Outcomes of Revision of Interposition Implant Trapeziometacarpal Arthroplasty

Background Implant arthroplasties for trapeziometacarpal osteoarthritis are often associated with high complication and revision surgery rates. There are no previous studies reporting revision outcomes of failed interposition implant arthroplasty. Methods A patient register search was done for all implant arthroplasties performed for trapeziometacarpal osteoarthritis during a 10-year period in a single hand surgical unit. Altogether, 32 patients had primary interposition implant arthroplasty (Artelon 22, Pyrosphere 6, Ortosphere 2, and Pyrodisk 2), and 19 of these patients had revision surgery with 23 revision procedures performed. In all, 15 of the revised 19 patients were reexamined clinically (Connolly-Rath score, Quick Disabilities of the Arm Shoulder and Hand, patient evaluation measure, the visual analog score for pain, thumb range of motion and strength measurements) and radiographically. Results The indication for revision surgery was pain alone or implant dislocation accompanied by pain in all cases. Thirteen of the revised 15 patients reported functional deficit and pain after revision. There was no statistically significant difference in the revision outcomes between patients operated on primarily with the Artelon implant versus pyrocarbon/ceramic implants. Compared to previous studies on revision surgery and primary trapeziometacarpal arthroplasty, our results showed slightly higher pain and poorer functional scores. Conclusions Interposition implant arthroplasty may yield high revision rates. The results after revision surgery may be worse than previously described, and there may also be a tendency for worse results than those of primary arthroplasty. Interposition implant arthroplasty should always be thoroughly contemplated.

An Easy and Effective Technique for Silicone Facial Implant Insertion and Fixation to Periosteum

In this paper, we present a simple way to place the implant into a harvested pocket and to subsequently fix it percutaneously. Eighteen patients (1 male, 13 females, 4 transgender), underwent facial implant placement; a total of 31 implants were placed (1 pair of angles of the mandible implants, 12 pairs of malar/sub-malar implants, and 5 chin implants). The intraoral approach was performed on 15 patients, and on the remaining three patients, the sub-ciliary lower lid approach was preferred. Patients were followed up for at least one year with a maximum follow-up of seven years (mean 1.8 years). In all the cases, except one, patients healed without complications. One case of implant displacement and infection was recorded. No other complication was documented. The technique described is similar to the one suggested by Peled, although some useful tips were added, namely the use of sutures, not only to fix the implant but also to drive it into the harvested pocket. In addition, larger absorbable “left in place” sutures were used, avoiding accidental implant dislocation during their removal. Further studies are required to gain a more complete understanding of the effectiveness and reproducibility of this surgical technique.

Long-term Outcomes of Silastic Arthroplasty of the Thumb Metacarpophalangeal Joint

Background: Silastic metacarpophalangeal arthroplasty (SMPA) has proven to be a durable option for end-stage arthritis in the non-thumb digits, while fusion has been the mainstay procedure for the thumb metacarpophalangeal joint (MP). Few studies exist to comment on the viability of thumb MP arthroplasty. This study reports both survival and objective outcomes following SMPA of the thumb. Methods: In an institutional review board-approved retrospective study, we identified 18 patients who underwent thumb SMPA at a tertiary academic center by 3 board-certified hand surgeons. Primary outcome measures were implant survival and post-operative complications. Secondary outcomes measures were quick Disabilities of the Arm, Shoulder, and Hand (quickDASH) scores, brief Michigan Hand Questionnaire (bMHQ), and postoperative pain as rated by the numerical rating scale. Results: Mean quickDASH and bMHQ scores at final follow-up were 35.6 and 70.6, respectively. The most common short-term complication was clinical deformity, followed by instability. The sole long-term complication was an implant dislocation in a previously asymptomatic patient. All patients reported reduction in pain. Three patients were indicated for revision surgery, 2 for persistent instability, and 1 for implant dislocation. Primary survivorship was 83% at mean follow-up of 5.8 years. Conclusions: Thumb SMPA is a viable option for end-stage arthritis. Pain relief in our series was unanimous. Among those that reported persistent symptoms or required revision, a majority had one or more key preoperative risk factors for failure as currently reported in literature. Larger, prospective series are needed to prove superior longevity and functional outcomes of thumb SMPA versus fusion.

Modified method of ostium intubation after endonasal endoscopic dacryocystorhinostomy

Introduction. The use of bicanalicular lacrimal implants designed to prevent ostium scarring after endonasal endoscopic dacryocystorhinostomy (EEDCR) may cause a number of complications. The use of Monoka monocanalicular implants (FCI, France) after EEDCR is not covered in the Russian scientific literature at all. Methods. 61 EEDCRs were performed in 56 patients with lacrimal pathway (LP) obstruction at the level of lacrimal sac cervix. In 29 cases, a new method of ostium intubation with two Monoka monocanalicular lacrimal implants (FCI, France) (that was proposed by the authors) was applied (group 1). In the remaining 32 cases, Bika bicanalicular implants (FCI, France) were used (group 2). Besides routine dacryological assessment, all patients underwent multislice computed tomography (MSCT), in which was LP were contrast-enhanced according to an original technique. Before being enrolled in either group, patients were standardized according to proposed criteria, which were based on the MSCT ones. LP extubation was performed 3 months after surgery. The follow-up period was 12 months. The following parameters were evaluated: subjective epiphora (Munk’s scale), dye test results, LP patency (irrigation test), and the shape of the ostium (nasal endoscopy). Results. Judging from the results of a comprehensive examination; favorable outcomes were achieved in 89.7% (26 cases) of patients from group 1, and in 90.6% (29 cases) of patients from group 2. In group 2, a number of complications were observed: lacrimal implant dislocation (3 cases, 9.4%), corneal epitheliopathy (2 cases, 6.2%), toxic allergic conjunctivitis (2 cases, 6.2%), lacrimal canaliculi dissection (1 case, 3.1%), lacrimal point ectopy (1 case, 3.1%), granulations within lacrimal canaliculi (1 case, 3.1%), and pterygium progression (1 case, 3.1%). In group 1, neither of the above mentioned complications occurred. Conclusion. For ostium intubation after EEDCR, with two Monoka monocanalicular lacrimal implants (FCI, France) passed through both the upper and lower lacrimal canaliculi is preferable in comparison with bicanalicular intubation using «Bika» (FCI, France).

New Measures for Prevention of Intra- and Postoperative Complications at Total Hip Replacement

The reasons of intraoperative and early postoperative complications i.e. implant dislocation and periprosthetic fractures, after hip replacement were analyzed and ways of their surgical prevention were elaborated. After 497 operations dislocation of the femoral component was detected in 24 (4,8%) cases including 15 - in the early postoperative period. The main reason of complication was inobservance of the prescribed motion activity regimen in the first postoperative days. In primary joint replacement periprosthetic fractures occurred in19 (3,8%) cases: in 15 (3%) cases the fracture developed intraoperatively and in 4 (0,8%) cases - after patients' discharge from the hospital. Application of the elaborated techniques of surgical prevention enabled to minimize the risk of such complications.

A Novel Quantitative Approach for Evaluating Contact Mechanics of Meniscal Replacements

One of the functions of the meniscus is to distribute contact forces over the articular surfaces by increasing the joint contact areas. It is widely accepted that total/partial loss of the meniscus increases the risk of joint degeneration. A short-term method for evaluating whether degenerative arthritis can be prevented or not would be to determine if the peak pressure and contact area coverage of the tibial plateau (TP) in the knee are restored at the time of implantation. Although several published studies already utilized TP contact pressure measurements as an indicator for biomechanical performance of allograft menisci, there is a paucity of a quantitative method for evaluation of these parameters in situ with a single effective parameter. In the present study, we developed such a method and used it to assess the load distribution ability of various meniscal implant configurations in human cadaveric knees (n=3). Contact pressures under the intact meniscus were measured under compression (1200 N, 0 deg flexion). Next, total meniscectomy was performed and the protocol was repeated with meniscal implants. Resultant pressure maps were evaluated for the peak pressure value, total contact area, and its distribution pattern, all with respect to the natural meniscus output. Two other measures—implant-dislocation and implant-impingement on the ligaments—were also considered. If any of these occurred, the score was zeroed. The total implant score was based on an adjusted calculation of the aforementioned measures, where the natural meniscus score was always 100. Laboratory experiments demonstrated a good correlation between qualitative and quantitative evaluations of the same pressure map outputs, especially in cases where there were contradicting indications between different parameters. Overall, the proposed approach provides a novel, validated method for quantitative assessment of the biomechanical performance of meniscal implants, which can be used in various applications ranging from bench testing of design (geometry and material of an implant) to correct implant sizing.