundárním důsledkem chronické, asymptomatické, dorzální midkarpální nestability. Četnost těchto stavů a vhodný způsob léčby není dostatečně literárně dokumentován.
The opinions on the surgical treatment of isolated scapho-trapezoid trapeziometacarpal arthritis remain divided, and even the aetiology of the origin of osteoarthritis of the joint has not been sufficiently explained. The most commonly used method of treatment for symptomatic scapho-trapezoid-trapeziometacarpal arthritis is arthrodesis, which uses restriction of movement in the wrist and is burdened with complications, especially in the form of painful pseudo-arthritis and development of radioscaphoid impingement. Another method of surgical treatment is the resection of the distal pole of the scaphoid, which often causes the disparity in midcarpal malposition between the proximal and distal carpal row and in some cases leads to progressive changes in the character of midcarpal joint destruction. This case highlights the condition where isolated scapho-trapezoid-trapeziometacarpal arthrosis is not inherently primary, but secondary consequence of chronic, asymptomatic, dorsal midcarpal instability. The frequency of these conditions and suitable method of treatment is not sufficiently documented in literature.
- Klíčová slova
- karpectomie, distální resekce scaphoidea, midkarpální nestabilita,
- MeSH
- artralgie MeSH
- člunkovitá kost chirurgie MeSH
- kosti zápěstní * abnormality chirurgie patofyziologie MeSH
- kostní dráty MeSH
- lidé středního věku MeSH
- lidé MeSH
- nestabilita kloubu * chirurgie patofyziologie radiografie MeSH
- ortopedické výkony metody MeSH
- osteoartróza * diagnóza chirurgie komplikace MeSH
- poloměsíčitá kost chirurgie MeSH
- progrese nemoci MeSH
- reoperace MeSH
- rozsah kloubních pohybů MeSH
- trapézová kost chirurgie MeSH
- trapézovitá kost chirurgie MeSH
- zápěstní kloub * chirurgie patofyziologie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
- práce podpořená grantem MeSH
PURPOSE OF THE STUDY: Arthrodesis of the trapeziometacarpal joint is the method of choice in the treatment of degenerative arthritis of this joint. This procedure was indicated most frequently in middle-age patients doing hard manual labor. Methods for achieving a solid fusion of the trapeziometacarpal joint are known and often reported in the literature. Frequently, they are associated with some failure rate, particularly as concerns bone union. Our study presents a simple and effective method verified in cadaver specimens and then currently used at our department. MATERIAL AND METHODS: The procedure for arthrodesis of the trapeziometacarpal joint was verified fist in fixed wrist and hand specimens at the Institute of Anatomy, 1 st Faculty of Medicine, Charles University in Prague. If the original shape of the basal thumb joint between the trapezium and the metacarpal is maintained, it allows for correct reduction and subsequent arthrodesis in a required position. In patients, surgical treatment included the use of implants, two DePuy shape-memory staples, which facilitate sufficient fragment compression and provide stable fixation. The staples were inserted in pre-drilled and gauged tunnels in the body of the trapezium and in the proximal metaphysis of the fist metacarpal. RESULTS: Between 2011 and 2014, the procedure was used in 14 patients diagnosed with primary arthritis of the trapeziometacarpal joint. The group comprised nine women and five men, the average age was 52 years and the range was 44 to 69 years. Surgery was most frequently carried out on the dominant upper extremity (85%); there was no bilateral surgery. The average follow-up was 18.3 months (range, 5 to 39 months). Solid fusion was recorded at 7 weeks after surgery in all patients except for the one still treated at the time of this paper submission. All patients were free of pain, ten reported satisfaction with grip strength and hand function, the rest would have preferred improvement in fine motor skills of the thumb. All of them found the cosmetic appearance of the hand satisfactory.. DISCUSSION: The methods generally used for trapeziometacarpal joint arthrodesis are reported to carry some risk of pseudarthrosis development. A lot of modifications have been described, from conventional procedures using AO lag screws or Kirschner wires to up-to-date plate systems involving angle-stable fixation. Total fusion of the trapeziometacarpal joint is disputable in patients with rheumatoid arthritis from the technical point of view as well as the relevance of indication criteria. Some authors consider this procedure a contraindication for patients with rheumatoid arthritis. The use of joint replacement in treating trapeziometacarpal joint arthritis is another complex issue. CONCLUSIONS: An arthrodesis of the trapeziometacarpal joint based on careful assessment of indication criteria proved to be a simple, effective and low-cost method of stable osteosynthesis that provided good conditions for solid fusion of the trapezium with the base of the fist metacarpal. It allowed for sufficient abduction and opposition of the thumb, thus permitting satisfactory hand grip strength and full involvement in everyday life activities and occupations. It provided stability of the thumb, its painless movement and good cosmetic looks.
- MeSH
- artrodéza metody MeSH
- dospělí MeSH
- estetika MeSH
- karpometakarpální klouby chirurgie MeSH
- lidé středního věku MeSH
- lidé MeSH
- následné studie MeSH
- osteoartróza chirurgie MeSH
- senioři MeSH
- síla ruky MeSH
- spokojenost pacientů MeSH
- trapézová kost chirurgie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
