RESUMEN
PURPOSE: Trapeziometacarpal (TMC) joint replacement has become a valid option in the therapeutic arsenal of TMC joint osteoarthritis in Europe. Good mid-term results of the MAÏA TMC joint prosthesis suggested that it is a reliable procedure. This study aimed to assess the long-term results of this modular uncemented ball-and-socket hydroxyapatite-coated implant. METHODS: This single-center retrospective study evaluated 92 MAÏA TMC joint prostheses in 76 patients with a minimum of 10 years of follow-up. Indications for the procedure were painful TMC joint osteoarthritis both at rest and during activity, despite nonsurgical treatment for more than six months. Pre- and postoperative clinical and radiographic outcomes were compared. RESULTS: Mean follow-up was 134 months (range: 120-158 months). Mean age at the time of surgery was 67 years (range: 53-84 years). The cohort comprised 86.8% of women (n = 66). The mean Quick Disabilities of the Arm, Shoulder, and Hand score improved from 61.3 ± 17.1 to 19.6 ± 16. Range of motion was restored, and postoperative mobility was comparable with that of the contralateral side. Final Kapandji opposition score was almost normal (9.2 ± 0.7). Final key pinch and grip strength improved by 26% and 39%, respectively. Eight implants were surgically revised, six for trapezium cup loosening and two for instability because of polyethylene wear. Three cases of traumatic fracture of the trapezium in older patients were successfully treated with a cast for eight weeks. Five of 26 (20.8%) cases of preoperative-reducible z-deformity were not totally corrected after surgery. The Kaplan-Meier survival over 10 years was 88% (95% confidence interval: 84-93) versus 93% (95% confidence interval: 87-98) over 5 years. CONCLUSIONS: MAÏA TMC joint prosthesis is a reliable long-term surgical procedure for TMC joint osteoarthritis, improving overall function beyond 10 years. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
Asunto(s)
Artroplastia de Reemplazo , Articulaciones Carpometacarpianas , Prótesis Articulares , Osteoartritis , Rango del Movimiento Articular , Hueso Trapecio , Humanos , Femenino , Persona de Mediana Edad , Masculino , Anciano , Osteoartritis/cirugía , Osteoartritis/diagnóstico por imagen , Estudios Retrospectivos , Estudios de Seguimiento , Anciano de 80 o más Años , Hueso Trapecio/cirugía , Hueso Trapecio/diagnóstico por imagen , Articulaciones Carpometacarpianas/cirugía , Articulaciones Carpometacarpianas/diagnóstico por imagen , Radiografía , Diseño de Prótesis , Resultado del Tratamiento , Huesos del Metacarpo/cirugía , Huesos del Metacarpo/diagnóstico por imagen , Evaluación de la DiscapacidadRESUMEN
BACKGROUND: The arthroscopic Latarjet procedure is a technically challenging technique that provides well-known results. The first series reported fixation with screws. An alternative fixation technique has been proposed, using a button, to improve the reproducibility and to decrease the complications due to screws. The first reports using this fixation technique have yielded comparable rates of fusion. The objective of this study was to assess the fusion rate and bone modifications with this type of fixation. METHODS: Two hundred sixteen patients were included in this prospective study. An arthroscopic Latarjet procedure, fixed with 1 button according to the Smith & Nephew technique, was performed by a single surgeon for the treatment of anterior instability. The radiographic protocol consisted of computed tomography scans at 3, 12, and 24 weeks postoperatively. We measured the coronal and sagittal positions of the bone block, distance between the bone block and the glenoid, diameter of the glenoid tunnel, fusion rate, and time to fusion. RESULTS: The position was deemed flush in 92.6% of cases in the coronal plane and under the equator in 87.5% of cases in the sagittal plane. At last follow-up, we observed 9 cases of nonunion (4%), as well as 18 cases of delayed fusion. The fusion rate was 92% at 3 months and 96% at 6 months. For bone blocks that ultimately healed, the diameter of the glenoid tunnel was <2 mm in 62% of cases at 3 weeks and <1 mm in 90% of cases at 3 months. Conversely, the diameter of this tunnel significantly increased and was >3 mm in all cases of delayed union or nonunion. CONCLUSION: The described technique achieved a reliable position of the bone block and a very good fusion rate with a new type of fixation. The time to obtain fusion can be lengthy, occurring between the third and sixth months. The diameter of the glenoid tunnel was the best predictive factor for fusion. Widening of the glenoid tunnel diameter >3 mm during the first 3 weeks was the most predictive factor for delayed union or nonunion of the bone block. This finding is probably explained by a sliding effect of the sutures through this tunnel, comparable to the bungee effect in anterior cruciate ligament repair in the knee.
Asunto(s)
Inestabilidad de la Articulación , Articulación del Hombro , Humanos , Articulación del Hombro/diagnóstico por imagen , Articulación del Hombro/cirugía , Estudios Prospectivos , Reproducibilidad de los Resultados , Artroscopía/métodos , Inestabilidad de la Articulación/cirugía , Escápula/cirugía , SuturasRESUMEN
OBJECTIVE: To evaluate the clinical outcome of lateral clavicle malunion treated with all-arthroscopic coracoclavicular (CC) stabilization. DESIGN: Retrospective, case series. SETTING: Department of hand and upper extremity surgery, university hospital center. PATIENTS: Forty-five patients with unstable and displaced lateral clavicle fracture treated between January 2015 and August 2019 were included in the study. INTERVENTION: Closed reduction and arthroscopic CC stabilization using cortical buttons. MAIN OUTCOME MEASUREMENTS: Shoulder pain and active motion. Patient-reported outcome measures included the Constant score, the Subjective Shoulder Value, the AcromioClavicular Joint Instability score, and the Specific AcromioClavicular Score. Radiographic evaluation assessed bony union and malunion. RESULTS: Mean duration of follow-up was 25 months (12-60 months). Five patients (11%) had lateral clavicle nonunion and 7 (16%) had lateral clavicle malunion (5 in the coronal plane and 2 in the axial plane). Lateral clavicle malunion did not significantly affect clinical or functional outcomes (P > 0.05). Mean active shoulder motion was forward flexion 163 degrees (SD 28), abduction 162 degrees (SD 26), and external rotation 63 degrees (SD 21). On average, the patients scored 88.3 (SD 17.7) in the Constant score, 90% (SD 12) in the Subjective Shoulder Value, 88.8 (SD 9.4) in the AcromioClavicular Joint Instability score, and 11.4 (SD 8.5) for SACS. The overall complication rate was 38% (including 7 malunions, 5 nonunions, 2 adhesive capsulitis, and 3 button malpositions). CONCLUSIONS: Closed reduction and internal fixation of lateral clavicle fracture with all-arthroscopic CC stabilization using cortical button potentiates bony union but may generate lateral clavicle malunion, which does not affect the clinical or functional outcome. This result can be attributed to CC ligament healing and acromioclavicular joint congruence. All-arthroscopic CC stabilization is a minimally invasive but demanding surgical alternative for managing unstable and displaced lateral clavicle fracture. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Asunto(s)
Articulación Acromioclavicular , Fracturas Óseas , Inestabilidad de la Articulación , Articulación Acromioclavicular/cirugía , Clavícula/cirugía , Fijación Interna de Fracturas , Fracturas Óseas/diagnóstico por imagen , Fracturas Óseas/cirugía , Humanos , Inestabilidad de la Articulación/cirugía , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
PURPOSE: Trapeziometacarpal (TMC) total joint replacement is increasingly being performed in Europe. MAÏA TMC total joint arthroplasty is a modular uncemented ball-and-socket hydroxyapatite-coated implant. This study assessed the midterm clinical and radiological results of the MAÏA TMC prosthesis. METHODS: This single-center retrospective study involved 80 patients who underwent 96 MAÏA TMC prosthesis implantations from February 2006 to April 2009, and who had a minimum of 5 years' follow-up. Indications for the procedure were painful TMC joint osteoarthritis affecting activities of daily living and a failure of at least 6 months of nonsurgical treatment. Pre- and postoperative clinical and radiographic data were reviewed. RESULTS: The mean age at surgery was 68 years (range, 53-84 years) and the median follow-up was 76 months (range, 60-102 months). The mean Quick Disabilities of the Arm, Shoulder, and Hand score improved from 61.3 ± 17.1 to 17.5 ± 16. The mobility of the thumb was restored to a range of motion comparable with that of the contralateral thumb. Opposition, defined by the Kapandji score, was almost normal (9.2 of 10; range, 6-10), as was the final mean key pinch and grip strength, which improved by 26% and 43%, respectively. Among the 96 implants, 4 (4.2%) were surgically revised for trapezium loosening. One dislocation was treated with closed reduction; 3 (3.1%) posttraumatic trapezium fractures were immobilized for 8 weeks. Among the 26 preoperative reducible z-deformities, only 5 (19.2%) were not totally corrected after surgery. The procedure success, by survival analysis over 6 years, was 93% (95% confidence interval, 87-98). CONCLUSIONS: MAÏA TMC total joint arthroplasty may be a reliable treatment option for TMC joint osteoarthritis, with very good results for pain relief, strength, mobility, and restoration of the thumb length, providing correction of most thumb z-deformities. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
Asunto(s)
Artroplastia de Reemplazo , Articulaciones Carpometacarpianas , Osteoartritis/cirugía , Anciano , Anciano de 80 o más Años , Femenino , Estudios de Seguimiento , Humanos , Prótesis Articulares , Masculino , Persona de Mediana Edad , Osteoartritis/diagnóstico por imagen , Osteoartritis/fisiopatología , Radiografía , Rango del Movimiento Articular , Recuperación de la Función , Estudios Retrospectivos , Factores de Tiempo , Resultado del TratamientoRESUMEN
PURPOSE: To evaluate whether the congruency between the joint surfaces of the lunate fossa of the distal radius and the proximal capitate might be a prognostic factor for functional, clinical, or radiographic results after proximal row carpectomy (PRC). METHODS: After reconstructing the computed tomographic arthrogram of patients with PRC, we evaluated the shape of the proximal capitate by measuring the radius of curvature of the tip of the capitate. The congruency of the future radiocapitate joint was then evaluated by the radiocapitate index in the frontal and sagittal planes. This was calculated by dividing the radius of curvature of the tip of the capitate by the mean radius of curvature of the lunate fossa. We determined the relationship between these morphological results and the functional (Disabilities of the Arm, Shoulder, and Hand [DASH] score, Mayo Wrist score, and pain relief), clinical (mobility and strength) and x-ray results (radiocapitate arthrosis). RESULTS: A total of 27 patients were reviewed at a mean follow-up of 59 months. The shape of the proximal capitate did not affect outcomes. In the frontal plane, a better radiocapitate congruency was significantly associated with an increase in wrist flexion and better functional results for the DASH. There was a non-significant relationship between congruency and improvement of Mayo Wrist score and pain relief. In the sagittal plane, the DASH score tended to improve when congruency was better. CONCLUSIONS: The shape of the capitate was not a prognostic factor for functional outcome after PRC. The radiocapitate index seems more relevant in predicting results at last follow-up. TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic II.