Miriam Marks

Ten year follow-up of pyrocarbon implants for proximal interphalangeal joint replacement

Results of anatomical resurfacing of the proximal interphalangeal joint using pyrocarbon implants showed reasonable clinical results with a high radiographic migration rate. The aim was to investigate the subjective, clinical, and radiographic results 10 years following surgery, and to compare them with our 2-year follow-up data. We re-evaluated 12 patients with 15 proximal interphalangeal implants on average 9.7 years after surgery. Pain significantly improved from 7.6 on a visual analogue scale pre-operatively to 1.4 at 2 years, and to 0.7 at the final follow-up. The mean total range of motion in all replaced joints was 36° pre-operatively and 39° at the 2-year follow-up, but had decreased significantly to 29° at 10 years. We saw one implant migration in addition to the eight migrated implants we already found 2 years after surgery. The moderate clinical results, combined with the high migration rate, mean that we no longer use this kind of implant.

Outcome measures and their measurement properties for trapeziometacarpal osteoarthritis: a systematic literature review

The objective was to identify all outcome measures used in studies on trapeziometacarpal osteoarthritis (TMC OA) and evaluate their measurement properties. In a two-step systematic literature review, we first identified studies including TMC OA patients and extracted all outcome measures. They were categorized according to the Outcome Measures in Rheumatology (OMERACT) core set for OA including five dimensions: pain, physical function, global assessment, imaging, and quality of life (QoL). Secondly, we retrieved articles on the measurement properties of the identified outcome measures for TMC OA patients. First, 316 articles including 101 different outcome measures were identified, addressing the OMERACT pain and function domains most frequently but under-representing QoL. Second, 12 articles investigating measurement properties of 12 outcome measures were identified. The methodological quality of these studies was poor to fair, implying that based on the literature no recommendations to use any of the outcome measures can yet be made.

A Modular Surface Gliding Implant (CapFlex-PIP) for Proximal Interphalangeal Joint Osteoarthritis: A Prospective Case Series

PURPOSE To evaluate the one-year postoperative clinical and patient-rated outcomes in patients receiving proximal interphalangeal (PIP) joint arthroplasty with a modular surface gliding implant, CapFlex-PIP. METHODS 10 patients each with primary osteoarthritis of a single PIP joint were assessed preoperatively (baseline), at 6 weeks, and 3, 6, and 12 months after CapFlex-PIP arthroplasty for lateral stability and range of motion of the affected digit. In addition, patients rated their pain using a numeric rating scale and function and overall assessment of their treatment and condition using the quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) and Patient Evaluation Measure (PEM) questionnaires, respectively. RESULTS The mean baseline active mobility of the affected PIP joint increased from 42° to 51° by one year, although this change was not significant. Patients reported reduced pain at one year, which was statistically significant. There was also a significant improvement between baseline and one-year QuickDASH (43 points vs 15 points, respectively) and PEM scores (51 vs 25 points, respectively). Absent or low lateral instability was observed in 9 joints at follow-up. All implants remained intact over the one-year postoperative period and there was no migration, osteolysis, or implant fracture. After study completion, 2 patients underwent tenolysis. CONCLUSIONS Patients experienced a significant reduction in pain and a trend towards increased mobility. All implants showed complete osteointegration without evidence of radiological migration. Lateral stability improved. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.

Measurement Properties of the German Michigan Hand Outcomes Questionnaire in Patients With Trapeziometacarpal Osteoarthritis

To investigate the reliability, validity, and responsiveness of the Michigan Hand Outcomes Questionnaire (MHQ) in patients with trapeziometacarpal (TMC) joint osteoarthritis (OA).

Packaging—A Problem for Patients with Hand Disorders? A Cross-sectional Study on the Forces Applied to Packaging Tear Tabs

INTRODUCTION Patients with hand disorders frequently experience difficulties opening peelable packaging. PURPOSE To investigate the forces patients can apply to tear tabs and to compare the results with normative data to make recommendations for the industry and clinical practice. STUDY DESIGN Descriptive, cross-sectional. METHODS One hundred patients with hand disorders were studied. The pinch pull force (PPF) applied to tear tabs of different lengths and materials (aluminum, plastic) was measured with a specially designed device. Key pinch was measured with a pinch gauge. Normative data were taken from another study on 402 healthy adults. RESULTS Patients were able to apply most force to the longest aluminum tab, using the key grip, but this was only 53% of the force exerted by healthy people. Key pinch determines PPF (R(2)=0.548, p≤0.001). CONCLUSIONS Manufacturers should provide long aluminum tear tabs. Health professionals are encouraged to measure key pinch to detect difficulties in opening packages. LEVEL OF EVIDENCE Level IV.

Comparison of clinical outcome with radiological findings after trapeziectomy with ligament reconstruction and tendon interposition

The aim of our study was to investigate if pre- and postoperative radiographic thumb carpometacarpal position is correlated with clinical and subjective outcomes. Radiographs of 105 patients undergoing trapeziectomy with ligament reconstruction and tendon interposition were analysed before, as well as 1 year after, surgery for dorsal subluxation and proximal migration of the thumb metacarpal bone. Furthermore, key pinch strength was measured and patients completed the Michigan Hand Outcomes Questionnaire. Baseline dorsal subluxation and scaphometacarpal distances significantly decreased from 8.2 mm and 11.0 mm to 5.2 mm and 5.1 mm at 1 year, respectively. There was no correlation between the amount of subluxation or proximal migration and the Michigan Hand Outcomes Questionnaire score or key pinch strength. These results suggest that postoperative position of the metacarpal base of the thumb does not affect clinical or subjective outcomes after trapeziectomy with ligament reconstruction and tendon reposition of the thumb carpometacarpal joint. Level of evidence: Level 3

Measurement properties of the EuroQoL EQ-5D-5L to assess quality of life in patients undergoing carpal tunnel release

The objective of this study was to investigate the measurement properties of the EuroQol EQ-5D-5L questionnaire (EQ-5D-5L). A total of 60 patients with carpal tunnel syndrome completed the EQ-5D-5L twice before surgical decompression and once more 6 weeks after surgery. In addition, they filled out the Short Form 12 and Michigan Hand Outcomes Questionnaire at the baseline and postoperative follow-up examinations. Test–retest reliability was excellent with an intraclass correlation coefficient of 0.81. Internal consistency was high with Cronbach’s alpha of 0.83. Good validity of the EQ-5D-5L was indicated by correlations of r = 0.7 and r = 0.5 with the Short Form 12 and Michigan Hand Outcomes Questionnaire, respectively. Moderate responsiveness was shown by an effect size of 0.5. The minimal important change was 0.09 points. Overall, the EQ-5D-5L demonstrates sound measurement properties and can be recommended as a suitable tool to assess quality of life in patients with carpal tunnel syndrome. Level of evidence: I

Healthcare costs and loss of productivity in patients with trapeziometacarpal osteoarthritis

The objective of this study was to analyse healthcare and productivity costs in patients with trapeziometacarpal osteoarthritis. We included 161 patients who received surgery or steroid injection and calculated their healthcare costs in Euro (€) over 1 year. Patients filled out the Work Productivity and Activity Impairment Questionnaire to assess loss of productivity at baseline, and after 3, and 12 months. In the surgical group, loss of productivity among employed patients first increased and then decreased (50%, 64%, and 25% at 0, 3, and 12 months). Productivity was more stable over time in the injection group (52%, 38%, and 48%). In the surgical group, estimated total annual healthcare and productivity costs were €5770 and €5548, respectively. In the injection group, healthcare and productivity costs were €348 and €3503. These findings highlight the need for assessing productivity costs to get a comprehensive view of the costs associated with a treatment. Level of Evidence III

Trapeziectomy With Suspension-Interposition Arthroplasty for Thumb Carpometacarpal Osteoarthritis: A Randomized Controlled Trial Comparing the Use of Allograft Versus Flexor Carpi Radialis Tendon

PURPOSE The objective of this randomized controlled trial was to compare the 12-month postoperative Michigan Hand Outcomes Questionnaire (MHQ) total score between patients with osteoarthritis (OA) at the first carpometacarpal (CMC I) joint who underwent trapeziectomy with suspension-interposition arthroplasty using the flexor carpi radialis (FCR) tendon and those receiving a human dermal collagen template (allograft). METHODS We included 60 patients with CMC I OA who met the indications for surgery. They were randomized into 1 of 2 groups: trapeziectomy using the FCR tendon or trapeziectomy with the allograft for suspension-interposition. Patients completed a set of questionnaires including the MHQ and were clinically assessed at baseline, 6 weeks, and 3, 6, and 12 months after surgery. Complications were recorded. RESULTS We operated on 29 patients using the FCR tendon; 31 patients received an allograft. Baseline MHQ total scores significantly increased from 51 (95% confidence interval [CI], 46-56) to 83 (95% CI, 78-87) and 53 (95% CI, 47-58) to 76 (95% CI, 69-84) by 12 months in the FCR and allograft groups, respectively. We found similar outcomes for both groups at all follow-up assessments. Five complications occurred in the FCR group, and 10 in the allograft group. Revision surgery was required for one allograft patient. CONCLUSIONS The use of the FCR tendon or allograft for trapeziectomy with suspension-interposition arthroplasty in patients with CMC I OA leads to similar outcomes with more complications, mainly tendon irritations, associated with the latter. Therefore, we only use the allograft in cases of severe instability requiring a larger amount of suspension-interposition material or for revision procedures after failed suspension-interposition with the FCR tendon. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic I.

Isoforce: A new outrigger system for static progressive orthotic interventions of the proximal interphalangeal joint with constant force transmission—Results of a biomechanical study

STUDY DESIGN Bench research-biomechanical study. INTRODUCTION Static progressive orthotic devices are efficient in treating contractures. However, current outriggers are unable to keep force transmission and the force application angle (FAA) constant. PURPOSE OF THE STUDY To evaluate the biomechanical performance of the Isoforce outrigger, a novel extension orthosis. METHODS A hand model was used to measure the required force at the outrigger and FAA, while simulating resolution of different contracture angles. We also tested feasibility in a small patient series. RESULTS The force required with the Isoforce device never exceeded 2.4 N, and the FAA did not change more than 6°. Corresponding figures for the reference devices exceeded 16 N and 20°. The 7 patients testing the Isoforce extension device showed an extension deficit that decreased from 40° at baseline to 25° at 6 weeks. They rated the device as very comfortable to wear. CONCLUSIONS Isoforce maintains constant force transmission and FAA throughout the full range of motion, promotes the lengthening of contracted structures, and is comfortable to wear. LEVEL OF EVIDENCE Not applicable.