Surgical management of basal joint arthritis of the thumb. Part I. Long-term results of silicone implant arthroplasty

Pellegrini, Vincent D.; Burton, Richard I.

doi:10.1016/s0363-5023(86)80136-8

Cited by 197 publications

(74 citation statements)

References 43 publications

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“…Further degenerative changes of the distal scaphoid and base of the thumb metacarpal were seen in 8 patients. shown good results concerning pain relief, but silicone implant wear with resultant reactive synovitis and bone resorption are reported complications [6]. In this long term review of simple trapeziectomy good pain relief with a high level of patient satisfaction was found.…”

Section: Resultsmentioning

confidence: 72%

“…Further papers have reported the results of simple excision of the trapezium [1,2,4,5], trapeziectomy with silastic interposition [6,7], and trapeziectomy with soft tissue interposition and ligament reconstruction [8,9]. Other surgical procedures for osteoarthritis of the trapeziometacarpal joint include partial trapeziectomy and interpositional arthroplasty (soft tissue [10], silastic, and titanium), arthrodesis of the trapeziometacarpal joint [11], and total joint replacement [12].…”

Section: Introductionmentioning

confidence: 99%

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Trapeziectomy for basal thumb joint osteoarthritis: 3- to 19-year follow-up

Gibbons

Gosal

Choudri

et al. 1999

International Orthopaedics

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A consecutive series of 40 trapeziectomies in 30 patients with basal thumb joint osteoarthritis was reviewed. Sixteen thumbs had pan-trapezial and 24 thumbs trapeziometacarpal osteoarthritis. Simple excision without soft tissue interposition was performed by the same surgeon using an identical surgical technique. Twentyeight patients were female (mean age 57 years) with a mean follow-up of 11 (3-19) years. Twenty-eight patients were satisfied with their operation, with 26 thumbs being pain free. Thumb pinch strength was improved by 40% compared to preoperative values, but still remained 22% weaker than the non-operated side.Résumé Une série de 40 trapézectomies pour arthrose trapézo-métacarpienne est présentée. Il s'agit de 30 patients dont 28 de sexe féminin, d'âge moyen 57 ans, avec un suivi de 11 ans (3 à 19). L'arthrose était péri-trapézienne dans 16 cas et trapézo-métacarpienne dans 24 cas. Une simple ablation du trapèze a été fait san interposition tissulaire, par la même Chirurgien. 28 patients sont satisfaits de l'intervention avec une première colonne indolore dans 26 cas. La force de la pince polycidigitale a été améliorée de 40% comparé à l'état pré-opératoire mais reste plus faible que celle du côté non opéré.

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Section: Resultsmentioning

confidence: 72%

Section: Introductionmentioning

confidence: 99%

Trapeziectomy for basal thumb joint osteoarthritis: 3- to 19-year follow-up

Gibbons

Gosal

Choudri

et al. 1999

International Orthopaedics

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“…25,36 Silastic implants provide satisfactory relief of pain and grip strength but instability or subluxation of the implant was seen in 25% of Swanson's own series. 24 There may be implant fracture and fragmentation 28,37 and there is progressive wear of the prosthesis, 37,38 with the risk of a destructive silicone synovitis. [37][38][39] Long-term studies report the need for revision in 10% to 35% of patients.…”

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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“…Proof of this stressful environment is evident by the high rate of mechanical failure of silicone implants at the CMC joint. 57 In most persons, the CMC joint functions well throughout a lifetime of relatively large imposed stress. Force at the joint is partially absorbed and resisted by healthy, strong ligaments.…”

Section: Deformitymentioning

confidence: 99%

“…9 Numerous techniques have been devised since, however, reports indicate mixed results. 57 Two main reasons for failure of this surgery are silicone implant fracture over time and silicone synovitis.…”

Section: Surgical Interventionmentioning

confidence: 99%