Evans Peter J, Marinello Patrick G, Shreve Mark
Orthopaedic Surgery, Rehabilitation and Sports Therapy, Cleveland Clinic Florida, Stuart, Florida.
Bone and Joint Center, Albany, New York.
JB JS Open Access. 2025 Jun 6;10(2). doi: 10.2106/JBJS.OA.25.00001. eCollection 2025 Apr-Jun.
The purpose of our study was to evaluate the clinical results and survivorship of a metal-stemmed implant for thumb basal joint hemiarthroplasty.
We performed 35 basal joint hemiarthroplasties in 32 patients. Of these, 26 thumbs (25 patients) had clinical follow-up of at least 12 months at our first review in 2014. The mean age of the patients was 54 years (range 43-68 years), and 88% were females. All patients had Eaton-Littler Stage II or III arthritis preoperatively. Average follow-up was 22.5 months (range 12-41 months) for the initial review and 144.4 months (range 126-160 months) for the last chart review and phone follow-up. The main outcomes were revision rate and time to revision. Preoperative and postoperative radiographs were examined to determine the amount of overall thumb ray lengthening and amount of subsidence of the implant between those revised and unrevised.
At 12-month follow-up, 16 of 26 thumbs (61.5%) had been revised with implant removal, resection of the remaining trapezium, and ligament reconstruction with tendon interposition. Another 3 thumbs were symptomatic and planning on future revision. Continued pain, stem loosening, and implant subsidence into the trapezium were the clinical reasons for revision. The mean time to revision was 18.1 months (range 8-41 months).
We found poor implant survivorship and an unacceptably high rate of reoperation with the stemmed thumb basal joint hemiarthroplasty device in our patient cohort.
Therapeutic Study-Level IV Case Series. See Instructions for Authors for a complete description of levels of evidence.
我们研究的目的是评估用于拇指掌指关节半关节置换术的金属柄植入物的临床效果和生存率。
我们对32例患者进行了35次掌指关节半关节置换术。其中，26例拇指（25例患者）在2014年我们的首次复查中有至少12个月的临床随访。患者的平均年龄为54岁（范围43 - 68岁），88%为女性。所有患者术前均为伊顿 - 利特勒II期或III期关节炎。首次复查的平均随访时间为22.5个月（范围12 - 41个月），最后一次病历复查和电话随访的平均随访时间为144.4个月（范围126 - 160个月）。主要结局指标为翻修率和翻修时间。检查术前和术后X线片，以确定整个拇指纵轴延长量以及翻修和未翻修患者之间植入物的下沉量。
在12个月的随访中，26例拇指中有16例（61.5%）进行了翻修，包括取出植入物、切除剩余大多角骨以及用肌腱植入进行韧带重建。另外3例拇指有症状并计划未来进行翻修。持续疼痛、柄松动和植入物下沉到大多角骨是翻修的临床原因。翻修的平均时间为18.1个月（范围8 - 41个月）。
我们发现，在我们的患者队列中，带柄拇指掌指关节半关节置换术装置的植入物生存率较低，再次手术率高得令人无法接受。
治疗性研究 - IV级病例系列。有关证据水平的完整描述，请参阅作者指南。
