Revision Procedures for Complications of Surgery for Osteoarthritis of the Carpometacarpal Joint of the Thumb

Conolly, W. Bruce; Rath, Suchitra

doi:10.1016/0266-7681(93)90166-d

Cited by 100 publications

(76 citation statements)

References 14 publications

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“…O tratamento ideal seria aquele que, além do alívio da dor, proporcionasse estabilidade articular com movimento e força. A simples ressecção do trapézio é relatada por poucos autores, como um possível risco de artrose entre as superfícies incongruentes da base do 1 o metacarpiano e do escafóide (32) . No entanto, estudos pós-operatórios de seguimentos a longo prazo não demonstraram essa complicação (3)(4)6) embora Iyer tenha observado quistos na base do 1 o metacarpiano em 60% de seus casos, que não influenciaram no resultado final (7) .…”

Section: Discussionunclassified

Estudo comparativo entre ressecção do trapézio e interposição tendinosa com e sem ligamentoplastia no tratamento da artrose carpometacarpiana do polegar

Pardini¹,

Freitas²,

Chaves³

et al. 2008

Rev. bras. ortop.

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Section: Discussionunclassified

Estudo comparativo entre ressecção do trapézio e interposição tendinosa com e sem ligamentoplastia no tratamento da artrose carpometacarpiana do polegar

Pardini¹,

Freitas²,

Chaves³

et al. 2008

Rev. bras. ortop.

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“…[31][32][33] It requires prolonged immobilisation, the average rate of nonunion is 13%, 34 and pain may recur because of degenerative changes in the overloaded scaphotrapezial joint. 27 Total joint replacements may become infected and the components may wear. Aseptic loosening may occur, and in the two largest published series 25,35 fewer than 50% of the prostheses were soundly fixed when reviewed at three and five years.…”

Section: Discussionmentioning

confidence: 99%

First metacarpal osteotomy for trapeziometacarpal osteoarthritis

Hobby

Lyall

Meggitt

1998

The Journal of Bone and Joint Surgery. British volume

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We report a long-term follow-up of abduction-extension osteotomy of the first metacarpal, performed for painful trapeziometacarpal osteoarthritis. Of a consecutive series of 50 operations, 41 thumbs (82%) were reviewed at a mean follow-up of 6.8 years. Good or excellent pain relief was achieved in 80%, and 93% considered that surgery had improved hand function, while 82% had normal grip and pinch strength, with restoration of thumb abduction. Trapeziometacarpal osteoarthritis is associated with degeneration of the palmar beak ligament 10 and articular degeneration starts on the joint surfaces adjacent to it. The cartilage of the dorsoradial joint surface is spared until late in the disease process. 10 A recent cadaver study has shown that extension osteotomy of the first metacarpal shifts the area of joint contact from the worn palmar cartilage to the normal dorsal surface. 11 We describe our experience of osteotomy in a large series of patients over a period of 12 years. Patients and MethodsWe carried out 50 operations in 42 patients; 41 thumbs (82%) in 33 patients were available for review at a mean of 6.8 years (2 to 12) from operation. The average age at operation was 57 years (20 to 73). Nine of the operations were in men and 32 in women, and the dominant hand was involved in 20 patients. Nine patients were lost to followup. Three had died, one had moved and could not be contacted, and three very elderly patients could not be traced. Another elderly man was too confused to co-operate. One patient was contacted by telephone but did not wish to be reviewed. When last seen she had complete relief of pain, full abduction and a strong grip. The patients were reviewed by a surgeon who had not been involved in the operation. Pain and hand function were assessed by the patient, using a self-administered questionnaire. Grip strength was measured with a Jamar dynamometer (Asimov Engineering Company, Los Angeles, California), and pulp to pulp (pinch) and lateral pinch (key-grip) with a B & L hydraulic pinch meter (B&L Engineering, Santa Fe Springs, California). The mean of three readings was compared with normal ranges matched for age and sex. 12 The range of movement and maximum abduction were measured clinically with a goniometer. Thumb opposition and the ability to flatten the palm were assessed and recorded. Indications for operation. Surgery was carried out when pain which interfered with everyday activities had not responded to conservative treatment with a splint, nonsteroidal anti-inflammatory drugs or injection with lignocaine and hydrocortisone. Osteotomy was only considered for mild and moderate degenerative changes confined to the trapeziometacarpal joint, scaphotrapezial wear being a contraindication. The preoperative radiographs were graded as described by Eaton and Littler 13 : grade 1, no radiological changes; grade 2, osteophytes or intra-articular fragments of <2 mm with no narrowing of

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“…24 This results in a large number of clinically reported dislocations. 22,25,26 Dislocations may be the result of an altered load flow due to subluxation of the thumb in advanced stages of osteoarthritis of the CMC I joint. If so, these changes could be detected indirectly by assessing changes in the bony microarchitecture of the trapezial bone.…”

Section: Introductionmentioning

confidence: 99%

Microstructural adaptation in trapezial bone due to subluxation of the thumb

Nufer

Goldhahn

Köhler

et al. 2007

Journal Orthopaedic Research

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Although the thumb saddle is one of the most common sites of degenerative osteoarthritis in the hand, little is known about the altered microstructure in osteoarthritic trapezial bones. External forces resulting from subluxation of the carpometacarpal joint of the thumb (CMC I) should provoke microstructural changes in the trapezium. The purpose of this study was to compare the regional differences of the microstructure between osteoarthritic and healthy trapezial bones. Fifteen trapezia harvested from female patients with radiologically and clinically diagnosed saddle joint osteoarthritis (OA) were compared with 15 unaffected controls. Microstructural parameters, such as bone volume ratio (BV/TV), three-dimensional connectivity (Conn.D), trabecular number (Tb.N), and trabecular thickness (Tb.Th) were studied using a microcomputed tomography (microCT) system. While the trapezial height in OA was 22% less, the sclerotic subchondral bone layer thickness was 50% higher in OA compared with the control group (p < 0.001). In the OA group there was a 42% higher bone volume ratio (p 0.001), an 18% increase in Tb.Th (p ¼ 0.006), and a 10% greater Tb.N (p ¼ 0.034) compared with the control group. Although in both groups BV/TV was significantly lower in the radial region, the radial column showed the highest relative increase in bone volume and structure compared with the control group (þ67% BV/TV, þ20% Tb.Th, þ23% Tb.N). The reinforcement of the bony microstructure in CMC I OA, especially at the radial side, is a sign for bone adaptation reacting to radially shifted joint forces. This has to be considered during the development of new prosthetic alternatives. ß

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Revision Procedures for Complications of Surgery for Osteoarthritis of the Carpometacarpal Joint of the Thumb

Cited by 100 publications

References 14 publications

Estudo comparativo entre ressecção do trapézio e interposição tendinosa com e sem ligamentoplastia no tratamento da artrose carpometacarpiana do polegar

Estudo comparativo entre ressecção do trapézio e interposição tendinosa com e sem ligamentoplastia no tratamento da artrose carpometacarpiana do polegar

First metacarpal osteotomy for trapeziometacarpal osteoarthritis

Microstructural adaptation in trapezial bone due to subluxation of the thumb

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