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Silicone Metacarpophalangeal Joint Arthroplasty for Osteoarthritis: Long Term Outcomes
Results: 222 patients met inclusion criteria. The average age was 62.8 years, and 73.9% of patients were female. 30-day mortality and morbidity rates were 0.5% mortality, 2.7% major complication, and 7.2% minor complication. The most common complications were postoperative anemia requiring transfusion (3.6%), deep surgical site infection (0.9%), and superficial surgical site infection (0.9%). Patients with greater than 3 cumulative comorbidities had significantly higher rates of postoperative complications (odds ratio [OR], 13.5; 95% confidence interval [CI], 1.8, 97.7; P < 0.001) Operative time greater than 175 minutes was independently associated with increased postoperative complications (OR, 3.7; 95% CI, 1.3, 10.7; P < 0.001). Summary Points: Based on comparison of our results to those available in the literature, patients undergoing elective total elbow arthroplasty have slightly higher complication rates than those undergoing shoulder, hip, or knee arthroplasty. Patients with greater than 3 comorbidities should be carefully counseled prior to undergoing total elbow arthroplasty due to significantly higher risks of postoperative complications.
Mayo wrist score at the final follow-up was excellent in 1 patient, good in 9, and fair in 8. Summary Points: Radial osteotomy can decrease overload and mechanical malalignment of the lunate, and simultaneously improve the vascularity of the carpus and provides reasonable, long-term clinical benefits. The clinical results were good at long-term follow-up, but the radiological improvement was not large. Pre-operative arthroscopic evaluation of cartilage damage can inform treatment decisions.
PAPER 07 Clinical Paper Session 1: Hand/Wrist Reconstruction 1 Friday, September 30, 2016 8:59e9:04 AM Treatment; Surgical Technique; Prognosis/Outcomes
Silicone Metacarpophalangeal Joint Arthroplasty for Osteoarthritis: Long Term Outcomes Level 4 Evidence
PAPER 06 Clinical Paper Session 1: Hand/Wrist Reconstruction 1 Friday, September 30, 2016 8:52e8:57 AM Treatment
Long-term Outcomes and Arthroscopic Assessments of Radial Osteotomy for Kienböck Disease Level 4 Evidence
Masahiro Tatebe, MD, PhD Hitoshi Hirata, MD Michiro Yamamoto, MD Katsuyuki Iwatsuki, MD Shigeru Kurimoto, MD, PhD Takanobu Nishizuka, MD COI: There is no financial information to disclose. Hypothesis: Kienböck disease is an aseptic necrosis of the lunate of unknown etiology, prevalent in young adults, and treatment aims to lower forces on the lunate, decrease pain and improve function. We conducted a retrospective evaluation of the 10-year clinical and radiological outcomes of radial osteotomy as a treatment for Kienböck disease. Methods: We analyzed pain, grip strength, wrist range of motion (ROM), radiological carpal geometry and staging of osteoarthritic changes under arthroscopy. Between 1993 and 2005, we identified 67 cases of unilateral Kienböck disease treated by radial osteotomy, with arthroscopic evaluation. Of these cases, 18 included a follow-up period over 10 years and formed our study group. The Mayo wrist score was used as an overall measure of outcome. Outcomes for 2 types of osteotomies were included: a step-cut osteotomy with fixed screws and an updated technique of 2 linear transverse osteotomies with volar plating using locked-plates. For cases with negative ulnar variance, resection of the radius was included to obtain a final ulnar variance of -1 to 0 mm. For positive ulnar variance, the goal was to obtain a correction of radial inclination of 10 degrees-15 degrees. Arthroscopic assessment was performed on the same day as the radial osteotomy, lesions of the articular cartilage were defined as softening, fibrillation, erosion, or defects of the joint cartilage, with an absence of lesions defined by a smooth appearance of the cartilage surface. All arthroscopic findings were classified in terms of the location of cartilage lesions. Results: Improvements in pain, ROM and grip strength were maintained over the 10-year follow-up, without radiological improvement in geometry (carpal height ratio and Stahl’s index). Mild osteoarthritic changes were identified in 33% of patients, with no effect on clinical results. Degree of cartilage damage determined post-operative grip strength improvement. The
Nathan Morrell, MD Travis Spangler Arnold-Peter C. Weiss, MD COI: Royalty: DePuy (Weiss) Receipt of Intellectual Property Rights/Patent Holder: DePuy (Weiss) Hypothesis: Silicone metacarpophalangeal (MCP) joint arthroplasty with implants are well-established in the rheumatoid patient population. The long term outcomes and survivorship for patients with osteoarthritis of the MCP joint are less clear given the higher functional demands of this patient group. Our study hypothesizes that silicone MCP arthroplasty provides excellent long term outcomes with a low complication rate in osteoarthritic patients. Methods: A consecutive case cohort of 35 patients with osteoarthritis of one or more MCP joints undergoing anatomically-neutral silicone MCP arthroplasty were followed in an IRB-approved longitudinal study of outcomes and survivorship over a 15-year period. Functional outcome parameters were assessed along with ROM/Strength and complications related to the implant or surgical procedure. All patients were available for long term assessment including radiographs. Results: Average follow-up exam for the consecutive cohort of 35 patients (40 implants) was 7.2 years. Average age was 60 years (range of 41-79 years) with 22 males and 13 females. In 31 patients, a single MCP joint was involved (MF ¼ 20; IF ¼ 10; SF ¼ 1). In 4 patients, multiple MCP joints were involved (IF/MF ¼ 3; IF/MF/RF ¼ 1). The dominant hand was involved in 23 patients. Seven (of 14) patients had a concomitant radial collateral ligament reconstruction of the index finger; no other digit had a collateral ligament reconstruction. Average VAS pain scores were 0.3 out of 10. Average final AROM were extension of 4 degrees (range of 0-21) and flexion of 73 degrees (range of 50-90). One patient had a revision MCP arthroplasty due to extensor lag and ulnar deviation (previous complicated history of infection and flexor tendon grafting in the same digit), providing a 97% survivorship. Radiographs demonstrated fractured implants in 4 of 40 implants but none exhibited instability, pain or ROM deterioration. Summary Points: The use of silicone MCP implants for the treatment of osteoarthritis appears sound. Survivorship is 97% (clinical) and 90% (radiographic) in long term follow-up. Collateral ligament reconstruction does not appear to effect stability or outcome (including the index finger). Radiographic fracture of the implant does not imply clinical deterioration of results.
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Mayo wrist score at the final follow-up was excellent in 1 patient, good in 9, and fair in 8. Summary Points: Radial osteotomy can decrease overload and mechanical malalignment of the lunate, and simultaneously improve the vascularity of the carpus and provides reasonable, long-term clinical benefits. The clinical results were good at long-term follow-up, but the radiological improvement was not large. Pre-operative arthroscopic evaluation of cartilage damage can inform treatment decisions.
PAPER 07 Clinical Paper Session 1: Hand/Wrist Reconstruction 1 Friday, September 30, 2016 8:59e9:04 AM Treatment; Surgical Technique; Prognosis/Outcomes
Silicone Metacarpophalangeal Joint Arthroplasty for Osteoarthritis: Long Term Outcomes Level 4 Evidence
PAPER 06 Clinical Paper Session 1: Hand/Wrist Reconstruction 1 Friday, September 30, 2016 8:52e8:57 AM Treatment
Long-term Outcomes and Arthroscopic Assessments of Radial Osteotomy for Kienböck Disease Level 4 Evidence
Masahiro Tatebe, MD, PhD Hitoshi Hirata, MD Michiro Yamamoto, MD Katsuyuki Iwatsuki, MD Shigeru Kurimoto, MD, PhD Takanobu Nishizuka, MD COI: There is no financial information to disclose. Hypothesis: Kienböck disease is an aseptic necrosis of the lunate of unknown etiology, prevalent in young adults, and treatment aims to lower forces on the lunate, decrease pain and improve function. We conducted a retrospective evaluation of the 10-year clinical and radiological outcomes of radial osteotomy as a treatment for Kienböck disease. Methods: We analyzed pain, grip strength, wrist range of motion (ROM), radiological carpal geometry and staging of osteoarthritic changes under arthroscopy. Between 1993 and 2005, we identified 67 cases of unilateral Kienböck disease treated by radial osteotomy, with arthroscopic evaluation. Of these cases, 18 included a follow-up period over 10 years and formed our study group. The Mayo wrist score was used as an overall measure of outcome. Outcomes for 2 types of osteotomies were included: a step-cut osteotomy with fixed screws and an updated technique of 2 linear transverse osteotomies with volar plating using locked-plates. For cases with negative ulnar variance, resection of the radius was included to obtain a final ulnar variance of -1 to 0 mm. For positive ulnar variance, the goal was to obtain a correction of radial inclination of 10 degrees-15 degrees. Arthroscopic assessment was performed on the same day as the radial osteotomy, lesions of the articular cartilage were defined as softening, fibrillation, erosion, or defects of the joint cartilage, with an absence of lesions defined by a smooth appearance of the cartilage surface. All arthroscopic findings were classified in terms of the location of cartilage lesions. Results: Improvements in pain, ROM and grip strength were maintained over the 10-year follow-up, without radiological improvement in geometry (carpal height ratio and Stahl’s index). Mild osteoarthritic changes were identified in 33% of patients, with no effect on clinical results. Degree of cartilage damage determined post-operative grip strength improvement. The
Nathan Morrell, MD Travis Spangler Arnold-Peter C. Weiss, MD COI: Royalty: DePuy (Weiss) Receipt of Intellectual Property Rights/Patent Holder: DePuy (Weiss) Hypothesis: Silicone metacarpophalangeal (MCP) joint arthroplasty with implants are well-established in the rheumatoid patient population. The long term outcomes and survivorship for patients with osteoarthritis of the MCP joint are less clear given the higher functional demands of this patient group. Our study hypothesizes that silicone MCP arthroplasty provides excellent long term outcomes with a low complication rate in osteoarthritic patients. Methods: A consecutive case cohort of 35 patients with osteoarthritis of one or more MCP joints undergoing anatomically-neutral silicone MCP arthroplasty were followed in an IRB-approved longitudinal study of outcomes and survivorship over a 15-year period. Functional outcome parameters were assessed along with ROM/Strength and complications related to the implant or surgical procedure. All patients were available for long term assessment including radiographs. Results: Average follow-up exam for the consecutive cohort of 35 patients (40 implants) was 7.2 years. Average age was 60 years (range of 41-79 years) with 22 males and 13 females. In 31 patients, a single MCP joint was involved (MF ¼ 20; IF ¼ 10; SF ¼ 1). In 4 patients, multiple MCP joints were involved (IF/MF ¼ 3; IF/MF/RF ¼ 1). The dominant hand was involved in 23 patients. Seven (of 14) patients had a concomitant radial collateral ligament reconstruction of the index finger; no other digit had a collateral ligament reconstruction. Average VAS pain scores were 0.3 out of 10. Average final AROM were extension of 4 degrees (range of 0-21) and flexion of 73 degrees (range of 50-90). One patient had a revision MCP arthroplasty due to extensor lag and ulnar deviation (previous complicated history of infection and flexor tendon grafting in the same digit), providing a 97% survivorship. Radiographs demonstrated fractured implants in 4 of 40 implants but none exhibited instability, pain or ROM deterioration. Summary Points: The use of silicone MCP implants for the treatment of osteoarthritis appears sound. Survivorship is 97% (clinical) and 90% (radiographic) in long term follow-up. Collateral ligament reconstruction does not appear to effect stability or outcome (including the index finger). Radiographic fracture of the implant does not imply clinical deterioration of results.
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