Arthrosis of The First Carpometacarpal Joint

Arthrosis of The First Carpometacarpal Joint

Centro Hospitalar de Entre Douro e Vouga
ORTHOPAEDICS DEPARTMENT Director : António Miranda MD
Spine Unit
MD Bessa da Silva and Artur Teixeira
Knee Unit
MD Francisco Silva, Manuel Mendonça and
Nuno Tavares
Shoulder and Elbow Unit
MD António Miranda and Herculano Nascimento
Foot and Ankle Unit
MD António Torres, Carlos Burmester and Marta
Gomes
Hip Unit
MD Cruz de Melo, Daniel Silva, Hernani Reis and
Sílvio Dias
Hand and Wirst Unit
MD J.M. Teixeira e A. Neto
Arthrosis of the first carpometacarpal joint
– pyrocarbon disc
Medicin Consultor
Dra. Natividade Duarte
ARTUR NETO2, VERA RESENDE1, JM. Teixeira2, F. Leal1, R. Frada1,
A. Miranda2 (Portugal)
Plastic Consultor
MD António Conde and Armindo Pinto
Neurosurgery Consultor
Prof. Manuel Laranjeira
Reumatology Consultor
Dra. Paula Valente
Residents
MD Vera Resende, Fernando Leal, Ricardo Frada
and João Teixeira
1 – Orthopaedics resident
2 – Orthopaedics graduate
PYROCARBON disc
Thick pyrocarbon layer encasing a graphite
core with a small amount of tungsten
•
•
•
•
Great tensile strength
Total
chemical
inertness
(biocompatibility)
Elasticity is similar to cortical
bone
Low coefficient of friction
Surgical technique
Step1: Skin Incision, Capsular Opening and Exposure
Step 5: Harvesting the Tendon
Step2: Metacarpal and Trapezial
Preparation
Step3: Tendon Passage Preparation
Step4: Preparing Joint Surfaces and Trial Reduction
Step6: Implantation
Step7: Secondary
Deformities
RESULTS
•
•
•
•
•
19 pacients
22 hands
Mean age 61 y (51-75)
II e III
Follow up 17,1 m (928)
RESULTS
Kapandgi Score
8,95
DASH
31,86
RESULTS
Score before surgery 8,81
After 1,43
Before
After
RESULTS
strength
Wrist
N: 6 active hand
Grip
Wrist
Active
Passive
Grip
N: 10 passive hand
Wrist
Grip
N: 3 both hands
SATISFACTION
• Very satisfied
16
• Satisfied
3
• Operated again
19
COMPLICATIONS
•
•
•
•
•
Mobility limitation
Sensitivity changes
Neuroma
Scar Pain
CRPS
• PYRODISC DISLOCATION
1
0
0
6
0
2
SOME CASES
Follow-up 28m
Pain 0 (6)
Kapandji 10
Strength 12,4-11,6 7-6,2
SOME CASES
Follow-up 27 m (R) 15 m (L)
Pain 0 (9) D 1 (9) E
Kapandji 10 10
Strength 21,6-18 6,6-5,3
SOME CASES
2 monhs
nowadays
Follow-up 25 m
Pain 0 (10)
Kapandji 9
Strength 18,8-17,6 6,5-8,2
CONCLUSIONS
•Eliminates pain
•Preserves trapezium
•Made from Bone Friendly PyroCarbon
•Preserves thumb height
•Tendon provides implant stability
•Maintains range of motion
•Good satisfation of the pacients