Systematic Review of Thumb Carpometacarpal Joint Hemiresection Interposition Arthroplasty Materials

Abstract

Background Osteoarthritis of the first carpometacarpal joint is a common condition. Various management options and surgical procedures have been described to treat symptomatic cases. Many systematic reviews examine aspects of thumb carpometacarpal joint osteoarthritis treatment, although none solely examines the outcomes of trapezial partial resection and interposition arthroplasty in stage II to III patients in detail, yet this technique is of growing interest as surgeons seek more nuanced, tailored approaches for osteoarthritis of the first carpometacarpal joint. Methods A systematic review of the thumb carpometacarpal joint hemiresection and interposition arthroplasty was performed with pain assessment as a primary outcome measure and patient-reported outcome measures (PROMs) and reoperation rate as secondary outcome measures. A search was performed between 2004 and 2019 using MEDLINE, Embase, and PubMed. Preferred Reporting Items and Systematic Reviews and Meta-Analyses guidelines were used. Results Twenty-nine articles met the inclusion criteria and were included in the final review. Pain relief and improved PROMs were described in all the articles using this technique with all the interposition materials. Materials such as polyurethane urea matrix and poly-l/d-lactide scaffold had higher complication rates. Revision rates varied and were highest with the polyurethane urea matrix. Conclusions This review shows that hemiresection interposition arthroplasty is a useful technique and provides symptomatic benefit in patients with Eaton-Littler stage II and III osteoarthritis. Revision surgery rates due to persistent pain and instability were higher with the use of implants. Larger and long-term studies of this technique using autologous or more bioinert materials and implants are required to assess duration of symptomatic benefit.

Outcomes of Revision of Interposition Implant Trapeziometacarpal Arthroplasty

“…5 However, the outcomes of interposition implant arthroplasty have not been superior to partial or total trapeziectomy and they may be associated with a high risk of complications and revisions. 3,4,5,18,20,21 This is probably related to several factors such as the complex mechanics of the TMC joint and biocompatibility and of the implant. The frequency of implant arthroplasty in our clinic was very low, 9 which might have contributed to the high revision rate in our study patients.…”

“…Revision surgery rates varied from 0% to 37.5% and were highest with Artelon. 5 Outcomes of the Pyrosphere implant have been reported in only 1 study, in which the results were good with no subluxation and dislocations of the implant, and no revision procedures were necessary. 28 In our study, the mean revision rate of various interposition implants was as high as 59%, which is higher than reported in the earlier literature.…”

“…28 In our study, the mean revision rate of various interposition implants was as high as 59%, which is higher than reported in the earlier literature. 5…”

“…This potentially benefits in minimal loss of thumb height and provides stability compared to simple trapeziectomy. 5 However, the outcomes of interposition implant arthroplasty have not been superior to partial or total trapeziectomy and they may be associated with a high risk of complications and revisions. 3,4,5,18,20,21 This is probably related to several factors such as the complex mechanics of the TMC joint and biocompatibility and of the implant.…”

“…Implant arthroplasty for trapeziometacarpal (TMC) osteoarthritis has shown variable results and has often been associated with high complication and revision surgery rates. [1][2][3][4][5] Generally, implant complications can be categorized into dehiscence; mechanical such as luxation, loosening, breakage, or wearing of components; and adverse tissue reactions leading to varying revision rates. 1 Some publications have reported outcomes of revision surgery for TMC osteoarthritis in general.…”