Use of the Swanson silicone trapezium implant for treatment of primary osteoarthritis : long-term results.

BACKGROUND: Instability of the prosthesis and silicone-induced synovitis have led most surgeons to abandon use of the Swanson trapezium implant for the treatment of primary osteoarthritis. However, the literature contains little information on the results of long-term follow-up. The present study was conducted to establish the long-term results and to highlight the problems associated with the implant. METHODS: Thirty-five patients (forty-five implants) of our initial forty-five patients (fifty-seven implants) were available for clinical review. The mean duration of follow-up was 13.8 years. The objective result was assessed with a 40-point clinical scoring system. The subjective result was measured with a visual analog scale. A clinical score of 30 to 40 points and a subjective score of 8, 9, or 10 points were considered a good-to-excellent result. Radiographs were evaluated to determine the position and deformation of the prosthesis and to check for osteolytic changes of the bone, indicating silicone-induced synovitis. RESULTS: The overall clinical and subjective results were good for twenty-seven thumbs (60%). Eighteen thumbs (40%) had a dislocation, and nine of them had a revision. Three more revisions were carried out because of silicone-induced synovitis, persistent pain after reflex sympathetic dystrophy, and deep infection in one thumb each. Revision surgery consisted of resection of the implant, with or without tendon interposition, or implantation of a new prosthesis. Of the thirty-two prostheses (thirty that had not been revised and two that had been revised) for which follow-up radiographs were available, six (19%) showed wear and deformation and five (16%) also were associated with osteolytic changes. CONCLUSIONS: The main problem associated with the prosthesis was dislocation. Surgical measures to improve stability did not prevent this complication. The results after revision because of dislocation were no better than those associated with unrevised dislocated implants. In addition to dislocation, radiographic signs of silicone-induced synovitis were frequently noted, although they did not necessarily lead to a poor result. We concluded that the results after long-term follow-up of the Swanson silicone trapezium implant for the treatment of primary osteoarthritis were poor and that our decision to stop using this implant in 1991 was correct.

Long-term results and loosening analysis of de la Caffinière replacements of the trapeziometacarpal joint.

The results of 77 de la Caffinière arthroplasties for osteoarthritis of the thumb carpometacarpal joint were reviewed. The mean follow-up period was 8.5 years (range, 2-16 years). The survival rate at 16 years was 72%. Clinical and subjective scores were good in primary implants, reasonable in revisions, and poor in salvage procedures. The total loosening rate was 44%. Half of the loosening cases led to revision; the other half had good results. Loosening occurred significantly more often in men and younger women. The use of this prosthesis is only advised for women, preferably those older than 60 years.

Salmonella panama osteomyelitis in an otherwise healthy patient. A case report.

A 22-year-old man had Salmonella panama osteomyelitis of the left distal tibia. He had endured a period of untreated diarrhea without fever 6 years before. The osteomyelitis was treated successfully with surgical debridement followed by 9 weeks of oral cotrimoxazole 960 mg twice daily. Salmonella osteomyelitis is rare. Most cases occur in patients with sickle cell anemia. Other conditions of local or generalized immunosuppression are also risk factors, but none were established in this patient, nor was he a chronic carrier. In reviewing the literature, no case of Salmonella panama osteomyelitis in an otherwise healthy patient was found. Although the osteomyelitis in this patient was possibly secondary to Salmonella enteritis 6 years before, the authors believe that enteric Salmonella infections should not be treated with antibiotics unless the infection is accompanied by systemic symptoms. Otherwise, the risk of chronic carriership is substantially increased. In case of Salmonella panama osteomyelitis, surgical debridement is recommended as the main component of treatment, followed by a prolonged period of specific antibiotic therapy.

[Good results but many complications in unilateral leg lengthening techniques]. / Goede resultaten, maar veel complicaties bij unilaterale beenverlengingstechnieken.

OBJECTIVE: Assessment of the results and complications of limb lengthenings according to Wagner and De Bastiani. DESIGN: Retrospective. SETTING: University Hospital Groningen, the Netherlands. METHODS: Between 1978 and 1993, 10 Wagner and 23 De Bastiani limb lengthenings were performed on 16 patients with leg length discrepancy and 3 patients with short stature. The lengthening procedures were assessed for mean lengthening, healing index (treatment days per centimeter of lengthening) and complications. The residual length discrepancy was measured indirectly. Total gain in body height was measured in the short stature patients. RESULTS: For the Wagner upper leg procedures the mean lengthening was 40 mm and the healing index 81 days/cm. For the lower leg these were 37 mm and 81 days/cm respectively, for the Bastiani lengthenings because of length discrepancy the figures were 70 mm and 46 days/cm (upper leg) and 53 mm and 52 days/cm (lower leg), and for short stature 74 mm and 46 days/cm (upper leg) and 57 mm and 55 days/cm (lower leg). There were 37 complications. Lengthening in 6 Wagner and 3 De Bastiani procedures was interrupted because of several of these complications. In 9 patients with length discrepancy the final result was satisfactory, 3 patients were not yet fully grown. Four patients had a residual length discrepancy of 2.5 to 3.5 cm. The short stature patients gained an average of 13.1 cm in height. CONCLUSION: Limb lengthenings are accompanied by many complications and patients should be monitored intensively, but the results are usually good.