Dual-mobility thumb carpometacarpal joint arthroplasty. Keypoints of surgical procedure for a satisfying outcome

Abstract

Thumb carpometacarpal (CMC) arthritis is a prevalent pathology, particularly among elderly women, with a significant impact on patients' quality of daily life. Total joint replacement can provide a shorter rehabilitation period and satisfying function, at least in the short term with encouraging findings according to recent studies concerning its complications (e.g., dislocation, loosening) and longevity. TOUCH® is a second-generation, dual mobility prosthesis with promising results. Step-by-step surgical technique and keypoints for successful implantation and satisfying thumb function are presented in this article.

Keywords: CMC I arthroplasty; Dual mobility; Neck offset; Porous coated implants; Thumb carpometacarpal arthritis.

Fig. 1

Female patient 62 years old with thumb CMC arthritis and De Quervain tenosynovitis of the left hand. After the 1st dorsal compartment release, the CMC capsule is longitudinally opened, and the metacarpal is dorsally dislocated (a). The base of the metacarpal is resected by a saw using a guide tool (b). The medullary canal of the metacarpal is prepared using rasps of increasing size (c), and the permanent stem is press-fitted flush with the bone. Note that the palmar edge of the metacarpal at the level of osteotomy is additionally resected (d).

Fig. 2

The distal articular surface of the trapezium is revealed using the special Hohmann retractor, and osteophytes of the circumference are excised with caution not to damage the central osteochondral area where a guide wire is put perpendicularly (a, b). The positioning and axis of the drill guide are checked by the image intensifier in anteroposterior and lateral views (c, d).

Fig. 3

The reamer is inserted over the guide wire (a), and the cavity for cup fixation is prepared in trapezium (b). The cup is press-fitted with its outer polished flange left outside of the bone (c), and the proper neck (with an offset in this case) is fixed on the stem (d).

Fig. 4

Mobility and stability check of the arthroplasty by putting the thumb in opposition (a), retropulsion (b), and tenodesis effect (c, d). Through these tests, the range of motion and the stability of the prosthesis are evaluated, and possible impingement can be detected.