RESUMO
Objectives: This study aims to report our experience with Clostridium Histolyticum collagenase (CCH) to support the importance of its clinical use and assess its clinical efficacy, complications, and recurrences. Methods: This prospective observational study of 66 patients with a 2-year follow-up. Patients with an extension lag major of 20° at the metacarpophalangeal joint (MPJ) and/or proximal interphalangeal joint (PIPJ) were included. We collected data on demographic and anamnestic details, MPJ and PIPJ contracture degrees, DASH score, complications, and recurrences. Results: The mean pre-injection contracture was 34° for MPJ and 31° for PIPJ. At the 2-year follow-up, the mean contracture for the MPJ and PIPJ were respectively 3° and 14.5°. The mean DASH score decreased from 21.8 before injection to 10,4 after 2 years. The disease recurrence occurred in 34.8% of the patients, all with PIPJ contracture. The main complication was skin breakage (25.7%). Conclusion: The CCH injections remain a consistent option in treating DD; withdrawal from the European market deprives surgeons and patients of low invasiveness and safe tool for treating DD. Level of evidence IV, Therapeutic study investigating treatment results, Case series .
Objetivos: O objetivo deste estudo é relatar nossa experiência com Clostridium Histolyticum colagenase (CCH) para apoiar a importância de seu uso clínico e para avaliar sua eficácia clínica, complicações e recidivas. Métodos: Estudo observacional prospectivo de acompanhamento por 2 anos em 66 pacientes com um atraso de extensão maior de 20° na articulação metacarpofalângica (MPJ) e/ou articulação interfalângica proximal (PIPJ). Foram coletados dados sobre detalhes demográficos e anamnésicos, graus de contração da MPJ e PIPJ, escore de DASH, complicações e recidivas. Resultados: A média da contração pré-injeção foi de 34° para a MPJ e 31° para a PIPJ. Com 2 anos de acompanhamento, a contração média para a MPJ e PIPJ foi de 3° e 14,5° respectivamente. A pontuação média do DASH diminuiu de 21,8 antes da injeção para 10,4 após 2 anos. A recorrência da doença ocorreu em 34,8% dos pacientes, todos com contração de PIPJ. A principal complicação foi a quebra da pele (25,7%). Conclusão: As injeções de CCH continuam sendo uma opção consistente no tratamento do DD; a retirada do medicamento do mercado europeu priva os cirurgiões e pacientes de uma ferramenta pouco invasiva e segura para o tratamento do DD. Nível de evidência IV, Estudo terapêutico que investiga os resultados do tratamento, série de casos .
RESUMO
ABSTRACT Objectives: This study aims to report our experience with Clostridium Histolyticum collagenase (CCH) to support the importance of its clinical use and assess its clinical efficacy, complications, and recurrences. Methods: This prospective observational study of 66 patients with a 2-year follow-up. Patients with an extension lag major of 20° at the metacarpophalangeal joint (MPJ) and/or proximal interphalangeal joint (PIPJ) were included. We collected data on demographic and anamnestic details, MPJ and PIPJ contracture degrees, DASH score, complications, and recurrences. Results: The mean pre-injection contracture was 34° for MPJ and 31° for PIPJ. At the 2-year follow-up, the mean contracture for the MPJ and PIPJ were respectively 3° and 14.5°. The mean DASH score decreased from 21.8 before injection to 10,4 after 2 years. The disease recurrence occurred in 34.8% of the patients, all with PIPJ contracture. The main complication was skin breakage (25.7%). Conclusion: The CCH injections remain a consistent option in treating DD; withdrawal from the European market deprives surgeons and patients of low invasiveness and safe tool for treating DD. Level of evidence IV, Therapeutic study investigating treatment results, Case series.
RESUMO Objetivos: O objetivo deste estudo é relatar nossa experiência com Clostridium Histolyticum colagenase (CCH) para apoiar a importância de seu uso clínico e para avaliar sua eficácia clínica, complicações e recidivas. Métodos: Estudo observacional prospectivo de acompanhamento por 2 anos em 66 pacientes com um atraso de extensão maior de 20° na articulação metacarpofalângica (MPJ) e/ou articulação interfalângica proximal (PIPJ). Foram coletados dados sobre detalhes demográficos e anamnésicos, graus de contração da MPJ e PIPJ, escore de DASH, complicações e recidivas. Resultados: A média da contração pré-injeção foi de 34° para a MPJ e 31° para a PIPJ. Com 2 anos de acompanhamento, a contração média para a MPJ e PIPJ foi de 3° e 14,5° respectivamente. A pontuação média do DASH diminuiu de 21,8 antes da injeção para 10,4 após 2 anos. A recorrência da doença ocorreu em 34,8% dos pacientes, todos com contração de PIPJ. A principal complicação foi a quebra da pele (25,7%). Conclusão: As injeções de CCH continuam sendo uma opção consistente no tratamento do DD; a retirada do medicamento do mercado europeu priva os cirurgiões e pacientes de uma ferramenta pouco invasiva e segura para o tratamento do DD. Nível de evidência IV, Estudo terapêutico que investiga os resultados do tratamento, série de casos.
RESUMO
BACKGROUND: Pyrocardan® (Wright Medical-Tornier) is a pyrocarbon implant proposed in the treatment of trapeziometacarpal joint (TMCJ) osteoarthritis. Our aim was to assess the clinical and radiographic results after Pyrocardan® arthroplasty at midterm follow-up. METHODS: In this prospective monocentric study, we enrolled 119 patients treated with Pyrocardan® for TMCJ osteoarthritis and followed up at a minimum of four years. The clinical outcome was assessed through the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, the Visual Analog Score (VAS) for pain and the Kapandji score collected pre-operatively, at three, six and 12 months, then yearly. Hand radiographs were taken before surgery, at three months and every year. Complications and re-operations were also recorded. RESULTS: The mean follow-up was 5.2 years (range, 4-9). DASH, VAS and Kapandji scores significantly improved at three (p < 0.001 in all cases) and six months (p < 0.001, p = 0.01 and p < 0.001, respectively), remaining stable over time. The dislocation and subluxation rates were 3.3% (4 cases) and 16.8% (20 patients), respectively. The two year, four year and seven year survivorship of the implant was 99%, 98% and 95%, respectively. CONCLUSION: Pyrocardan® arthroplasty provides a satisfactory clinical and radiographic outcome for treating TMCJ osteoarthritis, with a 97% survival rate at four years. We advocate comparative studies with more common techniques (i.e., trapeziectomy) to verify its cost-effectiveness.
