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PubMed2006

[Hip joint arthroplasty following surgical treatment of acetabular fracture].

PURPOSE OF THE STUDY: A group of 49 patients treated by total hip arthroplasty after previous surgery for an acetabular fracture are evaluated in this retrospective study. MATERIAL: In the period from 1997 to 2004, 49 patients, 35 men and 14 women, with posttraumatic arthritis following acetabular fracture were treated in our department. The average age was 42 years, with 67 % of the patients being younger than 40 years. The average follow-up was 42 montsh (range, 18 to 92). The acetabular fractures evaluated by the AO classification included type A1 in 17 patients, type A2 in seven, type B1 in nine, type B2 in six, type B3 in seven, type C1 in three and type C2 in two patients. METHODS: In 11 patients with aseptic necrosis of the femoral head without acetabular deformity, cementless Zweymüller Bicon or Spotorno CLS acetabular components were used. Twenty-nine patients with acetabular defects of type I and II, according to the American Academy of Orthopedic Surgeons (AAOS) classification, underwent acetabular reconstruction with the bone impaction grafting technique, using allogenic grafts and cementless Zweymüller Bicon acetabular components. Four patients with AAOS type III acetabular defects were treated with impacted morsellized bone allografts, using titanium mesh and cemented polyethylene acetabular cups. Three patients were treated with solid bone grafts fixed with osteosynthetic material. In two patients with type IV defects, osteosynthesis using a plate completed with allogenic bone graft, a mesh and a cemented cup were used. RESULTS: The patients were evaluated with the use of Harris hip scores. In 20 patients (43 %) the outcomes were excellent, and very good in 18 (37 %), satisfactory in six (12 %) and poor in four (8 %) patients. DISCUSSION: Hip joint arthroplasty following the surgical treatment of acetabular fracture is indicated in patients with post-traumatic hip arthritis. This frequently occurs due to complications associated with surgery for acetabular fractures, or the cause remains unknown. Some types of these fractures show a high proportion of poor results. The group can be divided into two different subgroups: the patients with a spherical, healed acetabulum and the patients with acetabular deformity or defect, of which the most serious condition is pseudoarthrosis of one or both columns. In the first subgroup, the surgical technique of acetabulum replacement is the same as in cases with arthritis due to degenerative disease. In the other subgroup, the procedure for cup implantation resembles revision arthroplasty for acetabular loosening. The options for treating defects or deformities and the implants used are identical in both situations. Therefore the results should be compared with those of revision arthroplasty and not primary implantation. Scars, fibrotic changes in muscles, para-articular ossification, bone defects, residual deformities of the acetabulum, devitalized bone fragments or hindering previous implants make the surgical procedure more difficult and interfere with good results. CONCLUSIONS: Total hip arthroplasty carried out after acetabular fracture is technically demanding. The prerequisite for a good result is to achieve primary stability of the acetabulum. Acetabular reconstruction is based, in the first place, on replacement of the missing bony tissue, and on providing conditions for correct alignment of the acetabulum and reliable primary and early secondary osteointegration. THA after acetabular fracture achieves poorer results than when it is indicated for degenerative disease. Key words: acetabular fracture, post-traumatic hip arthritis, total hip replacement.

Acetabulum↗
PubMed1991

Metachronous infections in patients who have had more than one total joint arthroplasty.

Sixty-eight patients who had had 159 replacement arthroplasties of more than one major joint between 1975 and 1984 and who had had an infection after at least one of these procedures were identified in a retrospective review. Subsequent infection in another total joint replacement was documented in ten of these patients. The risk of development of an infection about another total joint replacement after an infection had occurred about one total joint replacement in a patient who had had more than one arthroplasty was 18 per cent, according to the survivorship-analysis method of Kaplan and Meier. Many variables that were previously thought to increase the risk of infection, such as rheumatoid arthritis, older age of the patient, previous operations, and the use of corticosteroids or immunosuppressive agents, or both, were not found to increase the risk of a subsequent infection in patients who had had more than one arthroplasty with infection of one of the arthroplasties. The recent occurrence of a major systemic infection did increase the risk of infection about the other total joint replacements. Eight of the ten subsequent joint infections were due to the same causative organism as the index infection about a total joint replacement and occurred within the first year after the index infection. The initial treatment of the index infection included specific parenteral antimicrobial therapy combined with débridement and excisional arthroplasty in forty patients, removal of the components and arthrodesis in three patients, and débridement with retention of the prosthesis in twenty-five patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1991

Progression and regression of deep vein thrombosis after total knee arthroplasty.

In this study, patients indicated for primary total knee arthroplasty were prospectively evaluated with serial ascending venography in the index extremities to elucidate the incidence, timing, and evidence of propagation or diminution of any associated deep vein thrombosis. One of 30 limbs evaluated with preoperative venography was positive. Seventy-six knees in 59 patients were evaluated with early and late postoperative venograms. Overall, 47% of limbs were positive at early venography and 54% were positive at late venography. Comparison of early and late results revealed that, in the unilateral arthroplasty group, 86% of eventually positive limbs were already positive within one day after surgery. In the bilateral arthroplasty group, 85% of eventually positive limbs and 87% of eventually positive patients were already positive within one day after surgery. Five percent of unilateral arthroplasty patients and 12% of knees in bilateral arthroplasty patients demonstrated thrombosis proximal to the deep veins of the calf at the early venogram. Late venography demonstrated thrombus formation proximal to the deep veins of the calf in 12% of knees in the unilateral and bilateral groups. No limbs with thrombi less than 9 cm in length at early venography demonstrated thrombosis in or proximal to the popliteal vein at late venography. All thromboses demonstrating propagation into or above the popliteal vein between the early and late venograms did so despite warfarin therapy that had been initiated at the time of the initial positive venogram.

Aged↗
PubMed1991

Preoperative diagnostic protocol to predict candidates for unicompartmental arthroplasty.

Two hundred eight prosthetic knee arthroplasties were evaluated prospectively with a preoperative diagnostic protocol, the unicompartmental osteoarthrosis (UO) protocol. This is the first series of a preoperative diagnostic protocol able to predict localized osteoarthritic findings at surgery with reliability. The protocol was developed to accurately predict which osteoarthritic patients would be appropriate candidates for unicompartmental arthroplasties or high tibial osteotomy. The UO protocol reliability predicted which patients had isolated unicompartmental changes at surgery, allowing for the use of unicompartmental arthroplasties or high tibial osteotomy rather than tricompartmental prosthetic arthroplasty in 207 of 208 arthroplasties.

Arthroplasty↗
PubMed1989

Treatment of infected knee arthroplasty.

Forty-eight patients with 51 infected knee arthroplasties were treated at the authors' institution between 1973 and 1986 and followed for 5.5 (range, 0-14) years. Six methods to treat the infections were employed: antibiotics only, soft-tissue surgery, removal of the prosthesis, revision arthroplasty, arthrodesis, and amputation. Failure of the initial surgical treatment led to second revision surgery in 20 patients. At the follow-up examination, three patients (five knees) had died from septic complications and two patients had had above-knee amputation. Two of 32 patients had been successfully treated with antibiotics with no additional surgery. Four patients had successful soft-tissue surgery. Following removal of the prosthesis, the infection healed in four patients. In 12 of 19 patients (13 knees) with revision arthroplasty the infection healed, but only seven of these had functioning prostheses. The infection healed in all but one of the 21 patients with arthrodeses, and all but two were fused. Infected compartmental prostheses with good bone stock can be treated with an exchange arthroplasty using a two-stage procedure with tricompartmental revision prostheses. Otherwise, an arthrodesis using a two-stage procedure is recommended for the treatment of infected knee arthroplasty.

Adult↗
PubMed1987

Long-term complications of trapeziometacarpal silicone arthroplasty.

The trapeziometacarpal joint is often affected by arthritis and treated by surgical methods. The significant forces to which this joint is subjected challenge even the most sturdy prosthetic materials. Short-term complications of arthroplasty are caused by inadequate bony resection and instability. Serious long-term problems results from implant wear and the host tissues' response to the implant. Although silicone elastomer prostheses are generally well tolerated, wear-induced microparticles (15 micron or less) incite an intense inflammatory and destructive synovial response. This "silicone synovitis" typically presents more than two years after arthroplasty and is characterized by pain, swelling, and lytic lesions visible on roentgenogram. The silicone microparticles are generated by cyclic physiologic bearing, shear, and compression forces for which these implants have not been tested. The destructive synovitis is arrested by synovectomy, implant removal, and curettage of the lytic defects. Functional salvage requires conversion to resection arthroplasty or arthrodesis. Patients with silicone implant arthroplasty must be followed indefinitely, at frequent intervals, by clinical examination and roentgenograms. Overall, however, experience indicates that resection arthroplasty is the most predictable and functional procedure for the nonrheumatoid basal thumb joint.

Arthroplasty↗
PubMed1981

Total hip arthroplasty in the treatment of adult hips with current or quiescent sepsis.

Total hip arthroplasty was done in a series of fifty-seven hips with current or prior infection. Active pyrogenic infection existed in eighteen hips at the time of arthroplasty, in five there was probable pyogenic sepsis, and in twenty-seven there was no current pyogenic infection but there was good evidence of prior pyogenic infection. Seven hips had previously been infected with tuberculosis. All but three of the eighteen patients with active infection had a revision of a previous infected arthroplasty. One had had a resection arthroplasty (Girdle-stone) followed six months later by a total hip arthroplasty. The mean length of follow-up was forty-two months. Fourteen of the eighteen reconstructions were successful. The four that were unsuccessful had recurrent infection and included the only two patients with gram-negative organisms. There was no evidence of recurrence of infection in the other three groups (thirty-nine hips).

Adult↗
PubMed1993

Chevron osteotomy and single wire reattachment of the greater trochanter in primary and revision total hip arthroplasty.

Even at a medical center where hip arthroplasty is performed routinely without trochanteric osteotomy, selected arthroplasties still require greater trochanteric osteotomy. A technique of greater trochanteric biplane osteotomy and reattachment with one wire is described. The technique provides maximum stability with a minimum of internal fixation and it can be performed quickly. The postoperative rehabilitation protocol is the same as that used in hip arthroplasty patients without trochanteric osteotomy. Results with a minimum two-year follow-up period disclosed osseous union in 98% of 53 primary arthroplasties and 97% of 74 revision hip arthroplasties. Problems related to the greater trochanter necessitated reoperation in only two patients: one for reattachment of a migrated trochanter and one for trochanteric wire removal.

Arthroplasty↗
PubMed1995

[Outcome of hip shelf arthroplasty in adults after a minimum of 15 years of follow-up. Long term results and analysis of failures of 56 dysplastic hips].

PURPOSE OF THE STUDY: The goal of this study was to evaluate late results of hip shelf arthroplasty in adults after a minimum of 15 years follow-up. MATERIAL: 65 hip shelf arthroplasty performed for painful hip dysplasia between 1964 and 1977 were studied retrospectively in 1992. These 65 procedures were performed in 57 patients mean aged 32 +/- 14 years [17-56]. Nine patients (9 hips) were excluded (2 deceaded, 5 lost for follow-up, and two reoperated because of severe infection). Consequently, the functional results were evaluated for 56 hips (48 patients). Before surgery, according to Merle d'Aubigné's hip rating system, all the hips were painfull (mean pain score was 2.6 +/- 1.7 [0-5]). On radiography, all the hips had a dysplastic acetabulum and arthritic changes. Arthritic changes were severe in 32 hips (57.1 per cent). METHODS: The hip shelf arthroplasty was carried out according to Roy-Camille. 10 hips had additional varus femoral osteotomy. The 48 patients (56 hips) included were evaluated by means of Merle d'Aubigné's hip rating system and AP and false lateral weight-bearing Xrays. In 1992, 24 procedures were changed for total hip replacement (THR) (17 before 15 years (early failure) and 7 after 15 years of follow-up (late failure)). These 24 hips were included with their last hip rating observed just before THR. Survival analysis was performed according to Kaplan-Meier using date of revision for THR as end-point. RESULTS: After 16.1 +/- 5.6 years of follow-up the functional score for 56 hips was: excellent in 4 hips, very good in 7 hips, good in 10, satisfactory in 14, poor in 17, and bad in 4. The survival rate established for 65 hips was 60 per cent at 15 years and 40 per cent at 21 years. Only 39 hips shelf arthroplasties were still functional after 15 years (mean follow-up 19.1 +/- 3 years [16-28], but 18 hips (46.1 per cent) were painfree or slightly painful (pain score to 5 or 6). Among these 39 hips, the results were excellent in 4 hips, very good in 7 hips, good in 10, satisfactory in 10, poor in 6, and bad in 2. Arthritic change was the main reason for failures: the Kaplan-Meier survival rate at 21 years was 87 per cent when arthrosis was slight and only 15 per cent and 42 per cent when arthrosis was moderate to severe (p = 0.0001). The adverse effect of arthrosis was promoted by lack of congruency for early failures, and by severity of dysplasia and hip subluxation for late failures. The additional femoral varus osteotomies had no influence on functional or radiographic outcome. DISCUSSION: Our study indicated that hip shelf arthroplasty performed for painful acetabular dysplasia in adult has a 40 per cent probability survival rate at 21 years. The high rate of revision (42.8 per cent) could be related to the prevalence of severe pre-operative arthrosis. The low rate of lost for follow-up (8.7 per cent) and the long follow-up period (16.1 years) made our conclusion reliable. CONCLUSION: In spite of a high revision rate we recommend shelf athroplasty to treat acetabular dysplasia in adults. This procedure, very reliable in cases of moderate arthrosis, could be performed in cases of severe arthrosis to delay and make easier THR, but a low survival rate could be expected unless dysplasia, lack of congruency and subluxation were mild.

Acetabulum↗
PubMed1997

Cost effectiveness and quality of life in knee arthroplasty.

Few studies quantitate the cost of a quality well being as produced by arthroplasty surgery. The objective was to use the Quality of Well Being Index to calculate the cost per quality of well year in knee arthroplasty surgery. The difference in Quality of Well Being Index scores before and after the intervention was calculated and multiplied by the patient's life expectancy. The procedure cost was divided by this quantity resulting in the cost of a quality well year. One hundred patients underwent a primary knee arthroplasty. There were 30 males (average age, 62 years old) and 70 females (average age, 64 years old). The calculated costs per a quality well year were $30,695 (standard deviation $90,883) at 3 months, $17,804 (standard deviation $25,888) at 6 months, $11,560 (standard deviation $11,874) at 1 year, and $6656 (standard deviation $3567) at 2 years postsurgery. Health economists consider an intervention costing less than $30,000 per quality of well year a bargain to society. Cost effectiveness of knee arthroplasty surgery compares favorably with other surgical interventions such as coronary artery bypass surgery ($5000 per quality of well year) and extremely favorable with medical treatments such as renal dialysis ($50,000.00 for the quality well year). Knee arthroplasty is a cost effective procedure and should be considered an appropriate investment by society.

Arthritis, Rheumatoid↗
PubMed1997

Neurologic injury in the upper extremity after total hip arthroplasty.

The results of 7150 consecutive primary and revision total hip arthroplasties performed between 1976 and 1990 were reviewed retrospectively. Sixteen upper extremity neurologic palsies were identified in 16 patients. The incidence of upper extremity nerve palsies after total hip arthroplasty was 0.22%. There were five men and 11 women (average age, 59.5 years; range, 27-81 years). The neurologic injuries consisted of 10 ulnar palsies, four brachial plexopathies, one axillary nerve palsy, and one median nerve palsy. Patients were evaluated with respect to age, gender, preoperative diagnosis, type of procedure (primary versus revision), and surgical approach. Preoperative diagnoses included: inflammatory arthritis (11), osteoarthritis (two), avascular necrosis (one), developmental dysplasia of the hip (one), and posttraumatic arthritis (one). Fourteen of 16 patients (88%) had complete recovery. Two patients (12%) had persistent symptoms despite operative intervention. The only significant predisposing factor to developing an upper extremity neurologic injury after total hip arthroplasty was the preoperative diagnosis of an inflammatory arthropathy. Upper extremity neurologic injuries after total hip arthroplasty are rare. Patients with the preoperative diagnosis of an inflammatory arthropathy are at greater risk for experiencing upper extremity neurologic injury. The prognosis is favorable, with 88% of patients having complete recovery. Cautious induction of anesthesia and careful attention to patient positioning in the perioperative, intraoperative, and postoperative period are essential to help minimize the incidence of neurologic injuries in the upper extremity after total hip arthroplasty.

Adult↗
PubMed1998

Patient comorbidity: relationship to outcomes of total knee arthroplasty.

One hundred six patients treated consecutively with total knee arthroplasty were evaluated to determine whether preoperative comorbidity (as measured by patient class, knee score, short form, anesthesia severity assessment, and number of medical comorbidities) correlated with perioperative and postoperative outcomes, including length of stay, total (and specific) hospital charges, and validated outcome scores. The length of stay for total knee arthroplasty was longer in patients who had lower preoperative knee scores and for patients with greater medical and musculoskeletal morbidity. Greater total hospital costs were associated with Class C patients and patients with poor anesthesia morbidity ratings. Patients who were debilitated medically and had four or more risk factors had decreased postoperative outcome scores. Preoperative medical and musculoskeletal morbidity influence the results of total knee arthroplasty. These findings may be useful to surgeons for optimizing resource utilization and outcomes in patients undergoing total knee arthroplasty. These data must be accounted for when contrasting total knee arthroplasty results between different surgeons and institutions.

Age Factors↗
PubMed2000

A shortened course of anticoagulation to treat deep venous thrombosis after total joint arthroplasty.

OBJECTIVE: To study whether the course of anticoagulation therapy in patients who have deep venous thrombosis (DVT) after total joint arthroplasty can be shortened with a minimal risk of recurrence. DESIGN: A case series. SETTING: Kingston General Hospital, a university-affiliated tertiary care centre. PATIENTS: Eleven patients who were found to have DVT after total hip or knee arthroplasty on colour duplex Doppler ultrasonography, who fulfilled the study criteria and gave their informed consent. Exclusion criteria included chronic predisposing factors for thromboembolic disease, revision arthroplasty and a previous DVT. INTERVENTIONS: Anticoagulation with warfarin to achieve an International Normalized Ratio of 2.0 to 2.5, adjusted 3 times a week until resolution of the DVT by duplex ultrasonography. Clinical and ultrasonographic evaluation at 1 year to monitor DVT recurrence. OUTCOME MEASURES: Resolution and recurrence of the DVT. RESULTS: All patients showed resolution of the DVT at their first follow-up ultrasonography (mean 34 days post-operatively). There was no clinical or ultrasonographic evidence of recurrence at 1 year. CONCLUSION: Further study of a shorter course of anticoagulation therapy in patients who suffer DVT after joint arthroplasty should be considered.

Aged↗
PubMed1996

Comparison and quantitation of wear debris of failed total hip and total knee arthroplasty.

To compare the physical properties of debris particles associated with failed total hip and total knee arthroplasty, we applied a recently developed assay to electronically characterize the size, number, and composition of debris particles isolated from tissues adjacent to failed implants. We identified 21 samples (from 20 patients) of hip synovia and 35 samples (from 32 patients) of knee tissues that had been obtained at the time of revision arthroplasty. There were 12 females and 9 males in the hip group, and 16 females and 19 males in the knee group. Primary arthroplasty was performed for osteoarthritis (OA, 15 cases) or rheumatoid arthritis (RA, 6 cases) in the hip, and for OA (23) or RA (12) in the knee. Patients ranged in age from 23 to 85 (mean 59 years) for total hip, and from 27 to 84 (mean 61 years) for total knee arthroplasty. Implantation duration was from 5 to 123 months (mean 37.8) for total hip, and from 11 to 123 months (mean 63.1) for total knee arthroplasty. All of the implants were composed of cobalt-chromium alloy articulating with ultrahigh-molecular-weight polyethylene. The number of particles smaller than 10 microns ranged from 1.04 x 10(8)/g to 1.91 x 10(10)/g in the hip, and from 6.69 x 10(8)/g to 2.13 x 10(10)/g in the knee. Energy-dispersive X-ray spectroscopy and polarized light analysis showed both polyethylene and metal particles in most cases. The mean diameter of particles smaller than 10 microns was 0.72 +/- 0.2 microns in the hip, and 0.74 +/- 0.1 microns in the knee. Evaluation of particles larger than 10 microns showed a larger range of particle size in knee tissues (maximum 6.1 mm, mean 283 microns), than in the hip tissues (maximum 826 microns, mean 81 microns) (p < 0.001). Very small particles are common in both groups, but it appears that a larger range of particle sizes is present adjacent to failed knee than to failed hip prostheses. The higher frequency of large particles in failed knee prostheses probably reflects the perceived higher rate of delamination and fragmentation of tibial and patellar compared to that of acetabular polyethylene.

Adult↗
PubMed2004

Treatment of infected total knee arthroplasty in patients with rheumatoid arthritis.

The primary aim of treating infected knee joints after total knee arthroplasty is to eradicate the infection, but this is difficult to achieve. We reviewed the treatment of infections that occurred after total knee arthroplasty in patients with rheumatoid arthritis. The subjects were 14 patients with rheumatoid arthritis (3 men, 11 women; ages 38-81 years) who had 14 infected knee joints. The outcome was preservation of the implant in two cases, revision arthroplasty in six cases, arthrodesis in three cases, resection arthroplasty in one case, amputation in one case, and death in one case. If there is no loosening, preservation of the implant should be attempted. If preservation is impossible, revision arthroplasty is the next best option considering the effect on daily activities in patients with the disease affecting multiple joints.

Journal Article↗
PubMed1992

Unicondylar arthroplasty. A survivorship analysis.

A retrospective review of 52 cemented unicompartmental arthroplasties was undertaken to determine whether unicompartmental arthroplasty is an acceptable procedure for patients with isolated single-compartment disease. The average follow-up period was 8.3 years with a predicted survivorship of 93.75% at 10 years post-arthroplasty. Results comparable to those for tricompartmental design were achieved at similar follow-up intervals. While stressing the importance of patient selection in this procedure, the authors feel that unicompartmental arthroplasty is a viable alternative to tricompartmental arthroplasty in the treatment of single-compartment disease. Further long-term survivorship analysis is necessary to conclude that unicompartmental results are equal to those of tricompartmental design.

Actuarial Analysis↗
PubMedDate not supplied

Pyrolytic carbon proximal interphalangeal joint resurfacing arthroplasty.

PURPOSE: To evaluate the clinical results of a pyrolytic carbon resurfacing proximal interphalangeal joint (PIPJ) arthroplasty in patients with osteoarthritis. METHODS: A retrospective review of 18 PIPJ arthroplasties in 8 women with severe osteoarthritis performed by a single surgeon was completed with an average follow-up period of 13 months. Clinical assessment included range of motion (ROM), stability, and deformity. Radiographs were reviewed for evidence of loosening, subsidence, fracture, and osseointegration. Six patients, representing 16 joints, answered a questionnaire regarding pain relief, appearance, and overall satisfaction with the arthroplasty. Complications also were recorded. RESULTS: The average preoperative ROM was 10 degrees to 63 degrees, and the average postoperative ROM was 18 degrees to 71 degrees. Although the average arc of motion was unchanged, 9 joints had an increase in ROM and 9 joints had a decrease in ROM. All joints were stable laterally. Radiographic review indicated 2 joints with loosening at 4 months after surgery. Complications included 8 squeaky joints, 5 joint contractures, and 2 dislocations. Pain was relieved completely in 8 joints, and the pain rating on a visual analog scale was 3.6 out of 10 for the 8 patients who had residual pain. Patients were satisfied completely with the results of 9 joints. Although there was residual deformity in 4 joints, patients believed that 15 of 16 joints had improved in appearance. Five of 6 patients responded that they would have the surgery again. There have been no secondary procedures performed by us. CONCLUSIONS: The insertion of pyrolytic carbon implants for PIPJ arthroplasty is a technically demanding procedure, but it has the potential to achieve pain relief, stability, satisfactory ROM, and correction of the deformity; however, the results in this review were unpredictable and may not be superior to those achieved with other methods of arthroplasty. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic, Level IV.

Aged↗
PubMed1990

Convex condylar arthroplasty of the basal joint of the thumb: failure under load.

Twenty-five convex condylar silicone arthroplasties were done for treatment of arthritis confined to the basal joint of the thumb. The procedure was done in 19 patients with osteoarthritis and in 6 patients with rheumatoid arthritis. The average follow up was 4 1/2 years. This series of condylar arthroplasties is compared with a series of 24 Swanson trapezial arthroplasties, all done for treatment of osteoarthritis, with an average follow up of 5 1/2 years. The convex condylar arthroplasty is associated with a 15% failure rate in patients with osteoarthritis coupled with radiographic findings of significant bone resorption around the stem of the prosthesis in 84% of the remaining patients. The three failures were in the osteoarthritic thumbs and not in the rheumatoid thumbs. Fusion and tendon interposition arthroplasty are described as options for revision. We believe that the Swanson convex condylar hemitrapezium replacement should be reserved for the low-demand rheumatoid thumb.

Aged↗