I doubt if new implants really improve results, making surgery more expensive and increasing the number of complications (dislocations, infections...)
In my experience FCR Sling reconstruction following trapeziectomy has an excellent patient satisfaction profile, very good functional improvement and good longevity. In a case series of several hundred spanning 10 years I has seen only one patient return with a symptomatic degenerate trapezoid/metacarpal articulation. I have yet to see good evidence that implant arthroplasty provides a statistically significant greater functional improvement as compared to FCR reconstruction.
I see good results with simple trapeziectomy without any tendon procedure , I make two holes [ using towel clip] in the base of the 1st metacarpus and suture the capsule to it - I must admit that in few patients aduuction contracture of 1st metacarpus is not corrected but symptoms resolved even in those cases.
Dear Adolfo
This article may be useful for you:
Comparison of Ligament Reconstruction Tendon Interposition and Trapeziometacarpal Interposition Arthroplasty for Basal Joint Arthritis
Louis Catalano, MD; Landon T. Horne, MD; Evan Fischer, MD; O. Alton Barron, MD; Steven Z. Glickel, MD
Orthopedics
March 2008 - Volume 31 · Issue 3
In my internship in Centro Hospitalar São João, Porto, Portugal, we've done a study (that is still in writing phase) that compared ARPE arthroplasty vs LRTI, and the same showed that they had similar results in pain relief and range of motion, but arthroplasty showed better results (statistically significant) in recovering pinch and grip strength.
Both groups had similar gender and age parameters, mean follow up was 3,4years and both procedures had same rate of complications
There is currently an RCT running out of Canada looking at Pyrodisk V Trapeziectomy +-LRTI.
Currently there is no good evidence to suggest that a procedure that may take longer, and costs more is of benefit over trapeziectomy +-LRTI.
A recent publication in JHS suggested that in a small cohort of patients who underwent Pyrodisk replacement there was good outcomes, including good pinch grip strength, but this cohort was not compared to a more traditionally treated group, but rather to a group of people without TMCJ arthritis.
I have been used LRTI. I agree with Nelson Elias. There aren´t evidences of a best procedure.
To answer the question, whether trapeziectomy (with or without tendon interposition) provides a better or a less favoured outcome when compared to Implant arthroplasty, a randomised controlled trial should be conducted. This particular trial would be difficult to design due to the large number of different implant designs available in trapeziometacarpal joint replacement. Considering the above, the next best available option will be to compare trapeziectomy with one or two implant arthroplasty implant designs. This also creates another issue, which implants would you choose to compare against. Literature search shows that over the last 40-50 years many studies have been conducted but they included small numbers which makes the choice of implants to compare against trapeziectomy a difficult task.
in the next few months we will publish a literature review looking into the outcome of implant arthroplasty in trapeziometacarpal joint replacement analysing the results of all designs used since the Swanson implant in the 60s to the rcent pyrocarbon implants being used since the 2000s. This is a MSc project.
Implants generally do as well as any of the other procedures, the only problem you run into with the implants is their longevity, loosening and FB reactions. Recently I have been doing Suture suspension arthroplasty for the last five years and the results are good. We will soon be publishing our finding.
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