Session 8: Hand / Wrist
Torsdag d. 25. oktober
13:00-14:30
Lokale: Stockholm/Copenhagen/Helsinki/Oslo
Chairmen: Janni Thillemann og Michel Bocktryns
Lene Dremstrup, Lone Stilling, Lone Kirkeby, Lotte Priess Larsen, Torben Bæk Hansen
University Clinic for hand, hip and knee surgery, Regional Hospital West Jutland, Holstebro; Department of Orhopaedics, Aarhus University; University Clinic for hand, hip and knee surgery, Regional Hospital West Jutland, Holstebro; University Clinic for hand, hip and knee surgery, Regional Hospital West Jutland, Holstebro; University Clinic for hand, hip and knee surgery, Regional Hospital West Jutland, Holstebro
Background: Cup failure is a recognized problem in total trapeziometacarpal (TM) joint prostheses and therefore options for cup revision are needed. Trapeziectomy has been the primary salvage procedure and has shown better results than revision to a cemented cup. Since 2013 we have used cementless cup revision.
Purpose / Aim of Study: To evaluate the early results after cementless cup revision in TM joint arthroplasty.
Materials and Methods: A cohort of 23 patients (21 female) at mean age 56 years (range 46-72) were followed prospectively after cup revision in primary TM joint prosthesis. Indications for surgery were pain, dislocation, aseptic cup loosening. Cementless Moovis pressfit cup without bonegrafting (n=4) or cementless Moovis screw cup with distal radius cancellous bone autograft (n=19) were used. Patients were evaluated with grip strength, DASH score, pain measured by VAS at rest and activity, and standard radiographs preoperatively and after 3, 12, 24 months. Mean follow up time was 18.2 months (range 3-60). 20 patients had 12 months follow up.
Findings / Results: At one-year follow up DASH improved 18 (SD 21) points (p<0.002), grip strength improved 7.7 (SD 4.4) kg (p=0.009), and VAS pain at activity improved 3.8 (SD 2.5) points (p<0.004). 19 patients had radiographs with well-fixed cups based on visual judgement. One patient was revised to a trapeziectomy after 3 months because of cup loosening. There were no other revisions or complications. At two-years patients reported mean VAS 9.8 (range 8-10) on satisfaction with their result and all were willing to repeat the procedure.
Conclusions: Cementless cup revision after failed total TM joint arthroplasty provides clinically relevant functional improvement and high patient satisfaction at short-term follow up. Results are at the level of primary trapeziectomy in a similar age group.
University Clinic for hand, hip and knee surgery, Regional Hospital West Jutland, Holstebro; Department of Orhopaedics, Aarhus University; University Clinic for hand, hip and knee surgery, Regional Hospital West Jutland, Holstebro; University Clinic for hand, hip and knee surgery, Regional Hospital West Jutland, Holstebro; University Clinic for hand, hip and knee surgery, Regional Hospital West Jutland, Holstebro
Background: Cup failure is a recognized problem in total trapeziometacarpal (TM) joint prostheses and therefore options for cup revision are needed. Trapeziectomy has been the primary salvage procedure and has shown better results than revision to a cemented cup. Since 2013 we have used cementless cup revision.
Purpose / Aim of Study: To evaluate the early results after cementless cup revision in TM joint arthroplasty.
Materials and Methods: A cohort of 23 patients (21 female) at mean age 56 years (range 46-72) were followed prospectively after cup revision in primary TM joint prosthesis. Indications for surgery were pain, dislocation, aseptic cup loosening. Cementless Moovis pressfit cup without bonegrafting (n=4) or cementless Moovis screw cup with distal radius cancellous bone autograft (n=19) were used. Patients were evaluated with grip strength, DASH score, pain measured by VAS at rest and activity, and standard radiographs preoperatively and after 3, 12, 24 months. Mean follow up time was 18.2 months (range 3-60). 20 patients had 12 months follow up.
Findings / Results: At one-year follow up DASH improved 18 (SD 21) points (p<0.002), grip strength improved 7.7 (SD 4.4) kg (p=0.009), and VAS pain at activity improved 3.8 (SD 2.5) points (p<0.004). 19 patients had radiographs with well-fixed cups based on visual judgement. One patient was revised to a trapeziectomy after 3 months because of cup loosening. There were no other revisions or complications. At two-years patients reported mean VAS 9.8 (range 8-10) on satisfaction with their result and all were willing to repeat the procedure.
Conclusions: Cementless cup revision after failed total TM joint arthroplasty provides clinically relevant functional improvement and high patient satisfaction at short-term follow up. Results are at the level of primary trapeziectomy in a similar age group.
Lone Kirkeby, Poul Frost, Susanne Wulff Svendsen, Torben Bæk Hansen
University Clinic of Hand, Hip and Knee Surgery, Regional Hospital West Jutland, Holstebro; Danish Ramazzini Centre, Department of Occupational Medicine , Aarhus University Hospital, Aarhus; Danish Ramazzini Centre, Department of Occupational Medicine, Regional Hospital West Jutland - University Research Clinic, Herning; University Clinic of Hand, Hip and Knee Surgery, Regional Hospital West Jutland, Holstebro
Background: There are no published studies concerning return to work and disability after trapeziometacarpal (TM) total joint arthroplasty in patients of working age.
Purpose / Aim of Study: To determine the influence of occupational mechanical exposures on the prognosis after TM total joint arthroplasty with respect to return to work and patient-rated disability, hypothesizing that occupational mechanical exposures are negative prognostic factors.
Materials and Methods: The study is a register- and questionnaire based follow-up study of 239 patients aged 39-65 years (mean age 55 years), who were operated with a TM total joint arthroplasty in the period 2003-2015. Data concerning DASH, VAS and grip strength before the operation and 3 and 12 months postoperatively was combined with information about labour market attachment from the Danish National Register on Public Transfer Payments. The patients’ self- reported job title was linked to a job exposure matrix to obtain estimates of occupational mechanical hand-arm exposures. Uni- and multivariable Cox and Poisson regression models were used.
Findings / Results: A high DASH score before operation was associated with less chance of clinical relevant improvement in DASH 12 months after surgery. 127 patients were listed as active on the labour market at the time of surgery. Of these, 49% returned to work within 15 weeks, and 12 months after surgery 91% had returned. Forceful work was a predictor of later return to work.
Conclusions: The prognosis after TM total joint arthroplasty with respect to return to work and disability is generally good. High occupational mechanical exposures are associated with prolonged sick leave. Knowledge of the patient’s occupational exposures is necessary for conveying realistic expectations regarding the time needed off work postoperatively.
University Clinic of Hand, Hip and Knee Surgery, Regional Hospital West Jutland, Holstebro; Danish Ramazzini Centre, Department of Occupational Medicine , Aarhus University Hospital, Aarhus; Danish Ramazzini Centre, Department of Occupational Medicine, Regional Hospital West Jutland - University Research Clinic, Herning; University Clinic of Hand, Hip and Knee Surgery, Regional Hospital West Jutland, Holstebro
Background: There are no published studies concerning return to work and disability after trapeziometacarpal (TM) total joint arthroplasty in patients of working age.
Purpose / Aim of Study: To determine the influence of occupational mechanical exposures on the prognosis after TM total joint arthroplasty with respect to return to work and patient-rated disability, hypothesizing that occupational mechanical exposures are negative prognostic factors.
Materials and Methods: The study is a register- and questionnaire based follow-up study of 239 patients aged 39-65 years (mean age 55 years), who were operated with a TM total joint arthroplasty in the period 2003-2015. Data concerning DASH, VAS and grip strength before the operation and 3 and 12 months postoperatively was combined with information about labour market attachment from the Danish National Register on Public Transfer Payments. The patients’ self- reported job title was linked to a job exposure matrix to obtain estimates of occupational mechanical hand-arm exposures. Uni- and multivariable Cox and Poisson regression models were used.
Findings / Results: A high DASH score before operation was associated with less chance of clinical relevant improvement in DASH 12 months after surgery. 127 patients were listed as active on the labour market at the time of surgery. Of these, 49% returned to work within 15 weeks, and 12 months after surgery 91% had returned. Forceful work was a predictor of later return to work.
Conclusions: The prognosis after TM total joint arthroplasty with respect to return to work and disability is generally good. High occupational mechanical exposures are associated with prolonged sick leave. Knowledge of the patient’s occupational exposures is necessary for conveying realistic expectations regarding the time needed off work postoperatively.
Larsen Lotte Priess, Kirkeby Lone, Dremstrup Lene, Stilling Maiken, Hansen Torben Bæk
University Clinic for hand, hip and knee surgery, Regional Hospital Holstebro, Aarhus University, Denmark; University Clinic for hand, hip and knee surgery, Regional Hospital Holstebro, Aarhus University, Denmark; University Clinic for hand, hip and knee surgery, Regional Hospital Holstebro, Aarhus University, Denmark; University Clinic for hand, hip and knee surgery, Regional Hospital Holstebro, Aarhus University, Denmark; University Clinic for hand, hip and knee surgery, Regional Hospital Holstebro, Aarhus University, Denmark
Background: Total joint arthroplasty (TJA) of the trapeziometacarpal joint gives faster rehabilitation and better grip strength than trapeziectomy in younger working patients, but high failure rates have so far limited the use of TJA. However new cementless implants and cup designs strives to improve implant survival compared to previous cemented implants.
Purpose / Aim of Study: To compare the survival of a trapezium cup design with a collar and a high rotation point (MOTEC, Swemac AB) in a cemented and a cementless version in TJA as treatment in trapeziometacarpal osteoarthritis.
Materials and Methods: In a prospective cohort study, we compared the implant survival of 23 cementless titanium cups in 22 patients mean age 61 years (range 45- 72) M/F 0.44, with 52 cemented (Palacos Gentamycine bone cement) polyethylene cups in 48 patients mean age 62 years (range 48-77), M/F 0.30. The patients in the two cohorts were consecutively included in the period August 2009 - October 2010 (cemented) and November 2010 – June 2012 (cementless).
Findings / Results: In the cementless cups we found an overall revision rate of 0.43 after a mean observation time of 101 months (min 97). In the cemented cups we found an overall revision rate of 0.35 after a mean observation time of 82 months (min 72). One patient was revised due to infection, one due to luxation, one patient in the titanium group due to fear of metallosis and the rest due to aseptic loosening. There was no significant difference in survival rate when compared using a Kaplan Meier plot.
Conclusions: We found an unacceptable high revision rate regardless of using cementless or cemented fixation technique in this implant design. The implant stability seems to be negatively affected by the horizontal forces through the joint in grip and pinching due to the high rotation point combined with the collar.
University Clinic for hand, hip and knee surgery, Regional Hospital Holstebro, Aarhus University, Denmark; University Clinic for hand, hip and knee surgery, Regional Hospital Holstebro, Aarhus University, Denmark; University Clinic for hand, hip and knee surgery, Regional Hospital Holstebro, Aarhus University, Denmark; University Clinic for hand, hip and knee surgery, Regional Hospital Holstebro, Aarhus University, Denmark; University Clinic for hand, hip and knee surgery, Regional Hospital Holstebro, Aarhus University, Denmark
Background: Total joint arthroplasty (TJA) of the trapeziometacarpal joint gives faster rehabilitation and better grip strength than trapeziectomy in younger working patients, but high failure rates have so far limited the use of TJA. However new cementless implants and cup designs strives to improve implant survival compared to previous cemented implants.
Purpose / Aim of Study: To compare the survival of a trapezium cup design with a collar and a high rotation point (MOTEC, Swemac AB) in a cemented and a cementless version in TJA as treatment in trapeziometacarpal osteoarthritis.
Materials and Methods: In a prospective cohort study, we compared the implant survival of 23 cementless titanium cups in 22 patients mean age 61 years (range 45- 72) M/F 0.44, with 52 cemented (Palacos Gentamycine bone cement) polyethylene cups in 48 patients mean age 62 years (range 48-77), M/F 0.30. The patients in the two cohorts were consecutively included in the period August 2009 - October 2010 (cemented) and November 2010 – June 2012 (cementless).
Findings / Results: In the cementless cups we found an overall revision rate of 0.43 after a mean observation time of 101 months (min 97). In the cemented cups we found an overall revision rate of 0.35 after a mean observation time of 82 months (min 72). One patient was revised due to infection, one due to luxation, one patient in the titanium group due to fear of metallosis and the rest due to aseptic loosening. There was no significant difference in survival rate when compared using a Kaplan Meier plot.
Conclusions: We found an unacceptable high revision rate regardless of using cementless or cemented fixation technique in this implant design. The implant stability seems to be negatively affected by the horizontal forces through the joint in grip and pinching due to the high rotation point combined with the collar.
Maiken Stilling, Sebastian Breddam Mosegaard, Lene Dremstrup, Lone Kirkeby, Lotte Priess Larsen, Torben Bæk Hansen
Department of Orthopaedics, Holstebro Regional Hospital; Department of Orthopaedics, Holstebro Regional Hospital; Department of Orthopaedics, Holstebro Regional Hospital; Department of Orthopaedics, Holstebro Regional Hospital; Department of Orthopaedics, Holstebro Regional Hospital; Department of Orthopaedics, Holstebro Regional Hospital
Background: Cup failure in total trapeziometacarpal joint arthroplasty (TMJA) may be related to surgeon, implant and patient factors. We suspected that low trapezium bone mineral density (BMD) could increase implant migration and revision risk.
Purpose / Aim of Study: To evaluate the predictive value of trapezium BMD for cup migration until 2 years followup and/or cup revision due to aseptic loosening at any time point.
Materials and Methods: In a prospective cohort study we followed 204 patients (160 female) at mean age 58 years (range 42-76) with press-fit Moovis cup/dual-mobility articulation (n=134) or cementless Elektra screw-cup/metal-on-metal articulation (n=68). Preoperative trapezium BMD was measured with an “inner-elipse” measurement that we have formerly described and validated. Patients were followed postoperative, 3, 12, and 24 months with radiostereometry radiostereometry (RSA). A statistical regression model with adjustment for age and sex was used for prediction.
Findings / Results: Trapezium BMD did not predict cup subsidence or total cup translation until 2 years in any of the cup groups (p>0.64). Patients that were revised had 0.11 g/cm2 less preoperative trapezium BMD than patients who were not revised (p=0.027). Patients with osteopenia/osteoporosis (n=57) had 0.11 mm more cup subsidence at 2 years followup (p=0.04) but no increased revision risk (p=0.37). There was no effect of cup subsidence or total cup translation on risk of revision (p>0.24).
Conclusions: Preoperative trapezium BMD did not predict cup migration at 2 years, and we could not establish a cut-off value for acceptable preoperative trapezium BMD for TMJA. However, patients with preoperative osteopenia/osteoporosis had more cup-subsidence at 2 years, and revised patients had less preoperative trapezium BMD indicating that bone quality may influence the risk of aseptic loosening of the implant.
Department of Orthopaedics, Holstebro Regional Hospital; Department of Orthopaedics, Holstebro Regional Hospital; Department of Orthopaedics, Holstebro Regional Hospital; Department of Orthopaedics, Holstebro Regional Hospital; Department of Orthopaedics, Holstebro Regional Hospital; Department of Orthopaedics, Holstebro Regional Hospital
Background: Cup failure in total trapeziometacarpal joint arthroplasty (TMJA) may be related to surgeon, implant and patient factors. We suspected that low trapezium bone mineral density (BMD) could increase implant migration and revision risk.
Purpose / Aim of Study: To evaluate the predictive value of trapezium BMD for cup migration until 2 years followup and/or cup revision due to aseptic loosening at any time point.
Materials and Methods: In a prospective cohort study we followed 204 patients (160 female) at mean age 58 years (range 42-76) with press-fit Moovis cup/dual-mobility articulation (n=134) or cementless Elektra screw-cup/metal-on-metal articulation (n=68). Preoperative trapezium BMD was measured with an “inner-elipse” measurement that we have formerly described and validated. Patients were followed postoperative, 3, 12, and 24 months with radiostereometry radiostereometry (RSA). A statistical regression model with adjustment for age and sex was used for prediction.
Findings / Results: Trapezium BMD did not predict cup subsidence or total cup translation until 2 years in any of the cup groups (p>0.64). Patients that were revised had 0.11 g/cm2 less preoperative trapezium BMD than patients who were not revised (p=0.027). Patients with osteopenia/osteoporosis (n=57) had 0.11 mm more cup subsidence at 2 years followup (p=0.04) but no increased revision risk (p=0.37). There was no effect of cup subsidence or total cup translation on risk of revision (p>0.24).
Conclusions: Preoperative trapezium BMD did not predict cup migration at 2 years, and we could not establish a cut-off value for acceptable preoperative trapezium BMD for TMJA. However, patients with preoperative osteopenia/osteoporosis had more cup-subsidence at 2 years, and revised patients had less preoperative trapezium BMD indicating that bone quality may influence the risk of aseptic loosening of the implant.
Lone Kirkeby, Poul Frost, Susanne Wulff Svendsen, Torben Bæk Hansen
University Clinic of Hand, Hip and Knee Surgery, Regional Hospital West Jutland, Holstebro; Danish Ramazzini Centre, Department of Occupational Medicine , Aarhus University Hospital, Aarhus; Danish Ramazzini Centre, Department of Occupational Medicine, Regional Hospital West Jutland - University Research Clinic, Herning; University Clinic of Hand, Hip and Knee Surgery, Regional Hospital West Jutland, Holstebro
Background: The influence of high occupational mechanical exposures on implant failure in trapeziometacarpal (TM) total joint arthroplasty in patients of working age is unclear.
Purpose / Aim of Study: To determine the prognosis after TM total joint arthroplasty with respect to risk of revision, hypothesizing that occupational mechanical exposures are negative prognostic factors for implant survival.
Materials and Methods: A follow-up study of 239 patients aged 39- 65 years (mean age 55 years), who were operated with a TM total joint arthroplasty in the period 2003-2015. Information on job title was obtained preoperatively. Type of implant was registered and labour market attachment at the time of surgery was informed from the Danish National Register on Public Transfer Payments. Job titles were linked to a job exposure matrix to obtain estimates of occupational mechanical hand-arm exposures. Information on revision was registered. Time until revision was analysed using Cox regression models.
Findings / Results: Within a total of 850 person-years of observation, 54 out of 239 implants were revised due to failure. Higher revision rates were found in the early part of the inclusion period. Implant fixation (cemented/cementless) was not a predictor. The HR for the highest level of forceful work was 1.5 (95% CI 0.6-4.1) compared to work with low force requirements. For patients outside the labour market, the HR was 3.0 (95% CI 1.3-6.9).
Conclusions: There is still a relative high risk of implant failure after TM total joint arthroplasty. Forceful work did not statistically significant increase the risk. Patients outside the labour market and under 66 years old had a higher risk indicating that other factors also may influence implant survival. Larger studies are needed to rule out risk of failure in relation to forceful work.
University Clinic of Hand, Hip and Knee Surgery, Regional Hospital West Jutland, Holstebro; Danish Ramazzini Centre, Department of Occupational Medicine , Aarhus University Hospital, Aarhus; Danish Ramazzini Centre, Department of Occupational Medicine, Regional Hospital West Jutland - University Research Clinic, Herning; University Clinic of Hand, Hip and Knee Surgery, Regional Hospital West Jutland, Holstebro
Background: The influence of high occupational mechanical exposures on implant failure in trapeziometacarpal (TM) total joint arthroplasty in patients of working age is unclear.
Purpose / Aim of Study: To determine the prognosis after TM total joint arthroplasty with respect to risk of revision, hypothesizing that occupational mechanical exposures are negative prognostic factors for implant survival.
Materials and Methods: A follow-up study of 239 patients aged 39- 65 years (mean age 55 years), who were operated with a TM total joint arthroplasty in the period 2003-2015. Information on job title was obtained preoperatively. Type of implant was registered and labour market attachment at the time of surgery was informed from the Danish National Register on Public Transfer Payments. Job titles were linked to a job exposure matrix to obtain estimates of occupational mechanical hand-arm exposures. Information on revision was registered. Time until revision was analysed using Cox regression models.
Findings / Results: Within a total of 850 person-years of observation, 54 out of 239 implants were revised due to failure. Higher revision rates were found in the early part of the inclusion period. Implant fixation (cemented/cementless) was not a predictor. The HR for the highest level of forceful work was 1.5 (95% CI 0.6-4.1) compared to work with low force requirements. For patients outside the labour market, the HR was 3.0 (95% CI 1.3-6.9).
Conclusions: There is still a relative high risk of implant failure after TM total joint arthroplasty. Forceful work did not statistically significant increase the risk. Patients outside the labour market and under 66 years old had a higher risk indicating that other factors also may influence implant survival. Larger studies are needed to rule out risk of failure in relation to forceful work.
Larsen Lotte Priess, Kirkeby Lone, Dremstrup Lene, Stilling Maiken, Hansen Torben Bæk
University Clinic for hand, hip and knee surgery, Regional Hospital Holstebro, Aarhus University, Denmark; University Clinic for hand, hip and knee surgery, Regional Hospital Holstebro, Aarhus University, Denmark; University Clinic for hand, hip and knee surgery, Regional Hospital Holstebro, Aarhus University, Denmark; University Clinic for hand, hip and knee surgery, Regional Hospital Holstebro, Aarhus University, Denmark; University Clinic for hand, hip and knee surgery, Regional Hospital Holstebro, Aarhus University, Denmark
Background: Both trapeziectomy and total joint arthroplasty are well established operative treatments in osteoarthritis of the trapeziometacarpal joint (TMCJ), but so far, the possible benefits in functional outcome from choosing one type of treatment over the other have only been compared in very few studies.
Purpose / Aim of Study: To compare the functional outcome of trapeziectomy with total TMCJ arthroplasty as treatment in trapeziometacarpal osteoarthritis.
Materials and Methods: In a matched cohort study, we compared 27 patients at mean age 63 years (range 51-75) treated with trapeziectomy with 27 patients at mean age 61 years (range 51- 72) treated with Moovis (Stryker) total TMCJ arthroplasty. The two groups of patients were matched on gender, age, DASH score and preoperative labour market status. All patients were evaluated preoperatively and after 3 and 12 months.
Findings / Results: At 3 months, the patients treated with TMCJ arthroplasty had less pain at rest and activity and better grip strength (p<0.01) as compared with trapeziectomized patients. At 12 months, we found no difference between the two groups in DASH, pain or grip strength. In the subgroup of working patients below 67 years of age (n=13 per group), which were mean 58.5 years (range 51-66), treatment with TMCJ arthroplasty provided better grip strength, lower DASH score, and less pain at 3 months as compared to trapeziectomy (p<0.01). However, at 12 months followup, only grip strength was superior in patients treated with TMCJ arthroplasty (p<0.01).
Conclusions: In working patients below 67 years TMCJ provides faster rehabilitation, better grip strength and less pain compared to treatment with trapeziectomy. In elderly patients or patients with no labour obligations TMCJ arthroplasty may be reserved for patients with a high activity level due to the risk of implant failure and revision.
University Clinic for hand, hip and knee surgery, Regional Hospital Holstebro, Aarhus University, Denmark; University Clinic for hand, hip and knee surgery, Regional Hospital Holstebro, Aarhus University, Denmark; University Clinic for hand, hip and knee surgery, Regional Hospital Holstebro, Aarhus University, Denmark; University Clinic for hand, hip and knee surgery, Regional Hospital Holstebro, Aarhus University, Denmark; University Clinic for hand, hip and knee surgery, Regional Hospital Holstebro, Aarhus University, Denmark
Background: Both trapeziectomy and total joint arthroplasty are well established operative treatments in osteoarthritis of the trapeziometacarpal joint (TMCJ), but so far, the possible benefits in functional outcome from choosing one type of treatment over the other have only been compared in very few studies.
Purpose / Aim of Study: To compare the functional outcome of trapeziectomy with total TMCJ arthroplasty as treatment in trapeziometacarpal osteoarthritis.
Materials and Methods: In a matched cohort study, we compared 27 patients at mean age 63 years (range 51-75) treated with trapeziectomy with 27 patients at mean age 61 years (range 51- 72) treated with Moovis (Stryker) total TMCJ arthroplasty. The two groups of patients were matched on gender, age, DASH score and preoperative labour market status. All patients were evaluated preoperatively and after 3 and 12 months.
Findings / Results: At 3 months, the patients treated with TMCJ arthroplasty had less pain at rest and activity and better grip strength (p<0.01) as compared with trapeziectomized patients. At 12 months, we found no difference between the two groups in DASH, pain or grip strength. In the subgroup of working patients below 67 years of age (n=13 per group), which were mean 58.5 years (range 51-66), treatment with TMCJ arthroplasty provided better grip strength, lower DASH score, and less pain at 3 months as compared to trapeziectomy (p<0.01). However, at 12 months followup, only grip strength was superior in patients treated with TMCJ arthroplasty (p<0.01).
Conclusions: In working patients below 67 years TMCJ provides faster rehabilitation, better grip strength and less pain compared to treatment with trapeziectomy. In elderly patients or patients with no labour obligations TMCJ arthroplasty may be reserved for patients with a high activity level due to the risk of implant failure and revision.
Anne Skinnerup, Hanne Jacobsen, Tove Møl Christensen, Steen Olesen, Marianne Vestermark
Ortopædkirurgisk afdeling, Regionshospitalet VIborg, HEM; Fysio- og ergoterapi, ortopædkirurgisk afdeling, Regionshospitalet VIborg, HEM; Fysio- og ergoterapi, ortopædkirurgisk afdeling, Regionshospitalet VIborg, HEM; Ortopædkirurgisk afdeling, Regionshospitalet VIborg, HEM; Ortopædkirurgisk afdeling, Regionshospitalet VIborg, HEM
Background: Trapeziectomy is a common treatment for arthrosis of the carpometacarpal joint of the thumb. This can lead to instability and reduced strength of the thumb. The minimal invasive procedure of suture-button suspensionplasty (SBS) may address the issue of instability after trapeziectomy.
Purpose / Aim of Study: To evaluate patient satisfaction and functional outcome of trapeziectomy combined with SBS in a prospective cohort-study.
Materials and Methods: 13 patients with arthrosis of the carpometacarpal joint of the thumb were included. All underwent trapeziectomy and SBS, where a semi-flexible buttoned fiber-wire was inserted between the basis of the 1st and 2nd metacarpal. Clinical outcome was evaluated by PROM (quick-DASH questionnaire) and two functional tests: Strength (kg) of key grip and tip-tip grip. The data was collected preoperatively and at follow-up at 6 and 12 months. The unaffected thumb and the preoperative data served as control.
Findings / Results: Preoperatively, we found significantly lower strength in the affected thumb. Strength did increase, but not statistically significant, after 6 or 12 months. On the other hand, patient satisfaction was increased with a quick-DASH reduction of 18,67 points after 6 months and 15,34 points after 12 months.
Conclusions: The procedure significantly improved patient satisfaction. This study suggests a possibly clinically relevant improvement in thumb-strength. It is, however, not statistically significant, possibly due to a high variation of data and a small number of included patients. This results warrants a full size study and the inclusion of patients and collection of data is ongoing.
Ortopædkirurgisk afdeling, Regionshospitalet VIborg, HEM; Fysio- og ergoterapi, ortopædkirurgisk afdeling, Regionshospitalet VIborg, HEM; Fysio- og ergoterapi, ortopædkirurgisk afdeling, Regionshospitalet VIborg, HEM; Ortopædkirurgisk afdeling, Regionshospitalet VIborg, HEM; Ortopædkirurgisk afdeling, Regionshospitalet VIborg, HEM
Background: Trapeziectomy is a common treatment for arthrosis of the carpometacarpal joint of the thumb. This can lead to instability and reduced strength of the thumb. The minimal invasive procedure of suture-button suspensionplasty (SBS) may address the issue of instability after trapeziectomy.
Purpose / Aim of Study: To evaluate patient satisfaction and functional outcome of trapeziectomy combined with SBS in a prospective cohort-study.
Materials and Methods: 13 patients with arthrosis of the carpometacarpal joint of the thumb were included. All underwent trapeziectomy and SBS, where a semi-flexible buttoned fiber-wire was inserted between the basis of the 1st and 2nd metacarpal. Clinical outcome was evaluated by PROM (quick-DASH questionnaire) and two functional tests: Strength (kg) of key grip and tip-tip grip. The data was collected preoperatively and at follow-up at 6 and 12 months. The unaffected thumb and the preoperative data served as control.
Findings / Results: Preoperatively, we found significantly lower strength in the affected thumb. Strength did increase, but not statistically significant, after 6 or 12 months. On the other hand, patient satisfaction was increased with a quick-DASH reduction of 18,67 points after 6 months and 15,34 points after 12 months.
Conclusions: The procedure significantly improved patient satisfaction. This study suggests a possibly clinically relevant improvement in thumb-strength. It is, however, not statistically significant, possibly due to a high variation of data and a small number of included patients. This results warrants a full size study and the inclusion of patients and collection of data is ongoing.
Robert Gvozdenovic, Stig Joerring, Rasmus Wejnold Joergensen, Claus Hjort Jensen
, Herlev-Gentofte University Hospital of Copenhagen, Department of Orthopedics, Hand Surgery Unit; , Herlev-Gentofte University Hospital of Copenhagen, Department of Orthopedics, Hand Surgery Unit; , Herlev-Gentofte University Hospital of Copenhagen, Department of Orthopedics, Hand Surgery Unit; , Herlev-Gentofte University Hospital of Copenhagen, Department of Orthopedics, Hand Surgery Unit
Background: Minimally invasive techniques have been recommended in the treatment of painfull but stable scaphoid non-unions.
Purpose / Aim of Study: The purpose of this study was to determine if arthroscopically assisted bone grafting gave superior results in healing comparing to percutaneous screw fixation.
Materials and Methods: 164 consecutive patients with scaphoid non-unions were retrospectively analyzed. 148 were treated with the open grafting techniqes either with iliac or distal radius bone, leaving 16 patients treated with minimally invasive surgery. In the group treated percutaneously (n=8), the time from injury to surgery was 2,3 months (range 2 – 4 months) and it was 27,3 months (range 3- 180 months) in the arthroscopic group (n=8). The mean age was 42,5 years in the percutaneous group, 22 years in the arthroscopic, (range 20-66) / (range 16-32), respectively. In all cases, the Mini Acutrac headless fully threaded compression screw was used. Healing was assessed clinically and radiographically at a minimum follow- up of 12 weeks (range 4-56 weeks). Data were calculated with two-tailed Mann- Whitney U test based on p-value of p<0.05 which was considered statistically significant.
Findings / Results: We recorded no complications in any of the groups. All patients treated arthroscopically received cancellous bone grafting from the distal radius. They healed at median of 7,8 weeks (range 5-18). 7 patients in the percutaneous group healed at mean of 10,8 weeks (range 7-24). Mann Whitney U test showed the u value of 11, the critical value of U to be 13 (p<0.05), thus significantly faster healing in the arthroscopically treated group.
Conclusions: Arthroscopically treated patients achieved faster healing. Local bone grafting is considered as the main reason for this outcome. Younger population in the arthroscopically treated group may influenced the result.
, Herlev-Gentofte University Hospital of Copenhagen, Department of Orthopedics, Hand Surgery Unit; , Herlev-Gentofte University Hospital of Copenhagen, Department of Orthopedics, Hand Surgery Unit; , Herlev-Gentofte University Hospital of Copenhagen, Department of Orthopedics, Hand Surgery Unit; , Herlev-Gentofte University Hospital of Copenhagen, Department of Orthopedics, Hand Surgery Unit
Background: Minimally invasive techniques have been recommended in the treatment of painfull but stable scaphoid non-unions.
Purpose / Aim of Study: The purpose of this study was to determine if arthroscopically assisted bone grafting gave superior results in healing comparing to percutaneous screw fixation.
Materials and Methods: 164 consecutive patients with scaphoid non-unions were retrospectively analyzed. 148 were treated with the open grafting techniqes either with iliac or distal radius bone, leaving 16 patients treated with minimally invasive surgery. In the group treated percutaneously (n=8), the time from injury to surgery was 2,3 months (range 2 – 4 months) and it was 27,3 months (range 3- 180 months) in the arthroscopic group (n=8). The mean age was 42,5 years in the percutaneous group, 22 years in the arthroscopic, (range 20-66) / (range 16-32), respectively. In all cases, the Mini Acutrac headless fully threaded compression screw was used. Healing was assessed clinically and radiographically at a minimum follow- up of 12 weeks (range 4-56 weeks). Data were calculated with two-tailed Mann- Whitney U test based on p-value of p<0.05 which was considered statistically significant.
Findings / Results: We recorded no complications in any of the groups. All patients treated arthroscopically received cancellous bone grafting from the distal radius. They healed at median of 7,8 weeks (range 5-18). 7 patients in the percutaneous group healed at mean of 10,8 weeks (range 7-24). Mann Whitney U test showed the u value of 11, the critical value of U to be 13 (p<0.05), thus significantly faster healing in the arthroscopically treated group.
Conclusions: Arthroscopically treated patients achieved faster healing. Local bone grafting is considered as the main reason for this outcome. Younger population in the arthroscopically treated group may influenced the result.
Lærke Vig Lannov, Rasmus Wejnold Jørgensen, Claus Hjorth Jensen
Hand Clinic, Department of Orthopedics, Herlev-Gentofte University Hospital of Copenhagen; Hand Clinic, Department of Orthopedics, Herlev-Gentofte University Hospital of Copenhagen; Hand Clinic, Department of Orthopedics, Herlev-Gentofte University Hospital of Copenhagen
Background: A Danish validated Patient Reported Outcome Measure (PROM) specific to Dupuytren’s Disease (DD) does currently not exist. Such a PROM would be useful in the overall assessment of DD patients.
Purpose / Aim of Study: The aim of the study was to translate the Southampton Dupuytren Scoring Scheme (SDSS) into Danish and validate the translated version of the PROM.
Materials and Methods: The SDSS was translated by 5 clinicians according to guidelines by Swaine-Verdier et. al. 110 patients diagnosed with DD completed the translated PROM and were asked to indicate if the PROM accurately and adequately described the inconveniences they experience due to DD. The severity of DD was assessed clinically using the Tubiana classification method. 16 patients treated with collagenase injections were re-evaluated with SDSS and Tubiana min. 4 weeks post-operatively. Reliability of the SDSS was tested in terms of internal consistency expressed as Cronbach’s alpha and test-retest expressed as an intraclass correlation coefficient. Spearman’s rank correlation coefficient was calculated for SDSS and Tubiana in order to validate the construct of SDSS against clinical evaluation of severity of the disease, and responsiveness of the PROM was tested using point-biserial correlation and standardized response mean.
Findings / Results: The overall Cronbach’s alpha was 0.758 and the intraclass correlation coefficient was 0.816 (CI 95%: 0.533-0.927, P<0.0001). Spearman’s rank correlation coefficient was 0.55 (P= 0.007) preoperatively and 0.387 (P=0.139) postoperatively. The standardized response mean was 1.96 (95% CI: 1.42- 2.48), point-biserial correlation coefficient was 0.520 (P=0.039).
Conclusions: The SDSS shows great reliability, substantial responsiveness to change, and a high level of patient-approval and is therefore recommended to be used for patients with DD.
Hand Clinic, Department of Orthopedics, Herlev-Gentofte University Hospital of Copenhagen; Hand Clinic, Department of Orthopedics, Herlev-Gentofte University Hospital of Copenhagen; Hand Clinic, Department of Orthopedics, Herlev-Gentofte University Hospital of Copenhagen
Background: A Danish validated Patient Reported Outcome Measure (PROM) specific to Dupuytren’s Disease (DD) does currently not exist. Such a PROM would be useful in the overall assessment of DD patients.
Purpose / Aim of Study: The aim of the study was to translate the Southampton Dupuytren Scoring Scheme (SDSS) into Danish and validate the translated version of the PROM.
Materials and Methods: The SDSS was translated by 5 clinicians according to guidelines by Swaine-Verdier et. al. 110 patients diagnosed with DD completed the translated PROM and were asked to indicate if the PROM accurately and adequately described the inconveniences they experience due to DD. The severity of DD was assessed clinically using the Tubiana classification method. 16 patients treated with collagenase injections were re-evaluated with SDSS and Tubiana min. 4 weeks post-operatively. Reliability of the SDSS was tested in terms of internal consistency expressed as Cronbach’s alpha and test-retest expressed as an intraclass correlation coefficient. Spearman’s rank correlation coefficient was calculated for SDSS and Tubiana in order to validate the construct of SDSS against clinical evaluation of severity of the disease, and responsiveness of the PROM was tested using point-biserial correlation and standardized response mean.
Findings / Results: The overall Cronbach’s alpha was 0.758 and the intraclass correlation coefficient was 0.816 (CI 95%: 0.533-0.927, P<0.0001). Spearman’s rank correlation coefficient was 0.55 (P= 0.007) preoperatively and 0.387 (P=0.139) postoperatively. The standardized response mean was 1.96 (95% CI: 1.42- 2.48), point-biserial correlation coefficient was 0.520 (P=0.039).
Conclusions: The SDSS shows great reliability, substantial responsiveness to change, and a high level of patient-approval and is therefore recommended to be used for patients with DD.
Paula Engel, Elisabeth Brogren, Lars Dahlin, Henrik Søe, Stig Brorson
Department of Orthopaedic Surgery, Nordsjællands Hospital; Department of Hand Surgery, Lund University; Department of Hand Surgery, Lund University; Department of Hand Surgery, Herlev and Gentofte Hospital ; Department of Orthopaedic Surgery, Sjællands University Hospital
Background: Phalangeal fractures are common at all ages. Although often considered as minor injuries, the correct treatment can be challenging. Especially for younger doctors in emergency rooms or general practitioners, it may be difficult to decide which fractures have to be referred to an orthopaedic or hand surgeon.
Purpose / Aim of Study: Our aim was to provide a simple guideline for treatment of the most common finger fractures and dislocations.
Materials and Methods: We conducted a narrative review. Eighty- nine papers were identified from a PubMed search combining the MeSH-terms “fingers”, “fractures”, “bone” and “finger injuries”. We added the search terms “paediatric fractures”, “UCL-lesions” and “mallet finger”. We included meta-analyses, systematic reviews, randomised and non-randomised clinical trials from the past 10 years. Case studies were excluded. Thirty papers were retrieved in full text and included in the review.
Findings / Results: While stable, extra-articular fractures often can be treated non-operatively with closed reduction and buddy-taping, surgical fixation should be considered for unstable and displaced extra-articular fractures and most intra-articular fractures. The choice of treatment should aim at early, active mobilization in order to achieve optimal functional outcome.
Conclusions: Intra-articular fractures, fractures with concomitant ligament lesions, PIP joint fracture-dislocations, open fractures and certain paediatric fractures can lead to stiffness and poor functional outcome and should be referred to a hand surgeon.
Department of Orthopaedic Surgery, Nordsjællands Hospital; Department of Hand Surgery, Lund University; Department of Hand Surgery, Lund University; Department of Hand Surgery, Herlev and Gentofte Hospital ; Department of Orthopaedic Surgery, Sjællands University Hospital
Background: Phalangeal fractures are common at all ages. Although often considered as minor injuries, the correct treatment can be challenging. Especially for younger doctors in emergency rooms or general practitioners, it may be difficult to decide which fractures have to be referred to an orthopaedic or hand surgeon.
Purpose / Aim of Study: Our aim was to provide a simple guideline for treatment of the most common finger fractures and dislocations.
Materials and Methods: We conducted a narrative review. Eighty- nine papers were identified from a PubMed search combining the MeSH-terms “fingers”, “fractures”, “bone” and “finger injuries”. We added the search terms “paediatric fractures”, “UCL-lesions” and “mallet finger”. We included meta-analyses, systematic reviews, randomised and non-randomised clinical trials from the past 10 years. Case studies were excluded. Thirty papers were retrieved in full text and included in the review.
Findings / Results: While stable, extra-articular fractures often can be treated non-operatively with closed reduction and buddy-taping, surgical fixation should be considered for unstable and displaced extra-articular fractures and most intra-articular fractures. The choice of treatment should aim at early, active mobilization in order to achieve optimal functional outcome.
Conclusions: Intra-articular fractures, fractures with concomitant ligament lesions, PIP joint fracture-dislocations, open fractures and certain paediatric fractures can lead to stiffness and poor functional outcome and should be referred to a hand surgeon.