Porous polyurethaneurea (Artelon) joint spacer compared to trapezium resection and ligament reconstruction.

PURPOSE: To examine outcomes and complications of the porous polyurethaneurea (Artelon; Small Bone Innovations, Morrisville, PA) spacer compared to traditional surgical treatment of trapeziectomy with ligament reconstruction and tendon interposition (LRTI). METHODS: A retrospective chart review was undertaken of patients with carpometacarpal (CMC) arthritis who had either placement of an Artelon spacer or LRTI. Patients were brought back to clinic for interview and functional testing. Pain was graded using a visual analog scale. Grip and pinch strength, as well as range of motion at the first CMC joint, were measured. Nine-hole peg, Moberg pickup, and Jebson-Taylor tests were performed. Research and Development 36, Michigan Hand Outcomes, and Quick Disabilities of the Arm, Shoulder, and Hand questionnaires were administered. RESULTS: Thirty-eight patients received Artelon implants into the CMC joint, and 6 were lost to follow-up. Twelve of 32 patients (37%) required revision surgery with removal of implant and salvage arthroplasty. Twenty patients with nonrevised Artelon implants were compared with 10 patients who received 13 LRTI procedures. Patients with Artelon had significantly less pain improvement compared to those receiving the LRTI procedure. In addition, satisfaction was significantly decreased. There was no significant difference in any other functional or quality of life measures. CONCLUSIONS: In our practice, use of the Artelon joint spacer resulted in an explantation rate of 37%. Due to these findings, we have abandoned its use for treatment of basilar thumb osteoarthritis. In contrast to previous studies, pain and satisfaction are worse in patients with intact Artelon spacers than those who had received LRTI.

Cutaneous mucormycosis of the upper extremity in an immunocompetent host: case report.

Cutaneous mucormycosis, a relatively common infection in immunocompromised patients, remains rare in the immunocompetent patient outside the setting of major trauma. We report a case of an immunocompetent patient who developed left upper extremity Rhizopus infection following arterial puncture. Treatment included surgical debridement, liposomal amphotericin B, and hyperbaric oxygen wound therapy; the patient recovered fully. A review of the literature of cases of upper extremity Mucor infection is included for context. We feel that a high degree of suspicion for Mucor infection is warranted in patients with the described risk factors who do not respond to first-line antibiotics.

Results of revision metacarpophalangeal joint surgery in rheumatoid patients following previous silicone arthroplasty.

PURPOSE: Primary silicone metacarpophalangeal (MCP) joint arthroplasties have good results that deteriorate with time. The purpose of this study was to assess indications, patient satisfaction, and clinical and radiographic results following revision surgery in rheumatoid patients who had previously undergone silicone MCP arthroplasty. METHODS: Twenty hands in 18 patients (62 implants) had revision silicone MCP arthroplasties between 1986 and 2005 and had a greater than 1-year follow-up period (mean 5 y). A retrospective chart review was performed to collect preoperative and intraoperative data. Patients were then re-examined and administered a questionnaire addressing subjective outcome and satisfaction. RESULTS: Intraoperatively, 76% of the implants were fractured. Thirteen of 17 synovial biopsies revealed giant cell foreign body reaction. Preoperatively, the average arc of motion was from 16 degrees to 50 degrees , and ulnar drift was 24 degrees . Postoperatively, the average arc of motion was from 20 degrees to 54 degrees , and ulnar drift was 13 degrees . X-rays of 14 hands revealed that 15 of 44 revised implants had fractured. Sixteen patients (18 hands) were available to complete questionnaires. Twelve patients (14 hands) were satisfied and 3 were dissatisfied. Five of 16 patients would not have the revision again. These patients had worse average postoperative ulnar drift (30 degrees vs 9 degrees ) than the other 11 patients. All patients except one who had preoperative pain had at least moderate pain relief, and of the 6 patients who had revision surgery because of pain, 5 were satisfied. CONCLUSIONS: Revision silicone arthroplasty provides excellent pain relief, and the majority of patients were pleased with their results. Objective results, however, were generally poor. Soft tissue reconstruction is more difficult to achieve than the primary procedure, as evidenced by minimal improvement in ulnar drift, a high rate of implant fracture, and no change in arc of motion. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.