Elektra prosthesis for trapeziometacarpal osteoarthritis: a follow-up of 39 consecutive cases

Abstract

We present a prospective follow-up of 39 Elektra prostheses in 37 patients (32 women and five men), with a mean age of 56.5 (range 46-71) years; 34 patients had osteoarthritis and three had rheumatoid arthritis. Patients were followed using clinical examination, including measurement of pain on a visual analogue scale, mobility, and strength, after 6, 12, 26, and 52 weeks, and annually thereafter. Radiological examination was done preoperatively and after 6, 26, and 52 weeks, and annually thereafter. The mean follow-up time was 48 (range 3-91) months. Although we observed a fast recovery, including maintenance of mobility and a gradual increase in grip strength, there was a revision rate of 7/38 (24%) after 36 months, increasing to 17/38 (44%) after 72 months. The main reason for revision was loosening of the trapezial component, and biomechanical properties of the trapezial fixation may be the key problem in treating trapeziometacarpal osteoarthritis using a total prosthesis.

Equally good fixation of cemented and uncemented cups in total trapeziometacarpal joint prostheses

“…The clinical results are comparable to those of other studies (Ulrich-Vinther et al 2008, Klahn et al 2012), but different survival rates have been presented for both cemented and uncemented trapezium implants, and no clear recommendation for the choice of cemented and uncemented implants has been published based on long-term evidence. With a high risk of revision both implant types, there is a theoretical and practical advantage in using uncemented trapezium implants because conversion of a failed uncemented trapezium cup to a cemented cup is easier and less bone stock is lost than with cementing of the the primary trapezium cup.…”

“…We did not prepare the trapezium bone by threading before insertion of the cup. Compared with the reported failures (Hansen and Snerum 2008, Hernandez-Cortez et al 2012, Klahn et al 2012), we expect that this may prevent early failure and improve primary fixation to the stability level of cemented DLC cups. However, further studies are needed to investigate the long-term survival of the uncemented Elektra trapezium cup and the potential benefits of alleviating bone threading.…”

“…Revision of primary cemented implants often results in a trapeziectomy, and even though the results of revision surgery with trapeziectomy appear to be quite good (Hansen and Homilius 2010), a revision to another trapezium implant may provide better function in high-demand patients. The high revision rates of 15–44% reported for uncemented implants (Wachtl et al 1998, Hansen and Snerum 2008, Hansen and Vainorious 2008, Hernandez-Cortez et al 2012, Klahn et al 2012) indicate a problem with the bony fixation. Several reasons can be put forward such as poor bone quality in the trapezium preoperatively, smoking, implant material, implant design, implant coating, and surgical technique (Hansen 2011).…”

“…Our data suggest that a migration of below 1 mm would be an acceptable cutoff for loose implants. Klahn et al (2012) recently published findings of progressive aseptic loosening of the Elektra cup after more than 2 years, but they used threading of the bone before insertion of the cup. In line with this, we found that 1 Elektra screw cup loosened symptomatically at 2 years.…”

Outcome of uncemented trapeziometacarpal prosthesis for treatment of thumb carpometacarpal joint arthritis

“…The cemented implants were introduced by de La Caffinier24 in 1971. A high failure rate due to aseptic loosening has been observed with this prosthesis in most of the studies conducted in the past.…”