PMC:7233788 / 2169-6197 JSONTXT

{"project":"2_test","denotations":[{"id":"31910169-17021835-376538","span":{"begin":389,"end":390},"obj":"17021835"},{"id":"31910169-18780059-376539","span":{"begin":559,"end":560},"obj":"18780059"},{"id":"31910169-17021835-376540","span":{"begin":665,"end":666},"obj":"17021835"},{"id":"31910169-23917991-376541","span":{"begin":765,"end":766},"obj":"23917991"},{"id":"31910169-18780059-376542","span":{"begin":1019,"end":1020},"obj":"18780059"},{"id":"31910169-18780059-376543","span":{"begin":1268,"end":1269},"obj":"18780059"},{"id":"31910169-18780059-376544","span":{"begin":1637,"end":1638},"obj":"18780059"},{"id":"31910169-23917991-376545","span":{"begin":1818,"end":1819},"obj":"23917991"},{"id":"31910169-17021835-376546","span":{"begin":2398,"end":2399},"obj":"17021835"}],"text":"Introduction\nThe first carpometacarpal joint of the thumb given the myriad of activities that an average human undertakes. It can move in three main planes: abduction-adduction, flexion-extension and opposition. The main ligamentous stabilizers of this articulation are the anterior oblique ligament and the dorsoradial ligament.\nTrapeziometacarpal(TMC) osteoarthritis is a common entity (1). The eventual degenerative change of TMC joint including joint space narrowing, osteophyte formation, ligament attenuation and dorsal radial subluxation of the joint (2).\nTMC osteoarthritis is a common disease in postmenopausal women, leading to severe disability an pain (1, 3), Prevalence reported as high as 15% in older than 30 years and precise causes remain unclear (4). The typical presentation is insidious radial thumb pain that it is worsened with use, has decreased her ability to perform daily activities, decreases strength and dexterity. There has been an increasing stiffness and cramping with increasing stage (2). Physical examination often show a dorsoradial prominence of the first metacarpal base, pain is usually focus in trapeziometacarpal joint and crepitus may often be felt, and the grind test of the trapeziometacarpal joint will often produce pain (2).\nRadiographs of the TMC joint in the standard anteroposterior, 30° anteroposterior, lateral and oblique view help confirm the diagnosis. But not only radiographic evidence is enough in order to make the diagnosis, since approximately 25% of women and 8% of men will develop radiographic evidence of TMC osteoarthritis, and only 28% of this woman will admit to pain (2).\nSeveral different methods exist for the radiographic staging of TMC arthritis. Eaton-Littler classification system is currently most widely used for TMC osteoarthritis staging (4) (Table 1).\nTable 1. Classification of trapeziometacarpal joint arthritis\nStage Characteristics\nI Slight widening of the joins space, less than 1/3 subluxation\nII Narrowing of the trapeziomecarpal joint and osteophytes or loose bodies less than 2 mm in diameter\nIII Marked decrease in the trapeziometacarpal joint space, subchondral cyst, osteophytes or loose bodies biger than 2 mm\nIV Degeneration involves the scaphotrapezial joint. Conservative treatment including NSAIDs and splinting is mostly successful, and surgical treatment is only indicated in resistant cases (1, 3).\nSurgical options vary with the stage and nature of the disease. Multiple surgical procedures have been introduced since simple excision reported in 1949 by Geravis (5), include fusion, thumb metacarpal extension osteotomy, simple excision of the trapezium, trapeziectomy combined with interposition arthroplasty and total joint replacement.\nThe two most frequently used techniques currently are implant arthroplasty and trapeziectomy with ligament reconstruction and tendon interposition (LRTI). Although a prospective study by Martinez-Martinez et al comparing LRTI with implant arthroplasty, demonstrated no significant differences in Visual Linear Analogue Scale (VAS), Disabilities of the Arm, Shoulder and Hand (DASH) and pinch grip strength at 12-moth follow up.(6)Many authors continued to recommend trapeziectomy with ligament reconstruction and tendon interposition (LRTI) as the gold standard for surgical treatment, since high complication rates of implant arthroplasty and the need for more long-term studies (7).\nA number of different joint replacements have been developed including spacers, hemiarthroplasties and total joint replacements. The ARPE TMC joint total arthroplasty was introduced in 1991, it has become one of the established treatments for this disease, and ARPE TMC joint total arthroplasty have been reported 10-year survival rated of 94% with high patient satisfaction (8).\nThe purpose of this retrospective study was to determine the complication rate, the survival rate and patient satisfaction for a consecutive series of patients undergoing primary trapeciometacarpal total arthroplasty."}