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Interpositional Arthroplasties with Swanson Prosthesis for Osteoarthritis of the Trapeziometacarpal Joint – Early to Mid-term Results
Cynthia Tsang, MBChB; Erez Avisar, MD; Elliot Sorene, MB, BS, FRCS, (Tr, &; University College Hospital
University College Hospital, London, United Kingdom
INTRODUCTION:The trapeziometacarpal joint (TMJ) is the site most frequently requiring surgical intervention for osteoarthritis in the hand. There is a lack of consensus regarding the best treatment modality. Options including ligament reconstruction, resection arthroplasty, silicone implantation, tendon interposition and total joint arthroplasty are adopted based on patient factors and surgeon’s preference. Over the past decade, prosthesis instability has led to the lesser use of silicone implant. Our unit performed over 50 TMJ reconstructions combining the techniques of trapeziectomy, formation of a Weilby sling utilizing flexor carpi radialis, stabilizing the trapezial silicone implant, with good results and high patient satisfaction.
METHODS:Results of 54 consecutive cases is presented. Patients with Eaton stage III and IV disease were recruited between 2008 and 2011. All procedures were performed by the senior author. The mean duration of follow-up was 12 months.
RESULTS:The mean age at time of surgery was 63 years (range 45-82 years). 77% were female. Six patients elected for bilateral procedures, accounting for 22% of cases. Prosthesis subluxation occurred in 2 out of 54 cases, where implants were subsequently removed. Prosthetic instability was noted intra-operatively in two cases, deeming the patients unsuitable for the described procedure. First metacarpal base subluxation were pronounced in both cases. The technique was also successful employed following removal of an Artelon spacer from previous TMJ reconstruction. 22 out of 48 patients were available for functional assessment. Visual analogue score (VAS) for pain was comparable between the treated and contralateral hand, VAS 0.6 and 0.8 respectively (range 0-3 on both sides). Average DASH score was 21 (range 2-52). Pinch and grip strength were also comparable: pinch strength 5.7kg (operated) and 6.4kg (contralateral) and grip strength 10.9kg (operated) and 11.1kg (contralateral). Palmar abduction of over 80o was reached by all patients, with an average of 85o. Metacarpophalangeal joint hyperextension was minimal with an average of 0.2o (range 0-5o). Two patients requested to continue their follow-up at their local hospital after 3 and 12 months respectively. There was no postoperative morbidity at time of follow-up.
CONCLUSION:The early to mid-term results of this novel technique are encouraging in the management of Eaton stage III and IV osteoarthritis of the TMJ, providing pain relief and improved power and function. Long-term results are awaited. Silicone implant may remain a recommended option for treatment of TMJ osteoarthritis when surgical technique is carefully considered.
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