ABSTRACT
PURPOSE: Patients with carpometacarpal (CMC) osteoarthritis (OA) often present with metacarpophalangeal (MP) hyperextension and/or thenar atrophy. This study hypothesizes that MP fusion (MPF) performed at the time of CMC arthroplasty (CMCA) for patients who have moderate-to-severe thenar atrophy, MP hyperextension >30°, or MP arthritis will have greater long-term pinch strength and improvements in the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score from preoperative values when compared with the unoperated side or those who had CMCA only. METHODS: This study involved a retrospective review of long-term results from patients who underwent either CMCA or CMCA/MPF. The QuickDASH score, the pain visual analog scale (VAS), and an average of three pinch readings from each thumb were measured on the Baseline pinch gauge and recorded with a correction for hand dominance in right-handed patients. RESULTS: Fifty-three female patients with 70 operated thumbs were included in the study. The mean age was 67.2 years. There were 29 CMCAs and 41CMCA/MPFs. The mean follow-up was 6.3 years (range 2-16.9 years). At the latest follow-up, the mean CMCA/MPF pinch strength (11.3 lbs) was significantly stronger than that of CMCA (8.0 lbs) and carpometacarpal osteoarthritis thumbs (8.9 lbs). There was no significant difference in pinch strength between patients who underwent a CMCA and CMCOA thumbs (8.0 lbs vs 8.9 lbs, respectively). Preoperative QuickDASH demonstrated worse function in the CMCA/MPF group (55.8 vs 36.5). At the latest follow-up, QuickDASH and VAS revealed similar values in both the CMCA/MPF (10.5 and 0.66) and CMCA (18.5 and 0.52) groups. CONCLUSION: Long-term results demonstrate stronger pinch and greater improvement in QuickDASH scores in patients who underwent CMCA/MPF compared with those who underwent a CMCA or untreated carpometacarpal osteoarthritis thumbs. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
ABSTRACT
Purpose: Arthrodesis of the distal interphalangeal joint of the fingers and interphalangeal joint of the thumb is a common procedure for multiple diagnoses. The purpose of this study was to evaluate fusion rates and complications in patients who have been previously implanted with an X Fuse superelastic implant (Stryker). Methods: All patients who underwent distal interphalangeal and/or thumb interphalangeal joint fusion between June 2013 and May 2019 were included by the senior author. A chart review was used to note demographics; hand dominance; and medical and surgical history, including complications, comorbidities, clinical recovery, absence of pain, and functional use. Pre- and postoperative radiographs were evaluated for angular deformity, postoperative correction of that deformity, boney consolidation, and tine cutout. Results: Fifty-three patients (60 fingers; 43 women and 10 men) with a mean age of 62.6 years were included. The surgical diagnoses included hereditary osteoarthritis in 45 patients, rheumatoid arthritis in 4, psoriatic arthritis in 1, swan or mallet fingers in 5, ulnar motor loss instability in 2, and trauma or a fracture in 3. For X Fuse, an implant angle of 0° was used in 51 cases, whereas 15° was used in 9 cases. Bone consolidation was observed in all but 1 patient at an average time of 9.7 weeks (range 4.1-17.6 weeks). The X Fuse superelastic implant in small bones demonstrated minimal complications and a 98% (59/60) fusion rate. Conclusions: The X Fuse superelastic implant produced a reliable fusion, with no implant prominence and a 1.7% (1/60) rate of hardware removal. Type of study/level of evidence: Therapeutic IV.
