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PIP arthroplasties with DJOA prosthesis (22 cases)
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Anatomic and biomechanical studies of pathogenesis of trapeziometacarpal degenerative arthritis H. Najima, C. Oberlin
Service d'Orthopedie, Hospital Bichat and Laboratoire d'Anatomie des Saints-Pete de Paris, Paris, France Ligamentous laxity at the base of the thumb is often discussed as a primary cause of trapeziometacarpal osteoarthritis. Five • main ligamentous structures can be identified: the first intermetacarpal ligament (lst IML), the anterior oblique ligament (AOL), the ulnar collateral ligament (UCL), the posterior oblique ligament (POL) and the dorso radial ligament (DRL). But the mechanical properties (in particular strength) of them have not been demonstrated. The entire ligaments were obtained from 30 hand specimens with the aid of a microscope. We subjected each ligament to a strain-rate failure test (5.00 ram/rain) to determine the strength and elongation properties, using a tensiometer. The articular surfaces of the trapeziometacarpal joint in anatomic specimens were classified into four grades, according to a Collins' classification (grade 0: smooth cartilage surface, grade 1: fibrillation of cartilage limited to the superficial zones, grade 2: deep fibrillation but no exposure of bone, grade 3, 4: deep fibrillation with subchondral bone exposure). We studied the correlation between the mechanical properties of the ligament and the status of the trapeziometacarpal articular surface. As degrees progressed, tensile strength weakened greatly in the I st IML and the AOL, (the 1st IML from 11.9N to 1.43N average 4.81N, the AOL from 14.46N to 1.78N average 5.19N); however, with the UCL, the POL, and the DRL, tensile strength did not change significantly as degrees progressed. In studying the 1st IML, as we progressed from grade 0 to grade 4 (Collins' classification), tensile strength decreased greatly from grade 1 to the next. From grade 1 to grade 2, the drop was approximately 25%. With the AOL, tensile strength decreased sharply from grade 0 to grade 1, approximately 38%. Degrees of the trapeziometacarpal articular cartilage was associated with the strength of the AOL, the 1st IML. Our results suggest that the AOL and the 1st IML are the most important stabilizing structures of the trapeziometacarpal joint. Laxity of these ligaments occur simultaneously with degenerative arthritis. But we cannot support the hypothesis that ligamentous laxity is the cause of osteoarthritis.
One thousand limited wrist arthrodeses D. Ashmead, H. K. Watson, J. Weinzweig, J. Zeppieri
Hartford Hospital, University of Connecticut Medical Center, Hartford, Connecticut, USA Limited wrist arthrodesis is a useful method of treating specific carpal pathology which maximizes postoperative wrist motion and strength while eliminating pain and instability. This study represents our experience with 1077 cases in which limited wrist arthrodeses were performed over a 24-year period. Indications, technical considerations, and results of 798 triscaphe arthrodeses, 252 SLAC reconstructions, and 27 lunate-triquetral (LT) arthrodeses, are presented.
T H E J O U R N A L OF H A N D SURGERY VOL. 21B S U P P L E M E N T 1
Patients and methods The indications for triscaphe arthrodesis included symptomatic rotary subluxation of the scaphoid, degenerative arthritis of the triscaphe joint, mid-carpal instability, scaphoid non-union, and Kienbock's disease. Seven hundred and ninetyeight triscaphe arthrodeses were performed with an average follow-up of 52 months (range 12-192 months). The mean range of postoperative wrist motion was 75% of the normal opposite side except in wrists treated for Kienbock's disease, in which wrist flexion was 57% and extension was 73% of the normal side. Eighty-eight per cent of patients resumed their pre-operative employment. Two hundred and fifty-two patients underwent SLAC reconstruction with an average follow-up of 44 months (range 12-136 months). Of the patients treated for SLAC wrist with a capitate-lunate-hamate-triquetrum arthrodesis, 80% returned to their original jobs. Flexion and extension averaged 53% and 59% of the opposite normal side, respectively. Twenty-five patients underwent 27 LT arthrodeses with an average follow-up of 26 months (range 6-72 months). Indications for LT arthrodesis included LT instability, degenerative arthritis of the LT joint, and symptomatic congenital incomplete separation of the lunate and triquetrum. Postoperative wrist flexion averaged 63° and wrist extension 56°. Conclusion Limited wrist arthrodesis accomplishes the goals of pain relief and preservation of wrist motion and strength in patients with specific localized carpal pathology. Primary union rates are at least 96% in each group and no secondary degenerative arthritis has been found in these patients. In addition, patient satisfaction with these procedures has been quite high. The largest series to date of intercarpal arthrodeses demonstrates that these techniques are reliable and effective in dealing with a wide range of wrist pathology.
PIP arthroplasties with DJOA prosthesis (22 cases) A. Chamay
15 rue GdnJral-Dufour, CH-1204 Geneva, Switzerland Twenty-two DJOA Condamine prostheses (digital joint operative arthroplasty) were implanted at the PIP level and assessed at a mean follow-up of 40 months (12-74 months). The series comprised: type I, 9; type II, 5; type III, 8. These arthroplasties were performed on post-traumatic and idiopathic degenerative arthritis, but not in rheumatoid disease. The PIP joint was approached dorsally with a triangular tendinous flap pediculed on the central slip (20 cases). In the last two cases the palmar approach described by Simmen was used with a better success. Two secondary tenolyses were performed, one on both flexor and extensor tendons and one on extensor tendon only. No prostheses were removed. Radiologicaly, 23% (5) of the stems protruded into the medullary canals and 18% (4) of the DJOAs were deviated. Eighty-two per cent (18) of the arthroplasties were painfree, 73% (16) of the cases had an improved grip and pinch. The postoperative range of motion decreased with time but improved compared to the pre-operative measures. Type III gave a gain of 30° and an average mobility of 59°. Idiopathic arthritis gave better results than post-traumatic arthritis.
Anatomic and biomechanical studies of pathogenesis of trapeziometacarpal degenerative arthritis H. Najima, C. Oberlin
Service d'Orthopedie, Hospital Bichat and Laboratoire d'Anatomie des Saints-Pete de Paris, Paris, France Ligamentous laxity at the base of the thumb is often discussed as a primary cause of trapeziometacarpal osteoarthritis. Five • main ligamentous structures can be identified: the first intermetacarpal ligament (lst IML), the anterior oblique ligament (AOL), the ulnar collateral ligament (UCL), the posterior oblique ligament (POL) and the dorso radial ligament (DRL). But the mechanical properties (in particular strength) of them have not been demonstrated. The entire ligaments were obtained from 30 hand specimens with the aid of a microscope. We subjected each ligament to a strain-rate failure test (5.00 ram/rain) to determine the strength and elongation properties, using a tensiometer. The articular surfaces of the trapeziometacarpal joint in anatomic specimens were classified into four grades, according to a Collins' classification (grade 0: smooth cartilage surface, grade 1: fibrillation of cartilage limited to the superficial zones, grade 2: deep fibrillation but no exposure of bone, grade 3, 4: deep fibrillation with subchondral bone exposure). We studied the correlation between the mechanical properties of the ligament and the status of the trapeziometacarpal articular surface. As degrees progressed, tensile strength weakened greatly in the I st IML and the AOL, (the 1st IML from 11.9N to 1.43N average 4.81N, the AOL from 14.46N to 1.78N average 5.19N); however, with the UCL, the POL, and the DRL, tensile strength did not change significantly as degrees progressed. In studying the 1st IML, as we progressed from grade 0 to grade 4 (Collins' classification), tensile strength decreased greatly from grade 1 to the next. From grade 1 to grade 2, the drop was approximately 25%. With the AOL, tensile strength decreased sharply from grade 0 to grade 1, approximately 38%. Degrees of the trapeziometacarpal articular cartilage was associated with the strength of the AOL, the 1st IML. Our results suggest that the AOL and the 1st IML are the most important stabilizing structures of the trapeziometacarpal joint. Laxity of these ligaments occur simultaneously with degenerative arthritis. But we cannot support the hypothesis that ligamentous laxity is the cause of osteoarthritis.
One thousand limited wrist arthrodeses D. Ashmead, H. K. Watson, J. Weinzweig, J. Zeppieri
Hartford Hospital, University of Connecticut Medical Center, Hartford, Connecticut, USA Limited wrist arthrodesis is a useful method of treating specific carpal pathology which maximizes postoperative wrist motion and strength while eliminating pain and instability. This study represents our experience with 1077 cases in which limited wrist arthrodeses were performed over a 24-year period. Indications, technical considerations, and results of 798 triscaphe arthrodeses, 252 SLAC reconstructions, and 27 lunate-triquetral (LT) arthrodeses, are presented.
T H E J O U R N A L OF H A N D SURGERY VOL. 21B S U P P L E M E N T 1
Patients and methods The indications for triscaphe arthrodesis included symptomatic rotary subluxation of the scaphoid, degenerative arthritis of the triscaphe joint, mid-carpal instability, scaphoid non-union, and Kienbock's disease. Seven hundred and ninetyeight triscaphe arthrodeses were performed with an average follow-up of 52 months (range 12-192 months). The mean range of postoperative wrist motion was 75% of the normal opposite side except in wrists treated for Kienbock's disease, in which wrist flexion was 57% and extension was 73% of the normal side. Eighty-eight per cent of patients resumed their pre-operative employment. Two hundred and fifty-two patients underwent SLAC reconstruction with an average follow-up of 44 months (range 12-136 months). Of the patients treated for SLAC wrist with a capitate-lunate-hamate-triquetrum arthrodesis, 80% returned to their original jobs. Flexion and extension averaged 53% and 59% of the opposite normal side, respectively. Twenty-five patients underwent 27 LT arthrodeses with an average follow-up of 26 months (range 6-72 months). Indications for LT arthrodesis included LT instability, degenerative arthritis of the LT joint, and symptomatic congenital incomplete separation of the lunate and triquetrum. Postoperative wrist flexion averaged 63° and wrist extension 56°. Conclusion Limited wrist arthrodesis accomplishes the goals of pain relief and preservation of wrist motion and strength in patients with specific localized carpal pathology. Primary union rates are at least 96% in each group and no secondary degenerative arthritis has been found in these patients. In addition, patient satisfaction with these procedures has been quite high. The largest series to date of intercarpal arthrodeses demonstrates that these techniques are reliable and effective in dealing with a wide range of wrist pathology.
PIP arthroplasties with DJOA prosthesis (22 cases) A. Chamay
15 rue GdnJral-Dufour, CH-1204 Geneva, Switzerland Twenty-two DJOA Condamine prostheses (digital joint operative arthroplasty) were implanted at the PIP level and assessed at a mean follow-up of 40 months (12-74 months). The series comprised: type I, 9; type II, 5; type III, 8. These arthroplasties were performed on post-traumatic and idiopathic degenerative arthritis, but not in rheumatoid disease. The PIP joint was approached dorsally with a triangular tendinous flap pediculed on the central slip (20 cases). In the last two cases the palmar approach described by Simmen was used with a better success. Two secondary tenolyses were performed, one on both flexor and extensor tendons and one on extensor tendon only. No prostheses were removed. Radiologicaly, 23% (5) of the stems protruded into the medullary canals and 18% (4) of the DJOAs were deviated. Eighty-two per cent (18) of the arthroplasties were painfree, 73% (16) of the cases had an improved grip and pinch. The postoperative range of motion decreased with time but improved compared to the pre-operative measures. Type III gave a gain of 30° and an average mobility of 59°. Idiopathic arthritis gave better results than post-traumatic arthritis.