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Predictors of Successful Pyrocarbon Hemiarthroplasty for Treatment of Trapeziometacarpal Arthritis: A Single Institution Retrospective Review
Barbara Mullen, MD
1; Matthew Rode, BS, MS
2; Samuel Schrader, MD
1; Steve L. Moran, M.D.
31Mayo Clinic, Rochester, MN; 2Mayo Clinic Alix School of Medicine, Rochester, MN; 3Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, MN
Background: While trapeziectomy remains the standard surgical management of trapeziometcarpal(TMCP) arthritis, we have trialed pyrocarbon hemiarthroplasty as an alternative intervention with moderate success. Herein, we analyze factors associated with successful outcomes of TMCP pyrocarbon hemiarthroplasty at our institution.
Methods: We performed a retrospective review of patients treated with pyrocarbon hemiarthroplasty for TMCP arthritis at our institution. We assess preoperative, surgical, and postoperative radiographic factors associated with
implant success.
Implant success was defined as improved grip strength, decreased postoperative pain, self-reported functional capability and significantly improved condition via orthopedic joint registry survey, and no reoperation. Those with under one year follow-up were excluded.
Results: A total of 156 hemiarthroplasties(19% bilateral) were performed. Most(85%) were NuGrip implant; the rest were PyroHemiSphere. Median follow-up time was 6.4 years.
Average grip strength was only marginally increased from 24.5 to 25.5 kg(p=0.64). Improved grip strength was seen in 57% of thumbs(34/60) with a mean increase of 10(SD 7.8) kg. On logistic regression, men were significantly less likely to have improved grip strength when controlling for age(OR 0.30, 95%CI 0.09-0.89, p=0.03).
A reduction in pain was seen in 82% of cases(127/154) with 68% experiencing complete resolution(86/127). No factors were associated with decreased postoperative pain.
Functional survey response rate was 75%. Around 40%(33/82) endorsed entirely normal ability to do daily activities, 78%(64/82) near normal, and 74%(64/84) felt their function was much better. On multiple variable analysis, all normal functional ability was less likely when surgery was on the dominant hand(OR 0.34, CI 0.12-0.89, p=0.03) or there was evidence of subsidence on postoperative radiographs(OR 0.31, CI 0.11-0.81, p=0.02). Near normal functional ability was less likely in the setting of concomitant procedures (OR 0.29, CI 0.10-0.85, p=0.02). No factors were associated with self-reported significant improvement in condition.
Reoperation was required in a quarter of cases(38 thumbs). Survival rates from reoperation at 5 and 10 years were 75% and 72%. No factors were associated with reoperation. Pain improvement was the only functional outcome associated with reoperation(OR 0.22, CI 0.09-0.52, p=0.0006), which is anticipated as pain was the most common reason for reoperation.
Conclusion: Across functional metrics, no consistent factors were associated with pyrocarbon hemiarthroplasty success in our practice, but females, surgery on the nondominant hand, no concomitant procedures, and absence of postoperative radiographic subsidence were associated with improvement in some functional outcomes. Notably, the only postoperative functional metric associated with reoperation was absence of pain reduction.
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