Retrospective Study of a Series of 20 Ivory Prostheses in the Treatment of Trapeziometacarpal Osteoarthritis

Abstract

Background Many surgical treatment options for osteoarthritis (OA) of the trapeziometacarpal (TMC) joint exist. However, no procedure has been proven superior. Good results have been described for TMC joint replacement.

Purpose To analyze the results of the Ivory prosthesis in the treatment of symptomatic TMC OA.

Patients and Methods A retrospective single-center follow-up study was performed. Visual analogue scale (VAS) for pain, Disabilities of the Arm, Shoulder and Hand (DASH) score, Michigan Hand Outcomes Questionnaire (MHQ), active range of motion, strength, and radiological outcomes were assessed and analyzed. Differences between the operated and nonoperated hand were analyzed using paired t-tests. Twenty patients were included with a mean follow-up duration of 37.0 months.

Results Patients experienced minimal pain with a mean VAS pain score of 1.9. DASH and MHQ scores indicated mild to moderate impairments. Eighty-five percent of patients assessed the operation excellent or good. Significant differences were found in measurements of extension and palmar thumb abduction in favor of the contralateral hand. No significant differences in strength between both hands were found. Two patients had a dislocation of the prosthesis; one patient required open reduction and tightening of the joint capsule. The other dislocation was treated with trapeziectomy and interposition of a fascia lata allograft. One patient had a collapse of the trapezium requiring a revision procedure.

Conclusion Ivory prosthesis TMC arthroplasty can achieve good results in patients with symptomatic isolated TMC OA. In this series, however, revision surgery was required in 3 of 20 cases.

Keywords

trapeziometacarpal - osteoarthritis - prosthesis - Ivory - arthroplasty

Note

The ethical review committee approved this study. This work was performed at St Antonius Hospital Nieuwegein/Utrecht.

• References

• 1 Menon J. Partial trapeziectomy and interpositional arthroplasty for trapeziometacarpal osteoarthritis of the thumb. J Hand Surg [Br] 1995; 20 (5) 700-706
• 2 Wajon A, Vinycomb T, Carr E, Edmunds I, Ada L. Surgery for thumb (trapeziometacarpal joint) osteoarthritis. Cochrane Database Syst Rev 2015; 2: CD004631
• 3 Vermeulen GM, Slijper H, Feitz R, Hovius SER, Moojen TM, Selles RW. Surgical management of primary thumb carpometacarpal osteoarthritis: a systematic review. J Hand Surg Am 2011; 36 (1) 157-169
• 4 Wachtl SW, Sennwald GR. Non-cemented replacement of the trapeziometacarpal joint. J Bone Joint Surg Br 1996; 78 (5) 787-792
• 5 Cooney WP, Linscheid RL, Askew LJ. Total arthroplasty of the thumb trapeziometacarpal joint. Clin Orthop Relat Res 1987; (220) 35-45
• 6 de la Caffinière JY. Total trapezo-metacarpal prosthesis [in French]. Rev Chir Orthop Repar Appar Mot 1974; 60 (4) 299-308
• 7 Apard T, Saint-Cast Y. Results of a 5 years follow-up of Arpe prosthesis for the basal thumb osteoarthritis [in French]. Chir Main 2007; 26 (2) 88-94
• 8 Goubau JF, Goorens CK, Van Hoonacker P, Berghs B, Kerckhove D, Scheerlinck T. Clinical and radiological outcomes of the Ivory arthroplasty for trapeziometacarpal joint osteoarthritis with a minimum of 5 years of follow-up: a prospective single-centre cohort study. J Hand Surg Eur Vol 2013; 38 (8) 866-874
• 9 Guardia C, Moutet F, Corcella D, Forli A, Pradel P. Roseland® prosthesis: quality of life's studies about 68 patients with a mean followed-up of 43.8 months [in French]. Chir Main 2010; 29 (5) 301-306
• 10 Jager T, Barbary S, Dap F, Dautel G. Evaluation of postoperative pain and early functional results in the treatment of carpometacarpal joint arthritis. Comparative prospective study of trapeziectomy vs. MAIA(®) prosthesis in 74 female patients [in French]. Chir Main 2013; 32 (2) 55-62
• 11 Kaszap B, Daecke W, Jung M. High frequency failure of the Moje thumb carpometacarpal joint arthroplasty. J Hand Surg Eur Vol 2012; 37 (7) 610-616
• 12 Klahn A, Nygaard M, Gvozdenovic R, Boeckstyns MEH. Elektra prosthesis for trapeziometacarpal osteoarthritis: a follow-up of 39 consecutive cases. J Hand Surg Eur Vol 2012; 37 (7) 605-609
• 13 Vermeulen GM, Brink SM, Sluiter J, Elias SG, Hovius SER, Moojen TM. Ligament reconstruction arthroplasty for primary thumb carpometacarpal osteoarthritis (weilby technique): prospective cohort study. J Hand Surg Am 2009; 34 (8) 1393-1401
• 14 Huang K, Hollevoet N, Giddins G. Thumb carpometacarpal joint total arthroplasty: a systematic review. J Hand Surg Eur Vol 2015; 40 (4) 338-350
• 15 Wachtl SW, Guggenheim PR, Sennwald GR. Cemented and non-cemented replacements of the trapeziometacarpal joint. J Bone Joint Surg Br 1998; 80 (1) 121-125
• 16 Rizzo M. Metacarpophalangeal joint arthritis. J Hand Surg Am 2011; 36 (2) 345-353