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. 2014 Summer;22(2):79-82.

Early outcomes of arthroplasty of the first carpometacarpal joint using pyrocarbon spherical implants

Omar Bengezi  1 , Anthony Vo  2
Affiliations

Early outcomes of arthroplasty of the first carpometacarpal joint using pyrocarbon spherical implants

Omar Bengezi et al. Plast Surg (Oakv). 2014 Summer.

Abstract
in English, French

The first carpometacarpal joint (CMC) is the most common hand joint to develop osteoarthritis. A survey found that many hand surgeons have revisited implant arthroplasty because it preserves critical structures. However, there is currently no implant with an ideal design and material composition. The present study was the first to use and evaluate early outcomes of pyrocarbon spherical implants for arthroplasty of the first CMC in patients with Eaton-Littler stage II and III osteoarthritis. A single surgeon performed 24 arthroplasties (23 patients [20 women, three men] with a mean age of 56 years [range 46 to 75 years]) of the first CMC (nine right hands and 15 left hands) using pyrocarbon spherical implants from May 2010 to April 2013. All patients failed conservative management. At a mean (± SD) of 18.5±11.16 months postoperatively (range 4.3 to 38.9 months), the mean Kapandji score was 8.8 of 10 (range 7 to 10), the average pre- and postoperative values on the visual pain scale were 8.96±0.64 of 10 (range 8 to 10) and 1.13±1.22 of 10 (range 0 to 4), respectively. All patients were either very satisfied (score = 5) or satisfied (score = 4) with the procedure, with a mean satisfaction score of 4.76±0.44 of 5.00 (range 4 to 5). The mean postoperative Disabilities of the Arm, Shoulder and Hand (DASH) score was 11.79±14.29 (range 0 to 49.17). The most recent radiographic evaluations confirmed that all implants were stable with no erosion of nearby cancellous bone. There were no implant subluxations, dislocations or revisions. Early outcomes show promising results and support continued use of this implant for arthroplasty. However, longer-term follow-up will be needed to confirm these results.

La première articulation carpométacarpienne (CMC) est l’articulation de la main la plus touchée par l’arthrose. Une enquête a révélé que de nombreux chirurgiens de la main ont revu l’arthroplastie avec implant parce qu’elle en préserve les structures essentielles. La présente étude était la première à utiliser et à évaluer les résultats cliniques précoces d’implants sphériques en pyrocarbone pour l’arthroplastie de la première CMC chez des patients atteints d’arthrose de stades II et III selon la classification d’Eaton-Littler. Un seul chirurgien a effectué 24 arthroplasties de la première CMC (neuf de la main droite et 15 de la main gauche), au moyen d’implants sphériques en pyrocarbone, chez 23 patients (20 femmes, trois hommes) d’un âge moyen de 56 ans (plage de 46 à 75 ans) entre mai 2010 et avril 2013. Tous les patients ont échoué à une prise en charge prudente. Après une moyenne (± ÉT) de 18,5±11,16 mois après l’opération (plage de 4,3 à 38,9 mois), l’indice de Kapandji moyen était de 8,8 sur 10 (plage de 7 à 10), les valeurs préopératoires et postopératoires moyennes sur l’échelle visuelle de la douleur s’établissaient à 8,96±0,64 sur 10 (plage de 8 à 10) et à 1,13±1,22 sur 10 (plage de 0 à 4), respectivement. Tous les patients étaient soit très satisfaits (indice = 5) ou satisfaits (indice = 4) de l’intervention, et leur indice de satisfaction moyen s’élevait à 4,76±0,44 sur 5,00 (plage de 4 à 5). Le score DASH moyen d’incapacité du bras, de l’épaule et de la main était de 11,79±14,29 (plage de 0 à 49,17). Les évaluations radiographiques les plus récentes ont confirmé la stabilité de tous les implants, sans érosion de l’os spongieux avoisinant. Il n’y avait pas eu de subluxation, de dislocation ou de révision de l’implant. Les résultats cliniques précoces donnent des résultats prometteurs et appuient l’utilisation de cet implant en cas d’arthroplastie. Cependant, un suivi à plus long terme s’impose pour confirmer ces résultats.

Keywords: Arthroplasty; Carpometacarpal osteoarthritis; Pyrocarbon; Spherical implant.

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Figures

Figure 1)
Figure 1)
A pyrocarbon spherical implant for arthroplasty of the first carpometacarpal joint (Integra LifeSciences Corporation, USA)
Figure 2)
Figure 2)
Surgical technique of arthroplasty of the first carpometacarpal joint (CMC) using pyrocarbon spherical implants. A Marking the incision over the first CMC joint of the left hand. B From the radial styloid process, a longitudinal incision was made over the extensor pollicis brevis and the abductor pollicis longus tendons, terminating 1.5 cm distal to the base of the metacarpal bone. C The deep branch of radial artery was identified, freed and protected with a vessel loop. D The capsular periosteal flaps were elevated to expose the joint. E Following the resection of the distal surface of the trapezium and the base of the first metacarpal bone with a sagittal saw, the implant sizer was placed flat on the surface of the trapezium. F A round bur was used on the two resected surfaces to produce a cup in the centre. G A Broach (raspatory) was used to polish the surface of the cups. H and I The pyrocarbon spherical implant was inserted into position using an implant retriever. J Closure of the joint capsule using 2-0 undyed TiCron (Covidien, USA) sutures. K Closure of the skin using 4-0 Monocryl (Ethicon, USA) sutures
Figure 3)
Figure 3)
Plain radiograph of the right hand following arthroplasty of the first carpometacarpal joint using a spherical pyrocarbon implant
Figure 4)
Figure 4)
A 62-year-old woman with a Kapandji score of 10 of 10 for the left thumb (A) and right thumb (B), 29.6 and 17.3 months postoperatively, respectively
See this image and copyright information in PMC

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