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Trapezium Prosthetic Arthroplasty (Silicone, Artelon, Metal, and Pyrocarbon)

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Trapezium Prosthetic Arthroplasty (Silicone, Artelon, Metal, and Pyrocarbon) Trapezium Prosthetic Arthroplasty (Silicone, Artelon, Metal, and Pyrocarbon) Mark A. Vitale, MD, MPHa, Fraser Taylor, MB, BS, FRACSb,c, Mark Ross, MB, BS, FRACSb,c,d, Steven L. Moran, MDe,* KEYWORDS Thumb Trapezial-metacarpal (TM) joint Silicone Artelon Pyrocarbon Total joint arthroplasty KEY POINTS Trapezium prosthetic arthroplasty has been used to treat basal joint arthritis for nearly 5 decades. Implant arthroplasty seeks to preserve joint biomechanics, avoid metacarpal subsidence, and provide immediate stability. There has been rapid development of trapezial prosthetic implants, including synthetic interposition materials, metal total joint arthroplasties and pyrocarbon trapezial arthroplasties. While many recently available implants have been shown to have short-term success, determining the medium- to long-term outcomes require further study. INTRODUCTION method has specific advantages and disadvan- tages for the surgeon to consider. The basal joint of the thumb is the second most 1 In contrast to ablative resection and joint fusion commonly affected joint by arthritis. Degenerative procedures, which sacrifice function of the basal disease of this joint can result in significant pain, joint in an effort to provide pain relief, prosthetic ar- stiffness, weakness, and disability. Conservative throplasty offers the theoretic advantages of pres- measures, such as nonsteroidal anti-inflammatory ervation of normal anatomy and biomechanics. drugs, splinting, and intra-articular corticosteroid This could be accomplished without subsidence injections, can provide relief for some patients; for of the thumb metacarpal, with preservation of those with severe disease in whom nonoperative normal motion at the trapezialmetacarpal (TM) measures fail, many surgical methods are available, joint, prevention of metacarpophalangeal joint with successful outcomes reported in the literature. 2–4 hyperextension, and immediate stability. Although These procedures include trapeziectomy alone, the results of different joint replacement proce- trapeziectomy and ligament reconstruction with or 2,5–9 4,10 dures of the TM joint have been variable with re- without tendon interposition, arthrodesis, gards to these goals, this review summarizes the arthroscopic resection,11–15 metacarpal extension 16–19 history of implant arthroplasty, evolution of pros- osteotomy, and a variety of methods of thetic designs, and outcomes of implants available prosthetic implant arthroplasty. To date, no single for use. method has emerged superior, although each This work did not receive any financial support. MR and SLM consult for Integra Life Sciences. a Department of Orthopaedic Surgery, Mayo Clinic, 200 First Street, Rochester, MN 55905, USA; b Department of Orthopaedic Surgery, Princess Alexandra Hospital, 199 Ipswich Road, Woolloonabba, Queensland 4102, Australia; c Brisbane Hand & Upper Limb Clinic, 9/259 Wickham Terrace, Brisbane, Queensland, 4000, Australia; d School of Medicine (Orthopaedic Surgery), The University of Queensland, St Lucia, Queensland, 4067, Australia; e Division of Plastic Surgery, Mayo Clinic, 200 First Street, Rochester, MN 55905, USA * Corresponding author. E-mail address: [email protected] Hand Clin 29 (2013) 37–55 http://dx.doi.org/10.1016/j.hcl.2012.08.020 0749-0712/13/$ – see front matter Ó 2013 Elsevier Inc. All rights reserved. hand.theclinics.com 38 Vitale et al Overview/Classification of Modified PyroDisk (Integra Life Sciences, Trapeziometacarpal Implant Arthroplasty Plansboro, NJ) There is a bewildering array of implants currently available for use in thumb TM implant arthroplasty. Silicone The authors propose the following classification The history of trapezial implant arthroplasty began scheme in an attempt to bring some order into in the 1960s, when Swanson and colleageus20 the assessment and understanding of available proposed trapeziectomy and silicone arthroplasty options. to replace a degenerative TM joint. Silicone arthro- plasty of the trapezium has been extensively Total Replacement studied over the past 5 decades, and silicone elas- tomer implants, such as the Swanson endopros- Separate trapezial and metacarpal components thesis (Wright Medical Technology) have the de la Caffinie` re (Benoist Girard et Cye, longest track record of any of the implant arthro- Baguaux, France) plasties for the basal joint (Fig. 1).20 Results have Braun-Cutter prosthesis (Small Bone Inno- generally been limited by silicone synovitis, sec- vations/Avanta Orthopaedics, San Diego, ondary instability of the joint, and long-term California) implant failure.21–24 On a histologic level, this has Avanta Surface Replacement (SR) TM pros- been confirmed by the examination of failed sili- thesis (Avanta Orthopaedics) cone implants of the fingers, wrist, and elbow: billions of silicone particles smaller than 15 mm Hemiarthroplasty were found in the inflammatory debris surrounding these implants.25 Furthermore, there have been Anatomic recent experimental data demonstrating oxidation PyroCarbon Saddle (Integra Life Sciences, of silicone elastomer finger metacarpophalangeal Plansboro, NJ) and interphalangeal arthroplasty in vivo, which may lead to implant fracture.26 The prevalence of silicone synovitis, in the Nonanatomic trapezium, specifically, however, has been less CMI Carpometacarpal Implant (BioProfile/ common a problem than that reported with carpal Tornier, Edina, Minnesota) and small joint implants in general, although the NuGrip (Integra Life Sciences, Plansboro, outcomes have been mixed. In 1986, Pellegrini NJ) and Burton published their results of a series of PyroHemiSphere (Integra Life Sciences, 72 procedures in 53 patients with basal joint oste- Plansboro, NJ) oarthritis.6 In a subset of 32 silicone arthroplasties at an average of 3.2-year follow-up, there was Interposition Partial trapezial resection Unconstrained PyroSphere (Integra Life Sciences, Plansboro, NJ) Pyrocardan (BioProfile/Tornier) Constrained Artelon (Small Bone Innovations, Morris- ville, Pennsylvania) PyroDisk (Integra Life Sciences, Plans- boro, NJ) Total trapezial replacement Silicone (eg, Swanson [Wright Medical Technology, Arlington, Tennessee]) Fig. 1. Posteroanterior radiograph of a TM joint Metallic (eg, TrapEZX [Extremity Medical, silicone arthroplasty at 5 years postoperatively. Parsippany, New Jersey]) (From Bezwada HP, Webber JB. Questions regarding Pyrocarbon the Swanson silicone trapezium implant. J Bone Joint Pi2 (BioProfile/Tornier) Surg Am 2002;84(5):872; with permission.) Thumb Arthroplasty 39 early pain relief but a 50% loss of height and treatments. In 2002, Tagil and Kopylov31 reported subluxation of the metacarpal, with an average of a prospective, randomized trial of Swanson versus 35% of the width of the prosthesis. They reported trapeziectomy and abductor pollicis longus (APL) a 25% failure rate and reactive silicone giant suspension arthroplasty in 26 patients with osteo- cell synovitis with adjacent bone resorption in arthritis of the TM joint with an average follow-up several cases. The investigators concluded that of 3.6 years. There was no incidence of clinically silicone arthroplasty was not a viable option for evident silicone synovitis, but bone cysts devel- osteoarthritis of the basal joint, even though silicone oped in the metacarpal and the scaphoid and 2 hemiarthroplasty of the trapezium could result in silicone prostheses dislocated early. All 13 satisfactory outcomes in the low-demand rheuma- patients in the silicone group and 11 of 13 in the toid patient. Amadio and colleagues27 reported on APL arthroplasty group reported that they were a comparison of a trapezial silicone spacer in 25 satisfied, and pain relief was equivalent in both patients versus trapeziectomy alone in 25 patients groups, although half of the patients in each group and showed superior results with fewer com- had pain with heavy but not light work. Five of 13 plications in those with resection arthroplasty at patients in the silicone arthroplasty group had a follow-up, ranging from 1 to 9 years. Lanzetta subluxation during stressed pinch. In the same and Foucher28 conducted a retrospective study of year, Bezwada and Webber32 reported on the 85 patients with 98 surgical procedures divided long-term results of 90 silicone arthroplasties of into 3 groups—those receiving Swanson arthro- the TM joint in 85 patients at an average of 16.4 plasties, patients receiving Ashworth-Blatt he- years of follow-up. Of the 58 patients available miarthroplasties, and, lastly, patients receiving for follow-up (62 implants), 84% of thumbs had trapeziectomy with ligament reconstruction and satisfactory results with good to excellent pain re- tendon interposition (LRTI). At 5 years, 15% of lief and function. Grip, key pinch, and tip pinch patients receiving Swanson arthroplasties required strengths increased on average. Nineteen percent surgical revision, and radiographic evidence of sili- of cases, however, had radiographic subluxation, cone synovitis was common with one case and implant fracture occurred in 6% requiring revi- requiring surgery secondary to this reaction. Over- sion. The investigators reported that no patients all, however, the results of both Swanson arthro- had frank silicone synovitis. In 2003, MacDermid plasty and LRTI were superior to those of the and colleagues22 reported a series of 26 patients Ashworth-Blatt hemiarthroplasty. after silicone arthroplasty in which 88% had Lehmann and colleagues29 compared 27 improvement in
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